Understanding Addiction

Rather than one of our typical mind-bending dialogues, here’s some very practical information. If you are actively or recently addicted, live in the U.S., and are low on funds, this may be of use. I see it as getting the most out of the “disease model”. Thanks to Ram Meyyappan for offering to post this to our community.

Drug Addiction and Social Security Disability Benefits

Drug addiction can wreak havoc on an individual’s life and can often prevent an individual from working. What many people do not understand is that drug addiction is actually considered to be a disability by the Social Security Administration (SSA). If you are struggling with drug addiction or drug addiction recovery, you may be able to qualify for Social Security Disability benefits.

Qualifying for Social Security Disability Benefits with a Drug Addiction

It is important to note that even though the side effects of drug abuse can prevent an individual from performing gainful work activity, addiction alone is not enough to qualify a person for Social Security Disability benefits. If, however, the addiction results in other medical conditions, you can qualify for disability benefits due to the resulting conditions. According to the Social Security Blue Book (SSA’s manual on conditions that qualify for benefits), you can qualify for Social Security Disability benefits due to drug addiction if the drug addiction results in one or more of the following:

• Organic mental disorders, which will be evaluated under Section 12.02 of the Blue Book.
• Depressive syndrome, which will be evaluated under Section 12.04 of the Blue Book.
• Anxiety disorders, which will be evaluated under Section 12.06 of the Blue Book.
• Personality disorders, which will be evaluated under Section 12.08 of the Blue Book.
• Peripheral neuropathies, which will be evaluated under Section 11.14 of the Blue Book.
• Liver damage, which will be evaluated under Section 5.05 of the Blue Book.
• Gastritis, which will be evaluated under Section 5.00 of the Blue Book.
• Pancreatitis, which will be evaluated under Section 5.08 of the Blue Book.
• Seizures, which will be evaluated under Sections 11.02 or 11.03 of the Blue Book.

For more information on qualifying for benefits with a drug addiction, visit: http://www.disability-benefits-help.org/disabling-conditions/drug-addiction-and-social-security-disability

Applying for Social Security Disability Benefits with a Drug Addiction

You can apply for Social Security Disability benefits online (http://www.ssa.gov/pgm/disability.htm) or in person at your local Social Security office. When applying for benefits due to drug addiction, you will want to explain to the Social Security Administration how your drug addiction has resulted in one of the qualifying conditions in the Social Security Blue Book. For example, if your drug addiction has resulted in an irreversible personality disorder, you will want to provide the SSA with evidence documenting that you have been diagnosed with the associated personality disorder and proof of treatment. This means providing copies of your clinical records and treatment history.

The Technical Criteria for Social Security Disability Benefits

In addition to proving that you are disabled according to the SSA’s criteria when you apply for disability benefits, you will also need to prove that you meet the technical criteria. If you are applying for SSDI benefits, this means proving that you have earned enough work credits to qualify for the program. The SSA will determine if you have enough work credits to qualify when they pull your work history. For each year that you have worked, you will earn a maximum of four work credits. Depending on your age, a certain number of work credits will be needed to qualify for the SSDI program.

If you do not have enough work credits to qualify for SSDI benefits, you may still be able to qualify for SSI benefits. SSI is a needs-based program. In addition to meeting the SSA’s disability criteria, you must also meet the program’s financial criteria. As of 2013, in order to qualify for SSI benefits you cannot earn more than $760 per month as an individual or $1,060 per month as a couple. Your household assets must also not exceed $2,000 as an individual or $3,000 as a couple.

For more information on SSDI and SSI, visit: http://www.ssa.gov/disability/

Appealing a Denial of Benefits

You will receive notice regarding the SSA’s decision of your disability claim within three to six months of the date of your application. If the SSA decides to deny your application, you have 60 days from the date of the denial notice to file an appeal. The first stage of appeals is a Request for Reconsideration. It takes approximately two to six months to complete this appeal. Unfortunately, most appeals are denied at this level. You have the best chance of overturning the SSA’s denial of your benefits during the second stage of the appeal process, the disability hearing. During the disability hearing you will have the chance to present evidence to an Administrative Law Judge (ALJ) and explain why you need disability benefits. It is in your best interest to hire a disability attorney or advocate prior to attending the disability hearing.

Article by Ram Meyyappan
Social Security Disability Help

…by Hildur Jónsdóttir…

I have a problem with the term recovery. For many of us recovery implies that there once was a wholeness that was shattered through addiction, a wholeness that we need to recover, find again. I have toyed with the word restoration, but likewise, often there is little to restore. For many of us, our lives before addiction were never anything but shattered and disconnected. Yet this disconnection, these lives shattered, are the points of departure on our journey through life forward. Therefore we need to learn how to navigate from there, not back to a distant past, but to a future yet unknown to us.

Still, we have to come to terms with our past. We long for an understanding and for a meaning of our lives.

This writing is inspired by a fellow reader here who some months ago claimed in anguish: Do I have to continue to live with this shit? This shit in the basement that keeps thrusting its ugly head up into my consciousness here and now. My answer is yes. We have to live with the ogres from our past, named shame and guilt and regret and sorrow. But let me also share my contemplations on the concept of time.

I will start with an old parable from the Inuits in Greenland.

During the long, dark winter, when there is frost and snowfall, Inuits throw their waste in a heap outdoors, for it to be covered with snow in the next winter storm. A new layer of waste is added to the heap to be covered again, and then another and another. Each layer freezes into the same thick chunk of ice. When spring arrives, it is of no use to try to clear it up all at once. The only thing to do is to let each layer appear one after another as the higher chunk  thaws. So one layer thaws and is cleared away, then another, then another. No one can force their way prematurely to the bottom of the heap, but they can rest assured that every layer will finally be revealed and dealt with.

This parable corresponds beautifully with the Inuit concept of time. I have come to understand this. From the birth of man and consciousness, in earlier agricultural societies, time was circular. The rhythm of life was cyclical, from the beginning of life in spring through growth, harvest and finally death. Death was followed by rebirth, for nature and for man. The cycle would start all over again. The industrial revolution changed our concept of time, nature did not dictate it any more, but production lines did. Time became linear, just like production and progress. Peak performance was always in demand. Be productive! Act now! Consume now! Be happy now! And be greedy!

This is not to be mixed up with the concept of here-and-now as in mindfulness and meditation. These do not demand peak performance, instant happiness or suppression of emotions. Just attention – and time to be present.

The old Inuit concept of time sees no time spent, no time wasted, no time gone. Time arrives. Time only arrives. Each and every moment we receive the gift of time to be added to all the gifts of time already received. Yes, nature is cyclical, yet still unpredictable; the variations in weather, the movements of the sea animals and of the ice are never exactly the same. Nature asks of you only attention and time.

We amass abundance of time, a growing wealth of time. But time also uncovers what came before, allowing us to deal with it. Time will arrive and thaw the stiff and icy chunk of your past. And with your attention and readiness you will deal with everything that the thawing reveals, loosens and presents to you. Not all at once. Layer by layer.

The impact of this on my thinking and my relationship with my past is profound. Nothing in my life, in my traumas and experiences, in my relations to people, is ever going away. Nothing is lost and nothing is forgotten. I have nothing to “get over.” Everything is there, intact, ready to be added to, interpreted and reinterpreted, constructed, deconstructed and reconstructed. I can roam freely in my limitless treasure chest of time that reaches beyond my own physical limitations – and keep the lid open for it to receive the new gifts of time that keep coming to me.

My past, my amassed time, is therefore both intact but also constantly recreated. Because now I have the power of attention. I have the power to examine what all this once meant to me, but I also have the power to change what all this means to me now. I have gained an insight that I would almost call spiritual, where even my ancestors and the story of my extended and immediate family belong. And where all of you (in this community) belong. Instead of disconnection there is now connection, over space and over time. There is, in each moment, attention, time and power to grow.

Will a developmental-learning model of addiction (e.g., Maia Szalavitz, Gabor Maté , Stanton Peele, and me) ever make peace with the disease model? That would be a happy ending! Nora Volkow and I could eat muffins together…or maybe have a glass of wine. We could establish a space for sharing data and ideas, working together toward an explanation that incorporates the best of both worlds.

Yet I don’t think it’s in the cards. Not because the disease model is so far off base scientifically. In fact, where the brain in concerned, the distinction between learning and pathology isn’t always obvious, as epitomized by ADHD, autism, bipolar disorder, even schizophrenia. There’s got to be some allowance for overlap — doesn’t there?

It’s not that the disease model is so wrong, it’s that the baggage it carries may never fit in the same home as the learning model. Here’s what I mean:

Society’s understanding of addiction can be seen as advancing through three stages.

First, beginning in the Victorian era, addicts were considered morally flawed and indulgent. We could call that the “sin” model. Consequently, the appropriate response to addiction was to punish the addict through scorn, isolation, and maybe even jail time. Through shame and retribution, the addict might, with luck, go back to being good.

The second stage was the era of the disease model, beginning in the middle of the 20th century. The change was driven by the emphasis on helplessness in Alcoholics Anonymous, beginning in the 30s, and the evolution of residential treatment centers that stressed obedience to therapeutic regimes, beginning in the 50s. Finally, the proliferation of neuroscience in the 80s and 90s put a seal on the package by pointing to a diseased organ, namely the brain. Now specific neural changes could be pinpointed as the source of addiction, and the disease model ruled the roost.

According to the disease model, the appropriate solution to addiction was medicine. Specifically, addicts were to be urged to follow the advice handed down by medical practitioners. Rather than confess to being immoral, addicts were advised to confess to being incapable. The only hope to control addiction was to accept a regime imposed by an authority. In other words, to subdue a problem located on the inside, you needed to take orders from the outside. It is this baggage that seems destined to clash with the mindset of a third, more progressive view of addiction.

The third stage in our understanding of addiction is the learning model: a developmental sequence of events that gives rise to habitual patterns of thinking and feeling. This view of addiction admits the potency of social factors, like isolation and dislocation, as catalogued by Bruce Alexander. It makes sense of the impact of adversity in early development, as emphasized by Gabor Maté and Maia Szalavitz. And it allows for the influence of societal and cultural issues, as portrayed by Carl Hart and Johann Hari.

According to a developmental-learning definition, the appropriate response to addiction is neither shame and isolation nor submission to a therapeutic regime. Rather, it is further growth. The solution to addiction can’t be a medical regime that returns the addict to some previous level of normality. Nor can it be disempowerment, intended to counter built-in character flaws. Rather, people emerge from addiction through ongoing development. In this light, addiction can be viewed as a stage of individual development, and it must therefore be addressed through individual efforts based on individual perspectives, goals, and capacities. A developmental-learning model of addiction suggests that positive change must be pursued from within.

The final two stages in our understanding of addiction, the disease model and the learning model, have both achieved some of their plausibility on the basis of brain research. But the role of neuroscience in these two stages of conceptualization could not be more different. Neuroscience helped shore up the disease model by identifying deviations from what is considered standard neural architecture, a project we could call “neuronormativity.” Remember: the target was a cure. In contrast, the developmental-learning model of addiction embodies an emerging understanding of neuroplasticity. This replaces the search for normality with an emphasis on the brain’s capacity to change.

Thus, both models borrow something from the brain—a detailed breakdown of measurable biological events. But they are fundamentally different in orientation, and they perceive the brain in such very different ways that it’s hard to imagine how they might be reconciled. It’s the same problem that’s appeared in the tension between developmental psychology and mainstream psychiatry over many decades. The brain is either a normative thing that can go wrong and then be repaired, or it is an open system that can develop along diverse trajectories, integrating the meaning of experience according to its own expertise.

Addiction is one of those trajectories, but then so is progress beyond addiction.

NOTE TO READERS: I do try to respond to most of the comments in the comment section following each post, unless there is already a dialogue going and/or I have little or nothing to add.  But I can’t always keep up with the volume of comments (volume = GOOD!) I’ll have an easier time responding, and so will others, if you keep your comments relatively succinct. Try for two or three paragraphs, max. Longer “essays” can be very thoughtful and informative, but they take time to consider and respond to intelligently. That’s the trade-off.

…by Lisa Martinovic…

There’ve been times during the life of this blog that the Great 12-Step Snowball Fight has erupted — as is typical for any blog, podcast, or article on addiction. I’m not a fan of AA, but I’m not a 12-step basher either. I like to keep an open mind, and I thought this essay was so good that it’s worth giving the Steppers another think.

……………..

In the thirty-four years since I cleaned up, paths to sobriety have proliferated in tandem with rates of addiction. At last count there were some 14,000 treatment facilities in the US alone. If you have good insurance it might cover a stint in one of them. Private therapy is always an option for those who can afford it. For everyone else, it mostly comes down to white knuckling it or AA. But in recent years 12-step programs have been attacked on many fronts, charged with being too religious, dogmatic, disempowering, cultish. Which is unfortunate because although 12-step is not the only way to get sober, it is one way, and it’s been effective for millions of people over the past 80 years.

I certainly had a lot of judgments when I first started going to AA, but in my state of utter ruin I was in no position to be picky. I dove in despite my aversion to all things Christian. The internal conflict I experienced as an atheist and a feminist being told to ‘turn my will and my life over to the care of God’ was agonizing. I thrashed against concepts like “powerlessness” and “character defects,” made grand pronouncements in meetings, and challenged my long-suffering sponsors. Over time, I made peace with the program and have been clean and sober since 1982. Though I haven’t been to meetings in some fifteen years, I will always sing their praises.

In recent years I’ve been studying neuroplasticity on an informal basis and applying its principles to my daily life, especially vis-à-vis my addictive propensities: Chocolate truffles! Mad Men! Facebook!

Not long ago, musing about how 12-step really works, I realized that one of the oft-repeated AA sayings was in fact a description of neuroplastic change: “We don’t think our way into a new way of acting, we act our way into a new way of thinking.” If you take action to foster your sobriety deliberately, repeatedly, and within a supportive community, change happens precisely because you are altering the very structure of your brain. And it happens, I argue, whether or not you believe in God.

This may come as a surprise to those who think that the program is all about ‘turning it over.’ Countless people do precisely that, but sobriety doesn’t happen in the absence of a tremendous amount of real-world footwork. And footwork, be it psychotherapy or working the steps, is what changes your brain and paves the way from addiction to freedom.

As with any new practice, consistent participation in 12-step programs gradually and methodically builds new neural networks. Every sober foray into a situation you used to get high for — first date, party, being alone and lonely — strengthens your capacity to do so again. Thanks to your malleable brain, the more you do something sober the easier it becomes. But you may need to muddle through a thousand situations sober before it comes as naturally as it did when you were drunk. It’s hard for most of us to stick to our resolve that many times. But with the support of others it is possible.

AA contends that because our willpower has “failed utterly” to get us sober, we have no recourse but God. Really? Well, what does every participant at every meeting find every time? What is the common denominator? Not God, but other people getting sober. We find community. The generous support of other human beings carries us when we cannot carry ourselves.

I was thrilled to discover, through Marc’s books and others, that my theory about how we get sober is corroborated by science. By integrating the research into my own experience, I have developed a pragmatic approach to recovering from addiction—an unauthorized 12-step workaround.

I want to share this approach with addicts who know they need help but are unwilling to explore the 12-step route. I wrote an essay in STIR Journal for them, their loved ones, and those who would help them, and Marc has generously invited me to share it here.

By unpacking the neural mechanisms through which we achieve behavioral change I give addicts who hate “the God thing” a different way to access the 12-steps—and recovery.

Read the full essay here.

Marc: Also see this article for a recent court case pitting the 12-step oligarchy against one person’s atheism.

Over the last year, I’ve explored the terrain between meaning and dogma, choice and compulsion, I’ve taken you with me to Dharamsala, found surprising convergences between Buddhist philosophy and dopamine metabolism, pondered the application of mindfulness to treatment. But the theme I seem to land on most is the search for an alternative to the disease model of addiction — a way to understand addiction that does not pit disease against choice, or self-medication against self-indulgence.  So for this final post of the year, I want to bring this discussion to some sort of close. Not a final answer: no way. But a plateau where it’s possible to set up  camp and rest a bit before delving further into the wilderness of this almost intractable problem we’ve all lived with one way or another.

Because I’m feeling stuffed, indulgent and lazy, as I hope you are too this Christmas day, I’ll just copy and paste a few paragraphs from the first chapter of the book I’m working on. It’s just a draft at this point, more revision to be done, but I think this captures the kernel of what I want my book to say:

“Among the opponents of the disease model, almost no one has fought fire with fire and tackled the neuroscience behind it. Most of those arguing against the disease model, like the general public, are spellbound, if not paralyzed, by the notion of “brain change.” … It’s almost as if students of addiction make a choice: either admit the brain is a really important organ, in which case addiction is a brain disease, or put the brain back in the closet, in which case you can go on talking about choice, environmental factors, social anthropology, and all the rest of it.

This strikes me as exceptionally odd. Surely the brain that underlies addiction is the same brain that we use to perceive and respond to our environments, make choices, and reflect on the benefits of being high — in context. So it seems extremely likely that the brain is fundamental to addiction, whether we construe addiction as a disease, a choice, or a self-medication strategy.

The fact is: brains change. They’re supposed to. These days it’s called neuroplasticity. Brain change is the fundamental mechanism by which infants grow into toddlers who grow into children who grow into adults. Brain change underlies the transformations in thinking and feeling that characterize early adolescence. (By some estimates, the prefrontal cortex loses 30,000 synapses per second during this period.) Brain change is necessary for perspective-taking and language acquisition in early childhood, and for falling in love, with a partner or with one’s children, later in life. And for learning to play a musical instrument or appreciate opera. Brains have to change for learning to take place. Without physical changes in brain matter, learning is impossible. Synapses appear and self-perpetuate or weaken and dissipate. These processes alter the communication patterns between brain regions and build unique configurations of synapses (synaptic networks) that represent knowledge, familiarity, and memory itself. The relation between learning and brain change has been studied for more than 100 years, it was reasonably well understood by the 1940s, and the search for specific cellular mechanisms of learning continues to point to new levels and mechanisms of change. Whether repairing the damage caused by a minor stroke or altering emotional processes in the wake of trauma, neuroplasticity is at the top of the brain’s resumé.

Proponents of the disease model argue that addiction changes the brain. And they’re right: it does. But the brain is designed to change. It’s primary functions — to think, feel, remember, and act — are served by structural transformations at every level, from gene expression to the size and shape of the cortex itself. The premise that brain change equals brain disease is so ill-founded, it’s hard to know exactly where to start chopping.

A new model of addiction and a plan for the book

This book makes the case that addiction results from accelerated learning — the acquisition of thought patterns that rapidly self-perpetuate because of the brain’s tendency to become sensitized to highly attractive rewards. I see this as a developmental process, accelerated by a neurochemical feedback loop that’s particular to strong attractions. Like other developmental outcomes, addiction isn’t easy to reverse, because it’s based on synaptic restructuring. Like other developmental outcomes, it arises from neural plasticity and uses it up at the same time. Addiction is definitely bad news for the addict and all those within range. But the severe consequences of addiction don’t make it a disease, any more than the consequences of violence make violence a disease, or the consequences of racism make racism a disease, or the folly of loving thy neighbour’s wife make infidelity a disease. What they make it is a very bad habit…

This book shows why the disease model is wrong — and how that wrongness is maintained by a biased view of the neural data. Then it shows how we can replace the disease model, not by shunning the biology of addiction but by examining it more closely. Rather than throw the brain out with the bathwater, as some anti-disease crusaders have attempted, I examine brain changes under a microscope that integrates depth and detail. And I show them to be developmental changes in an organ designed to restructure itself. I show how common neurodevelopmental processes yield uncommon results when we become attached to a narrow set of goals that squeeze out the competition….

I show how addiction arises through neural changes that constitute development, not disease — changes that nevertheless conspire to make it increasingly hard to quit. And I show how recovery is achieved when addicts continue to develop, by strengthening new connections among desire, self-regard, and self-control.”

So, stay tuned. The book, to be released in 2014, will spell out this meta-perspective through the telling of biographical accounts, slices of the incredible life stories some of you have shared with me — or who still might talk with me when I finally catch up enough to email, skype, and/or call you. And I’ll connect these stories to the science of brain change in a way that I hope will be accessible, persuasive, and un-put-downable as they say on back covers.

But as far as this blog goes, I think I’ll give this debate a rest — and move on to other things. We all need a break.

With that in mind, Happy Holidays, Happy New Year, get some rest, some peace, some refreshment, and some fun. Thanks for going the distance with me this year…and I promise to be staring at you from your inbox, once again, in 2014.