Behaviors, Habits, Addictions, and Eating Disorders
Ahabit is a way of behaving that is repeated so often it no longer involves conscious thought. Examples of habits are brushing one's teeth every morning before school and evening before bed, or walking the dog every morning before school or work. These habits typically are considered “good” habits to have because they are of benefit to the person performing them. Other habits, such as stealing an item from a department store at each visit to the store or drinking alcohol to excess frequently at a friend's house, would typically be considered “bad” habits because they may bring harm to the person performing them.
Another definition of habit is an addiction. Both good and bad habits can be addictive in nature. When someone eats a healthful cereal with fruit for breakfast every morning, that person has established a good habit because it is important to eat a nutritious breakfast every day. If, though, the person became so dependent on eating a particular brand of cereal every morning that his mood changed for the worse if he was unable to eat the cereal one morning, his habit would be more serious. One could argue that he was addicted to the cereal. Of course one can't become physically addicted to a brand of cereal the way one can become physically addicted, for example, to the nicotine in cigarettes, but this does serve as an example of how a habit can sometimes turn into an addictive behavior.
This chapter focuses on several types of negative habits and behaviors and ways to treat them. From substance abuse and eating disorders to Internet addiction and gambling, these habits can pose potentially life-threatening risks.
Addiction is a physical or mental need for a substance or activity. It is most commonly defined as dependence on harmful, habit-forming drugs. When most people think of the word addiction, they conjure
images of a world they expect never to know. They imagine emaciated heroin addicts in dark alleys or remember rock stars that died as a result of overdoses. Addiction doesn't always look as menacing as public-service announcements or after-school television programs depict it. In fact, many people come into contact with some kind of addiction every day or are addicted to some substance they might consider benign (harmless). While addiction is common, becoming addicted to a substance or an activity can have serious consequences. And it's not something that just happens to “other” people.
Many adults, and an increasing number of teenagers, drink coffee first thing every morning. In fact, many people feel that without their first cup, normal daily functioning would be impossible. This reflects the problem inherent to addiction—the need itself. The subject of the addiction may seem harmless or even healthy (such as exercise addiction), but too much of anything can be dangerous. Having a cup of coffee to start the day is not a problem; however, it is possible to become addicted to caffeine (the addictive substance in coffee). Although there is not much attention paid to caffeine as a drug of addiction because it doesn't have many of the health and social consequences associated with addiction to alcohol, prescription, and illegal drugs, it “hooks” people much the same way.
In the case of alcoholics (those addicted to alcohol), many feel that they must have a drink before they can socialize. Addictions of all types, whether they are to hard drugs, such as heroin, or everyday substances, such as caffeine or sugar, can disrupt people's lives and ruin their mental and physical well-being. Addiction to drugs and alcohol, because they are mind-altering substances, poses more of a direct threat to users than do substances that don't immediately change people's perceptions.
Addiction is dependence. Infants, for example, are dependent on their parents for sustenance and other basic needs, such as shelter. Addicted people are dependent on a substance to function normally and feel good. Addicts are scared of the consequences of separation from their substance of choice. Addicted people exist at many levels of functioning and degrees of healing. There are addicts in all walks of life, from physicians and attorneys to schoolteachers and actors. Some of these addicted people are able to perform their jobs without anyone else becoming aware of their problems. They are able to fool others into thinking they can function normally. But others are seriously harmed:
their addictions prevent them from holding onto jobs or even engaging in activities with family and friends.
To truly heal and recover from addiction, addicts need to admit to themselves that they need help. Recovery from addiction is a process that involves taking a good, hard look at one's self. Self-examination can be quite intimidating, and many people would rather avoid it and hide in drinking, drugging, or codependency (extreme emotional or psychological reliance on someone with an illness or addiction). Self-discovery not only means uncovering the positive attributes a person may be unaware of; but also means coming to terms with shortcomings, flaws, and inadequacies and learning to accept those qualities.
Learning about the different forms of addiction and tools for recovery and healing can help those suffering from it. These coping strategies can help friends and families of people with addictions, too.
Most people who use drugs are seeking an altered state of consciousness. The need to alter consciousness is not a new phenomenon. Historical evidence shows that people of all cultures and eras have experimented with mind-altering substances, both natural and synthetic (human-made or artificial). People who use drugs seek to make the world around them look and feel different. This might mean trying to make a bleak life seem better or simply more interesting.
Drugs often make people feel confident and powerful. That's why taking drugs is called “getting high.” Drugs give users a false sense of power that, of course, recedes when the artificial high ends. Addiction occurs when a person compulsively attempts to continue that high by taking a drug over and over again.
People use drugs for many, many reasons. For example, adolescents have reported that they experimented with marijuana to enhance sexuality; to feel more confident; for pleasure and relaxation; to make themselves more comfortable in social situations; to understand themselves better; for acceptance by their peers or to achieve elevated social status; to defy authority; and to expand their minds.
There are many theories about why some people choose to use drugs when others do not. Initial experimentation and addiction are two very different behaviors, though. The reason many people continue to seek out drugs after their first use is, again, an attempt to reproduce the same
pleasure and an altered state of consciousness initially achieved the first time a certain drug was used. The second time and each instance thereafter, a user is trying to recapture the intensity of that first experience. Ultimately, these feelings cannot be replicated, and this is when an addiction starts. Drug users in search of that elusive pleasure will continue to search for the feelings inspired by their first time, even if all the consecutive uses affect them adversely; this is particularly dangerous with crack cocaine. (Many drug experts suggest that the initial experience of using crack cocaine is so intense that it takes only one use to kick-start an addiction.) Furthermore, over time, addicts' bodies develop a tolerance for a drug, meaning they will eventually have to take more and more of their drug of choice each time they use in order to achieve the same high.
Addiction counselors and others who work with substance abusers consider drug use and abuse to be a self-destructive behavior. According to this model, the user may not be consciously aware of being deeply depressed and engaging in self-destructive activities. Psychoanalytic counselors also interpret drug abuse as a form of suicidal behavior. Proponents of psychoanalysis believe that an addict is usually unaware of his or her deep-rooted problems, and the addiction is a symptom of unreleased pain resulting from these buried problems.
Causes of Substance Abuse
There isn't one single cause of drug addiction. This is one of the reasons drug addiction is very hard to treat. Years ago the term “addictive personality” became very popular in the media. Many in the drug and alcohol addiction counseling field consider this term misleading because it suggests that drug abusers are to blame for their illness because they have defective personalities. A better way to describe a person's predisposition to substance abuse might be psychological (mind-related) vulnerability. This means that the addict has or had some prior psychological factor that placed him or her at greater risk for substance abuse.
For example, people who have mood disorders may sometimes self-medicate (make themselves feel better or more in balance) by using prescription or illegal drugs. There are a number of personality traits that are thought to be shared by substance abusers. These traits include high emotionality; anxiety; immaturity in relationships; low frustration tolerance; inability to express anger; problems with authority; low self-esteem; perfectionism; compulsiveness; feelings of isolation; sex-role confusion; depression; hostility; and sexual immaturity. Stress is also
thought to be a factor contributing to substance abuse. This is not referring to run-of-the-mill, everyday stress from work or school, but the kind of stress that is the result of traumatic experiences, such as the sudden loss of a loved one. Stress in early childhood, such as having been sexually or physically abused, can also lead to substance abuse.
A sense of self is one of the most important factors in the potential for drug addiction. People with a strong sense of self appreciate their individuality and are aware of their talents and place in the world. They are able to begin, develop, and complete projects and to coexist comfortably in different types of relationships. People with a weak sense of self are more likely to seek out alcohol and drugs as way to boost their sense of self, but it quickly vanishes once the drug wears off.
According to addiction counselors and researchers, preventing substance abuse in young people is more about giving them good reasons to live and helping them to foster a strong sense of self rather than keeping them away from the dangerous and enticing world of drugs.
Families and Drug Abuse
A family history of substance abuse is another powerful risk factor. Because substance abuse tends to run in families, much research has focused on pinpointing the genetic predisposition to substance abuse. Twin studies have found that the rates of use, abuse, or dependence on alcohol and drugs are higher for identical twins that have exactly the same genetic makeup than for fraternal twins that only share some genes. Other research found that genetic influences are stronger for abuse of some drugs than for others, and that abusing any category of drugs—such as sedatives, stimulants, opiates, or heroin—was associated with a greater likelihood of abusing every other category of drugs. Also, each category of drug had unique genetic influences, and heroin was the drug with the greatest genetic influence for abuse.
Family and social environmental factors also influence whether an individual begins using drugs. A poorly functioning family system may contribute to the development of an addiction just as powerfully as a genetic predisposition.
Adolescence is a time of change and risk. Because teens are just beginning to develop their fragile sense of self, they are more prone to fall victim to substance abuse. This vulnerability is heightened because teens are exploring identity, social skills, and independence. Peer pressure, the need to fit in and be liked, often causes teens to experiment with alcohol and drugs. If a teen is at a party and everyone around is partying, one
might feel compelled to take a drink or smoke cigarettes or marijuana. Usually these situations do not occur as they do in the movies, where other kids actually pressure their peers; rather, peer pressure tends to work in more subtle ways. If a teen is feeling left out and alone at a party, he or she might believe that joining others smoking marijuana will help to gain acceptance into a group of friends. This is a reflection of teens' needs to feel as though they are part of a group—that they belong.
A teen feeling like the odd one out might even turn to doing drugs in private as a way to escape the frustration or pain of loneliness. Since drugs and alcohol are often easily available to teens, and avoiding contact with them is often difficult, many teens will have encounters with substance abuse either with themselves or people they know. Willpower and a strong sense of self seem to be qualities that keep people from giving in to substance use, abuse, and addiction.
Depressants are the family of substances that slow down, or depress, bodily functions. They tend to make the user sleepy or sluggish. The following drugs are depressants.
Narcotics include opioids, the class of drugs derived from the poppy plant and the synthetic or semi-synthetic compounds that mimic opiates. Opiates, drugs derived from the natural alkaloids of the poppy plant, have been used for thousands of years in Asia both for pleasure and medicinal uses. Natural opiates include morphine, codeine, and heroin. Synthetic or semi-synthetic opioids include fentanyl, oxycodone, and meperidine. They cause a wide variety of effects and side effects, such as pain relief, euphoria, respiratory depression, drowsiness, constriction of the pupils, nausea and vomiting, itching, and constipation. Narcotics tend to be easily addictive when used regularly because of their quick and powerful effects.
Narcotics can be ingested, injected, snorted, or smoked. When opioids are smoked, it takes just five seconds for the drug to reach the brain. If a person addicted to narcotics is without that drug for even four to six hours after the narcotic use stops, he or she can feel the beginnings of withdrawal.
Tolerance to Narcotics
Tolerance (the ability to resist the effects of something) develops quickly with the use of narcotics. Users must take more and more of the drug to get the desired effect. This can lead to overdose. Detoxification (cleansing the body of a toxic substance) is necessary for the body to recover. In order to detoxify and cleanse the body of the drug, withdrawal must occur. Withdrawal is the experience of ridding the body of the substance to which it has become accustomed. Withdrawal from opioids can cause a wide range of symptoms including: appetite suppression; nausea and vomiting; dilated pupils; gooseflesh; restlessness; intestinal spasm; abdominal pain; muscle spasms; kicking movements (the reason for the expression, “kicking the habit”); diarrhea; increased heart rate and blood pressure; chills, hot flashes, and sweating; irritability; insomnia; violent yawning; severe sneezing and runny nose; crying and tearing; nasal inflammation; and depressive moods and tremors.
Without treatment, withdrawal symptoms may last from seven to 10 days. Most opioid withdrawal symptoms are very uncomfortable but are not life threatening. When withdrawal occurs under medical supervision, medications may be given to reduce symptoms such as anxiety, agitation, muscle aches, sweating, runny nose, cramping, vomiting, and diarrhea.
Anti-Anxiety Drugs and Sleep Aids
Benzodiazepines and barbiturates are in the sedative-hypnotic class of drugs and are usually prescribed by doctors for anxiety disorders or to induce sleep; benzodiazepines, such as Valium (diazepam), Ativan (lorazepam), Klonopin (clonazepam), and Xanax (alprazolam) are the most commonly prescribed anti-anxiety drugs. These drugs also may be prescribed as relaxants or sleep aids. Long-term use of benzodiazepines can be addicting, and they are often
taken in combination with other drugs by patients with addiction disorders. (It is important to remember that even if a doctor prescribes a drug for someone, that person can abuse the drug and become addicted to it.) Commonly prescribed barbiturates include amobarbital, pentobarbital, butabarbital, phenobarbital, secobarbital, and methylphenobarbital.
Anti-anxiety drugs and sleep aids are taken orally, in pill form. They cause drowsiness, relaxation, and a sense of well-being. Effects are similar to those of alcohol. When used over any extended period of time, barbiturates can cause extreme physical and psychological dependence. Tolerance to the euphoric effects occur quickly, so more and more must be used to develop the desired effect. Withdrawal may cause dizziness, weakness, sleeplessness, anxiety, tremors, nausea, vomiting, delirium, delusions, and hallucinations.
Overdose is common with these types of drugs. In fact, they are often the drugs of choice for people attempting to commit suicide. Symptoms of overdose are severe mood alteration; confusion and disorientation; slurred speech; impaired motor coordination; involuntary rapid eye movement from side to side; dilated pupils; and respiratory depression.
There are other drugs with barbiturate-like effects that are not classified as barbiturates, such as methaqualone, better known by the trade name, Quaaludes, or the street name ludes. Quaaludes were thought to be a nonaddictive alternative to barbiturates when they were introduced in the 1960s. They turned out to have high abuse potential. They're very popular with college and high school students and have been illegal since 1984. They are often mixed with alcohol, creating a deadly combination. They produce sedation and sleep. Methoqualone may cause headaches, hangovers, fatigue, dizziness, drowsiness, menstrual disturbances, dry mouth, nosebleeds, diarrhea, skin eruptions, numbness, and pain in the arms and legs. Eight to 20 grams can produce severe toxicity, coma, and death. Tolerance builds quickly, and withdrawal is much like detoxification from barbiturates.
Cannabis sativa is the plant that is used to produce both marijuana and hashish. Marijuana is the unprocessed, dried leaves, flowers, seeds, and stems of the plant. Hashish is stronger, and made from the resin (liquid or semisolid substance) of the plant. Tetrahydrocannabi-nol (THC) is the strongest psychoactive compound found in cannabis. There are many street names for marijuana: pot, grass, weed, bud, kind
bud, herb, and reefer are a few. The cigarettes used to roll and smoke the drug are sometimes called doobies, joints, spliffs, fatties, roaches, or blunts. Marijuana can also be smoked in a pipe, or a water pipe, called a bong. In the United States it is the most widely used illicit drug.
The effects of pot often depend on the potency (strength) of the drug. The strength of marijuana has increased tremendously since the 1960s. The common effects of pot smoking are feelings of exhilaration, increased appetite (the “munchies”), relaxation and giddiness (including uncontrollable laughter), increase in heart rate, drowsiness, dry mouth and tongue (referred to as “cotton mouth”), impaired short-term memory, altered perception of time and space, dilated pupils, and paranoia (irrational fear for one's safety). Chronic (frequent) use can cause physical dependence. The long-term adverse effects of marijuana are still unknown, however long-term use commonly leads to addiction and psychological dependence on the drug. Regular users begin to depend on smoking pot to relax and even to sleep. Habitual users often smoke pot immediately upon awakening.
Withdrawal from pot can cause irritability, decreased appetite, sleep disturbances, sweating, nausea, and diarrhea. Hangovers are common the day after smoking pot. They are different from hangovers after drinking alcohol, however. Pot hangovers cause dizziness and inability to concentrate. Marijuana is known to damage the heart and lungs and to suppress the body's immune system. Pot can also make men infertile (unable to father children) and interfere with women's menstrual cycles.
Stimulants are the family of substances that work by increasing the levels of a chemical in the brain associated with pleasure, movement, and attention. They tend to make users feel unusually alert, energetic, and active. Because of their potential for addiction, stimulants are no longer prescribed, as they were in the past, for conditions such as asthma, obesity, and other conditions. Today, they are prescribed to treat just a few specific health conditions, such as attention-deficit / hyperactivity disorder (ADHD), which is a condition marked by difficulty sustaining attention, hyperactivity, and impulsive behavior; narcolepsy, a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep; and, less commonly, depression when other treatments have been unsuccessful. The following drugs fall in to the category of stimulants.
Amphetamines are central nervous system stimulants that give the user a temporary feeling of energy. A popular nickname for amphetamines is “uppers” because they make the user feel up and wide awake. Amphetamines have been used to improve performance—to stay awake, lose weight, or increase concentration—and to get high. When people use them to get high, they generally crush or dissolve them and then snort or inject the mixture.
Therapeutic doses of amphetamines stimulate the central nervous system, increase blood pressure, widen the pupils, quicken the breath, lower appetite, and decrease fatigue. Higher doses can cause agitation, blurred vision, tremors, and heart palpitations. Severe reactions can result in dilated pupils, sweating, cramps, nausea, heart problems, hypertension, panic, aggressive and violent behavior, hallucinations, delirium, high fevers, convulsions, and seizures. People have died from amphetamine abuse because of burst blood vessels, heart attacks, and high fevers. Physical dependence to moderate doses of amphetamines is highly unusual, but psychological dependence from even low doses is common. Chronic users of amphetamines have long-term health consequences. When long-term use of amphetamines is discontinued, withdrawal symptoms may include fatigue, depression, and disturbed sleep patterns.
Methamphetamine is an amphetamine that can be prescribed by a physician but is rarely prescribed because of its potential for abuse. Most of the methamphetamine sold on the street comes from foreign or U.S. laboratories, although it is also made in small, illegal laboratories, or even in private homes. Methamphetamine is a white, odorless, bitter-tasting crystalline powder that dissolves in water or alcohol and is taken orally, by snorting the powder, by injection, or by smoking. Some street names for it are meth, zip, go-fast, cristy, and chalk. In its crystalline form, the drug is called crystal meth, ice, Tina, or glass. When meth is mixed with water and injected with a needle it is called crank. Sometimes crank is mixed with crack cocaine. The mixture is called “croak.”
Methamphetamine abuse changes how the brain functions, and these changes may explain some of the problems users have thinking and controlling their emotions. Taking even small amounts of methamphetamine can produce increased wakefulness, increased physical activity, decreased appetite, increased respiration, and rapid
or irregular heartbeat, as well as increased blood pressure and body temperature.
Over time, methamphetamine abuse can cause many health problems, including extreme weight loss, severe dental problems, anxiety, confusion, sleeplessness, mood disturbances, and violent behavior. Chronic methamphetamine abusers also may become paranoid (extreme, irrational fear or mistrust of others), have hallucinations, or experience delusions, such as the feeling that they can fly or that insects are crawling under their skin.
Crystal meth is even more dangerous than the typical, older forms of amphetamines because it gets into the system faster, lasts longer, and can have even more deadly effects. In addition to tremors and convulsions, increased blood pressure, irregular heart rate, and intense anxiety, users also may have mood swings and violent thoughts and behavior.
Cocaine is another central nervous system stimulant. It comes from the coca plant, found in South America. (From 1891 to 1903,
the soft drink Coca-Cola contained extracts of the coca leaf.) Some street names for cocaine are blow, C, coke, and snow. It is usually snorted but also may be injected or smoked. At one time, cocaine was very expensive, and only the very wealthy could buy it. Crack is a form of cocaine that is smoked; it is much more potent (strong), cheaper, and sold in rocks. Crack is highly addictive; some experts say even one use has the potential to make someone addicted.
Cocaine causes an initial euphoric high that can last from 15 to 30 minutes. People on cocaine tend to talk rapidly and feel like they are invincible. Socially awkward people on cocaine jump out of their shells and act tremendously self-confident, often arrogant. A cocaine user may feel sexually stimulated at first, but as the drug wears off this usually doesn't last.
The high from cocaine is short-lived, and “crashing” quickly sets in. A person crashing from a cocaine high is usually depressed, paranoid, irritable, and extremely tired. Because the high is so brief, cocaine users tend to buy a large amount of the drug and go through it quickly. Cocaine has the reputation of being a social drug, and people tend to do it with groups in bars and clubs. For serious users, cocaine binges can last for days. On a binge, a user will snort cocaine every half-hour for days on end. They will live without sleep or food until they crash from exhaustion.
Cocaine is highly addicting, although it is not physically addictive in the way that narcotics, such as heroin, can be. That is, physical tolerance to cocaine does not develop. Rather, users need to take it again and again to avoid crashing. Even one-time use of cocaine can result in death.
PCP (phencyclidine) is a man-made drug that alters people's perceptions of sight and sound and makes users feel distanced and detached. Also known as angel dust, it usually looks like white or colored chunks, powder, or crystals. It is often smoked but also may be snorted or eaten. Low doses produce muscle stiffness and poor coordination, slurred speech, drowsiness, confusion, numbness of the arms and legs, profuse sweating, nausea, vomiting, flushing, and increased heart rate. Strange and violent behavior can result from higher doses. In some cases effects from PCP have lasted up to 10 weeks. Heavy users can experience deep anxiety, depression, and psychotic symptoms.
Hallucinogens or psychedelics were the most popular class of drugs in the 1960s. Timothy Leary (1920–1996), a doctor from Harvard University, coined the phrase, “Tune in, turn on, drop out,” encouraging young people everywhere to experiment with psychedelics. Hallucinogens affect people by distorting reality, and, at higher doses, often cause hallucinations (the illusion of seeing or hearing something that isn't really present). (Other drugs, even alcohol and marijuana, can cause hallucinations, too.)
Synthetic hallucinogens are LSD (lysergic acid diethylamide), mescaline (peyote), and DOM and STP (2,5-dimethoxy-4-methylamphetamine), an amphetamine derivative. LSD is also called acid. Synthetic hallucinogens are manufactured in underground laboratories that exist only to serve the illegal drug market. Natural hallucinogens include buttons from the peyote cactus (the active ingredient, mescaline, can also be synthetically produced), morning glory seeds, and psilocybin mushrooms (these are often called “shrooms” or “magic mushrooms”; they are not the kind of mushrooms found in supermarkets).
The slang term for taking hallucinogens is “tripping.” The experience an individual can have on psychedelics varies widely. The emotional and mental state of the user at the time of “dropping” or taking the drug sets the tone for the trip. If the individual has any feelings of doubt or fear, the drug often exaggerates these emotions. This can cause a nightmarish experience, called a “bad trip.” Trips can last anywhere from four to 24 hours depending on dosage and circumstances.
LSD can be taken in different forms. Because it is highly potent, only small amounts are necessary. It is sometimes produced in pill form. More commonly, sheets of LSD called blotter paper are produced. The user puts a tiny piece of the sheet in his or her mouth. These pieces are called dots, tabs, or doses. Sometimes acid is taken in liquid form. The effects of LSD are usually felt within an hour. Physical effects include increased blood pressure, dilated pupils, rapid heartbeat, muscular weakness, trembling, nausea, chills, and hyper-ventilation. (Sometimes LSD is mixed with amphetamines, and the effects match the speedy physical effects of that class of drugs.) Another possible effect of taking LSD is the flashback. Up to a year after the acid trip, users may have hallucinations caused by LSD left in their systems.
Mescaline is made from the peyote cactus. The heads or “buttons” of the cactus are dried and put into capsules. It is usually taken orally but also may be smoked or injected. It is less potent than LSD. Physical effects include dilated pupils, high body temperature, nausea and vomiting, and muscular relaxation. Mental effects include euphoria, heightened sensory perception, hallucinations, and difficulty in thinking. Higher doses can cause headaches, dry skin, hypotension (lowering of the blood pressure), cardiac depression, and slowing of respiration.
Designer drugs, called such because they are “designed” in a laboratory, were created in the 1970s by underground chemists attempting to subvert the drug laws of the day. The designer drugs were only a molecule or two different than some of the synthetic drugs then listed as illegal according to the Controlled Substance Act.
MDMA, better known as Ecstasy, is a very popular designer drug. Some street names for Ecstasy are X, E, XTC, Rave, or Adam. It is related to amphetamines and mescaline. It is also called the “love drug” or the “hug drug” because it enhances empathy and relatedness. It also causes a positive mood change, a drop in defense mechanisms, and elevated mood. Some of the negative effects of Ecstasy are the potential for overdosing, extreme fatigue, dilated pupils, dry mouth and throat, tension in the lower jaw, grinding of the teeth, and over-stimulation. It can also cause extreme paranoia and panic that call for emergency care.
Ketaminehydrochloride is another potentially deadly designer drug. It is a drug widely used as an animal tranquilizer by veterinarians during surgery. Also known as Special K or vitamin K, it is made by drying ketamine (often in a stove) until it turns from a liquid to a white, crystalline powder. It is a very powerful hallucinogen. It is usually snorted, but it is sometimes sprinkled on tobacco or marijuana cigarettes and smoked. Ketamine is frequently used in combination with other drugs, such as Ecstasy, heroin, and cocaine.
People high on ketamine may have profound hallucinations that include visual distortions and a lost sense of time, sense, and identity. Users report having profoundly terrifying experiences while high. Some report experiencing total temporary paralysis (loss of the ability to move or feel sensation). The high lasts anywhere from a half hour to two hours. Because users generally become unable to speak or even see what is
happening around them, it is not a social drug. Like other designer drugs, ketamine is often cut with other drugs and poisonous agents.
In 2010, awareness grew of several new synthetic stimulants packaged and marketed as “bath salts” (or sometimes “plant food”). The name bath salts comes from the white, crystalline form of the drug, which resembles legally sold salts used in bathing products, however the drugs are unrelated to such salts. Bath salts are found in head shops (stores where drug paraphernalia is sold), gas stations, and on the Internet under names such as “Zoom,” “Ivory Wave,” “Purple Wave,” “Cloud Nine,” “Vanilla Sky,” or “Bliss,” and are thus easy to access and inexpensive, leading to use by adolescents and teens. The drug is usually swallowed or smoked (though it can also be snorted or injected) to obtain a high similar to that of cocaine or amphetamines. Side effects can include headaches, panic attacks, agitation, paranoia, hallucinations, violent behavior, and even death.
The packages state that the products are not for human consumption in an effort to avoid being labeled as illegal drugs, and the makers of the products constantly tinker with the ingredients used to keep one step ahead of the authorities. However, after increasing reports of poisonings related to bath salts in 2011, the DEA banned three of the synthetic stimulants—Mephedrone, 3,4 methylenedioxypyrovalerone (MDPV), and Methylone—used to make such products. In 2012, Congress passed and President Obama signed the Synthetic Drug Abuse Prevention Act to ban dozens of different chemicals used to make the drugs. The act does not name specific recipes, so that all synthetic drugs like bath salts are covered.
Another recent designer drug is a synthetic version of marijuana commonly called spice, K2, incense, or potpourri, which, like bath salts, was sold legally on the Internet and in places like malls, convenience stores, and gas stations. The chemicals in such products are usually manufactured in China and then sprayed on incense that can be burned or leaves that can be smoked or made into a tea, leading to
a psychoactive high. Side effects can include vomiting, hallucinations, agitation, increased sweating, inability to talk, memory loss, high blood pressure, psychosis, violent behaviors, and death. As with bath salts, the manufacturers tried to stay one step ahead of the authorities by changing ingredients to keep the drugs legal, which means that the high and the side effects may be different each time someone uses a different formulation of the drug. However, the Synthetic Drug Abuse Prevention Act signed into law in 2012 now covers these products as well as bath salts.
Inhalants are chemical vapors that people sniff to get high. The sniffing of glue, solvents, aerosols, cleaning agents, gas from dessert topping sprays, and other gases is another means people use to achieve a high. Because common, everyday products found in most homes and grocery stores can be used as inhalants, sniffing, also called huffing, is popular with teens and others who don't have money or access to buy illegal drugs. People who use inhalants are sometimes referred to as “huffers.”
Because the inhalants are legal, everyday products, many teens do not view sniffing as being as harmful as doing “hard” drugs. This is a dangerous and untrue belief. Symptoms of inhalant use are slurred speech, mental disorientation, headaches, dizziness and weakness, muscle spasms, euphoria, and nystagmus (eye movement from side to side). Some of the more serious adverse effects are nausea and vomiting, confusion, panic, tension, aggressive behavior, and permanent brain damage. At higher doses, use of inhalants can cause respiratory depression, heart failure, and loss of consciousness, resulting in coma and death.
Alcohol and Alcoholism
Alcohol is classified as a central nervous system depressant like barbiturates and tranquilizers. Although it is legal for persons of over age 21 in the United States to use, it is still very much a drug. It is, however, a socially acceptable drug, unlike some of the drugs already discussed. After tobacco, alcohol is the most widely used psychoactive drug in the world.
Drinking alcohol, whether beer, wine, or liquor, causes a vast array of effects. Even small amounts of alcohol impair drinkers so much that they cannot perform simple motor tasks. Every tissue in the human body is affected by alcohol consumption. Individual effects of drinking vary. Body weight and size, sex, metabolism, the amount of alcohol consumed
at the time, and the type and amount of food in the stomach determine the blood alcohol level. Mild intoxication can cause feelings of warmth, flushed skin, impaired judgment, and decreased inhibitions. Deeper intoxication can cause a slowing of reflexes and more obvious lessening of judgment and inhibitions. Slurred speech, double vision, and memory and comprehension loss can follow.
Drinkers may experience vomiting, incontinence (losing bladder or bowel control), and the inability to stand on their own. Many people pass out when they've had too much to drink. Blackouts are not uncommon. In a blackout, drinkers will not remember large segments of their experiences. Coma and death are possible results of excessive drinking. Drinking even a small amount of alcohol can result in a hangover. Hangovers can cause headaches, fatigue, nausea, shakiness, and extreme thirst. (For those who insist on drinking, consuming plenty of water before, during, and after will prevent the dehydration that is a consequence of alcohol consumption.)
Alcohol abuse is when drinking causes problems in people's lives. Short-term abuse can cause the physical reactions described above, along with the possibility of serious hazards incurred by loss of faculties. Drunk driving is the most serious and immediate consequence. Drunk people may make bad decisions that can cost them their lives and the lives of those they love. The decision to get behind the wheel after drinking can result in drivers having to spend the rest of their lives in prison. Death is
the most serious result of driving drunk. People who have been drinking, even those who do not think they are drunk, should never drive, no matter the circumstances.
Alcohol can be addictive. The physical and psychological need for alcohol can turn into a chronic disease known as alcoholism. People suffering from alcoholism cannot keep from drinking and cannot stop drinking even though they know that they are harming their health and their lives. Alcoholism runs in families, and researchers believe that certain genes may increase the risk of alcoholism, but it is not yet known exactly which genes increase susceptibility to alcoholism.
Long-term effects of alcohol abuse and alcoholism include liver diseases, such as cirrhosis, and cancer. These are usually fatal. Alcoholics have
higher rates of peptic ulcers, pneumonia, cancer of the upper digestive and respiratory tracts, heart and artery disease, tuberculosis, and suicide than the rest of the population. Fetal alcohol syndrome (FAS) is a condition that drinking mothers pass on to their infants. Pregnant women should not drink alcohol at all. FAS is the leading cause of birth defects.
Withdrawal from Alcohol
Six to 12 hours after the last drink, an alcoholic can begin to feel the effects of withdrawal from alcohol. The stage one symptoms are psychomotor agitation, anxiety, insomnia, appetite suppression, stomach problems, elevated heart rate and blood pressure, sweating and tremors. Within 24 hours, stage two withdrawal symptoms begin. They include the symptoms of stage one, plus hallucinations and seizures.
Nicotine is an addictive drug that is legal in the United States for persons over the age of 18. It is found in tobacco products, most notably cigarettes. Although the law prohibits selling cigarettes to minors, smoking is common among teens. Many people do not think of cigarettes
as drugs but smoking is the most lethal of all the addictive behaviors. Smoking kills more people each year than AIDS, fires, illegal drugs, and suicides combined. It is best to avoid smoking altogether because it is among the most difficult addictions to shake.
Smoking causes coughing, shortness of breath, fatigue, yellow teeth, bad breath, heart disease, lung cancer, throat and mouth cancer, dry skin, dry hair, emphysema (a chronic lung disease), asthma, and a variety of other problems. At one time, the dangers of nicotine and smoking were not as well known as they are today, and smoking was a symbol of “being cool.” That era is long gone. And the proven negative effects of smoking are well documented. Pregnant and breast-feeding women face special risks and dangers when it comes to smoking. For example, a fetus exposed to the effects of smoking runs the risk of having a low birth weight.
Caffeine is a stimulant found in coffee, some teas, chocolate, some over-the-counter drugs, energy drinks, and cola drinks. Due to the popularity of these products, especially coffee and cola drinks, caffeine is the most popular drug in the world. It is sometimes used medically, but mostly caffeine is used non-medically for its stimulating effect on mood and behavior. When someone wakes up in the morning and can't get started without a cup of coffee, this is a classic sign of caffeine addiction. People who regularly consume five or more cups of coffee per day develop a tolerance to caffeine. Withdrawal from caffeine or even a reduction in the amount consumed may cause headache, irritability, and drowsiness.
Treatment for Addiction
Whether a person is suffering from alcoholism, nicotine addiction, or drug addiction, treatment is necessary for successful recovery. Going “cold turkey,” the idea of abruptly quitting using a substance without any treatment, only works for a very small minority. Many people believe in the saying “once an addict, always an addict.” That is, recovery from addiction is thought to be a lifelong process and not one that stops once an addict initially stops using. Many former addicts who have been substance-free for years still consider themselves in recovery. There are many options available for people seeking help to recover from addictions.
Alcoholics Anonymous (AA)
Alcoholics Anonymous (AA) is the most famous treatment organization in the world. AA meetings take place just
about everywhere in the United States each day and in other countries as well. AA is based on a 12-step recovery plan. These are the steps successful members of AA completed:
- We admitted we were powerless over alcohol—that our lives had become unmanageable.
- Came to believe that a Power greater than ourselves could restore us to sanity.
- Made a decision to turn our will and our lives over to the care of God, as we understood Him.
- Made a searching and fearless moral inventory of ourselves.
- Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
- Were entirely ready to have God remove all these defects of character.
- Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became willing to make amends to them all.
- Made direct amends to such people wherever possible, except when to do so would injure them or others.
- Continued to take personal inventory, and when we were wrong, promptly admitted it.
- Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
- aving had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.
These steps have been modified and used by many other recovery programs for all different types of addictions. AA is a plan for self-reflection and taking responsibility. Some people are uncomfortable with the word God, and the reference to God as a Him. Those individuals can substitute other words for any spiritual language, and the steps can still work for them.
Abstinence from all alcohol is a requirement for those in AA. New members are given a sponsor, a recovering alcoholic (called such because many former alcoholics feel they are always in recovery) who can lead them through the process. The sponsor stands by to assist the new members. If they feel they might relapse (that is, return to drinking), they are told to call their sponsor right away for guidance.
Methadone maintenance is a popular treatment for heroin addicts. Methadone is a substitute drug for heroin. It is prescribed and distributed in a controlled environment. It helps to relieve the severe symptoms of withdrawal from heroin, without enforcing abstinence. The goal of methadone maintenance is to wean a heroin addict from heroin and then, ultimately, from methadone, which does not have as severe withdrawal symptoms as does heroin. Widespread HIV infection among heroin addicts (from sharing dirty needles) increased the acceptance of methadone maintenance as a treatment for addiction in the United States. (European countries have used this treatment for years without problems.)
Intervention is a popular mode of treatment for addiction and other behavioral problems. Intervention is an organized visit upon the afflicted individual by friends and loved ones. Often a counselor is present, and counselors almost always help to plan the meeting.
The intervention is designed to confront the person suffering from addiction in a nonjudgmental fashion. Group members tell the individual that they are aware of the addiction and that they care for the person and want him or her to seek help and get better. Often an intervention helps addicts realize that their addiction is not a secret and that they are affecting their friends' and loved ones' lives. An intervention also may backfire, causing the subject of the intervention to become immediately defensive and storm out of the meeting. That is why taking this approach needs to be considered very carefully and should involve a trained substance abuse counselor.
Other Treatment Considerations
Anyone suffering from addiction and attempting to recover will experience a certain degree of pain and discomfort. The person must believe that kicking the habit is worth it and be willing to ride out the discomfort to reach sobriety. While this is much easier said than done, there are some tools that recovering addicts can use to ease the road to recovery.
It makes sense for all people to eat healthful diets and get enough sleep, but for people that have been abusing their bodies with a substance, healthy eating is even more important. Regular exercise is also vital for the recovering person.
Acupuncture is used to help ward off cravings. Acupuncture is an ancient Chinese method of placing very thin needles in strategic points on the body. The points correspond to energy meridians, and they restore balance to the body. Ear point acupuncture is often offered in methadone clinics for heroin addicts.
Meditation is focusing intently on one sound, idea, image, or goal. For a person recovering from addiction, meditation may be extremely difficult but it can be extremely valuable. When someone stops to look at waves crashing on the beach or a candle flame or even a tree in the park, often that person will enter into a trance-like state. This is a form of meditation. Artists of all types often become so
involved in the act of making art that it becomes a meditation.
Concentration is one of the most difficult tasks for recovering addicts. Thoughts and obsessions run like wildfire through the mind. Meditating is like going on vacation in the mind even while the body is stuck in one spot. Meditation also helps with insomnia (sleeplessness), a problem for many recovering people. Meditation before bed (but not in bed) helps to create deep and peaceful sleep.
A mantra is simply a sound, word, or phrase that is repeated over and over during meditation. Many people think the best mantras are the ones that have no distinct meaning, the ones that are simply sounds. (For instance, the sound “ohm” is a popular choice.) This is so that the meditator will not begin thinking about meditation. The goal of meditation is to go to a place of focus where passing, disturbed thoughts do not interfere with relaxation.
The most important factors in healing from addiction are honesty and love of self. Without those fundamental foundations, no treatment plan can work. Once the person with an addiction admits to being sick and needing help, he or she is ready to begin the long road to feeling whole again. The addiction has likely become a great comfort to the addict, something he believes he can't do without. Giving up that idea and letting go of the substance itself is not easy, but it can be done. Just as getting hooked changes people's lives, they can change again, for the better, by recovering from their addictions.
Compulsions are habitual behaviors or mental acts a person is driven to perform in order to reduce stress and anxiety. Psychological vulnerability,
cultural and social factors, as well as contact with others engaging in compulsive behaviors all influence the development of compulsive behaviors. It is important to note that any of the following activities or behaviors in moderation is fine. However, when a normal activity becomes one in which the person is trapped in a pattern of repetitive behaviors he or she cannot control, it is considered a compulsion.
Gambling can be a dangerous compulsion. Compulsive gamblers often spend all their money, exhaust their savings, and even resort to stealing money to support their habits. People can become addicted to betting on sports events, playing poker, or playing slot machines in bars and casinos. Something about the possibility of winning, perhaps the risk and the consequent adrenaline rush, spur on compulsive gamblers. Virtual casinos and online gambling sites are immediately available to those who cannot travel to popular gambling destinations like Las Vegas, Nevada, or Atlantic City, New Jersey. Easy online access to gambling has increased the numbers of teens that gamble. Unlike actual casinos, the Web sites do not require proof of age or an ID. As a result, the underage gamblers can gain instant access to virtual casinos.
The Center for Online Addiction (www.netaddiction.com ) exists to serve people with all forms of Internet addiction, including addiction to online gambling. Addiction to online auction houses, such as ebay, is another form of compulsive gambling.
Internet addiction is a broad term that describes many kinds of compulsive behaviors. Many potentially addictive activities in real life are replicated on the Internet. The reason Internet addictions are a bit more dangerous is that people often feel secluded sitting in front of their computer screens. There is a sense that they won't get caught in the act.
According the Center for Online Addiction, there are different types of Internet addiction:
- Cyber-sexual addiction is an addiction to adult chat rooms or cyber-porn.
- Cyber-relationship addiction is addiction to meeting people on the Internet, usually in chat rooms or through newsgroups. People who grow addicted to meeting people in the virtual world often stop seeing and speaking to their friends from real life.
- Net compulsions are the gambling related activities described above.
- Information overload is compulsive Web surfing and researching. Sometimes information overload can keep people up all night surfing, which may leave them to tired for their normal daily activities.
- General computer addiction describes those who compulsively play video games or program their computers.
People who hide out in a cyber universe are often troubled and have difficulty socializing with real people. Counseling may help Internet addicts come out from behind their computers and rejoin the real world.
Exercise addiction is compulsive exercise that harms rather than improves people's health. People addicted to exercise think about exercise constantly and plan their every moment around the next time they can run, bike, take a class at the gym, or lift weights. They talk constantly about fitness. They begin to associate only with those people who will indulge their addiction: people who also exercise all the time. If someone gets really angry or depressed by missing a workout, or if he or she constantly exercises and stops taking part in other social activities, that individual might be an exercise addict.
Exercise addiction can lead to exhaustion and even death. Women may stop getting their periods, and men who are obsessed with muscles sometimes succumb to taking dangerous steroids to bulk up. For most people, a new exercise regimen, often under the supervision of a doctor or a trainer, is truly beneficial for their health. But in some cases, the healthful benefits of exercise are lost and replaced with the desperate need to exercise all the time.
Often exercise addiction is related to body image disorders, like anorexia nervosa, bulimia nervosa, and body dysmorphic disorder. In all three of these illnesses, people see themselves not as they are, but as a distorted, fat people who do not measure up to society's standards of thinness or fitness. (In the case of body dysmorphic disorder, fat is not always the culprit but rather a constant unhappiness with parts of, or the shape of, one's body.) Women and girls tend to suffer from this kind of disease most often, but increasing numbers of boys and men are affected too.
Exercise addiction can develop for other reasons as well. For instance, athletes can become addicted to training in their quest to improve their performance. Abuse of steroids can occur along with exercise addiction. Steroids are a class of drugs that increase the male hormone testosterone in the body. This increases muscle mass when accompanied by weight training. In the weight lifting world, there is a focus on looking “buff” or very muscular. Many men (and women, too) who weight train sometimes become so focused on the goal of attaining huge muscles that they turn to steroids as a means of bulking up.
Self-injury or self-harm, often expressed by cutting or burning oneself, is considered an impulse-control behavior problem, but also may be symptom of another mental health disorder such as depression, a personality disorder, or it may occur along with an eating disorder. It is a dangerous, unhealthy way to deal with emotional problems such as pain, anger, and frustration. Self-injury may give people a brief moment of relief, but the painful emotions that caused it quickly return.
Self-injury is common among teenage girls, but anyone can develop this dangerous behavior. Those who self harm sometimes carve on their body with razor blades, stick themselves with pins, and squeeze and pinch their faces.
It is very important that people who self-injure receive therapy to uncover the reasons they are hurting themselves. Therapy aims to help people manage the issues that trigger the behavior. Recovering from self-injury may take a long time because it may have become a major part of a person's life and because it may be a symptom of another mental disorder.
A mania is an excessive or unreasonable enthusiasm for an activity, especially a destructive activity such as stealing or starting fires. Low levels of serotonin, a naturally occurring chemical in the brain, are common in people prone to impulsive behaviors.
Kleptomania is the compulsion to steal. Kleptomaniacs lead dangerous lives, stealing things every chance they get. It's not enough for them to simply shoplift from stores. Kleptomaniacs steal from their friends, teachers, and loved ones. Like other behaviors involving risk, the risk of getting caught seems to satisfy some need in people who compulsively steal.
Pyromaniacs are people that feel compelled to start fires. This compulsion not only may kill the person who sets the fire, but also anyone caught in the way. Experts believe that some firesetters may be seeking attention while others are thrill-seekers. Teens who set fires often have committed other crimes such as vandalism or sexual offenses. Pyromaniacs are often angry people, but the anger is often suppressed. Setting fires is a way for them to express their anger. Usually pyromaniacs don't get help until it is too late. A serious fire is often the event that forces them into therapy.
Compulsive shopping is an addiction that causes people to run up their credit card bills and get so buried in debt that they sometimes have to declare bankruptcy (legally declare themselves unable to pay their bills due to lack of money). Many people, at one time or another, purchase an item that they do not really need or want. Compulsive shoppers, however, go on frequent shopping sprees and buy many things that they just don't need at all. Somehow, standing in front of the item before they buy it, they believe that their lives will be better if they own the item. As a result, they end up with closets full of unnecessary items.
Compulsive shoppers are searching for love in the form of material objects. They experience tension or anxiety before they make a purchase,
and a sense of relief following the purchase. Often they continue shopping until a loved one stops them or they lose everything to debt. Compulsive shopping tends to run in families, and many people with this disorder also suffer from depression, anxiety, substance abuse disorders, and eating disorders.
Sex addiction is the compulsion to repeatedly seek out people and have sexual relations with them. Sex addicts put themselves in dangerous situations regularly just to fulfill their need to have sex. People who are sex addicts sometimes meet strangers in bars, or almost anywhere, and go some place with that stranger to engage in casual sexual activity. Of course, when a stranger is involved there is a great deal of danger from potential personal harm. People who engage in such behaviors are not just being promiscuous; rather, they are psychologically driven by their sex addiction.
Sex addiction is treatable. Once addicts confront and accept their behavior, they can begin to look at the reasons why they are compelled to have sex all the time. Often sex addicts experienced sexual abuse (when a person is forced to engage in sexual activities against his or her will) as children. Their sex addiction is a way of having control over their bodies and the act of seduction they compulsively perform is a way of controlling a partner. Sex addiction is never connected to healthy love and desire.
Most sex addicts deny their addiction, and successful treatment of addiction requires that people admit that they have a problem. Often, a crisis—such as the loss of a job, the end of a marriage, or illness—must occur before sex addicts seek treatment. Treatment focuses on controlling the addictive behavior and helping the person develop a healthy sexuality. Support groups and 12 step recovery programs for people with sexual addictions, such as Sex Addicts Anonymous, help many people to recover.
Eating disorders are dangerous psychological (relating to the mind) illnesses that affect millions of people, especially young women and girls. Many experts describe eating disorders as addictions. The most widely known eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder, in which people eat abnormally large quantities of food in short periods of time.
At first glance, eating disorders appear to center on worries about food and weight; however, mental health professionals believe these disorders are often about more than simply food. Besides psychological factors that may predispose people to eating disorders, including low self-esteem, depression, anxiety, or loneliness, other factors such as troubled family and personal relationships; difficulty expressing emotions; a history of physical or sexual abuse; or the experience of being teased, taunted, or ridiculed about body size, shape, or weight may increase the risk of developing an eating disorder. Twin and family studies suggest that the tendency to develop an eating disorder also has a genetic origin.
People suffering from eating disorders battle life-threatening obsessions with food and unhealthy thoughts about their body weight and shape. People with the most severe eating disorders are also more likely to have symptoms of depression and low self-esteem. Untreated, these disorders can lead to death. Recovery from an eating disorder is possible, though it is a difficult process that should not be done alone. The first steps toward recovery are for the sufferer to accept that there is a problem and to show a willingness to focus on his or her feelings rather than on food and weight.
Anorexia nervosa is a condition in which a person refuses to maintain a healthy body weight (persons whose weight is at least 15 percent below their normal body weight fall into this category). Anorexic people starve themselves, even though they may be very hungry. They become terrified of gaining weight and obsessed with food and weight. They often develop strange eating habits, refuse to eat with other people, and exercise strenuously to burn calories and prevent weight gain. People with anorexia continue to believe they are overweight even when they are dangerously thin.
This condition often begins when a girl or young woman who is slightly overweight or normal weight starts to diet to lose weight. After losing weight she wanted to lose, she continues her efforts to lose weight, and dieting becomes an obsession. People with anorexia take pleasure in how well they can avoid eating and measure their self-worth by their
ability to lose weight. Eating and weight gain are viewed as weaknesses and personal failures.
In addition to avoiding eating whenever possible, anorexics will often display high levels of energy that seem at odds with their frail physical conditions. They may also develop odd oral habits, including chewing gum throughout the day, drinking an excessive amount of coffee or diet soda, and chain-smoking.
The medical complications of anorexia are similar to starvation. When the body attempts to protect its most vital organs, the heart and the brain, it goes into “slow gear.” Menstrual periods stop, and breathing, pulse, blood pressure, and thyroid function slow down. The nails and hair become brittle, the skin dries, and the lack of body fat produces an inability to withstand cold temperatures. In addition, personality changes may occur. The person suffering from anorexia may have outbursts of anger and hostility or may withdraw socially. In the most serious cases, death can result.
People who suffer from bulimia eat compulsively and then purge (get rid of the food) through self-induced vomiting, use of laxatives (drugs that induce bowel movements), diuretics (drugs that expel water from the body through urination), enemas (a process that expels waste from the body by injecting liquid into the anus), strict diets, fasts, exercise, or a combination of several of these compensatory behaviors. Bulimia often begins when a person is disgusted with the excessive amount of food consumed and vomits to get rid of the food and calories.
Many bulimics are at a normal, healthy body weight or above because of their frequent binge-purge behavior, which can occur from once or twice a week to several times per day. Many bulimics who maintain normal weight may manage to keep their eating disorder a secret for years. As with anorexia, bulimia usually begins during adolescence or young adulthood.
A particularly stressful event or depression often triggers an episode of binge eating. The binge eating may temporarily relieve
a bulimic's feelings of depression or stress, but often deeper feelings of depression, disappointment, and anxiety will follow, which in turn triggers an episode of purging. Many bulimics report feeling out of control when bingeing and use similar terms to describe their need to purge their bodies of the food they just consumed.
Binge eating and purging are dangerous. Purging can result in life-threatening heart conditions because the body loses vital minerals. The acid in vomit wears down tooth enamel and the lining of the esophagus, throat, and mouth and can cause scarring on the hands when fingers are pushed down the throat to induce vomiting.
Many bulimics suffer from low self-esteem and may even have suicidal thoughts. Often they are rigid perfectionists who think in absolutes (“I am bad because I ate that”). Like anorexics, bulimics will make negative statements about their bodies and suffer extreme guilt after eating even normal portions of food. They may begin to withdraw from social activities, particularly those that will make it difficult for them to purge without suspicion.
Binge eating is a common problem among people who are overweight and obese. Besides consuming unusually large amounts of food in a single sitting, binge eaters generally suffer from low mood and low alertness and experience uncontrollable compulsions to eat. They have food cravings before binge episodes and feelings of dissatisfaction and restlessness after binges.
The National Institute of Mental Health (NIMH is one of the National Institutes of Health) reports that binge-eating disorder is the most common eating disorder. Nearly 3% of adults will have a binge-eating disorder at some point in their life.
People who suffer from binge eating often:
- Feel that eating is out of their ability to control
- Eat amounts of food most people would think are unusually large
- Eat much more quickly than usual during binge episodes
- Eat until the point of physical discomfort
- Consume large amounts of food, even when they are not hungry
- Eat alone because they feel embarrassed about the amount of food they eat
- Feel disgusted, depressed, or guilty after overeating
Binge eaters usually suffer from obesity (extreme overweight). Many have been “yo-yo” dieters (experiencing large ups and downs in weight from a cycle of dieting) their entire lives.
Other Types of Disordered Eating
There are those eating disorders that do not fall under the categories of anorexia or bulimia; rather, these people exhibit a wide range of disordered eating and unhealthy weight management strategies. Since they cannot be diagnosed as anorexic or bulimic, these individuals will typically receive a diagnosis of an “eating disorder not otherwise specified (EDNOS).” An example of disordered eating is a person of normal weight who eats no fat and occasionally purges. She would not be considered bulimic because she is not bingeing, and she also is not anorexic because she is not dangerously underweight. She would therefore be diagnosed with EDNOS.
Causes of Eating Disorders
Many factors contribute to the development of eating disorders. Some are biological and genetic, while others are a direct result of the cultural and family environments.
There are factors contributing to the development of eating disorders that are biological, or genetic. For example, if a person has a relative in her immediate family with an eating disorder, she is at a higher risk to develop an eating disorder.
Disordered eating also may be triggered by the initial act of starving, binge-eating, or purging. This is because these behaviors can change an individual's brain chemistry. Starvation and overeating can both lead to the production of brain chemicals that induce feelings of peace and euphoria (happiness). These good feelings mask feelings of anxiety and depression, both of which are commonly experienced by people suffering from eating disorders. This has caused some researchers to conclude that some people with eating disorders may use food (or starvation) as a way to relieve depression, anxiety, or other emotional upset.
People suffering from eating disorders share many of the same personality traits. For example, eating-disordered people lean toward being perfectionists. Many of them suffer from low self-esteem, despite their accomplishments and perfectionist ways. Extremist thinking, too, is present in many people with eating disorders. They assume that if being thin is “good” then being even thinner is better. This leads to the thought that being the thinnest is the absolute best; it is this thinking that pushes some anorexics to plummet to body weights of 50 or 60 pounds.
Often, people who live with eating disorders have no sense of self. They simply do not feel that they know who they are or their place in the world. An eating disorder, however, offers a sense of identity to these individuals in that it enables them to say, “I am thin,” and “I am dieting.” This eventually leads them to define themselves solely on their appearance and their dangerous actions rather than with their positive qualities and accomplishments.
Eating disorders, in general, occur primarily in industrialized societies, such as the United States, Australia, Canada, Europe, and Japan. In all of these places, the media (TV, movies, magazines) bombard people with the virtues and importance of being thin. Television, movies, magazines, and advertisements promise that being thin will bring a person success, power, approval, popularity, friends, and romantic relationships. Women, in particular, are held to an almost-impossible-to-achieve standard of physical fitness and beauty, the height of which is
being slender and thin. (In fact, female fashion models now weigh an average of 25% less than an average woman.) Because of these media messages, and how young women report feeling about their weight and body shape, a link between eating disorders and social pressures can be established.
Social factors that may contribute to eating disorders include rigid definitions of beauty that exclude people who do not conform to a particular body weight and shape; cultures that glorify thinness and overemphasize the importance of obtaining a “perfect body”; and cultures that judge and value people based on external physical appearance rather than on internal qualities such as character, intellect, generosity, and kindness. Appearance-driven concerns, rather than health needs, continue to motivate many people to lose weight. Society emphasizes these appearance-driven concerns by describing overweight and obese people in a negative manner.
People are shaped in part by their experiences with their families. Families contribute to an individual's emotional growth. If someone is raised in a dysfunctional family, he or she may have feelings of abandonment and loneliness. Certain families have dynamics in which rigidity, overprotectiveness, and emotional distance are commonplace. If parents make all of a child's decisions for her, when she becomes a teenager and must make decisions for herself, she may find she doesn't have the tools to do so. All of these dynamics can promote the development of eating disorders in the future.
Families in which unrealistically high expectations are placed on children also may lead people to develop disordered eating. The disordered eating is used as a way to cope with feelings of inadequacy and as a way to control at least one area of their lives.
Children also receive their first messages about their bodies from their families. If parents place too much emphasis on physical appearance, it can lead to low self-esteem in those children, placing them at risk for developing eating disorders when they are older.
Most children learn their eating habits and food preferences from their families. Often times, cleaning one's plate or not eating too much or even parents' close control of the food their children eat can lead to disordered eating later in life. Parents' attitudes toward food and their own bodies greatly affect children's attitudes toward food and how they will feel about themselves.
Eating disorders are often set off or triggered by an event or a circumstance in the life of an individual who is already prone to developing such a condition. A period of adjustment, such as leaving home to attend summer camp, prep school, or college, can easily
trigger disordered eating in an individual with such tendencies already in place. A traumatic event in someone's life, such as sexual abuse, can also trigger the development of an eating disorder. Other triggers may seem harmless yet represent large life changes, such as moving, starting a new school or job, graduation, and even marriage. Triggers are usually closely tied to the end of a valued relationship or a feeling of loneliness.
The most common trigger of an eating disorder, however, is dieting. Very often dieting can lead people to disordered eating of some sort, including anorexia or bulimia.
The Physical and Psychological Consequences of Eating Disorders
An eating disorder can have serious physical and psychological consequences. Untreated, some of the effects of eating disorders are irreversible and life-threatening. For these reasons, early detection and treatment is essential and can save a person's life.
How Anorexia Nervosa Affects the Body
Anorexia causes many physical problems. For instance, it upsets the normal functions of hormones. For girls, this means the body is unable to produce enough of the female hormone estrogen because it does not have enough fat. This may cause an absence of menstrual cycles, called amenorrhea. For boys, anorexia causes a decrease in the production of the male hormone testosterone, which results in a loss of sexual interest.
An anorexic body lacks the protective layer of fat it needs to stay warm. To compensate for the lack of fat, lanugo (fine hair) will grow all over the body to keep it warm. Another problem anorexia causes is a decrease in bone mass. The body needs calcium for strong bones. Since an anorexic is not eating enough food, which is the source of calcium, the body's bones suffer and weaken. Later in life, this could
result in dangerously thin, fragile bones—the condition is known as osteoporosis.
Additionally, without the fuel it needs, an anorexic's body will respond as if it is being assaulted and begin to fight back in order to survive. To survive the body must have energy, but because the body has no food to turn into energy, it seeks out the muscles, and eventually, the organs (heart, kidneys, and brain) for sustenance—often causing permanent damage to the organs in the process. This is the most serious consequence of anorexia and can lead to cardiac arrest and/or kidney failure, both of which may result in death.
How Bulimia Nervosa Affects the Body
The frequent purging that occurs with bulimia does serious damage to the body. Self-induced vomiting can severely damage the digestive system. Repeated vomiting also damages the esophagus (throat) and eventually it may tear and bleed. Vomiting brings stomach acids into the mouth, causing the enamel on the teeth to wear away. As a result, the teeth may have cavities, become weakened, and appear ragged.
Other consequences include swollen salivary glands, which gives some bulimics the appearance of having chipmunk cheeks, and cuts and sores on the knuckles from repeatedly sticking one's fingers down the throat to induce vomiting (known as “Russell's sign”). Stomach cramps and difficulty in swallowing are also common.
If laxatives (drugs that induce bowel movements) are abused, constipation may result because the body can no longer produce a bowel movement on its own. Abuse of laxatives and diuretics (drugs that expel water from the body through urination) can also cause bloating, water retention, and edema (swelling) of the stomach. Because the body is being denied the nutrients and fluids it needs to survive, the kidneys and heart will also suffer. Specifically, a lack of potassium will result in cardiac abnormalities and possible kidney failure, which may also result in death.
How Binge-Eating Disorder Affects the Body
The physical effects of binge eating are not as severe as those of anorexia and bulimia because the body is not denied food or put through the painful process of purging. Nevertheless, there are some potentially serious consequences for binge eaters.
Since binge eaters may suffer from obesity, health complications such as diabetes or heart problems can develop. Health problems from yo-yo dieting can include hypertension (high blood pressure) and long-term damage to major organs, such as the kidneys, liver, heart, and other muscles.
How Exercise Addiction Affects the Body
Many anorexics and bulimics exercise compulsively in order to lose weight. Compulsive exercise is extremely dangerous and can cause many painful injuries, including stress fractures, damaged bones and joints, as well as torn muscles, ligaments, and tendons. Even worse, the injuries may become more serious as many compulsive exercisers often continue their routines despite their injuries.
When an eating disorder is successfully treated, the body can heal and return to normal. Sometimes, however, the eating disorder has continued for so many years that there is too much damage for a full recovery to occur. A person may have to live with a weak heart or kidneys for the rest of his or her life. A woman may be unable to conceive a child because her reproductive system cannot function properly or may suffer from the debilitating bone disease osteoporosis.
How Eating Disorders Affect the Mind
The psychological consequences of eating disorders are complex and difficult to overcome. An eating disorder is often a symptom of a larger problem in a person's life. The disorder is an unhealthy way to cope with the painful emotions tied to the problem. For this reason, the emotional problems that triggered the eating disorder in the first place can worsen as the disorder takes hold.
Research has shown that many people suffering from an eating disorder also suffer from other psychological problems. Sometimes the eating disorder causes other problems, and sometimes the problems coexist with the eating disorder. Some of the psychological disorders that can accompany an eating disorder include depression, obsessive-compulsive disorder, and anxiety and panic disorders.
In addition to having other psychological disorders, a person with an eating disorder may also engage in destructive behaviors as a result of low self-esteem. Just as an eating disorder is a negative way to cope with emotional problems, other destructive behaviors, such as self-injury and substance abuse, are similar negative coping mechanisms.
Depression is one of the most common psychological problems related to an eating disorder. It is characterized by intense and prolonged feelings of sadness and hopelessness. In its most serious form, depression may lead to suicide (the taking of one's own life). Considering that an eating disorder is often a secret, a person who is suffering feels alienated and alone. A person with an eating disorder may feel that it is impossible to openly express his or her feelings. As a result, feelings of depression may worsen the effects of an eating disorder, making it difficult to break the cycle of disordered eating.
With counseling and support, it is possible to combat these negative feelings and prevent them from progressing over time. Psychotherapy, especially cognitive behavioral therapy and other “talk” therapies, can help ease feelings of depression, which in turn gives a person better tools with which to fight an eating disorder.
Obsessions are constant thoughts that produce anxiety and stress. Compulsions are irrational behaviors that are repeated to reduce anxiety and stress. People with eating disorders are constantly thinking about food, calories, eating, and weight. As a result, they show signs of obsessive-compulsive behavior. When people with eating disorders also show signs of obsessive-compulsive behavior with activities and things not related to food and weight, they may be diagnosed with obsessive-compulsive disorder (OCD).
Some obsessive-compulsive behaviors practiced by eating disorder sufferers include storing large amounts of food, collecting recipes, weighing themselves several times a day, and thinking constantly about the food they feel they should not eat. These obsessive thoughts and rituals worsen when the body is regularly deprived of food. Being in a state of starvation causes people to become so preoccupied with everything they have denied themselves that they think of little else.
Feelings of Anxiety, Guilt, and Shame
Everyone experiences feelings of anxiety (fear and worry), guilt, and shame at some time; however, these
feelings become more intense with the onset of an eating disorder. Eating disorder sufferers fear that others will discover their illness. There is also a tremendous fear of gaining weight.
As the eating disorder progresses, body image becomes more distorted, and the eating disorder becomes all-consuming. Some sufferers are often terrified of letting go of the illness, which causes many to protect their secret eating disorder even more.
Eating disorder sufferers have a strong need to control their environment and will avoid social situations where they may have to be around food in front of other people or where they may have to change their
behavior. The anxiety that results causes people with eating disorders to be inflexible and rigid with their emotions.
Bulimics and binge eaters, specifically, experience guilt and shame about their disorders. This is mainly because, unlike anorexics, they are not usually in denial, and they do realize that there is a problem. Bulimics will feel anxiety before, during, and after a binge and can only relieve this anxiety through purging. Purging, however, brings on overwhelming feelings of guilt and shame. Binge eaters also feel anxiety during a binge, but because they do not purge, they feel ashamed over their lack of control around food.
Eating Disorders and Other Destructive Behaviors
It is common for people with eating disorders also to struggle with drug and/or alcohol addiction. In fact, research shows that one-third of bulimics have a substance-abuse problem, particularly with stimulants (drugs that excite the nervous system) and alcohol. This may stem from the fact that people with eating disorders have difficulty coping with their emotions and use negative means, such as drugs, to mask their problems. Drugs and alcohol provide temporary escapes from reality but, similar to eating disorders, can progress into serious problems that require treatment to overcome.
Eating Disorders and Sexuality
Eating disorders often develop around puberty, when the body is changing and maturing. This time of change can produce anxiety and confusion for both boys and girls because puberty is the beginning of sexual maturity. Girls develop breasts, start menstruating, grow taller, and develop more body hair. Boys' sexual organs (the penis and testicles) grow. Boys also grow taller, get more body and facial hair, and develop bigger muscles.
The sexual feelings that accompany puberty are new, and these feelings may embarrass some young people. When someone is suffering from an eating disorder, issues surrounding sexuality can become even more complicated. Some people may seek out sexual relationships to feel close to someone and ease feelings of isolation. Others may avoid sexual relationships altogether because they feel ashamed of their bodies.
In some cases, an eating disorder is triggered by sexual abuse. In these instances, an eating disorder sufferer is usually acting out in response to
a painful event. She may gain or lose weight in an attempt to make herself sexually undesirable. She may avoid sexual relations as a way to take control of her body and prevent painful feelings from resurfacing. The anger and distrust felt toward the opposite sex may result in complete rejection of the opposite sex. On the other hand, some eating disorder sufferers may have many sexual partners in an attempt to erase the past and gain acceptance from the opposite sex.
Treatment and Recovery from Eating Disorders
Treatment and recovery go hand in hand. It is very hard to recover from an eating disorder without any treatment. Recovery is a long process, and some eating disorder sufferers may have to enter treatment more than once. Some people may even try different kinds of treatment programs during their recovery until they find one that works for them.
There may be obstacles to starting treatment. The fear of becoming fat and losing control, which drives most eating disorders, is very strong and hard to eliminate. Also, eating disorder sufferers may be in denial about their condition and may be unwilling to consider treatment. These feelings may be based on a fear of letting go of the illness that they feel is part of their identity. Eating disorder sufferers must learn to refocus their thoughts from food and weight to their emotions so that they can deal with the root cause of the disorder. Since many feelings that need to be addressed have been buried by the disorder, professional counseling is important for a successful recovery.
In order for treatment to work, a person must be ready to be treated. Some sufferers may even say they are ready but really are not. They may pretend to change their attitude about food, but they are still starving
themselves or bingeing and purging their food secretively. When people do not fully commit to a treatment program, they will most likely continue suffering from the deadly illness even after completion of the program.
Treatment usually begins with an assessment by a physician or mental health counselor. Depending on the severity of the eating disorder, the sufferer will either enter an inpatient or outpatient program. Inpatient programs, or hospitalization, are for the most severe cases. To be hospitalized, the sufferer is usually at a critical point in the illness where his or her life is in danger or at risk because of strong suicidal thoughts. Outpatient programs are conducted at a facility or doctor's office that the patient visits while still living at home.
Whether the program is inpatient or outpatient, it will usually include various forms of counseling and medical care to treat the physical effects of the illness. The most common forms of counseling include nutrition, individual, family, and group. Nutrition counseling teaches the patient about healthy eating habits and designs appropriate meals. Its goal is to slowly bring the sufferer's weight back up to a safe level that can be easily maintained without dieting or provoking obsessive behavior about food.
Cognitive-behavioral therapy (CBT) teaches people how to monitor their eating and change unhealthy eating habits. It also teaches them how to change the way they respond to stressful situations. Interpersonal psychotherapy (IPT) helps people look at their relationships with friends and family and make changes to resolve problems. Group therapy has been found helpful for bulimics, who are relieved to find that they are not alone or unique in their eating behavior.
A combination of behavioral therapy and family systems therapy is often effective with anorexics. Family therapy considers the family as the unit of treatment and focuses on relationships and communication patterns within the family rather than on the personality traits or symptoms displayed by individual family members. Problems are addressed by changing how the family works and responds to problems rather than by trying to change an individual family member. People with eating disorders who also suffer from depression sometimes benefit from medications to help relieve symptoms of depression and anxiety.
Group therapy has been found helpful for bulimics, who are relieved to find that they are not alone or unique in their eating behavior.
In support groups, eating disorder sufferers meet to offer support, understanding, and hope to one another as they battle their disorders. Support groups, like group counseling, help sufferers to not feel so alone in their illnesses and learn from others' experiences.
The Recovery Process
Recovery is not easy. With treatment, which can take months to years, about one-third of people with eating disorders recover, one-third vary between recovery and relapse, and the remaining third do not recover. To recover fully, people with eating disorders need to build their self-esteem so that they can believe that they deserve the love of others. Some people are able to make an initial recovery, but many find recovery to be an ongoing, lifelong process.
An eating disorder sufferer has certain goals, both physical and psychological, that he or she needs to try to reach in recovery. The physical aims should include the ability to eat a variety of healthful foods (without bingeing and purging) and maintain a healthy weight. Females should start their menstrual periods either for the first time or again without the help of medication.
The psychological aims of recovery should include a noticeable decrease in the fear of food and becoming fat as well as the ability to establish strong relationships with family and friends again. Another goal is to realize the role society and the media play in furthering disordered thinking about people's weights and body shapes. This realization can help sufferers learn to accept their bodies without having to live up to unrealistic standards of beauty and thinness. An eating disorder sufferer also must learn and practice positive coping skills and engage in activities that do not involve food or weight control.
Preventing Eating Disorders
Many eating disorder organizations focus on prevention—stopping eating disorders before they even start. The belief is that awareness and
education can go a long way in preventing these painful disorders, which can become lifelong struggles. Many eating disorder experts promote teaching prevention at a young age since eating disorders usually begin in adolescence.
Prevention programs aim to provide people with the tools they need to cope with the problems that may contribute to an eating disorder.
- reordering thoughts on food and weight
- focusing on health
- understanding the dangers of dieting
- developing a positive body image
- rebelling against cultural and media messages that encourage unhealthy behaviors
- explaining why fat is not the enemy
- helping to end fat discrimination
Reordering Thoughts about Food and Weight
The first step in preventing the development of eating disorders is to reorder feelings and thoughts about food and weight. Eating disorder experts recommend that people reject unhealthy messages about weight, body shape, and diet. Since body shape and weight are determined mostly by genetics, there is only so much a person can do to control or change weight and body shape. Trying to fight against or change the body's set point (the weight at which one's body naturally falls) is unhealthy and possibly dangerous because it creates a cycle of yo-yo dieting. Research has shown that while not every diet leads to eating disorders, 80 percent of eating disorders are initially triggered by dieting.
Developing a Positive Body Image
Developing a positive body image is necessary to the prevention of eating disorders. Many people struggle with this issue and must work hard at accepting their bodies. Eating disorder experts emphasize the importance of exercising for health reasons rather than to burn calories and lose weight. The same experts also recommend becoming politically active in the fight against unhealthy cultural messages because this fight can be a source of positive feelings and empowerment.
Other suggestions include:
- Avoid negative talk about food and weight.
- Avoid referring to foods as “good” or “bad.”
- Don't participate in weight-loss programs or experiment with weight-loss products.
- Exercise moderately; don't engage in unhealthy or excessive exercise programs.
- Talk about body-image issues with close friends and family.
- Don't criticize people for gaining weight.
- Don't compliment people for losing weight.
- Encourage family and friends to question societal and cultural attitudes about weight and body shape.
For More Information
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