Archive for May, 2007
Recently I have been in contact with Heather Wilson of Peer Assitance Fame, a National Speaker of Note and good friend.Â I asked her to send something for the web site and she chose to discuss a little Q and A.Â Here it is and if any one needs help do not hesitate to call her or anyone involved in Peer Assistance.
Q: I am a CRNA in the CA BRN Diversion Program. My contract requires me to attend a variety of 12 step program meetings. I don’t feel like they are helping me because I don’t believe in God. In fact, this is exactly why I do not want to attend anymore.
A: You raise an interesting point, and you are certainly not alone. There are some key points to consider here. First, Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) do not mandate anybody to believe in God. Twelve step programs also have 12 Traditions, necessary for the cohesiveness and effectiveness of the group. The Third Tradition states, “The only requirement for membership is a desire to stop drinking/ using,” therefore the atheist or agnostic cannot be denied. Next, the Second Step states, “Came to believe that a power greater than ourselves could restore us to sanity.” We believe in a “Higher Power,” and yes, the vast majority of members choose to believe that God is their Higher Power. Many have even taken the word “God” and made their own acronym, such as “Good Orderly Direction.” It is also common to see members using the AA or NA group as their Higher Power; or nature. In the Third and Eleventh Steps where “God” is mentioned, it is immediately followed by, “as we understood Him,” because this is highly subject to personal belief and interpretation. Lastly, the only suggestion I would like to offer is to try to have an open mind. If you focus on what makes you different from everyone else in the group, then you will feel isolated and alone. If you focus on the similarities and concentrate on identifying instead of comparing- then you will start to feel “a part of” rather than “apart from.”
Q: I am a newly recovering opiate addict/ CRNA. The counselor at my treatment center tells me that I cannot drink alcohol. I don’t even like alcohol!Â I would much rather do “other” things. I’ve never had a drinking problem, so I don’t understand why I cannot have a glass of wine with my dinner every now and then.
A: I can sum up the answer in one sentence: â€œIf you canâ€™t have the drug you love, you love the drug youâ€™re with.â€ What does that mean?
The basic pathophysiology in the brain can be explained very easily. Anything that is addicting, whether it is opiates, ethyl alcohol, benzodiazepines, cocaine, et cetera- all follow the same final common pathway. At the base of the brain is a structure called the ventral tegmental area (VTA) which projects dopamine to the nucleus accumbens in the frontal cortex. Therefore, whether you are tickling mu receptors, enhancing GABA, or blocking the reuptake of norepinepherine- it will invariably result in a rush of dopamine in the frontal cortex. This rush of dopamine is what we seek; it is the â€œhighâ€ that addicts crave.
Interestingly enough, whenever there is activity associated with procreation or survival (such as sex and food), the pathway of dopaminergic projection is identical. This is a deeply embedded, primitive pathway. It explains why addicts and alcoholics will do whatever it takes to get their fix- because it is as important as procreation and survival. It becomes a primal drive.
Back to the original question of why an opiate addict cannot drink alcohol: the brain does not know the difference. Even if alcohol is not your drug of choice, you are still â€œpushing the dopamine button.â€ There are countless anecdotals of people who, for example, are primary alcoholics who relapse on hydrocodone. Or primary opiate addicts who become full-blown alcoholics. (As a side note, taking pain medication on a short term basis for injury or surgery is an entirely different Q&A.)
If anyone is interested, I would be happy to share some scientific articles via e-mail. Abstaining from all mood and mind-altering substances is an evidence-based suggestion for all addicts and alcoholics. The disease is cunning, baffling and powerful. It is also very patient. It will wait a lifetime for you to pick up again.
Heather Wilson, CRNA, MS
AANA Peer Assistance Advisors Committee
Co-chair CANA Peer Assistance