An Introduction to Alcoholism

What is alcoholism? According to the American Medical Association, “alcoholism is an illness characterized by significant impairment that is directly associated with persistent and excessive use of alcohol. Impairment may involve physiological, psychological or social dysfunction.” Psychologically speaking, alcoholism has less to do with “how much” someone is drinking, and more to do with what happens when they drink. If you have problems when you drink, you have a drinking problem.

The word alcohol comes from the Arabic “Al Kohl,” which means “the essence.” Alcohol has always been associated with rites of passages such as weddings and graduations, social occasions, sporting events and parties. The media has often glamorized drinking. Television viewers happily recount the Budweiser frog, the beach parties and general “good time” feeling of commercials selling beer. Magazine ads show beautiful couples sipping alcohol. Love, sex and romance are just around the corner as long as you drink the alcohol product being advertised.

The reality is that alcohol is often abused because it initially offers a very tantalizing promise. With mild intoxication, many people become more relaxed. They feel more carefree. Any preexisting problems tend to fade into the background. Alcohol can be used to enhance a good mood or change a bad mood. At first, alcohol allows the drinker to feel quite pleasant, with no emotional costs. As an individual’s drinking progresses, however, it takes more and more alcohol to achieve the same high. Eventually the high is hardly present.

How Common is Alcoholism?

Alcoholism is a complex disease, which has been misunderstood and stigmatized. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Alcohol Dependence and Alcohol Abuse are among the most common mental disorders in the general population, with about eight percent of the adult population suffering from Alcohol Dependence and five percent from Alcohol Abuse.

It is widely accepted that there is a genetic predisposition toward alcoholism. According to DSM-IV, the risk for Alcohol Dependence is three to four times higher in close relative of people with Alcohol Dependence.

The Progression of the Disease

Alcoholism is a progressive disease and follows several phases:

The Social Drinker: Social drinkers have few problems with alcohol. A social drinker can basically take or leave it. There is no preoccupation with drinking. A social drinker is able to control the amount of alcohol consumed and rarely drinks to the point of intoxication. For these individuals, drinking is a secondary activity. It is the party, the meal, the wedding that interests the social drinker, not the opportunity to drink.

The Early Stage: An individual who is experiencing the early stages of alcoholism will begin to have an assortment of problems associated with drinking. In early stage alcoholism, a person may start to sneak drinks, begin to feel guilty about his or her drinking, and become preoccupied with alcohol. Blackouts, drinking to the point of drunkenness, and increased tolerance (needing more alcohol to achieve the same effect) are all signs of early alcoholism.

An individual who is entering the early stage of alcoholism will seek out companions who are heavy drinkers and lose interest in activities not associated with drinking. Family and friends may begin to express concern about the person’s consumption of alcohol. Work problems, such as missing work or tardiness, may also take place.

Middle Stage: By the time someone has entered the middle stages of alcoholism, his or her life has become quite unmanageable, although the alcoholic still denies that he or she has a problem. At this point, the alcoholic will often drink more than intended. He or she will drink in an attempt to erase feelings such as anger, depression and social discomfort. Drinking in the morning to relieve a bad hangover may also take place. The alcoholic’s health care provider may begin to suggest that the alcoholic stop drinking. The individual may try to stop drinking, but without success. Job loss, medical problems, and serious family conflicts occur during this phase.

Late Stage: At this stage, the alcoholic’s life has become completely unmanageable. Medical complications are numerous and include liver diseases such as cirrhosis or hepatitis. Acute pancreatitis (inflammation of the pancreas), high blood pressure, and bleeding of the esophageal lining can result from prolonged use. The heart and brain are compromised so that an alcoholic is at a higher risk for a heart attack or stroke. Depression and insomnia and even suicide are more prevalent at this stage.

A condition known as Wernicke-Korsakoff Syndrome, which involves  memory loss, indicates that the individual has sustained brain damage from drinking. A child born to a woman who drinks during her pregnancy may have a condition called fetal alcohol syndrome, causing a number of birth defects.

An alcoholic at this stage has become physically addicted to alcohol and will experience seizures or delirium tremens (DTs) if he or she stops drinking. It is extremely important to seek out medical care at this point in the disease process.


If an individual is dependent on alcohol, he or she should be supervised medically during a detoxification process. Further treatment may include individual or group counseling.

Mental health professionals have been trained to treat substance abuse problems. You can seek out treatment with an individual counselor or by entering an inpatient or outpatient substance abuse treatment program.

Support groups such as Alcoholics Anonymous, Smart Recovery, and Rational Recovery have helped many alcoholics to stay sober, allowing them to live productive lives.

Some Contact Numbers:

Alcoholics Anonymous: AA World Services, Inc., Box 459, New York, NY 10163, (212) 870-3400,

Addiction Center: 424 E Central Blvd. #636 Orlando, FL 3280, (877) 655-5116

Rational Recovery Systems, Inc.,

Smart Recovery, 24000 Mercantile Road, Suite 11, Beachwood, OH 44122, (216) 292-0220,

Stages of Change


Almost 20 years ago, two well-known alcoholism researchers, Carlo C. DiClemente and J. O. Prochaska, introduced a five-stage model of change to help professionals understand their clients with addiction problems and motivate them to change. Their model is based not on abstract theories but on their personal observations of how people went about modifying problem behaviors such as smoking, overeating and problem drinking.

The six stages of the model are:

  • precontemplation
  • contemplation
  • determination
  • action
  • maintenance
  • termination

Understanding your readiness to change by being familiar with the six-stage model of change can help you choose treatments that are right for you. A treatment professional with the right training will understand where you are in terms of readiness to stop drinking and help you find and maintain the motivation to stop drinking.


Individuals in the precontemplation stage of change are not even thinking about changing their drinking behavior. They may not see it as a problem, or they think that others who point out the problem are exaggerating.

There are many reasons to be in precontemplation, and Dr. DiClemente has referred to them as “the Four Rs” —reluctance, rebellion, resignation and rationalization:

  • Reluctant precontemplators are those who through lack of knowledge or inertia do not want to consider change. The impact of the problem has not become fully conscious.
  • Rebellious precontemplators have a heavy investment in drinking and in making their own decisions. They are resistant to being told what to do.
  • Resigned precontemplators have given up hope about the possibility of change and seem overwhelmed by the problem. Many have made many attempts to quit or control their drinking.
  • Rationalizing precontemplators have all the answers; they have plenty of reasons why drinking is not a problem, or why drinking is a problem for others but not for them.


Individuals in this stage of change are willing to consider the possibility that they have a problem, and the possibility offers hope for change. However, people who are contemplating change are often highly ambivalent. They are on the fence. Contemplation is not a commitment, not a decision to change. People at this stage are often quite interested in learning about alcoholism and treatment. They know that drinking is causing problems, and they often have a mental list of all the reasons that drinking is bad for them. But even with all these negatives, they still cannot make a decision to change.

In the contemplation stage, often with the help of a treatment professional, people make a risk-reward analysis. They consider the pros and cons of their behavior, and the pros and cons of change. They think about the previous attempts they have made to stop drinking, and what has caused failure in the past.

Determination: Commitment to Action

Deciding to stop drinking is the hallmark of this stage of change. All the weighing of pros and cons, all the risk-reward analysis, finally tips the balance in favor of change. Not all ambivalence has been resolved, but ambivalence no longer represents an insurmountable barrier to change. Most individuals in this stage will make a serious attempt to stop drinking in the near future. Individuals in this stage appear to be ready and committed to action.

This stage represents preparation as much as determination. The next step in this stage is to make a realistic plan. Commitment to change without appropriate skills and activities can create a fragile and incomplete action plan. Often with the help of a treatment professional, individuals will make a realistic assessment of the level of difficulty involved in stopping drinking. They will begin to anticipate problems and pitfalls and come up with concrete solutions that will become part of their ongoing treatment plan.

Action: Implementing the Plan

Individuals in this stage of change put their plan into action. This stage typically involves making some form of public commitment to stop drinking in order to get external confirmation of the plan. If they have not done so already, individuals in this stage may enter counseling or some form of outpatient treatment, start to attend AA meetings or tell their family members and friends about their decision—or all of the above.

Making such public commitments not only helps people obtain the supports they need to recover from alcoholism, but it creates external monitors. People often find it very helpful to know that others are watching and cheering them on. What about the others who may secretly, or not so secretly, hope they will fail? For people who get sober and stay sober, one of the many pleasures is to disprove the negative predictions of others.

Nothing succeeds like success. A person who has implemented a good plan begins to see it work and experiences it working over time, making adjustments along the way. The many things that alcohol may have taken from the person begin to be restored, along with hope and self-confidence and continued determination not to drink.

Maintenance, Relapse and Recycling

The action stage normally takes three to six months to complete. Change requires building a new pattern of behavior over time. The real test of change is long-term sustained change over many years. This stage of successful change is called “maintenance.” In this stage, an alcohol-free life is becoming firmly established, and the threat of a return to old patterns becomes less intense and less frequent.

Because alcoholism is a chronic disease, the possibility of relapse is always present. Individuals may experience a strong temptation to drink and fail to cope with it successfully. Sometimes relaxing their guard or “testing” themselves begins a slide back. People at this stage of change are armed with a variety of relapse prevention skills. They know where to get the supports they need.

Alcoholics who relapse learn from the relapse. The experience of relapsing and returning to sobriety often strengthens a person’s determination to stay sober.


The ultimate goal in the change process is termination. At this stage, the alcoholic no longer finds that alcohol presents a temptation or threat; he has complete confidence that he can cope without fear of relapse.

Dealing with Denial in Alcoholism


Denial is a characteristic distortion in thinking experienced by people with alcoholism. For decades, people who treat alcoholics, and recovering alcoholics themselves, have puzzled over why alcoholics continue to drink when the link between alcohol and the losses they suffer is so clear. Denial is an integral part of the disease of alcoholism and a major obstacle to recovery. Although the term “denial” is not specifically used in the wording of the diagnostic criteria, it underlies the primary symptom described as drinking despite adverse consequences.

Treatment professionals are beginning to recognize that not all individuals with alcoholism have the same level of denial. In fact, people have various levels of awareness of their alcohol use problems, which means they are in different stages of readiness to change their behavior. Professionals have taken advantage of this insight about alcoholism to develop treatment approaches that are matched to a person’s readiness to change and that motivate people to enter the change process even when they are frightened of what’s in store. However, despite these advances in treatment, many individuals with alcoholism persist in denying their problem, and typically, the more severe the addiction, the stronger the denial.

The power of the alcoholic’s denial may be so strong that it carries over to the alcoholic’s family and important people in his or her life, convincing them that the alcoholic’s problem is something other than it is—weak health, bad luck, accident proneness, depression, a tendency to be preoccupied and worried, a mean temper and countless other possible problems.

Many adults young and old have experienced a shock of recognition when they look back over their childhood and realize that their mother or father, a beloved grandfather or a family friend was an alcoholic. No one talked about it; everyone covered it up. The stigma of alcoholism and the many myths that have merged to form a distorted portrait of people with alcoholism have strongly contributed to denial both on an individual and a societal level. The hope of health professionals and others who have worked to educate the public that alcoholism is a disease and not a defect of willpower or a moral failure is that, now and in the future, fewer people will have to experience this shock of recognition when it is too late to do anything about it, and that people will get the treatment they need when they need it most—before alcoholism has led to irreversible consequences.

When people close to an alcoholic are affected by their own and the alcoholic’s denial, they often act in ways that protect the alcoholic from experiencing the full consequences of his or her behaviors. This type of protective behavior, although often motivated by love and concern, is referred to as enabling, because it permits the individual to continue drinking and allows the disease to progress, the symptoms to intensify and the consequences to become worse for all concerned. Like denial, enabling is another one of the symptoms of alcoholism—a symptom displayed by others, not by the alcoholic—that is not specifically mentioned in the diagnostic criteria, but that is a well-recognized aspect of the disease. Special groups, like Al-Anon and Alateen, have been established to help people concerned about the alcoholics in their lives to understand them and to help them, largely by gaining the strength to stop enabling. Overcoming denial and enabling is often the first step into treatment for the alcoholic.

Are You an Enabler?


Enabling is a term often used in the context of a relationship with an addict. It might be a drug addict or alcoholic, a gambler, or a compulsive overeater. Enablers, rather than addicts, suffer the effects of the addict’s behavior.

Enabling is “removing the natural consequences to the addict of his or her behavior.” Professionals warn against enabling because evidence has shown that an addict experiencing the damaging consequences of his addiction on his life has the most powerful incentive to change. Often this is when the addict “hits bottom” – a term commonly referred to in Alcoholics Anonymous.

Codependents often feel compelled to solve other people’s problems. If they’re involved with addicts, particularly drug addicts, they usually end up taking on the irresponsible addict’s responsibilities.

Their behavior starts as a well-intentioned desire to help, but in later stages of addiction, they act out of desperation. The family dynamics become skewed, so that the sober partner increasingly over-functions and the addict increasingly under-functions.

This builds resentment on both sides, along with the addict’s expectation that the over-functioning partner will continue to make things right when the addict doesn’t meet his or her responsibilities.

The Al-Anon program suggests that you don’t do for the alcoholic what he or she is capable of doing. Yet, codependents feel guilty not helping someone, even when the person caused the situation and is capable of finding a solution. It’s even harder for codependents to say no to requests for help. The pressure to enable can be intense, particularly coming from suffering or angry addicts, who generally use manipulation to get their needs met.

Examples of enabling include: giving money to an addict, gambler, or debtor; repairing common property the addict broke; lying to the addict’s employer to cover up absenteeism; fulfilling the addict’s commitments to others; screening phone calls and making excuses for the addict; or bailing him or her out of jail.

How to Stop the Enabling Behavior

Often addicts aren’t aware of their actions when intoxicated. They may have blackouts.

It’s important to leave the evidence intact, so they see how their drug use is affecting their lives. Consequently, you shouldn’t clean up vomit, wash soiled linens, or move a passed-out addict into bed. This might sound cruel, but remember that the addict caused the problem. Because the addict is under the influence of an addiction, accusations, nagging, and blame are not only futile, but unkind. All these inactions should be carried out in a matter-of-fact manner.

Stopping enabling isn’t easy. Nor is it for the faint of heart. Aside from likely pushback and possible retaliation, you may also fear the consequences of doing nothing. For instance, you may fear your husband will lose his job. Yet, losing a job is the greatest incentive to seeking sobriety. You may be afraid the addict may have an auto accident, or worse, die or commit suicide. Knowing a son is in jail is sometimes cold comfort to the mother who worries he may die on the streets. On the other hand, one recovered suicidal alcoholic said he wouldn’t be alive if his wife had rescued him one more time.

You may have to weigh the consequences of experiencing short-term pain vs. long-term misery, which postpones the addict’s reckoning with his or her own behavior. It requires great faith and courage not to enable without knowing the outcome. Although enabling can prolong the addiction, not all addicts recover, despite counseling and going to many rehabs. This is why the 12 Steps are a spiritual program of recovery. They begin with the recognition that you’re powerless over the addict. The desire for sobriety must come from him or her.

To avoid unnecessarily suffering the consequences of an addict’s drug use, it’s vital you begin to reclaim your sense of autonomy and take steps wherever possible not to allow the addict’s drug use to put you in jeopardy. Allowing the addict to drive you or your child while under the influence is life threatening. On the other hand, taking on the role of designated driver gives the addict free license to use or drink. The spouse might refuse that enabling role by taking a separate car. If the addict is charged with DUI, it might be a wake-up call.

Always have a Plan B to cope with addicts’ unreliability; otherwise, you end up feeling like a victim. Sometimes, Plan B might be going to a 12-Step meeting or just staying home and finishing a novel. The important thing is that it’s a conscious choice, so that you don’t feel manipulated or victimized.

It’s a good idea to follow through with plans, whether it’s keeping counseling appointments or social engagements that the addict refuses to attend at the last minute. This precludes the addict’s attempt to manipulate the family.

Having some recovery under his belt, one husband resolved to remain on vacation with the children when his alcoholic wife suddenly decided she wanted to return home. He later remarked, “It was the first time in years that my mind was free of obsessing about her.”

In another situation, an alcoholic husband picked a fight an hour before guests were arriving for dinner. He threatened to leave unless they were uninvited. When his wife refused, he stormed out and hid in the bushes, while his wife enjoyed herself. Feeling ashamed, he never repeated that ploy.

Enabling has implications for all codependents, because they generally sacrifice themselves to accommodate others’ needs, solve others’ problems, and assume more than their share of responsibility at work and in relationships.

Common examples are a woman looking for a job for her boyfriend, a man paying his girlfriend’s rent, or a parent meeting his child’s responsibilities that the child can do or should be doing. Learning to be assertive and set boundaries are often the first steps in stopping enabling. See my book How to Speak Your Mind – Become Assertive and Set Limits.

5 Tips For Recognizing The High-Functioning Alcoholic Or Addict


In the field of addiction treatment, some of the most tragic stories are those of high-functioning addicts. The friends, neighbors, relatives and co-workers you look up to – envy even – for their beautiful homes, loving children and successful careers may be dealing with a secret addiction that is destroying them from the inside out.

How long do you think it would take to identify the signs of addiction in someone close to you? Most people assume they’d perceive a problem rather quickly, keeping an eye out for major life consequences such as job loss or destroyed relationships. But according to a 2007 study by the National Institute on Alcohol Abuse and Alcoholism, only 9 percent of alcoholics fit this stereotype.

The majority of addicts are high-functioning – high-power executives, surgeons in the operating room, successful professionals, hard-working stay-at-home moms and others you may not suspect even if you know them intimately over a long period of time.

High-functioning addicts are masters of disguise whose struggles with drugs and alcohol may go unnoticed for years, often with increasingly severe consequences. Here are a few ways to unmask the high-functioning addict in your life:

#1 Beware of Denial

High-functioning addicts don’t fit the standard definition of an addict. They may not drink or use drugs every day; they may drink only the finest wines and liquors; and they may have avoided the serious consequences that befall other addicts and their families.

Because they don’t fit the stereotype, high-functioning addicts can spend years, even decades, in denial. If they manage a family and career and fulfill their daily responsibilities, they reason, there’s no way they could have a drug or alcohol problem. Even if they acknowledge that they drink or use drugs more than they should, they may feel entitled to indulge as a reward for their hard work.

The addict’s denial may be compounded by family and friends who fail to recognize or confront the problem. They may vow that they’ve never seen their loved one drunk or high (because the addict hides it well, has built a tolerance or uses drugs alone), or even pat the addict on the back for being able to “handle their liquor” so well. High-functioning addicts may not stand out in a crowd, often because they surround themselves with other heavy drinkers and drug users who fuel their denial.

#2 Observe Uncharacteristic Patterns of Behavior

Despite their best efforts at concealment, even the most functional addicts experience ramifications of their drug use. For some, it may be subtle changes in behavior that are uncharacteristic of their sober selves, such as skipping social events, a change in attitude or lack of focus. Or you may notice physical symptoms of addiction, such as insomnia, shakiness, paranoia or other health concerns. For others, it could be sloppiness at work, missing deadlines, frequently calling in sick, engaging in risky behavior or failing to fulfill family obligations.

#3 Don’t Accept Excuses

Often intelligent and charismatic by nature, high-functioning addicts have well-rehearsed excuses for every unusual behavior or slip-up. After a late night out with colleagues, they may explain they had to overindulge as part of the office culture. Or perhaps cocaine and prescription drugs boost their productivity at work, or a bottle of wine in the evening takes the edge off after a stressful day. Whatever the behavior, there’s a well-reasoned justification that sets everyone at ease and allows the addiction to continue.

#4 Watch for a Double Life

High-functioning addicts are adept at maintaining a double life. To the outside world, it may appear that the individual has it all. Inside, they may be plagued by uncontrollable cravings, unsuccessful attempts to quit, obsessive thoughts about their next drink or high, and other hallmarks of addiction. One moment, they may see clear signs that they have lost control; the next, they quickly intellectualize and rationalize the problem away. The lies and secrets begin to exact a heavy toll, leaving the addict exhausted, ashamed and alone.

Many high-functioning addicts are waiting for some sign – a “rock bottom” – to motivate them to seek treatment, which may not come for 10 to 20 years, if ever. Some gradually lose control of their drinking or drug use over a number of years, while others experience a dramatic event, such as a drunk driving arrest, job loss or divorce, that brings the severity of their problem to the forefront.

#5 Don’t Ignore the Signs

Someone who doesn’t fit the stereotype of an alcoholic or drug addict can still have a serious disease. A comfortable income and position of power at work or at home may cushion them from the consequences of their drug use, while a sense of self-importance or belief that they can resolve their own problems may prevent them from seeking treatment.

Even though they continue to function, high-functioning addicts pose a significant danger to themselves and others. High-functioning addicts are some of the most difficult individuals to help, but they are not hopeless. Since it’s likely that they will wait until they’ve lost it all before they acknowledge a problem, they rely on the people closest to them to intervene.

Treatment must be accessible and appealing for the high-functioning addict, and families and friends play an important role in this mission. If you recognize the signs of addiction in someone you care about, you’ve taken an important step by getting past your own denial. Next step: Put an end to enabling. Enlist the help of a professional interventionist to confront the addiction and help the addict into treatment.

Keep in mind that when questioned about their drug use, a high-functioning addict may vehemently deny that a problem exists and make greater efforts to hide their drug or alcohol use rather than agree to treatment. It often requires a series of attempts to break through the many layers of denial.

Let’s Call Alcohol Poisoning What It Really Is: Drug Overdose


It’s that time of year when tropical locations and the smell of alcohol beckon to teens and college kids looking to shed their inhibitions and bring home wild stories for their friends. Spring is also a great time to get real about the dangers of alcohol abuse.

Last year at this time, reports came in about the heartbreaking deaths of unsuspecting spring breakers, including a 19-year-old University of Florida freshman whose blood alcohol concentration was five times the legal limit. Her friends took her to bed because she was having a hard time walking, and she was found dead in a friend’s condominium the next morning.

Later that year, alcohol poisoning took the lives of 27-year-old Grammy-winning singer Amy Winehouse and Warrant singer Jani Lane.

We all-too-frequently hear about people dying from drug overdose. What a lot of people don’t realize, especially teens and college students, is that the drug responsible for these tragedies is often alcohol, either alone or in combination with prescription medications or other drugs.

What Is Alcohol Poisoning?

Alcohol poisoning occurs when someone’s blood alcohol level is so high it becomes toxic, usually following a binge drinking episode. Alcohol is absorbed quickly into the bloodstream and is filtered out by the liver at a rate of about one drink per hour (one drink is defined as 12 ounces of beer, 1.5 ounces of spirits or 5 ounces of wine). When someone drinks large amounts of alcohol in a short time period, their blood alcohol concentration can spike to hazardous levels.

Just as dangerous as an overdose on prescription medications or illicit drugs, alcohol poisoning can be life-threatening and usually requires emergency medical treatment. Symptoms of alcohol poisoning include:

  • Confusion
  • Disorientation
  • Severe dehydration
  • Hypothermia (dangerously low body temperature)
  • Pale, bluish skin
  • Irregular heartbeat and low blood pressure
  • Vomiting
  • Choking
  • Shallow breathing
  • Seizures
  • Unresponsiveness or unconsciousness
  • Coma

Alcohol poisoning affects about 50,000 Americans each year. The people most likely to suffer from alcohol poisoning are college students, chronic alcoholics and those taking medications that interact with alcohol.

In the hospital, alcohol poisoning is treated like other drug overdoses with treatments including oxygen therapy, intravenous fluids or pumping the stomach. In addition to significant health risks, heavy alcohol consumption puts young people at risk of drunk driving, legal problems, getting into fights, and becoming victims of theft, sexual assault or other crimes.

An Unheeded Warning

Despite our best efforts, young people aren’t getting the message about alcohol. The National Institutes of Health reported a 25 percent increase in alcohol overdose among Americans ages 18 to 24 between 1999 and 2008. Overdoses involving alcohol in combination with other drugs increased 76 percent during that time.

A Feb. 2012 study published in the journal Drug and Alcohol Review shows that young people don’t know how to consume alcohol responsibly. Study participants’ “usual” drinks were substantially larger than one unit as defined by government guidelines, and they tended to underestimate the alcohol content of their drinks. Fewer than half gave correct responses when surveyed about their knowledge of safe alcohol consumption.

While passing up alcohol altogether may be a parent’s preference, the reality is that many spring breakers drink – a lot. A University of Wisconsin study showed that 75 percent of college males and 43 percent of females reported being intoxicated on a daily basis during spring break. Most are binge drinking – the average male consumes 18 drinks per day and the average female consumes 10 per day, according to a survey by the Journal of American College Health. Even kids who don’t normally consume alcohol are more likely to drink during spring break.

To prevent last year’s tragedies from resurfacing this spring, we need to spend as much time talking with our children about responsible drinking and the dangers of binge drinking as we do preaching abstinence. Although it is a socially acceptable and commonly used drug, alcohol is still a drug – and it can be just as risky as more feared drugs such as heroin and cocaine.

David Sack, M.D. is board certified in Addiction Psychiatry and Addiction Medicine. He is CEO of Elements Behavioral Health which has drug rehab and addiction treatment programs in California, Florida, and Tennessee.

‘Addicted’ to an Addict? 5 Warning Signs of Codependency


People can become addicted to any number of substances or behaviors, including drugs, gambling, sex and food, but can you become addicted to another person? In some sense, yes – it’s called codependency, and it can be extremely damaging to both individuals.

Codependency can arise in any type of relationship, but we most commonly think of the addict and their highly enmeshed spouse or partner. By denying the existence of a problem, trying to control the addict’s drug use or rescuing them from the consequences of their actions, the partner enables the addiction. The partner feels needed and the addict feels justified in maintaining their drug habit. It’s a win-win that actually ends up being lose-lose.

Where do we learn codependent behaviors? Most people learn them from their role models growing up, especially if they were raised in an addicted or dysfunctional home. For example, children of alcoholics are up to four times more likely to become addicts themselves, and about half go on to marry an addict and duplicate the addict/codependent model they saw in their parents. Others may suffer traumatic experiences early in life, which contribute to low self-esteem, a fear of abandonment and other codependent traits.

Since enmeshment is the only way they know how to be in a relationship, few people recognize their own codependent patterns, instead labeling themselves selfless or “too nice.” All they know is that they have a pattern of unstable, one-sided and in some cases abusive relationships. Here are a few additional signs that you may be in a codependent relationship:

#1 Taking Responsibility for Others

People who struggle with codependency feel a heightened sense of responsibility for the thoughts, needs and decisions of others, as well as their ultimate satisfaction in life. Often in a controlling or manipulative way, they try to solve other people’s problems and offer unsolicited advice, doing far more than their share to ensure the individual’s happiness.

Although their efforts may at first seem noble, they are in fact driven by the codependent’s need to feel needed. Serving others, often to the exclusion of their own needs and desires, is the only way they feel valued and loved. All of this self-sacrifice leads to anger and resentment, which often manifests in other mental health issues, including depression, anxiety, eating disorders, sex and relationship addictions, and substance abuse, as well as physical health problems.

#2 Putting Someone Else’s Feelings Above Your Own

Codependent individuals have little sense of self. To sustain some sort of interpersonal connection, they focus on how their partner feels, how they think and what they believe rather than paying attention to their own feelings, values and beliefs. They become consumed by the other person and lose themselves in the process.

#3 Going to Extremes to Hold Onto a Relationship

A codependent relationship is based on fear. Fears of abandonment, being alone or being rejected lead to an extreme need for acceptance and approval, which in turn leads to desperate attempts to please others. The codependent partner resents the addict for being sick, yet fears getting well could mean losing their identity as the addict’s caretaker. As a result, they accept blame where it properly falls elsewhere, change their clothing and appearance to please others, give up friends or hobbies, and go to other extremes to maintain the status quo.

#4 Difficulty Recognizing and Communicating Emotions

There is a sharp disconnect between who the codependent partner is and who they think they are. Because their identity is so wrapped up in another person, their emotions mirror the addict’s. If the addict is having a good day, so is the codependent partner. Without the addict’s influence, the codependent has difficulty making decisions and recognizing and asserting their own wishes. In some cases, they choose to be in a relationship with the addict out of pity or a belief they can “fix” them, mistaking those feelings for love.

#5 Inability to Set and Maintain Personal Boundaries

In the absence of healthy role models, codependent individuals struggle to set personal boundaries that protect them from harm. They say yes when they mean no and take charge of situations that others are capable of handling. Doing so supplies a false sense of self-confidence even as they fail to protect themselves from victimization.

Just as an addict needs treatment to stop depending on drugs, the codependent partner can benefit from counseling, support groups (such as Co-Dependents Anonymous) and other interventions to stop depending on the neediness of others. For codependents, recovery is less about their relationship with an addict and more about restoring a healthy sense of self. It’s about learning to love and care for oneself rather than trying to fix someone else.

David Sack, M.D., is board certified in addiction psychiatry and addiction medicine.  Dr. Sack served as a senior clinical scientist at the National Institute of Mental Health (NIMH) where his research interests included affective disorders, seasonal and circadian rhythms, and neuroendocrinology.  He currently serves as CEO  of Elements Behavioral Health, a network of addiction treatment centers that includes Promises rehab centers in California, The Ranch in Tennessee, The Recovery Place drug rehab in Florida, and Right Step and  Spirit Lodge in Texas.

Are Athletes Primed for Prescription Drug Addiction?


During Olympic season, the public watches in awe as talented athletes from around the world compete, secretly waiting to see which ones are going to test positive for steroids. But steroids aren’t the only drug problem plaguing elite athletes. There is growing concern in a number of sports that players are sacrificing their health and their careers to prescription drug addictions.

A Budding Epidemic in Sports

Two of the most commonly abused medications in sports are narcotic painkillers, such as Vicodin and OxyContin, and prescription stimulants, such as Ritalin or Adderall. Prescription painkillers are frequently prescribed (at least initially) for legitimate pain complaints following injuries sustained on the field. Their widespread misuse isn’t surprising given the aggressive nature of sports and the intense pressure on athletes to play injured.

Retired NFL players misuse opioid pain medications at a rate more than four times that of the general population, according to a study from Washington University. More than half (52 percent) of NFL retired players said they used prescription pain medication, 71 percent of whom admitted abusing the drugs during their sports career.

Athletes are drawn to prescription stimulants because they believe the drugs give them a boost of focus and energy. Seeking a competitive edge, some players feign symptoms of attention deficit hyperactivity disorder (ADHD) to get “legal” amphetamines. According to records from Major League Baseball, the number of players getting “therapeutic use exemptions” from baseball’s amphetamines ban quadrupled in recent years. While some players undoubtedly have a legitimate medical need for ADHD medications, it appears that others are merely looking for ways to evade the amphetamine ban.

A Set-Up for Addiction?

Being a professional athlete may seem like a dream job, but intensive training and pressures to perform can have unexpected side effects, including an increased risk of addiction and other mental health issues. Why the association between sports and drug addiction?

Theories abound, but a growing body of research shows that exercise can stimulate the dopamine reward system in the brain much like drugs of abuse. While most of us could use more exercise in our lives, elite athletes may develop a compulsive preoccupation with training that resembles addiction. A study published in the Journal of Sports Sciences, which tracked competitive runners in the U.S. and triathletes in Hong Kong, found more than half had compulsive-exercise tendencies. As Texas Rangers outfielder Josh Hamilton described it when he was sidelined with a back injury, “alcohol and drugs were the closest thing I could find to getting that feeling when I was playing the game.”

The heavy physical training elite athletes endure may prime the brain for addiction. According to a study from Tufts University, an extreme preoccupation with training can mimic the biological effects of drug abuse, leading to withdrawal-like symptoms such as anxiety and depression when the exercise stops. Exercise releases the body’s natural opioids, endorphins, and has long been touted for relief of stress, anxiety and depression. These findings could help explain why athletes often struggle with substance abuse, especially once they leave their sport.

In addition to the biological components, athletes face extreme pressure to impress coaches and please adoring fans, which may contribute to drug and alcohol abuse, eating disorders and other mental health issues. Exhaustion from training and competing has also led to symptoms of depression and anxiety in some athletes.

Self-Medicating Pain and Loss

When athletes get injured or retire, they may feel torn about losing their place in the spotlight. The let-down many athletes experience can bring on unexpected mental health issues. Several beloved athletes have come forward with their struggles, including:

Seven-time Olympic medalist and former world record holder Amanda Beard, whose swimming career was marked by depression, bulimia and substance abuse.

Eight-time world record holder Geoff Huegill battled drug abuse, dramatic weight gain and depression following his retirement from swimming after the 2004 Olympics.

After spending a season on injured reserve, Tennessee Titans wide receiver O.J. Murdock died of what appeared to be a self-inflicted gunshot wound.

For athletes, the perks of the job may actually contribute to the problem. Many have the means to fund hefty drug habits, yet exhaust all of their resources by the time they realize they need treatment. Since their family, friends, coaches, the public and even law enforcement want to see them continue playing, many are shielded from the negative consequences of their addiction.

Inside reports suggest that the professional sports culture may encourage and even facilitate drug dependency among players, making addictive medications easily accessible and taking whatever measures necessary to keep the players on the field. As awareness has grown about the epidemic of prescription drug addiction, sports organizations are tightening the reigns but problems remain:

Former New York Jets backup quarterback Erik Ainge missed the entire 2010 season because of an addiction to painkillers following a football injury.

Randy Grimes, former lineman for the Tampa Bay Buccaneers, came forward in 2009 to talk about his addiction to prescription painkillers.

Former NBA player Chris Herren gave up his career to a 14-year drug addiction.

Last year, hockey player Derek Boogaard died at age 28 of a drug overdose while recovering from a concussion.

In 2009, former Philadelphia Eagles defensive tackle Sam Rayburn was arrested for attempting to obtain a controlled substance by forgery or fraud to fuel a prescription painkiller addiction that at its peak involved consuming more than 100 Percocets a day.

The tragic stories, too numerous to mention, highlight the harsh realities behind the glamorous image of sports stardom. At the same time the medical community at large is trying to distinguish legitimate from illegitimate needs for prescription medication, sports doctors and team managers must strike this same balance or risk having their best players sidelined by addiction.

David Sack, M.D., is board certified in addiction psychiatry and addiction medicine.  Dr. Sack served as a senior clinical scientist at the National Institute of Mental Health (NIMH) where his research interests included affective disorders, seasonal and circadian rhythms, and neuroendocrinology.  He currently serves as CEO  of Elements Behavioral Health, a network of addiction treatment centers that includes Promises in California, The Ranch in Tennessee, The Recovery Place in Florida, and Right Step and  Spirit Lodge drug rehabs in Texas.

7 Behaviors You Can Change Now to Avoid Developing an Addiction


Your grandfather was an alcoholic. You were emotionally mistreated as a child. And your dysfunctional family continues to complicate your life on a daily basis. With this many risk factors, the odds of avoiding addiction certainly aren’t the most favorable. While you can’t control your genes, your past or the family you come from, getting hooked on drugs is not inevitable. Here are a few simple behaviors you can change now to help avoid a lifetime battle with addiction:

#1 Experimenting with Drugs

The only surefire way to avoid drug or alcohol addiction is to refrain from experimenting in the first place. However, as we know from the failed War on Drugs, this “just say no” approach simply doesn’t work. People are curious, bored and in pain, and have always looked to drugs and alcohol to feel better.

Still, understanding your personal risk factors can help you make an educated decision. Do you have a family history of drug or alcohol problems? Have you struggled with depression, anxiety or other mental health issues? If you’re at high risk for addiction, don’t take the chance – invest your energies in finding healthier ways to feel good.

#2 Hanging Around Heavy Drinkers and Drug Users

Surrounding yourself with drug users creates a sub-culture where getting high is acceptable and even encouraged. An occasional drink with friends is innocent enough, but being around people who have few interests outside of partying can be a set-up for addiction. Even if you think your strong values and decision-making skills make you immune to peer pressure, it’s human nature to want to fit in and share interests with the people close to you (hence the popularity of Facebook, Pinterest, and other social media sites).

#3 Isolating Yourself

Social connection is a basic human need. We need other people to support us during difficult times and to witness our lives in happier times. While not everyone can or should be a social butterfly, being a hermit not only puts you at greater risk of addiction but also diminishes your overall satisfaction with life.

Without a social network, you’re more likely to be bored and lack a sense of purpose in life, which are reasons people frequently cite for experimenting with drugs. You may not notice that your drug or alcohol use is getting out of control, but the people who care about you will. Isolating also can be a sign of mental illness, which increases the risk of substance abuse.

Instead of hiding out, keep yourself occupied in more productive pursuits where you’re likely to meet people with similar interests. Take a class, start a new hobby, volunteer in the community – all of these can change your perspective and improve your outlook, thereby shielding you from addiction.

#4 Ignoring Feelings

How do you cope with feelings of sadness, anger and disappointment? Do you ignore them and hope they’ll go away, or do you take steps to resolve them?

If you can’t face your feelings and problems head-on, you’re bound to find some sort of escape. For some, it may be shopping or gambling; for others it may be food, sex or drugs. Using drugs to cope may be a sign that you’re self-medicating an underlying mental health condition like depression or anxiety. Without proper diagnosis and treatment, those suppressed feelings may drive you to abuse drugs or alcohol. Roughly half of people with substance use disorders also have some form of mental illness.

The problem with self-medication is that drugs can only numb the pain temporarily, and in the long run, end up causing more pain. The longer feelings are suppressed, the longer other mental health issues go undiagnosed and unaddressed and the fewer healthy coping mechanisms you’re able to put into practice.

#5 All Work and No Play

People who have difficulty relaxing, being themselves and having fun may depend on drugs or alcohol to put them at ease. Studies show that the addictive mind is one that desperately wants to feel good but derives less pleasure from the things that usually make people happy. Although drug use may seem fun at first, the brain is programmed to gain less pleasure from it over time, setting you up for double the disappointment later on.

#6 Taking Senseless Risks

Some of the brightest, most influential thinkers are risk takers. But we’re not talking about strategic risk-taking. We’re talking about the kinds of risks you later regret. Maybe your thirst for novelty gets someone hurt or your inability to control your impulses ends up irreparably damaging your reputation. Once you’ve reached this point, drug use seems less troublesome. After all, what’s one more risk?

#7 Settling for the Quick Fix

You could exercise to get better sleep, but why? There’s a pill for that. Most of us could benefit from a change in diet to lower our cholesterol, but no need. There’s a pill for that, too. If you’re more likely to pop a pill than change your lifestyle, you’re not alone. It’s the American way. But it’s also the addict’s way.

The quick-fix mentality prevents people from addressing the real issues affecting their physical and mental health. Change requires a shift in thinking. Rather than seeking out immediate gratification, dig deeper to find the underlying cause of your discomfort and consider non-drug alternatives. This may mean occasionally taking the harder path, and perhaps suffering a little in the process.

No one is destined to become an addict. Like diabetes, heart disease and other chronic diseases with a strong behavioral component, you can minimize your risk of addiction by changing how you think and act. Will it be easy, quick or fun? Not likely, but isn’t that the point?

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of addiction treatment centers that includes Promises, The Ranch outside Nashville, and Right Step in Texas.

6 Skill Sets Every Child Needs to Guard Against Addiction


Addicts aren’t the only ones who are haunted by the shame of addiction. Parents are often plagued with worry: “If only I had been a better parent, maybe none of this would’ve happened.”

Addiction is not parents’ fault (about half the risk is genetic), but you can influence the course of your child’s life by helping them develop the skills that protect against addiction.

#1 Coping Skills

One of the most important goals in treating addiction is equipping addicts with effective coping skills. The skills they learned in childhood might have been tempered by difficult life events, or perhaps they never developed appropriate coping mechanisms at all.

In either case, a need to self-medicate anger, disappointment and other difficult emotions is one of the most common reasons people turn to drugs and alcohol.

By learning how to cope with the full range of emotions – both the ones that feel good and the ones that feel miserable – children become resilient. Coping skills can be as basic as proper self-care (diet, sleep and exercise) or healthy distraction (talking to a friend or taking a walk), or they can be as complex as learning to differentiate between the things we can control and those we cannot.

#2 Social Skills

Human beings crave connection with other human beings. Studies show that social skills are essential for children to make friends, do well in school, and cope with life’s ups and downs. Those who aren’t able to lean on others for support are at greater risk of anxiety, depression and substance abuse.

Talking to children about other people’s feelings, beliefs and desires helps build empathy, a fundamental tool for social interaction. This dialogue can begin as early as age two or three by describing the way characters in books or television shows might be feeling in a given situation and how they might deal with those feelings. Skills such as appropriate eye contact, sharing, taking turns, active listening and assertive communication can also be taught directly and through role modeling.

#3 Life Skills

It’s surprising how many people arrive in drug rehab with minimal life skills. They haven’t balanced a checkbook, prepared a basic meal or washed their own laundry, and it shows in their confidence and ability to function each day. While young children wouldn’t be expected to have mastered these skill sets, the groundwork can be put in place early on.

School doesn’t always equip children with the real-world skills they will need to navigate adolescence and adulthood. Parents play a critical role in teaching their children healthy study habits, money management, cleaning their room, staying organized and creating a daily routine.

#4 Emotional Regulation Skills

Poor impulse control and a need for immediate gratification are strongly correlated with addiction. Although these qualities are normal at certain developmental stages, most children begin to use self-regulation skills without outside intervention. Those who have an extreme or persistent lack of self-control are at higher risk of bullying, academic difficulties, substance abuse and other problem behaviors.

Studies show that self-regulation skills in kindergarten predict literacy, vocabulary and early mathematics skills and are important for social development. Taking a time out, labeling and validating a child’s feelings (both pleasant and unpleasant), and offering positive feedback for appropriate behavior are all useful strategies that aid in responding to emotions appropriately.

Harsh discipline, yelling and spanking, on the other hand, do not teach self-regulation. It is also important for parents to consistently set limits and enforce consequences so that children understand the expectations.

#5 Critical Thinking Skills

Critical thinking encourages children to think for themselves rather than giving in to peer pressure. Schools are effective at teaching children what to think but not necessarily how to think. Starting as early as kindergarten, parents can help their children develop these skills by asking open-ended questions and working through a variety of possible solutions. After a decision is made, it can be helpful to reflect on it and ask your child what they might do differently next time.

#6 Distress Tolerance Skills

Many of the most dreaded behaviors that arise in children, including drug use, are the result of mismanaged stress. While distress tolerance skills alone will not prevent addiction, they do empower children to sit with their emotions without trying to escape or numb them.

One of the greatest disservices modern parents do to their children is getting in the way of the child’s innate learning process. “Helicopter parenting” – the increasingly common practice of hovering over children so they don’t get hurt or have to face problems – has contributed to a society that values immediate gratification over resilience. By intervening in arguments between a child and their friends or doing a tough homework assignment for their child, for example, parents deprive their child of valuable lessons and the skills to cope with stress, as well as the confidence boost that goes along with each small success.

Instead, let your kid be a kid. Life is full of moderate stressors that encourage the development of new skills and provide a sense of mastery. You can supplement this process by introducing your child to novel experiences like making a new friend or trying a new game and allowing them to work through problems on their own.

All of these skill sets can be gained through a combination of experiences at school, explicit teaching and, most importantly, parental role modeling. If you accept accountability for your own feelings, provide plenty of praise and support without overprotecting, and avoid using drugs or alcohol yourself, you can put your child in the best possible position to avoid addiction and other serious problems later on.

 David Sack, M.D., is board certified in Psychiatry, Addiction Medicine, and Addiction Psychiatry. As CEO of Elements Behavioral Health he oversees addiction treatment programs such as Promises Treatment Centers  in Malibu and Los Angeles, The Ranch in Tennessee, and The Recovery Place in Florida.  You can follow Dr. Sack on Twitter.

Are You In Recovery But Not Really Recovering?


For an addict, it seems that there is no undertaking more daunting – and no accomplishment more gratifying – than getting sober. With drugs and alcohol out of the way, the possibilities are endless.

While this is true for many people in early recovery, there are exceptions. Particularly in the first year, some recovering addicts experience “dry drunk syndrome” – a period when they become inexplicably angry, depressed and distant and are at increased risk of relapse. Much to the dismay of loved ones, a new way of life that began in treatment can take a reversal, resulting in even greater dissatisfaction and instability than before the addict stopped drinking or using.

Not to be confused with the inevitable ups and downs in early recovery, dry drunk is a high-risk stage marked by drug cravings, distorted thinking and emotional dysregulation. Although the recovering addict manages to abstain from drug or alcohol use, they either haven’t made the changes in other areas of their lives essential for a fulfilling, productive and sober lifestyle or they made progress only to return to long-held negative attitudes and patterns.

A dry drunk is characterized by:

  • Frustration and hopelessness about the goals, experiences and dreams lost to addiction
  • Inability to make decisions
  • Judging themselves and others harshly
  • Difficulty expressing themselves or sharing their feelings
  • Blaming others for their dissatisfaction
  • Taking a hands-off approach to life and recovery (e.g., isolating or cutting back on 12-Step meetings)
  • Unpredictable moods, anger or irritability
  • Jealousy of others who set goals and pursue their dreams
  • Lashing out against or withholding support from loved ones
  • Feeling numb, as though nothing excites them anymore
  • An exalted sense of self-importance or an “all about me” attitude
  • Replacing drugs or alcohol with other addictive behaviors such as work, sex or gambling

If a recovering addict is not moving forward, they are at risk of moving backward. In addition to robbing the addict and their loved ones of happiness and healing, dry drunk syndrome can be a precursor to relapse. Restlessness, boredom, discontent and magical thinking are all signs that a recovering addict could be inching their way back to active addiction.

The prognosis isn’t all doom and gloom. The first hurdle – getting sober – has been surmounted; now ongoing 12-Step work and counseling are needed to address the emotional and psychological issues preventing the recovering addict from becoming healthy and whole.

Reconnecting with a dream or discovering a new passion can replace the time and energy once devoted to drug use and help the recovering addict grow confident in their abilities. To combat grandiosity, attention-seeking or self-centeredness, recovering addicts may benefit from giving back, often by greeting others at 12-Step meetings, sponsoring a newcomer or volunteering in the community.

Recovery is about much more than not using drugs or alcohol. It is a process of redefining one’s life. This is why we set realistic expectations from the start, advising clients that recovery is a lifelong series of reassessments and adjustments. Even when it’s more comfortable to isolate or make excuses (“At least I’m still sober!”), being in recovery means doing the work each and every day. As one day turns into 100, and 100 turns into 1,000, recovery replaces addiction as a way of life.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. Dr. Sack is CEO of Elements Behavioral Health, a network of addiction and mental health treatment programs. You can follow Dr. Sack on Twitter

Five Potential Addictions We Sometimes Overlook


When most people contemplate addiction, they think about cigarettes, alcohol, and illicit drugs like crystal methamphetamine, cocaine, and heroin. And certainly those substances are highly addictive—they are incredibly difficult to quit once a person is hooked, and prolonged use/abuse typically results in any number of negative life consequences. But these obvious potential addictions are far from the only possible problem areas.

Though addiction has traditionally been viewed purely in terms of substances, the American Society of Addiction Medicine now embraces a much broader definition that encompasses not only drug and alcohol abuse, but process (behavioral) addictions. Of course, everything we ingest is a substance of some sort, and everything we do is a behavior of some sort, so just about anything can become an addiction. Below is a short list of things many of us eat, drink, or do on a regular basis that can and sometimes do turn into addictions.

  1. Guzzling Caffeine
    Caffeine is a stimulant that occurs naturally in coffee, tea, and yerba mate plants. It is also added to numerous consumer products, including a wide variety of sodas, some candies, and most “energy” drinks. Regular caffeine users, even those who take in as little as 100 milligrams per day—the amount in half a cup of coffee—can develop physical dependency and experience withdrawal symptoms such as headaches, irritability, nausea, and fatigue when they don’t get their fix. While some people may think they just like coffee or other caffeinated products, many actually consume caffeine to stave off withdrawal symptoms (morning lethargy, mid-afternoon headache, etc). For the most part, the consequences of caffeine addiction are mild, though some people do experience anxiety or rapid heartbeat when caffeine is consumed to excess, and others may miss work or social engagements while dealing with symptoms of withdrawal.
  2. Snacking on Junk Food
    Here’s a scary thought: Brain imaging shows that high-sugar, high-fat foods activate the same regions of the brain as heroin, opium, and morphine. In other words, processed sugar and fat (along with processed wheat and salt) stimulate the rewards center of the brain, causing many people to “binge” eat with cookies, chips, soda, and other “junk” foods. (Have you ever seen anyone binge-eat with salad greens? Probably not, because healthier, naturally grown foods don’t cause the same reaction in the brain.) So the next time you decide to unwind after a hard day with a pint of ice cream or a bag of cheese doodles and find yourself thinking, At least I’m not an alcoholic or an addict, you might want to think again.
  3. Popping Prescription Pills
    Prescription drug abuse is the intentional use of a medication without a prescription, in a way other than prescribed, or for the experience or feeling it causes. The number of people using prescription medications is very much on the rise. This is especially true with young people. After marijuana, prescription medications are now the most commonly abused substances among high school seniors, with Vicodin and Adderall topping the list. Much like “hard” drugs such as heroin and cocaine, these doctor-prescribed medications flood the brain with dopamine. Over time this can produce cravings, tolerance, withdrawal, and all of the other symptoms (and consequences) of illicit drug addiction. The dangers of prescription medications are often underestimated because many people think that a doctor would never prescribe something that could harm them. This line of thinking makes it very easy to rationalize addictive behavior. The individuals most at risk for prescription medication addiction are adolescents, women, older adults, people with a family history of addiction, and those with an underlying psychological condition such as profound childhood trauma, anxiety, or depression.
  4. Having Sex
    Watching and masturbating to porn, having regular sex, having an affair, visiting a strip club, and even being sexual with a prostitute does not, per se, make someone a sex addict. Sexual addiction occurs when an individual loses control over his or her sexual behaviors, tries to stop but can’t, and experiences negative consequences as a result of his or her sexual acting out. Individuals who struggle with compulsive and addictive sexual fantasies, urges, and behaviors sometimes lose hours, even days, to the pursuit of sex, and their sexual acting out continues despite relationship, career, financial, and even legal problems. Thanks to the increasingly affordable and anonymous access to online sexual content (porn, virtual sex) and anonymous and/or casual sexual encounters (set up through chat rooms, dating sites, and “adult friend finder” smartphone apps), compulsive sexual behavior is affecting more and more people, at ever-younger ages. In fact, one recent study on hypersexual disorders found that for 54 percent of sex addicts the problematic behavior started before the age of 18.
  5. Tanning
    Most readers probably remember Patricia Krentcil, a.k.a. “Tan Mom,” the 44-year-old woman with skin like shoe leather who was, in April of this year, charged with child endangerment after her 6-year-old daughter suffered first-degree burns in a tanning booth. Krentcil’s addiction is sometimes, perhaps jokingly, referred to as “tanorexia.” However, an addiction to tanning is a very real and very unfunny issue. Studies show that people who frequently use tanning beds experience changes in brain activity during their exposure to UV rays that mimic the patterns seen with drug use. Other studies show that frequent tanners exhibit classic symptoms of addiction, such as craving and withdrawal. So it appears that tanorexia may cause, in addition to skin cancer and other dermatological issues, psychological and emotional problems common to addiction.

This article is not meant to scare readers. After all, most people who drink coffee, eat junk food, and engage in other seemingly innocuous behaviors are able to do so in moderation. It is only when people lose control over the activity that it becomes problematic (in terms of addiction). If you or someone you know is concerned about one of the five activities delineated above or any other seemingly harmless behavior, try to stop for 30 days. If you are able to quit without experiencing cravings or withdrawal, you are probably not addicted. If, however, you become irritable, experience headaches, crave the substance/behavior, or are simply unable to stop, there may well be a problem that probably needs to be addressed with the assistance of a qualified professional.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of addiction treatment programs that includes Promises Treatment Centers, The Ranch outside Nashville, Right Step drug rehab in Texas, and The Recovery Place rehab in Florida.

Does Addiction Run in Your Family? How to Talk to Your Kids About Their Risk


If you’ve lived through a family member’s addiction, whether a grandparent, aunt, cousin, sibling or your own, you intimately understand the gravity of the disease. But your children, blissfully unaware of their family history, may not take drugs and alcohol as seriously as they should – that is, until you make them.

What a Family History of Addiction Means

Genetics accounts for about half the risk of developing addiction. Those with a family history of addiction, meaning one or more blood relatives has had a drug or alcohol problem, are at a significantly higher risk of suffering from addiction and other mental health disorders. Children of alcoholics, for example, are four times more likely than other children to become alcoholics themselves. They also tend to suffer from low self-esteem, poor academic performance, abuse and neglect, and other issues at higher rates than other children.

Avoiding the Avoidable

Fortunately, genes aren’t all we pass on to our children. Environment, upbringing and parenting style make up the other half of a child’s addiction risk and are, at least to some extent, within our control. Since we cannot yet reliably predict the risk for developing addiction, you best serve your child by preparing them for all eventualities. Just as you would talk to them about their risk for diabetes or heart disease, having your own series of “genetic counseling sessions” with your child can help safeguard them against addiction.

Explain the Facts. Educate your child about the nature of addiction so they know what they’re up against. Addiction is a chronic, progressive disease that rewires the brain’s response to drugs and alcohol. There is no “cure” for addiction, but there are various medications, support groups and therapies that can help people recover.

There’s no need to make threats or attempt to scare your children into abstinence. Addiction is a health issue, not a moral failing or character flaw. Since approaching it with blame or shame may drive them closer to drugs and away from open conversation with you, skip the judgments and stick to the facts.

Meet Them Where They’re At. Conversations about drugs and alcohol should start as early as elementary school and no later than middle school, when children are first exposed to the concept and your influence still reigns supreme. Roughly one in 10 13- to 14-year-olds has used drugs or alcohol, a number that increases exponentially by the time children reach 17 or 18 years of age.

For younger kids, use television shows, movies and news stories to start a discussion about the harm drugs can cause. With older kids, ask open-ended questions about how they feel about drug use and what their friends are experiencing. Let them set the depth and pace of the conversation – this way, if they aren’t ready to talk now they’ll know they can come to you later.

Be Bold. Whether you believe it’s realistic or not, make it clear that while experimentation may be acceptable in some families, your children don’t have the same luxury. The “just say no” approach isn’t always effective, especially with teens, but it’s the best advice when addiction runs in the family.

Even if your child isn’t willing to abstain from drugs and alcohol permanently, encourage them to hold off as long as possible. Research shows that teens who begin using drugs before age 14 are at greater risk for addiction than those who delay their first use until age 21 or older.

Strengthen Their Defenses. With drugs and alcohol, knowledge only goes so far. The reality is teens who know better don’t always do better. A more effective alternative to “just say no” is bolstering your child’s emotional, physical and spiritual defenses against addiction. A child that knows how to cope with stress and has high resilience and self-esteem will be less likely to self-medicate with drugs than a child that lacks these skills.

A warm and caring home environment, where children feel they can share their feelings, where family time is cherished, and where kids are met with praise and unconditional love, encourages open conversation. There are many ways children can socialize without using drugs or alcohol, such as joining a club or team sport. If they go to parties, help them find ways to fit in without drinking or using drugs (e.g., by practicing ways to say no and having excuses ready if they need to leave). Kids who pursue their passions and volunteer to serve others are more likely to have a sense of meaning and purpose in their lives, steering them away from negative influences.

Get Involved. If your child isn’t talking to you, you can be certain they’re talking to someone, who may or may not provide accurate information or have their best interests in mind. From the pre-teens on (if not earlier), your child should know your rules about drug use as well as the potential consequences for violating a rule. Kids who clearly understand their parents’ expectations, and whose parents set a good example by following their own rules, are less likely to use drugs.

Particularly when addiction runs in the family, stay alert to additional risk factors such as poor academic performance, having friends who use drugs or going through a period of high stress. Just as you would take your child to the doctor for an infection or cold, talk to a substance abuse counselor, treatment center or other health care professional if you think your child may have a drug problem.

‘Why Me?’

Having a family history of addiction is not your child’s fault, but neither is a genetic propensity for obesity, depression or cancer. Still, what we inherit becomes our responsibility – and is, in a sense, a blessing that can put your child on notice that the rules of engagement with drugs and alcohol are different for them.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of mental health and addiction treatment centers that includes Promises, The Ranch, Right Step, The Recovery Place, The Sexual Recovery Institute, Malibu Vista, and Spirit Lodge.