Understanding Process Addictions

As addiction science evolves, the medical community continues to find support for the claim that addiction is a chronic brain disease. In the past decade, numerous studies have reinforced direct causation of drugs and alcohol on the brain's reward center, neural pathways, memory, cognitive function, and motivation.

Further research by the American Society of Addiction Medicine includes process addictions—also sometimes referred to as urge-driven disorders or behavioral addictions—in the current understanding of how the brain is affected by artificial stimuli.

Non-substance-related disorders are hotly disputed, even though the American Psychiatric Association (APA) included some of them in its most recent edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM). In the current American healthcare system, an official designation listed in the DSM allows rehab facilities and health practitioners to provide a universal standard of care and treatment within coverage options recognized by insurance companies.

The updated version, DSM–5, references the following process addictions:

• Eating Disorders, including binge eating, anorexia nervosa, bulimia nervosa, and other related conditions
• Gambling Disorder, recognized as a quantifiable behavioral addiction disorder
• Internet Gaming Disorder, closely related to Gaming Disorder, now listed as a condition "warranting more clinical research and experience before it might be considered for inclusion in the main book as a formal disorder"

There are other notable urge-driven disorders, including but not limited to:

• Hypersexual activity
• Compulsive shopping
• Exercise addiction
• Internet and/or social media addiction
• Compulsive pornography viewing
• Food addiction

However, not all of these are currently recognized by the DSM–5. This doesn't make them less valid—especially if they're co-occurring conditions to substance abuse. It just means the APA has yet to conclusively affirm them as disorders.

What Science Indicates

According to studies cited by the National Institutes of Health, researchers believe "all entities capable of stimulating a person can be addictive, and whenever a habit changes to an obligation, it can be considered an addiction."

Medical experts at the APA, the Institute of Medicine, and the American Medical Association adhere to a definitive explanation of addiction that evidence indicates is a brain disease. The Addiction Recovery Guide details the explanation: “It’s the uncontrollable, compulsive drug craving, seeking, and use, even in the face of negative health and social consequences. Addiction is a condition caused by persistent changes in brain structure and function. Both developing and recovering from it depend on biology, behavior, and social context.”

As the experts point out, a person can become compulsively dependent on or obsessed with anything due to chemical changes in the brain, now reliant on artificial stimuli to the pleasure and reward center. This is what makes behavioral disorders different than, say, someone frequently engaging in certain hobbies or activities. While the physical signs of addiction aren't often present with behavioral disorders, the mental symptoms may closely resemble substance addiction.

The polarized thoughts regarding process addictions seem to relate to how an individual's particular habits can be classified as behavioral disorders. Some professionals identify process addictions by the compulsivity factor, similar to obsessive-compulsive disorder, which is recognized by the APA. This rationale is linked to the alteration of the brain's structure and function.

Detractors point to longitudinal studies that indicate process addictions are more of a "transient, limited behavioral problem" which won't persist. It eventually dissolves over time, mostly due to people taking stock of their lives and choosing to modify certain habits.

Reasons for Process Addictions

The absolute causes of process addictions are unclear. However, there seems to be a correlation between dysregulation, especially in response to trauma, and urge-driven disorders.

Dysregulation is a condition that impairs psychological, metabolic, or physiological process regulation. For example, a teenager who is frequently bullied may immerse herself in video games as a means to control her environment. Or, someone who was physically abused as a child may use the thrill and perks of gambling to create an inflated sense of worth.

Further, while the APA doesn't recognize an addictive personality as a psychiatric diagnosis, there are often certain characteristics common among people who suffer from process addiction:

• Increasing dopamine, the "pleasure chemical," by acting on impulsive tendencies or engaging in risky activities or behaviors
• Co-occurring conditions such as substance abuse, anxiety, depression, or borderline personality disorder
• Nonconformity, which includes a loss or gain of social structure, excessive narcissism, or defiance of authority

Key protective factors such as an established sense of purpose, positive relationships, good self-control, community involvement, and others often help to balance the urge to participate in particular behaviors. But, since many process addictions are often initially viewed as harmless activities, the crisis of the behavior might not be noticeable until there's a real problem.

Symptoms of Process Addiction

It's important to note that with the definition of addiction as a brain disease, not everyone who uses drugs or alcohol becomes addicted, just as someone who goes on a shopping spree after receiving an employment bonus isn’t automatically a compulsive shopper.

Process addiction may be present if someone displays the following symptoms:

• Acting on compulsive impulse to continue the behavior
• Obsessing about the need to engage in an activity
• Developing a tolerance to negative aspects of the behavior, no matter how difficult
• Losing control over participation, such as how much to do it or for how long
• Hiding the behavior or denying there's a problem
• Experiencing adverse reactions when unable to engage in the activity
• Finding it difficult to control or refusing to stop the behavior
• Continuing with the activity or behavior even if it causes harm 

Treating the Whole Person

At Cottonwood Tucson, we believe addiction of any type starts with chemical changes in the brain. Our team of experts seeks to help clients understand the root causes of these issues and advance through recovery in healthy, meaningful ways.

We provide personalized holistic behavioral therapy options for people wanting treatment for process addictions. Contact us today to see how we can help you or a loved one.

By Tracey L. Kelley

Why Substance Abuse Affects Nutrition

The statistics regarding America's lack of nutrition are rather astounding. Consider the following:

• Dietary guidelines for 2015-2020 released by the Office of Disease Prevention and Health Promotion indicate that 117 million Americans—approximately half of all adults in the nation—have at least one preventable chronic condition related to inadequate diet and lack of exercise.
• The average American consumes nearly four times the recommended daily intake of sugar—a whopping 22 teaspoons of added sugar, not accounting for amounts found in foods such as condiments, cereal, and yogurt. Extra sugar does more than harm your teeth: it contributes to high blood pressure and cholesterol; causes fatigue; and may even contribute to worsening depression.
• Recent study findings from the National Institutes of Health reveal that Americans have a higher risk of dying from cardiometabolic diseases—type 2 diabetes, stroke, and heart disease—if their diets are heavy with unprocessed red meat, processed meats, sugar-sweetened beverages, and sodium. What's more, it's not enough to avoid or eliminate these foods; people must also increase daily intake of more healthy options such as fruits, vegetables, nuts and seeds, seafood omega-3 fats, and whole grains. The researchers' analysis indicates almost half of deaths due to cardiometabolic diseases had a direct correlation to these dietary factors.

If you're in recovery from substance abuse, you're also rebuilding the structure of your nutrition. It's important to start the process in treatment and slowly adapt to better habits.

The Relationship Between Substance Abuse and Nutrition

While you may have a friend or a loved one who can eat sloppy burgers and a mess of fries seemingly without consequence, that fact is all of us operate more efficiently with whole food fueling our bodies and minds.

Scientists and physicians are taking a closer look at what they call "nutritional psychiatry" and are evaluating how what we eat affects our thinking and functioning. Whole foods rich with antioxidants, minerals, and vitamins provide nourishment to the brain. "Live" foods also protect the brain from oxidative stress caused by the waste produced when you use oxygen. Oxidation damages cells and heightens inflammation.

Another important aspect of nutritional psychiatry is understanding gut health. Surprisingly, one of the most powerful neurotransmitters activated in your brain first starts in your gastrointestinal tract—serotonin. Serotonin helps inhibit pain, control appetite and sleep, and regulate moods. In an article for Harvard Health Publishing, physician Eva Selhub details just how many neurons are in your digestive system, and what happens when poor eating habits make it harder for "good" bacteria to absorb fundamental nutrients, ward off toxins from "bad" bacteria, and keep the neural pathways between the gut and brain clear.

For someone suffering from substance abuse, these signals are crossed. Maintaining a proper diet is difficult when:

• Alcohol and drugs contribute to an increasing depletion of essential vitamins and minerals, which compromises multiple mind and body functions.
• Mental health issues may complicate substance use and interfere with healthy habits.
• Repeated use of illicit substances doesn't usually permit frequent grocery shopping and preparing nutritious meals.
• Addictive substances may increase or decrease appetite, causing extreme fluctuations with calorie consumption, metabolism, and nutrient processing. 

Quite often, people entering treatment for substance abuse are malnourished. This may be apparent in a variety of ways, such as slow-healing wounds; kidney and liver complications; immune system disorders; and anxiety and insomnia. Additionally, for people dealing with alcoholism—a high caloric carbohydrate due to the sugar content—they often crave other unhealthy carbs, sugar, and salt.

This compounds nutritional deficiencies.

In addition to the health conditions many Americans face due to a poor diet, malnourished people also frequently experience:

• A compromised immune system, leading to further infection or illness
• Acid reflux, abdominal pain, and bowel tissue decay
• Hepatitis, HIV/AIDS, and other infectious diseases
• Higher stress and agitation
• Prenatal issues

Medical detoxification and a comprehensive whole foods eating plan help people move forward with nutritional wellness.

Overcoming Dietary Issues Related to Substance Abuse

Nutrition experts stress that proper hydration and a slow correction of micro- and macronutrient deficiencies help individuals in recovery reduce malnutrition and junk food withdrawal.

That's right—some people suffer withdrawal symptoms when they initially eliminate foods that are high in processing, fat, simple carbohydrates, salt, and sugar. For example, similar to certain addictive drugs, junk food often spikes dopamine, located in the pleasure center of the brain. To quit cold turkey triggers a number of problems, including headaches, irritability, anxiety, mood swings, insomnia, dehydration, constipation, and other health issues.

Today's Dietician recommends patients go through a form of medical nutrition therapy in stages, which may include:

• Healing the body after medical detoxification with calorically-balanced meals, increased hydration, managed sleep, and stress-relieving techniques
• Improving aspects of nourishment with the introduction of nutrient-dense foods
• Assessing mood imbalances and behaviors to create stability through diet modifications such as regulating insulin, increasing amino acids, and adding omega 3-6-9 compounds
• Helping clients understand the differences between hunger cues, substance cravings, and uncovered emotions
• Recognizing the potential for co-occurring disorders such as binge eating and taking dietary and psychological prevention measures

Nutritional Care at Cottonwood Tucson

The professionals at Cottonwood use nutrition as a primary component of addiction detox, along with individualized medication protocol, counseling, and holistic practices such as yoga, Tai Chi, equine therapy, and meditation.

Our behavioral health dieticians develop nutritional plans for residents that promote clear thinking with stable, confident, and happy moods. They also collaborate with Cottonwood chefs and culinary staff to create menus supportive of the neurobiological needs of all patients.

By Tracey L. Kelley

The Epidemic of Painkiller Addiction

In 2015, Harvard Medical School reported that "four times as many prescription painkillers are provided each year now compared with the 1990s." In 2017, the U.S. Department of Health and Human Services (HHS) implemented a public health emergency, and developed a campaign to focus on specifically reducing opioid dependency. In its research, HHS cited the following statistics from the Centers for Disease Control and Prevention:

• In 2016, approximately 115 people died each day in the U.S. from opioid overdoses.
• In that same year, reports indicated the number of deaths from fentanyl and prescription/illegal opiates was five times greater than in 1999.
• Also in 2016, more than 63,000 deaths occurred—over 65 percent were due to opioids.

Why People Abuse Painkillers

The Substance Abuse and Mental Health Services Administration (SAMHSA) reported in July 2017 that prescription drug misuse is second only to marijuana as the most commonly-used illegal drug.

SAMHSA indicated that more than 90 percent of Americans surveyed in 2015 used prescribed pain relievers in the previous year. Of that number:

• Nearly 64 percent misused these medications in order to alleviate pain.
• Approximately 6 percent misused tranquilizers issued by medical professionals, usually to relax or to sleep more efficiently.

In some respects, prescribers are responsible for controlling access to painkillers. Their scope of knowledge regarding painkiller alternatives is more extensive than what the average person might know, especially when it involves medication.

But when patients approach healthcare providers with complaints of pain, it's difficult for medical professionals to evaluate, as each individual's perception of pain—particularly chronic pain—is subjective. There's no universal aspect of measurement that can be applied.

Because every person has different pain receptors, various prescription medications may be offered to help reduce the severity of symptoms.

Some recommended drugs—such as anti-inflammatories or NSAIDs more powerful than over-the-counter varieties—have what's called a "ceiling effect" where an increased dose doesn't provide greater pain relief. With different types of opioids—narcotic analgesics such as Percocet, hydrocodone, Tylenol with codeine, methadone, OxyContin, Lortab, fentanyl, and others—some people develop a tolerance to a certain dose, even if pain hasn't subsided, so dosing is increased without limitation. This is the start of addiction.

Additionally, some physicians think we have a "prescription culture." Researcher Marcia Meldrum of the University of California studied the history of pain care applications and shared her findings in a variety of medical journals. “Too many people see drugs as the answer to not only pain, but to improve their lives," she's quoted as saying in the Canadian Medical Association Journal. "If the solution also means they may become somewhat dependent on a drug, they probably think, 'Well, that would be better than this.'"

Consequently, many medical professionals seek to alleviate symptomatic problems with painkillers, even when causation isn't clearly identified.

Overprescribing Painkillers May Contribute to Epidemic Increase

Unfortunately, the medical community isn't completely without fault in the painkiller epidemic, and more lawsuits are coming to light. Here are just a few:

• In March 2018, NBC News reported five physicians accepted bribes to prescribe more fentanyl than medically necessary.
• A story in Rheumatology News discussed the details of several lawsuits brought against physicians for excessive prescribing of painkillers—including a Oklahoma doctor who "prescribed three million doses over five years," often in combination with anti-anxiety medication and muscle relaxers.
• Another March 2018 story from CNN outlined the particular conflicts with the "pay to prescribe" incentive systems of some pharmaceutical companies. For example, one lawsuit described how a doctor would only prescribe a certain manufacturer's drug to patients, regardless of how serious side effects impacted them, and how much money he received as a result. The Drug Enforcement Administration investigated this doctor and discovered he prescribed buprenorphine, another type of opiate, "for non-legitimate medical reasons" and received bonuses from the drug company.
• Fortune magazine revealed in a June 2018 feature that the HHS and the Department of Justice issued charges in a massive class action lawsuit against 601 defendants—including physicians, nurses, clinics, and pharmacies—because of a reported $2 billion in healthcare fraud involving opioids.
• Owners of Purdue Pharma—the manufacturer of OxyContin—and many of the company's board members and executives are embroiled in a multi-district case worth billions of dollars with other painkiller drug manufacturers and distributors. The primary reason for the lawsuit: "an illegal business model leading to addiction and deception to enrich a few while leaving a path of devastation and destruction in its wake."

What's Being Done Now

The Washington Post reported in August 2017 that as of that time, 17 states had enacted rules to limit the number of painkillers doctors can prescribe. Some restrictions were by number of days allowed for a prescription; others by type of drug and dosage.

Arizona is one of those states. Effective April 2018, state lawmakers:

• Limited initial opioid prescriptions to a five-day supply, unless post-surgical—then a 14-day supply is allowed in most circumstances
• Restricted dosage of initial opioid prescriptions to under 90 MME per day, or morphine milligram equivalents
• Required that schedule II opioids—which are many of the narcotic analgesics mentions above—can no longer be prescribed without a doctor's visit, with extremely few exceptions
• Mandated that pharmacies dispense schedule II drugs with red caps and labels warning of "potential addiction"

Additionally, in 2019, a gradual rollout throughout the state enforces mandatory electronic prescription tracking for schedule II opioids.

For full details about changes to protect Arizona residents, review the Turning the Tide Controlled Prescription Monitoring Program. You can also follow real time statistics on the painkiller epidemic on a special site updated by the Arizona Department of Health Services.

Comprehensive Care at Cottonwood Tucson

If you or someone you love is struggling with painkiller addiction, please reach out to our staff right away. We can be reached at 888-727-0441 or you can fill out our contact form.

By Tracey L. Kelley

Laughter as Medicine: Learning to Meditate and Laugh Together

It sounds peculiar to laugh and meditate at the same time, especially when the general perception of meditation is to sit quietly and be still. But a few daily lighthearted chuckles and chuffs often stimulate changes in helpful "feel good" brain chemicals such as endorphins, serotonin, and dopamine. Laughing, like meditation, can reduce symptoms of anxiety, depression, and stress.

Laughter Meditation: Part of Laughter Yoga

Sometimes jokingly referred to as "The Art of Hahaha," laughter meditation exercises come from the practice of laughter yoga. There are many sources of this style, but one of the most frequently cited is Dr. Madan Kataria, or the "The Laughter Guru" and founder of Laughter Yoga International in 1995. He uses a combination of exercises and yogic breathing techniques to help people grin, snicker, and chortle their way to better health.

As a medical doctor, Kataria relies on clinical studies to prove his point that laughter—often without the use of comedy, jokes, or other humorous prompts—provides a number of benefits, including:

• Stimulates oxygen throughout the brain and body
• Releases endorphins, dopamine, and serotonin
• Reduces cortisol, which helps alleviate stress
• Lowers blood pressure
• Strengthens the immune system
• Eases digestion
• Promotes relaxation

What's more, Kataria notes your body apparently can't tell the difference between real laughter and fake laughter, but will still experience the residual effects. So initially, you may have to work yourself into a giggle fit, but eventually, your natural response takes over.

The scientific community continues to be intrigued by the effects of laughter on wellness. The term gelotology relates to the study of laughter and its effect on the body. For example:

• The Cancer Treatment Centers of America uses laughter therapy as a physical exercise with patients as part of its Mind-Body Medicine program. Often conducted in a group setting, what starts as a deliberate "hee hee" or "ha ha" builds into big hoots around the room as people laugh—well, at everybody else!
• Many researchers have articles detailing laughter as a wellness aid and how regular laughter improves the health of senior citizens.
• The Mayo Clinic reports "data is mounting about the positive things laughter can do," including relieving pain, connecting with others, and decreasing negative thoughts.
• For nearly 30 years, Dr. Lee Berk studied the effects of laughter on the brain and body. Of note, he examined how laughing generates gamma frequencies in the same way meditation does, which helps synchronize neuronal activity. This may be particularly helpful for people in recovery.
• Laughter Online University offers a free PDF as to the benefits of this type of therapy and why it works.

Primarily, researchers agree that when we laugh, even if we have to jumpstart a chuckle to get a full belly laugh going, we end up in a happy place. Here's an interesting TEDx Talk from laughing yoga instructor Ida Abdalkhani, indicating that within about two minutes, fake laughter becomes real.

Laughter Meditation Exercises

To start practicing more mindful laughing, sometimes it's as easy as a smile. Not as a forced response to someone telling you to smile, but simply as a response to something that makes you feel joyful. Then, you can continue to smile more as you encounter people and feel more natural about it. No one is saying you must smile, but you're creating a conscious path to do so more frequently.

Now, start working with laughter meditation exercises. Here are a few to try:

• Dr. Kataria offers a gentle giggling exercise.
• Stephanie Nash leads a session in the Chopra Well.
• Here's a 10-minute "laugh along" video led by Robert Rivest.
• This is a longer laughter wellness session, about 15 minutes or so, from Sebastian Gentry, that includes movement.
• Laughter yoga teacher Bianca Spears invites you to laugh with her in a variety of ways.

Feel silly yet? Good! That's the point. Laughter meditation isn't designed to make light of what you may experience in life, but to help you find ways to add more joy to your day. There's the balance. Encouraging your body and mind to have more positive responses helps you continue to move forward with your health.

If you'd rather not watch a video, consider this solo practice from The Chopra Center. After the 10-minute session, capture your experience in a meditation journal for future reference.

Holistic Wellness at Cottonwood

When residents receive addiction and mental health treatment at Cottonwood Tucson, there's a combined approach to the philosophy of care. Mental, emotional, physical, and spiritual aspects are all addressed in order to create whole being wellness. From advanced nutrition to equine therapy, EMDR, and yoga, there are many complementary techniques to enhance healing. Learn more about this holistic treatment approach.




By Tracey L. Kelley

Addiction Detox: Nothing to Fear

When you realize it's time to get treatment for a drug or alcohol problem, there are many unknowns. One common fear people have is what happens during detoxification.

There's no question that substance abuse changes not only brain chemistry, but also a person's physiology. Stopping suddenly or without proper supervision are probably the worst actions someone can take when they're ready to be healthy. The mind and body are too reliant on the artificial effects produced by the substances.

Think of how a car reacts when brakes are applied with a quick and forceful motion. Sure, it may slow down or even stop, but not without severe jolting and systems locking up. Your biological system needs a gradual, controlled release from toxicity in order to recover. It may take only a few hours after not using drugs or alcohol for someone to experience severe or even life-threatening withdrawal symptoms. There's no reason to suffer through this.

Because addiction is a brain disease and affects each individual in different ways, not everyone requires the same type of detoxification. A medically-managed detox administered by credentialed addiction specialists makes the process safe, comfortable, and effective.

So, there's nothing to fear: detox may just be the first step in your eventual healing.

Understand What's Happened to You

Medical experts agree that once people require alcohol or drugs to function day-to-day, they have physical and mental dependencies. This means you currently may suffer or eventually will have complications with the following:

• Imbalances in or damage to the autonomic nervous system, which regulates numerous processes in the body, including breathing and heart rate; control over digestion, waste elimination, circulation, and pain response; and production of important fluids
• Compromises to brain chemical and neurotransmitter function, which in turn prohibits proper cognitive ability and behavioral responses; and feeds the compulsion to use illicit substances
• An increased risk of pancreatitis, liver failure, respiratory arrest, stroke, or heart attack
• A greater chance of organ damage, hemorrhagic stroke, coronary heart disease, obesity, and cancer, especially for women

If medical professionals at your treatment facility determine substance use has caused you mental or physiological impairment, the first step of wellness is to evaluate the need for detox and if so, to what degree. Physical stabilization helps prepare the body and mind for gradual, effective recovery.

When Detox Is Necessary

A team of experts examines each person for certain characteristics that determine if medically-supervised detoxification is necessary. While it may not be, you'll probably need it if there's evidence of:

• Abuse of multiple substances, such as opioids and alcohol
• Co-occurring conditions, such as binge eating disorder, depression, anxiety, or PTSD
• Chronic or acute health conditions that either aren't managed well or may be life-threatening
• Extensive or long-term substance abuse
• Relapse from previous rehabilitation

What to Expect During Detox

Understandably, the difficulties of physical withdrawal are top-of-mind with many people considering treatment. Pop culture is riddled with terrifying stories about what a person may go through purging chemicals from his or her system. But what happens during a medically-guided detox, while initially uncomfortable, doesn't have to be frightening when you know what to expect.

The discomfort you may feel while going through physical detoxification depends on three factors:

• Types of substances used
• Length of addiction
• Intensity of addiction

You may or may not experience the following during detox:

• Body aches, headaches, and fever
• Wakefulness and/or fatigue
• Persistent nausea and vomiting
• Welts, acne, or rashes
• Muscle spasms or shakiness
• Increased appetite
• Moodiness and irritability
• Anxiety or depression
• Delirium tremens, often referred to as DTs, that make someone experience misinterpretation and confusion
• Hallucinations or paranoia

The timeframe for detoxification varies by individual. Some people discover they feel better after two or three days. Other people may need up to three weeks for their bodies to eliminate toxins and return to a general state of ease.

A medically-managed detoxification process means you'll have doctors and nurses supervising your experience, and perhaps advising a medication protocol to help alleviate symptoms. These professionals may also help with other health complications. Proper nutrition and hydration are critical components to the process as well.

Once your body feels better, and you're not experiencing intense cravings, you'll begin the next phase of healing: emotional and mental stabilization. For true recovery, it's critical to determine the root causes contributing to addiction and find healthy ways to maintain your sobriety.

Your treatment should also include what's known as a continuum of care plan. This is the recommended course of action for emotional and psychological rehabilitation after toxins are removed from your body. Your care plan may include group and individual therapy, EMDR, 12-Step meetings, and other applications that support your sobriety.

Excessive Use Requires More Recovery Time

Here's a vital fact to understand: the greater the intensity of substance abuse, the longer it takes to detoxify. Initial inpatient treatment may effectively start the process. But if your substance abuse included extreme alcoholism or the use of narcotics, it could take up to two years before you stop experiencing withdrawal symptoms.

This is nothing to be ashamed of—you simply have to prepare for a different health journey, and continue to uncover new layers of resiliency. Use the tools of your care plan, along with exercise, a clean diet, and a strong support system, to help your progress. Remember: this is your plan for life. Each step forward you take matters.

Cottonwood's Health Services

No one should ever attempt to detoxify from mood-altering substances without the assistance of qualified professionals. At Cottonwood Tucson, we have an expert staff to help you stay comfortable and understand what's happening at every point in the process. Our compassionate care approach supports you and your journey to wellness.

Learn more about how we can help you begin a satisfying life of sobriety.

By Tracey L. Kelley