An interesting article about relapse

For my last post, my one bit of research, and I use this term lightly, was to link to a definition of tolerance. That led me to an interesting site.

There I found an interesting article related to relapse. They’ve found that neurogenesis, that is the generation of new nerve cells in the brain, may lead indirectly to context-driven-relapse.

“New findings from our lab show that neurogenesis—the generation of new neurons in the adult brain—in the hippocampus may strengthen memories tied to drug-seeking behavior in rodents with methamphetamine addiction-like behavior,” says Dr. Chitra Mandyam, senior investigator of the two studies. These findings suggest new approaches for reducing relapse risk. Says Dr. Mandyam, “We also demonstrated that inhibiting neurogenesis during abstinence with a small synthetic molecule prevented context-driven drug-seeking.”

They link to two recent studies so this seems legit. I suggest reading the article itself. It is quite technical but not too much, if I can follow it… What I didn’t follow was how long a period of abstinence they mean, but presumably it is the short term, as in early recovery.

They go on to describe drugs that can help by preventing neurogenesis, but I gather this is still in the early phase of testing. Still, I like to keep my mind active by mostly reading and learning new things. The idea of preventing new brain cells seems like a bad one to me (simply because neurogenesis is an expected effect of brain stimulation, which is important to me because I try to keep my brain active and thus hopefully “young”), but at least this mechanism whereby we are prone to drug-seeking behaviour due to memories when new brain cells form, is something to be cognizant of. The real work for me at the beginning of recovery was to keep my mind on other things, to be aware of my cravings but not act on them, and then eventually the interest to get drugs went away. This for me simply emphasizes how important it is to remain in control and avoid temptation in early recovery. After that, my opinion vs others related to addiction treatment diverges somewhat, since I don’t believe one need make any effort after the first few weeks. I didn’t. (Of course my experience was subjective. When I tried to quit a few years before, I relapsed after nine months, so saying “the first few weeks” might seem unreasonable. That’s just the way it went for me when I had made up my mind to stay clean for good. So it might be prudent to apply greater discipline in say… the first year.)

Here are the sources for the article:


Another addict dead

Judging by a Facebook share yesterday, by a counsellor from the rehab I attended in 2010, yet another life has been lost to addiction. It’s different for me this time in that it wasn’t someone from my friends list, so I don’t get to see the RIP posts on their wall… But still.

I won’t see many of those RIP’s anymore. I have almost none of those friends left, and those who remain are stable, I think. But there were two such deaths last year, and quite a few in the years before that, starting the month I left that rehab in March 2010.

And all this happened despite the fact that most of the people I knew from there had already defriended me a long time ago. They didn’t like my atheism posts, and the posts critical of them. I recall one girl in particular, who was a gullible idiot, who had everybody in that rehab anxious because she believed that a schizophrenic man was possessed and was “speaking in demonic tongues”.

That… the belief in the supernatural, is common among them. Ironically every person I know of who died due to their addiction, was a theist who believed not only in god, but also accepted the 12-step plan programs. Every one of them that I know of, who died, was in and out of such a program. I do not know of any other sceptic, from either of the rehabs I attended, not one person who rejected what they were taught there. (The second program I refer to is the outpatient program I attended, as a formality to comply with a court order and get my son back.)

I cannot emphasize enough how glad I am that I did not Facebook friend any of the people I met in the second program; otherwise I’d have a whole new generation of friends who relapse and die.

Anyway, if you are an addict who has had help, whether you believe in the nonsense they teach you in 12 step programs or not, you really need to understand the seriousness of relapse. Every time you go back to active use, you increase the probability of your death. If you’re a heroin addict and don’t stay clean, you will almost certainly die of your addiction. That’s just the way it is. This is your life. It’s the only one you get. Don’t fuck it up.

The worst of recovery jargon – No, you don’t just “pick up” a drug again.

We should choose our words carefully, because words are more than just words. Figures of speech come with innuendo that can subtly change the meaning of a sentence as a whole, such that words chosen poorly, whether they are chosen intentionally or not, tell us more than just the subject being discussed. Words conjure images in our minds. Words tell a story. Words come with emotion, or they can be used to detach from or dismiss emotions that should be felt or expressed. Words can lift us up or break us down. In a group setting such as NA or other 12 step meetings, familiar jargon repeated often enough can have an indoctrinating effect by reinforcing a narrative about addiction and recovery that’s easier to believe than harsh reality. A beautiful lie is always preferable to an unpleasant or inconvenient truth, so we are prone to believing what we want to believe.

That’s what I hate about NA; it’s a group setting where the woo is pushed on addicts when they are vulnerable. In a meeting, you only hear from others who have been conditioned to believe the same as you. Ideas about drugs and addiction are introduced to you initially by therapists, and reinforced by the group. You end up believing them even though they contradict what most people intuitively believe about addiction. You become convinced that you are experts, and people who aren’t addicts don’t understand. But in reality, what people believe intuitively in society is more likely to be true than what you as an addict in an isolated group of addicts would like to believe. In truth, that feeling of fellowship, just because you all fucked up the same way, doesn’t qualify you for anything other than the probability of fucking up again. Of course there is wisdom to be gained from individuals who have overcome addiction, but the mob mentality of 12 step programs contains mostly wishful thinking and mistaken beliefs. A belief that’s fundamentally wrong, no matter how sincerely it may be held or how popular it is, is still wrong.

In recovery, there are a number of common phrases used that I dislike. Most of them are annoying. Phrases like “in these rooms” or “work the steps” or “service” are examples of phrases that are annoying. Then there’s “practice powerlessness” and “let go and let God” that tell a narrative and help put recovering addicts into a mindset where they accept the woo of 12 step programs. But there’s one phrase that I dislike more than any other: “pick up”, as in “I was clean for 3 months, then I picked up again”.

The first time I heard this, I was in rehab in 2009, and we were watching a video about addiction and relapse. In every case, the addict mentioned how they had “picked up” again, and “used”. (Used is another one.)

But you don’t just pick up, as if drugs are everywhere and using again is an automatic exercise, as if returning to using drugs takes no time, thought, or effort. The phrase is a euphemism of course, one that sneaks the narrative into our minds that relapse is not a conscious process involving many choices, actions and planning.

Let’s examine exactly what I would need to do, if I were to choose to relapse today. Firstly, I need the opportunity. As it happens, my son is staying with his cousins for a few days, so I have a window of opportunity. But the choice to relapse would likely have been made weeks in advance. Then I’d need to find a dealer. Since I deleted all the dealer’s numbers I had, that would involve driving to an area where I know I can find drugs, and hanging around long enough for dealers to approach me. Assuming I found one with meth, I’d still need something to smoke it with. They don’t sell meth pipes here, unless you’re really lucky, since crack cocaine is the popular drug in Johannesburg. So on the way home, I’d need to buy a 12V light bulb and a plastic pen. My mother stays with me… So I’d have to wait until she’s busy watching TV or sleeping. Then, take a craft knife, a pair of side-cutters, a small screwdriver and scissors, carefully cut open the bulb and remove the filament, being careful to avoid breaking the globe. Then, after throwing away the cartridge containing the ink, remove the stopper from the back of the pen, and cut the end off because it tapers to a point that’s too thin, which is also difficult because plastic pens can easily be crushed by accident. (Probably best to have a couple of globes and pens; and this is even more difficult if you’ve already been using because meth makes you clumsy.) Only after doing all of that would I be able to smoke meth.

In summary, all of the above would involve weeks of careful planning, and might involve making arrangements to ensure that I could be alone to use on the day dedicated to using. On the day itself, I’d first need to wait for the working day to end, and have an excuse to come home late, then it might take an hour to find a dealer, and a few more hours before being able to smoke the meth. Getting the homemade meth pipe ready would also take a while, and all in all this would take a great deal of planning and effort. There would also be a lot of idle time, the weeks leading up to the chosen day, time while waiting for the dealer, the time driving to and from the dealer as well as wherever I purchased the 12V light bulb, the time waiting for the opportunity to make the meth pipe, then the act of throwing the meth into the pipe, taking out a cigarette lighter and smoking it. In all of that time, there’d be plenty of opportunity to think about what I was doing. Doing all of the above involves many decisions, many tasks, many choices, and many actions. There is absolutely no part of it that’s automatic. There would literally be thousands of opportunities during all of that where I’d have the chance to change my mind. Thousands.

I’m not exaggerating. You don’t just fucking pick up a drug. You choose to do so, but it is not a single choice. Rather it is a series of many choices. You plan and carry out that plan. You have thousands of opportunities to change your mind and not use the drug.

When you euphemize all of that with “pick up”, you do yourself and those who listen a major disservice. You proliferate the standard narrative that addiction is a disease… You can’t help it… You’re powerless, and your life is unmanageable. Poor you, the victim who automatically resumed using by simply picking up. And if you should clean up again, and describe your relapse as picking up, you fail to take responsibility for all those poor choices, planning and actions you took to resume using drugs. Well, sorry but if that’s your attitude, then I say, “Fuck you!”

Addiction is not a disease. But it isn’t only a single choice either. Every time you use, you make hundreds of little choices, and there are many opportunities to stop using drugs. “Pick up” is truly a deplorable euphemism.