Introduction 1
About This Book 2
Foolish Assumptions 3
Icons Used in This Book 3
Beyond the Book 4
Where to Go from Here 4
Part 1: the Hole in the Heart: Detecting Addiction 5
Chapter 1: Addiction: What Is It? 7
Defining Substance Use, Abuse, and Addiction 8
Understanding what addiction is 8
The difference between abuse and dependence 9
Your personal definition of addiction 11
The Role of Experimentation 13
Assessing Your Addiction Risk 13
Warning signs of addiction 14
A comment for families and friends of the addicted person 14
Exploring Methods and Models of Treatment 15
Treatment centers and professional help 15
Things to consider when deciding on your treatment 16
The twelve-step program and other self-help approaches 16
The Ins and Outs of Recovery 17
Overcoming fears and obstacles to recovery 17
What to do if you slip 17
How to relate to family, friends, and colleagues 18
What family and friends can do 18
Chapter 2: Substance Use, Substance Abuse, and Addiction 19
The Basics of How Substances of Abuse Work 19
The Drug Lineup 20
Marijuana (THC) 21
Sedatives and tranquilizers 22
Stimulants 23
Psychedelics 24
Opiates and narcotics 26
Dissociative anesthetics 27
Anti-anxiety and antidepressant drugs 27
Volatile hydrocarbons (inhalants) 28
Steroids 30
Chapter 3: Behavioral Addictions: Addictions Without Substances 31
Some General Advice 32
Compulsive Gambling 32
Three phases of compulsive gambling 33
The impact of compulsive gambling 34
Sex and Pornography 36
Pornography addiction 37
Sex addiction 37
Love addiction 38
Computer Games and the Internet 39
Food Addiction 41
Eating too much 41
Eating too little 41
Work Addiction 42
Do I have a problem? 42
How work addiction starts 43
Kicking the habit when everyone is asking for more 44
Chapter 4: Dancing with the Tiger: The Risks of Experimenting 47
Going with the Flow: Peer Pressure and Other Influences 48
Partying and club drugs 49
Hooking up 49
“I didn’t know what I was doing” 50
Rebellion and experimentation 50
The Risks of Experimentation and Addiction 51
Drinking, drugging, and driving 51
Unsafe sexual behavior 51
The sex trade 52
Crime 52
Anger and aggression 53
Child abuse and neglect 54
Health risks 55
The Costs of Addiction to Families 56
The blame game 56
The consequences to you and your family 57
Part 2: Taking Those First Steps 59
Chapter 5: Recognizing Addiction in Yourself and Others 61
Am I at Risk? 62
Genetics: Addiction Across Generations 63
Determining who’s susceptible 64
Applying your family history 64
How a Body Gets Addicted 65
From the mind out 65
From the body in 66
What drugs are the most addictive? 67
Waking Up to Your Own Addiction 68
Starting with self-observation 69
Taking a quick self-assessment 69
Breaking down the types of addictions 71
Perceiving Addiction in a Loved One 76
Case study: Jack and his daughter 76
Recognizing the warning signs 77
Chapter 6: Assessing Your Readiness: Do You Need Help Now? 81
Understanding Your Role as the Client 82
Assessing the Options 82
Avoiding hopelessness 83
Choosing what’s right for you 84
Matching Your Characteristics to Treatment Options 84
Client characteristics 84
Treatment characteristics 89
Making a treatment choice 90
Deciding When to Start 91
Cost-benefit analysis of seeking help 91
Self-assessing your readiness for change now 92
Chapter 7: Quitting: Easy to Say, Hard to Do 95
Successful Quitting 95
Becoming Aware of Your Triggers 96
External triggers 97
Internal triggers 97
Combination triggers 97
Time as a trigger 98
Your identity as a trigger 98
The ease of availability as a trigger 99
Magical thinking 99
Increasing Your Motivation to Change 100
Factors That Affect Your Ability to Find Addiction Freedom 101
Geographical change 101
A change of job 102
New relationships 102
Codependency with a partner 103
A recovering partner 104
Part 3: Examining Treatment Approaches 105
Chapter 8: Treatment Choices 107
Different Viewpoints on Addiction 107
The moral dimension 108
The disease perspective 108
The pharmacological perspective 109
Thinking your way free: The cognitive-behavioral perspective 110
Addictions as a bad habit: The learning models 110
The psychodynamic perspective 111
The biopsychosocial perspective 112
Combination Treatments 113
The twelve-step treatments and other variants of the AA model 114
Treatments based on cognitive behavioral, psychodynamic, and learning methods 115
Chapter 9: Reviewing Inpatient and Outpatient Treatment Options 119
Interventions: Breaking Through Denial and Fear 120
How an intervention works 122
Intervention principles 124
Choosing an interventionist 125
Residential Versus Outpatient Care: Deciding What’s Best for You 125
Outpatient Treatment 126
Psychotherapy 126
Controlled drinking 127
Risk reduction 128
Tips on seeking outpatient professional help 129
Residential or Inpatient Treatment 130
The stages of inpatient treatment 130
It’s voluntary 131
The rules of rehab 131
How long is long enough? 132
Aftercare 132
The Minnesota Model 133
Relapse Prevention 134
Therapeutic Communities and Sober Living 135
How therapeutic communities work 135
A focus on rehabilitation 136
How effective are therapeutic communities? 136
Who obtains treatment from a therapeutic community? 136
How long should you stay in treatment in a therapeutic community? 137
Andrew’s Choice: A True Story of Getting into Treatment and Achieving Success 138
How things began 138
One day in rehab 139
Chapter 10: Treating Physical Dependence 141
Understanding Your Body’s Reactions to Drugs 142
Detoxification: What Is It, and How Does It Work? 143
The goals of detox 144
The process: In the body 146
The process: In the mind 146
Knowing What to Expect with Detoxification Treatments 147
Detox from alcohol and other sedatives/hypnotics 148
Detox from stimulants such as cocaine and amphetamines 150
Detox from opiates 150
Detox from marijuana 151
Detox from inhalants/solvents 151
Medications That May Help 151
Medications for alcohol problems 151
Medications for treating benzodiazepine withdrawal 152
Medications for treating opiate addiction 153
Medications for stimulant abuse 153
Maintenance medications and craving reducers 153
Methadone Treatment 155
What is methadone? 155
Methadone myths 156
Who should choose methadone treatment? 157
Does it work? 157
Chapter 11: Twelve-Step Programs 159
Types of Twelve-Step Programs 160
The Actual Twelve Steps 161
Working Your Program 162
Hitting bottom and working toward recovery — one day at a time 163
Discovering spirituality 164
Using affirmations 164
Deciding Whether a Twelve-Step Program Is Right for You 165
Problems with Twelve-Step Programs 166
What the critics say 166
Is a twelve-step program enough? 167
Chapter 12: Joining Self-Help and Support Groups 169
Secular Organizations for Sobriety and Save Our Selves (SOS) 170
The SOS approach 170
Joining an SOS group 171
Self-Management and Recovery Training: SMART 171
The SMART approach 171
Joining SMART 172
Women for Sobriety (WFS) 173
The WFS approach 173
Joining WFS 173
Religious Organizations 175
Chapter 13: Psychedelic Therapies and Other Alternative Treatments 177
Psychedelics 178
Acupuncture 181
Correlational research 182
Clinical trials 182
Ibogaine 183
How ibogaine may work 183
Ibogaine research 184
Ketamine 185
Nutritional Therapy 186
Addictions and poor nutrition 186
What is good nutrition? 187
Macrobiotic diets 187
Meditation 189
Harm-Reduction Approaches 191
Chapter 14: Teen Treatment 193
Why Alcohol and Drugs Are More Destructive When You’re Young 194
It’s easier to damage a growing brain 194
Teens have a tougher time these days 194
What to Do When You Suspect Substance Abuse in a Loved One 195
Advice for parents 196
Advice for good friends 197
A word about denial 197
Be prepared for a long haul to a healthy recovery 199
Making the investment in teen treatment 199
Getting Treatment as a Teen 200
Asking for help: Any time is a good time 200
Finding a counselor 201
Relating to your counselor 202
Counseling in group programs 204
Residential treatment: Group and individual treatments 205
Harm reduction programs for youth 206
Remembering That Slips Aren’t Freefalls 207
Part 4: Life in Recovery 209
Chapter 15: Overcoming Barriers to Recovery 211
Be Prepared: The First Step 212
Building Your Skills for Recovery 212
Pacing: Taking Things One Step at a Time 214
If you’re going too fast, slow down 214
If you’re bogged down, pick up the pace 215
Pacing with time 215
Pacing with activities 215
Building Resilience 216
Maintain personal hygiene 216
Explore your senses 216
Exercise 217
Handling Your Everyday Fears 218
The work of worry 218
Death and dying 219
Abandonment 220
Handling Your Fears about Recovery 220
Short-term fears: Withdrawal problems 220
Long-term fears 221
Avoiding Self-Anger: A Slippery Slope to Relapse 222
Putting judgments on hold 223
Recognizing negative moods 223
Recognizing stressful situations 224
Taking Action: Storming the Barricades 225
Taking action to commit to change 225
Taking action against triggers that increase cravings 226
Taking action to build self-confidence 226
Taking action against negative moods 227
Chapter 16: Handling Slips and Relapse 229
Slips Versus Relapse: What’s the Difference? 229
Why Relapse Happens 230
You can almost count on it 230
Triggers for relapse and what to do about them 231
High-risk situations and their remedies 232
The good news: Relapse is preventable 233
Learning from Relapse 233
Examining your relapse 233
Doing things differently next time 234
Getting Your Balance Back 235
Medications may help 236
Getting back on track 236
Deciding whether you need some extra help 236
Chapter 17: Handling Work and Family During Recovery 237
Dealing with Relationships During Recovery 238
Dealing with positive changes 238
Dealing with negative changes 239
Dealing with Family Problems 240
Do the right thing: Be a good role model 240
How families are affected by addiction 241
Making positive changes in family relationships 242
Solving family problems by changing norms 242
Making long-term plans for positive change 243
Dealing with Work Problems 244
Scenario one: You were hardworking to begin with 244
Scenario two: You lose your job due to your addiction 245
Dealing with Financial Problems 246
Relapses, Restarts, and How They Affect Your Family 247
Coming to terms with a relapse 248
Restarting with the help of your family 249
Chapter 18: For Families and Friends: Ways to Make a Difference 251
Breaking Through Denial and Codependency 252
Overcoming denial 254
Dealing with resistance 254
Preparing for Change 256
Helping Your Loved One Follow Through 257
Recognizing negative emotions 258
Empathizing: “I feel your pain” 258
Supporting Change over the Long-Term 259
The six weeks of helping 259
Expecting and getting through relapse 260
The Ups and Downs of Change 261
Dropping expectations and falsely positive images 261
Turning downs into ups 262
Sustaining Optimism and Support in Your Family 263
Leaving fantasy-land to find realistic optimism 264
Being deserving of victory and success 264
Part 5: the Part of Tens 265
Chapter 19: Ten Ways to Help a Friend or Loved One 267
Talk Things Over Truthfully While You Listen Attentively 267
Recognize the Telltale Signs of Addiction 268
Confront Denial 268
Help Get Treatment 269
Let Go of Your Need to Control the Situation 270
Hold Criticism at Bay 270
Offer Balanced Support 271
Understand What You’re Fighting 271
Remain Optimistic 272
Know What to Do When Treatment Efforts Fail 272
Chapter 20: More Than Ten Self-Help Resources 273
Self-Help Books for Problems Related to Addictions 273
Self-Help Websites for Managing Addictions 275
Websites for Treatment Models 275
Websites for Families and Teens 277
Websites for Problems Related to Addictions 278
Online Lectures on Addiction-Related Topics 278
Treatment Centers 279
Index 281
