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Some 16 million Americans are estimated to suffer from alcohol use disorder (AUD). Many of them don’t receive the help they need.

If left untreated, alcohol misuse can quickly spiral out of control. When alcohol use begins to have a negative impact on a person’s health and relationships, it may be diagnosed as an alcohol use disorder. Recognizing the warning signs of alcohol misuse and getting appropriate treatment can make a significant difference in someone’s recovery process.

A short questionnaire such as CAGE can help determine if you should be concerned about your alcohol consumption. CAGE is an acronym with each letter representing one of the four questionnaire questions:

Have you ever felt you should cut down on your drinking?
Have people annoyed you by criticizing your drinking?
Have you ever felt bad or guilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?

Two or more ‘yes’ answers are considered clinically significant, indicating an alcohol problem.

The more traditional “Jellinek Curve,” created by E. Morton Jellinek in the 1950s is a parabola representing several stages of alcohol addiction and recovery. Jellinek coined the term “disease concept of alcoholism,” an important step toward the medicalization of alcohol misuse away from simply regarding it as moral turpitude. His research demonstrated that alcohol addiction is a pernicious disease progressing through several distinct phases.

In the initial “pre-alcoholic” stage people drink to feel better about themselves, to dull their pain, or to eliminate anxiety and depression. In stage 2, alcohol misuse escalates to blackout experiences, and efforts to hide the increasing alcohol consumption.

In the “middle alcoholic” third stage, family members and friends begin to worry about the alcohol misuse and may also notice physical signs such as facial redness, weight gain or loss, sluggishness, or stomach bloating. The person struggling with alcohol use may now skip work, forget or ignore important tasks, and become irritated easily.

Stage 4 corresponds to a severe alcohol use disorder. Drinking has become the total focus of all activities, even at the expense of the person’s livelihood, health, and relationships. Tolerance for large amounts of alcohol is considerable and abstaining from alcohol may result in withdrawal symptoms. Any attempt to stop using without help at this late stage may result in tremors or hallucinations (delirium tremens) and could induce seizures.

Since 2013, physicians and addiction professionals have also been using eleven criteria for alcohol use disorder listed in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). The eleven symptoms also indicate a progression, starting with the perception of drinking too much and failed attempts to cut back (1–2), escalating to neglect, recklessness, and sickness (7–9), and culminating in (substance) tolerance and withdrawal symptoms (10–11).

The DSM-5 describes several levels of severity for alcohol misuse:
mild AUD – the presence of 2 to 3 symptoms
moderate AUD – the presence of 4 to 5 symptoms
severe ­AUD – the presence of 6 or more symptoms

At the vertex of the Jellinek parabola we find the vicious cycle of continuing “obsessive drinking,” but its right arm represents recovery from addiction, beginning with an “honest desire for help” and learning that “alcoholism is an illness.”

Recovery does not have to wait for this low point, though. The honest desire to change can begin at any level and many treatment providers—including Harmony—offer different levels of care for the respective degrees of severity.

While a severe alcohol use disorder may require medically supervised detoxification and residential treatment, earlier stages of the disease may well be reversed in an intensive outpatient program. Alcohol misuse is often driven by underlying mental health issues such as trauma, anxiety, and depression. Any such co-occurring conditions need to be addressed in a comprehensive treatment approach at any level.

Levels of care can also function in a step-down fashion. A severe AUD may first require around-the-clock residential treatment, followed by partial hospitalization, before eventually stepping down to an intensive outpatient program (IOP). There is also continuous 12-Step facilitation and alumni support. Delaying necessary treatment is never a good option. The earlier alcohol misuse is caught and halted, the better the chance of a full recovery.

Addiction to alcohol is a serious condition that requires comprehensive treatment. If the AUD is severe and the alcohol misuse has been going on for a long time, withdrawal symptoms—such as delirium tremens—can become life-threatening. Substance addiction is a chronic disease that will not simply go away and relapse is not uncommon, simply requiring further treatment.

Harmony Foundation is one of the longest-running and most successful addiction treatment centers in the world. If you or a loved one are struggling with alcohol or drug addiction, or you have questions about our programs, call us today at (970) 432-8075 to get the help needed as soon as possible. Our experienced staff is available 24 hours a day, seven days a week.

The month of June saw a bleak anniversary. June 17 marked exactly 50 years since President Nixon designated drugs as “America’s public enemy number one” in a special message to Congress, launching the so-called “war on drugs,” now widely perceived as an ineffective if not counterproductive weapon in the battle against addiction.

The war on drugs was and still is a US-led global campaign of drug prohibition, military aid, and military intervention, with the aim of reducing the illegal drug trade. The initiative considers substance misuse primarily a criminal activity and consequently focuses on interdiction with tactics that are meant to discourage the production, distribution, and consumption of illegal psychoactive drugs—with little regard for the actual reasons why Americans misuse drugs and alcohol in the first place.

As this harsh military and law enforcement approach to substance misuse and addiction hit the half-century milestone, a growing number of lawmakers, public health experts, and community leaders in the US were asking what it has really achieved.

In many parts of the US, some of the more drastic policies implemented during the war on drugs are scaled back or scrapped altogether. Last year, Oregon voters decriminalized possession of small amounts of almost all illicit drugs, taking a major step away from the arrest, charge, and jail model for possession that has been a centerpiece of the war on drugs.>

Decriminalization has been tried overseas—with great success. In 2001, Portugal became the first country in the world to decriminalize the consumption of all drugs.  As TIME magazine reported in 2018, the drug-related death rate in Portugal plummeted to “five times lower than the EU average and stands at one-fiftieth of the United States. Its rate of HIV infection dropped from 104.2 new cases per million in 2000 to 4.2 cases per million in 2015.”

Most importantly, drug use declined overall among the 15–24-year-old population, the cohort most at risk of initiating dangerous drug misuse. Before decriminalization, an estimated one percent of the entire Portuguese population was addicted to heroin and the country had the highest rate of HIV infection in the European Union. In Latin America, Uruguay has also pursued a very liberal policy on drug use in recent years.

US Representatives Bonnie Watson Coleman (D-NJ) and Cori Bush (D-MO) along with the Drug Policy Alliance, a non-profit organization seeking to advance policies that “reduce the harms of both drug use and drug prohibition” are now seeking a similar approach for the United States.

The Drug Policy Reform Act (DPRA) introduced by Coleman and Bush in June, calls for the federal government “to refocus its strategies for addressing substance use” as a health issue, not a criminal issue. The DPRA would end criminal penalties for drug possession at the federal level, shift the regulatory authority from the Attorney General to the Secretary of Health and Human Services (HHS), expunge records and provide for resentencing, and reinvest in alternative health-centered approaches. The bill would also eliminate many of the life-long consequences associated with drug convictions, including the denial of employment, public benefits, immigration status, drivers’ licenses, and voting rights.

“Every 23 seconds, a person’s life is ruined for simply possessing drugs. Drug possession remains the most arrested offense in the United States despite the well-known fact that drug criminalization does nothing to help communities, it ruins them. It tears families apart and causes trauma that can be felt for generations,” said Queen Adesuyi, Policy Manager for the Office of National Affairs at the Drug Policy Alliance.

Most experts no longer regard addiction to alcohol and drugs as criminal behavior based on character flaws but as a serious chronic disease. For example, the American Society of Addiction Medicine (ASAM) defines addiction as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”

The threat of punishment is ineffective because, by definition, people with addiction are compelled to repeat the harmful behavior despite serious negative consequences. Most people with a severe substance use disorder (SUD) are desperately trying to numb emotional pain—caused by trauma, depression, anxiety, or other mental health conditions—by engaging in substance misuse and then are trapped in an addiction cycle that only makes that pain worse.

A severe SUD requires holistic treatment on multiple levels, not incarceration. Recovering from this disease involves patients giving up their maladaptive coping mechanisms—drugs and alcohol—and substitute them with healthy coping skills.

Harmony Foundation is a nonprofit alcohol and drug addiction recovery program that promotes physical, emotional, and spiritual healing, empowering our clients to embark upon the lifelong journey of recovery.

If you or a loved one are struggling with alcohol or drug addiction, or you have questions about our programs, call us today at (866) 686-7867 to get the help needed as soon as possible. Our experienced staff is available 24 hours a day, seven days a week. 

Anxiety disorders are among the most common mental health conditions in the United States, affecting some 40 million adults, or more than 18 percent of the US population every year. Although widespread, less than 40 percent of people with anxiety receive any kind of treatment.

Furthermore, many popular anti-anxiety strategies miss the point because they work with the wrong part of the brain, Judson Brewer warns in his new book Unwinding Anxiety. The renowned addiction psychiatrist and neuroscientist argues that anxiety “hides in your habits” and habits are formed in the “old brain,” namely the limbic system. The more ancient part of the human brain—evolutionarily speaking—is a set of structures that deal with emotions and memory. The limbic system regulates autonomic or endocrine function in response to emotional stimuli and also is involved in reinforcing behaviors important to survival.

Willpower, substitution, and priming the environment against harmful habits all engage the “new brain,” the prefrontal cortex (PFC) while the pesky habits are run in the old brain. “So exactly when you need your willpower—which resides, remember, in the prefrontal cortex/new brain—it’s not there, and your old brain eats cupcakes until you feel better and your new brain comes back online.”

“Brewer shows how anxiety exists inside the habits that make up our everyday lives, and habits are sticky. They won’t go away just because we tell ourselves to breathe— because, as crazy as it sounds when talking about anxiety, our brain is attracted to these habits because they create some sense of reward, “ Kira Newman summarized Brewer’s approach on Greater Good Magazine.

Anxiety arises from the evolutionary useful function of fear which teaches humans to avoid dangerous situations. However, if fear is combined with uncertainty it turns into the far less useful anxiety.

“When fear-based learning is paired with uncertainty, your well-intentioned PFC doesn’t wait for the rest of the ingredients (e.g. more information),” Brewer writes. “Instead, it takes whatever it’s got in the moment, uses worry to whip it together, fires up the adrenaline oven, and bakes you a loaf of bread you didn’t ask for: a big hot loaf of anxiety.”

To disengage from harmful habits (including anxiety), Brewers recommends a three-step process he refers to as “gears.”

The first gear is mapping your mind. As in his previous book The Craving Mind, Brewer explains the mechanics of the human brain’s reward-based learning process as three basic steps: Trigger-behavior-reward. If the result of a behavior is judged to be positive (reward), the behavior is repeated when triggered again. This is also the basic “habit trap” of addiction as Brewer explained in The Craving Mind.

“I could line up their habit loop in my head. Trigger. Behavior. Reward. Repeat. In addition, they used substances as a way to ‘medicate’; by being drunk or high, they could prevent (or avoid) unpleasant memories or feelings from coming up.”

This is exactly why anxiety, depression, and trauma are so strongly correlated with substance use disorder (SUD). In Unwinding Anxiety, Brewer described the habit loop of a patient with anxiety:

Trigger: Anxiety in the afternoon
Behavior: Start drinking
Reward: Numbing, forgetting, feeling intoxicated

“You learn a habit based on how rewarding the behavior is,” writes Dr. Brewer. “The more rewarding a behavior is, the stronger the habit.” The way out is to become aware of this loop. “That’s what mindfulness helps us do: build awareness so that we can observe our caveman brains in action.” Brewer stresses that you won’t get anywhere with rational analysis of a behavior’s merits.

“To change a behavior, you can’t just focus on the behavior itself. Instead, you have to address the felt experience of the rewards of that behavior.” … “The only sustainable way to change a habit is to update its reward value.”

“We need to give our brains new information to establish that the value that they had learned in the past is now outdated.” Brewer frequently asks patients to pay close attention to this felt experience.

As many people found out the hard way, it’s notoriously difficult to quit smoking, even if the thinking prefrontal cortex is fully aware of the health risks. As Brewer puts it: “No patient of mine has ever marched into my office and asked me how to help them smoke more.”

So instead of explaining the dangers of nicotine use, Brewer teaches patients to pay attention when they smoke. “Most people start smoking when they are teenagers, so they have laid down a strong reward value for cigarettes: being young and cool at school, rebelling against their parents, all of that.”

To break that well-established habit loop, smokers should be mindful of how rewarding smoking is right now. One woman realized that smoking “smells like stinky cheese.” Brewer emphasizes the felt experience (old brain) that may disengage the unhealthy habit. This is not an analytical process in the PFC, the newer and much weaker brain. If you want to change the behavior, “you have to rub your brain’s little orbitofrontal cortex nose into its own poop so that it clearly smells how stinky it is. That’s how your brain learns.”

Psychologist Jonathan Haidt uses a rider-and-elephant analogy to explain this scenario: the emotional, limbic part of the brain is like an elephant, the rational PFC part is like the elephant’s rider. The rider of the elephant may think he or she is in charge, but when there’s a disagreement between the elephant and the rider, the elephant usually wins. It’s the elephant who gets anxious or addicted and it’s the elephant who has to be retrained to achieve sustained change.

Brewer’s second gear for defeating habit loops is paying attention to the results of your actions.
“When you have identified and mapped out your habit loops (first gear) and are ready to practice driving in second gear, ask yourself this simple question: What do I get from this behavior?”

Answering this question requires careful attention to the “actual, visceral, embodied sensations, emotions, and thoughts.” Brewer reissues his warning that this is not intellectual training! “While thinking is helpful for decision-making and planning, we often give the thinking part of our brain too much credit. Remember, it’s the weakest part of your brain….” “How do you get the big muscular guy to do your bidding? You hire someone to become the heavyweight’s coach or trainer.”

If patients follow this approach, their brain will slowly and naturally become disenchanted with its anxiety (and other) habits, allowing more space for healthier habits to form.

So instead of:

Trigger: Start to struggle
Behavior: Think it will suck (fixed mindset)
Reward: Increased likelihood of it sucking

Second gear mindfulness could lead to this sequence instead:

Trigger: Start to feel frustrated
Behavior: Notice the habitual reaction and ask “What do I get from this?”
Reward: See how unrewarding the old habit is; get disenchanted with feeding the frustration

Brewer’s third gear then is “anything that helps you step out of your old habit loop.” Brewer suggests several strategies including curiosity which he calls “our innate superpower.” Rather than judging yourself for being anxious, or getting obsessed about where your anxiety is coming from, just get curious. Take a step back and ask What does it feel like, and where in the body do you feel it?

There is also the mindfulness practice known as RAIN:
Recognize and relax into the present moment
Accept and allow it to be there
Investigate your bodily sensations, emotions, and thoughts
Note what is happening
Similar to people with substance use disorder, patients with anxiety may focus on “one day at a time” to achieve what Brewer calls “anxiety sobriety.” Reminding his readers that “our brains hate uncertainty,” Brewer writes that “with certainty comes a reduction in anxiety.” There is more certainty in the present moment; ergo less anxiety.

“If we’re anxious now, we create a bead of anxiety. If we do this a lot, we make an anxiety necklace… If in this moment, we step out of an anxiety habit loop, we don’t add that bead to the necklace and have the opportunity to add a different bead instead.”

Brewer’s analysis shows why treating anxiety and addiction requires a comprehensive, holistic approach. It takes time and effort to disrupt entrenched habit loops. “To hack our brains and break the anxiety cycle, we must become aware of two things: that we are getting anxious and/or panicking and what results from anxiety/panicking.”

“All we have is now. And what we make of this moment creates that bead that we add to our necklace.”

Some 16 million Americans are believed to have alcohol use disorder (AUD). Many of them don’t receive the help they need despite the ongoing addiction crisis that has been plaguing the United States for many years now. An estimated 93,000 people in the US die from alcohol-related causes each year.

A new study by researchers at Washington University School of Medicine in St. Louis involving data from more than 200,000 people with and without AUD found that although the vast majority of those with alcohol use disorder see their doctors regularly for a range of issues, fewer than ten percent get treatment for alcohol misuse.

“Alcohol use disorder is a chronic disease, but compared to other chronic diseases, it’s wildly untreated,” said senior author Laura Jean Bierut, MD and professor of psychiatry. “For example, two-thirds of patients with HIV and 94 percent of patients with diabetes receive treatment, compared with only 6 percent of people with alcohol use disorder.”

“It’s not that these people aren’t in the healthcare system,” said first author Carrie Mintz, MD and assistant professor of psychiatry. “But although they see doctors regularly, the vast majority aren’t getting the help they need.”

Analyzing pre-pandemic data gathered from 2015 through 2019 via the National Survey on Drug Use and Health, the researchers found that about 8 percent of those surveyed met the current criteria for alcohol use disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the authoritative guide to the diagnosis of mental disorders in the US.

Of the surveyed people who met the DSM-5 criteria, 81 percent had received medical care in a doctor’s office or spent time in a hospital or clinic during the previous year. But only 12 percent reported they had been advised to cut down on their drinking, 5 percent were offered information about treatment, and only 6 percent actually received treatment, some of whom were not referred by their doctors but sought out treatment options by themselves.

The researchers found that although most people with alcohol use disorder had access to healthcare and although 70 percent reported they had been asked about their alcohol use, there was no attempt to follow up with treatment options.

“Some primary care doctors may not feel comfortable telling patients they should cut down on drinking, prescribing medication to help them cut back or referring them to treatment because they don’t specialize in treating alcohol misuse; but the result is that many people who need treatment aren’t getting it,” said Professor Bierut. “We used to see the same thing with smoking, but when physicians became educated about smoking and learned that many of their patients wanted to quit or cut back, doctors began offering more treatment, and more people were able to quit. We think the same thing may be possible with alcohol.”

The study confirms that alcohol misuse was a serious public health issue even before the onset of the COVID pandemic. In January 2020, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) published an analysis that found that “nearly 1 million people died from alcohol-related causes between 1999 and 2017.”

“Alcohol is not a benign substance and there are many ways it can contribute to mortality,” NIAAA Director George Koob wrote a little over a year ago. “The current findings suggest that alcohol-related deaths involving injuries, overdoses, and chronic diseases are increasing across a wide swath of the population. The report is a wake-up call to the growing threat alcohol poses to public health.”

That was before the beginning of the COVID pandemic which is believed to have caused a dramatic rise in drug and alcohol misuse. “We know alcohol use and misuse have increased during the pandemic,” Professor Mintz said in May 2021. “It seems there has been a shift toward heavier drinking. Plus, many doctor’s offices, AA groups, and other support groups were shut down for a period of time, so we would hypothesize that even the relatively small percentage of people in treatment may have declined during the past year.”

The Washington University researchers noted that during the pandemic, alcohol sales in the US increased by 34 percent. Consequently, they expect that as the country emerges from COVID-19 and returns to normal, the number of people with alcohol use disorder will have climbed.

Addiction to alcohol is a serious condition that requires comprehensive treatment. If the AUD is severe and the alcohol misuse has been going on for a long time, withdrawal symptoms—such as delirium tremens—can become life-threatening. Detoxification without qualified medical supervision can lead to seizures and other dangerous conditions.

Harmony Foundation is one of the longest-running and most successful addiction treatment centers in the world. If you or a loved one are struggling with alcohol or drug addiction, or you have questions about our programs, call us today at (866) 686-7867 to get the help needed as soon as possible. Our experienced staff is available 24 hours a day, seven days a week.

“Methamphetamine availability and methamphetamine-related harms have been increasing in the United States,” warned the Centers for Disease Control and Prevention (CDC) last year.

While the country’s headlines focused on the COVID-19 pandemic and occasionally on the continuing opioid crisis, another drug epidemic has been slowly escalating, as we reported on this blog in June 2020.

Methamphetamine is now among the most misused illicit drugs in the United States. According to the CDC, “During 2015–2018, an estimated 1.6 million US adults aged ≥18 years, on average, reported past-year methamphetamine use; 52.9 percent had a methamphetamine use disorder, and 22.3 percent reported injecting methamphetamine within the past year. Co-occurring substance use and mental illness were common among those who used methamphetamine within the past year.”

“The continued escalation of methamphetamine use, alone or with opioids, presents providers with complex medical challenges and difficult consequences for patients, families, and the legal and health care systems,” reported Michael Jann on Psychiatric Times in May. “Separately, each drug represents an epidemic and a crisis. Together, they magnify the medical complications facing our society.”

The CDC emphasized the importance of addressing co-occurring mental health concerns when treating methamphetamine addiction.

“The overlap of methamphetamine use with mental illness, especially serious mental illness, suggests an important role for mental health providers to engage in care with this population, in coordination with addiction and other health care providers. Treatment of co-occurring mental and substance use disorders has been a recognized gap in the system of care and persons who use methamphetamine might be particularly affected.”

The opioid epidemic started to escalate again after a brief leveling-off period in 2018. The latest preliminary CDC data show an alarming 29 percent rise in overdose deaths from October 2019 through September 2020—largely driven by the powerful synthetic opioid fentanyl.

In Colorado, overdose deaths involving fentanyl more than doubled in 2020 compared with 2019, rising 111 percent to 452 deaths last year from 214 in 2019. “All overdose deaths, including from heroin, cocaine, and methamphetamine, totaled 1,223 in 2020, up nearly 20 percent from 1,062 the year before, according to state health department data that is preliminary and expected to rise even higher,” reported The Colorado Sun in February.

Many health professionals believe the COVID-19 pandemic, which kept people isolated and led to increased rates of anxiety and depression, is largely responsible for the current worsening of the twin addiction epidemics.

“Fentanyl is like kerosene. Methamphetamine is like natural gas. Then the COVID pandemic is like, ‘Let’s add some diesel fuel,’” Dr. Joshua Blum, an addiction professional at Denver Health told The Colorado Sun. “It’s like one flammable agent added to another.”

The concurrent misuse of opioids such as heroin and fentanyl and stimulants such as cocaine and methamphetamine is on the rise, as Tom Valentino recently reported in Addiction Professional.

Treating polysubstance addiction requires a comprehensive, holistic approach. Misusing more than one drug concurrently can complicate addiction treatment and recovery. Drugs taken in combination can boost the narcotic effects of the substances in unforeseeable ways. Their toxic effects increase and withdrawal symptoms become more severe and prolonged.

Harmony Foundation is one of the longest-running and most successful addiction treatment centers in the world. We provide trauma-informed dual-diagnosis care that addresses substance use and mental health concerns. If you or a loved one are struggling with alcohol or drug addiction, or you have questions about our programs, call us today at (866) 686-7867 to get the help needed as soon as possible. Our experienced staff is available 24 hours a day, seven days a week.