Addiction Myths That Are Hard To Quit
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Which Addiction-Quitting Methods Work Best?
In Tuesday’s newsletter we asked you what, in your opinion, is the best way to cure an addiction. We got the above-depicted, below-described, interesting distribution of responses:
- About 29% said: “Addiction cannot be cured; once an addict, always an addict”
- About 26% said “Cold turkey (stop 100% and don’t look back)”
- About 17% said “Gradually reduce usage over an extended period of time”
- About 11% said “A healthier, but somewhat like-for-like, substitution”
- About 9% said “Therapy (whether mainstream, like CBT, or alternative, like hypnosis)”
- About 6% said “Peer support programs and/or community efforts (e.g. church etc)”
- About 3% said “Another method (mention it in the comment field)” and then did not mention it in the comment field
So what does the science say?
Addiction cannot be cured; once an addict, always an addict: True or False?
False, which some of the people who voted for it seemed to know, as some went on to add in the comment field what they thought was the best way to overcome the addiction.
The widespread belief that “once an addict, always an addict” is a “popular truism” in the same sense as “once a cheater, always a cheater”. It’s an observation of behavioral probability phrased as a strong generalization, but it’s not actually any kind of special unbreakable law of the universe.
And, certainly the notion that one cannot be cured keeps membership in many 12-step programs and similar going—because if you’re never cured, then you need to stick around.
However…
❝What is the definition of addiction?
Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.
Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.❞
~ American Society of Addiction Medicine
Or if we want peer-reviewed source science, rather than appeal to mere authority as above, then:
❝What is drug addiction?
Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drugs.
Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of an organ in the body, both have serious harmful effects, and both are, in many cases, preventable and treatable.❞
~ Nora D. Volkow (Director, National Institute of Drug Abuse)
Read more: Drugs, Brains, and Behavior: The Science of Addiction
In short: part of the definition of addiction is the continued use; if the effects of the substance are no longer active in your physiology, and you are no longer using, then you are not addicted.
Just because you would probably become addicted again if you used again does not make you addicted when neither the substance nor its after-effects are remaining in your body. Otherwise, we could define all people as addicted to all things based on “well if they use in the future they will probably become addicted”.
This means: the effects of addiction can and often will last for long after cessation of use, but ultimately, addiction can be treated and cured.
(yes, you should still abstain from the thing to which you were formerly addicted though, or you indeed most probably will become addicted again)
Cold turkey is best: True or False?
True if and only if certain conditions are met, and then only for certain addictions. For all other situations… False.
To decide whether cold turkey is a safe approach (before even considering “effective”), the first thing to check is how dangerous the withdrawal symptoms are. In some cases (e.g. alcohol, cocaine, heroin, and others), the withdrawal symptoms can kill.
That doesn’t mean they will kill, so knowing (or being!) someone who quit this way does not refute this science by counterexample. The mortality rates that we saw while researching varied from 8% to 37%, so most people did not die, but do you really want (yourself or a loved one) to play those odds unnecessarily?
See also: Detoxification and Substance Abuse Treatment
Even in those cases where it is considered completely safe for most people to quit cold turkey, such as smoking, it is only effective when the quitter has appropriate reliable medical support, e.g.
- Without support: 3–5% success rate
- With support: 22% success rate
And yes, that 22% was for the “abrupt cessation” group; the “gradual cessation” group had a success rate of 15.5%. On which note…
Gradual reduction is the best approach: True or False?
False based on the above data, in the case of addictions where abrupt cessation is safe. True in other cases where abrupt cessation is not safe.
Because if you quit abruptly and then die from the withdrawal symptoms, then well, technically you did stay off the substance for the rest of your life, but we can’t really claim that as a success!
A healthier, but somewhat like-for-like substitution is best: True or False?
True where such is possible!
This is why, for example, medical institutions recommend the use of buprenorphine (e.g. Naloxone) in the case of opioid addiction. It’s a partial opioid receptor agonist, meaning it does some of the job of opioids, while being less dangerous:
It’s also why vaping—despite itself being a health hazard—is recommended as a method of quitting smoking:
Similarly, “zero alcohol drinks that seem like alcohol” are a popular way to stop drinking alcohol, alongside other methods:
This is also why it’s recommended that if you have multiple addictions, to quit one thing at a time, unless for example multiple doctors are telling you otherwise for some specific-to-your-situation reason.
Take care!
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This Chair Rocks: A Manifesto Against Ageism – by Ashton Applewhite
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It’s easy to think of ageism as being 80% “nobody will hire me because I am three years away from standard retirement age”, but it’s a lot more pervasive than that. And some of it, perhaps the most insidious, is the ageism that we can sometimes internalize without thinking it through.
10almonds readers love to avoid/reverse aging (and this reviewer is no different!), but it’s good once in a while to consider our priorities and motivations, for example:
- There is merit in being able to live without disability or discomfort
- There is harm in feeling a need to pass for younger than we are
And yet, even things such as disabilities are, Applewhite fairly argues, not to be feared. Absolutely avoided if reasonably possible of course, yes, but if they happen they happen and it’s good that we be able to make our peace with that, because most people have at least some kind of disability before the end, and can still strive to make the most of the precious gift that is life. The goal can and should be to play the hand we’re dealt and to live as well as we can—whatever that latter means for us personally.
Many people’s life satisfaction goes up in later years, and Applewhite hypothesizes that while some of that can be put down to circumstances (often no longer overwhelmed with work etc, often more financially stable), a lot is a matter of having come to terms with “losing” youth and no longer having that fear. Thus, a new, freer age of life begins.
The book does cover many other areas too, more than we can list here (but for example: ranging from pro/con brain differences to sex and intimacy), and the idea that long life is a team sport, and that we should not fall into the all-American trap of putting independence on a pedestal. Reports of how aging works with close-knit communities in the supercentenarian Blue Zones can be considered to quash this quite nicely, for instance.
The style is casual and entertaining, and yet peppered with scholarly citations, which stack up to 30 pages of references at the back.
Bottom line: getting older is a privilege that not everyone gets to have, so who are we to squander it? This book shares a vital sense of perspective, and is a call-to-arms for us all to do better, together.
Click here to check out This Chair Rocks, and indeed rock it!
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Eat It! – by Jordan Syatt and Michael Vacanti
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One of the biggest challenges we often face when undertaking diet and exercise regimes, is the “regime” part. Day one is inspiring, day two is exciting… Day seventeen when one has a headache and some kitchen appliance just broke and one’s preferred exercise gear is in the wash… Not so much.
Authors Jordan Syatt and Michael Vacanti, therefore, have taken it upon themselves to bring sustainability to us.
Their main premise is simplicity, but simplicity that works. For example:
- Having a daily calorie limit, but being ok with guesstimating
- Weighing regularly, but not worrying about fluctuations (just trends!)
- Eating what you like, but prioritizing some foods over others
- Focusing on resistance training, but accessible exercises that work the whole body, instead of “and then 3 sets of 12 reps of these in 6-4-2 progression to exhaustion of the anterior sternocleidomastoid muscle”
The writing style is simple and clear too, without skimping on the science where science helps explain why something works a certain way.
Bottom line: this one’s for anyone who would like a strong healthy body, without doing the equivalent of a degree in anatomy and physiology along the way.
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Hormones & Health, Beyond The Obvious
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Wholesome Health
This is Dr. Sara Gottfried, who some decades ago got her MD from Harvard and specialized as an OB/GYN at MIT. She’s since then spent the more recent part of her career educating people (mostly: women) about hormonal health, precision, functional, & integrative medicine, and the importance of lifestyle medicine in general.
What does she want us to know?
Beyond “bikini zone health”
Dr. Gottfried urges us to pay attention to our whole health, in context.
“Women’s health” is often thought of as what lies beneath a bikini, and if it’s not in those places, then we can basically treat a woman like a man.
And that’s often not actually true—because hormones affect every living cell in our body, and as a result, while prepubescent girls and postmenopausal women (specifically, those who are not on HRT) may share a few more similarities with boys and men of similar respective ages, for most people at most ages, men and women are by default quite different metabolically—which is what counts for a lot of diseases! And note, that difference is not just “faster” or “slower””, but is often very different in manner also.
That’s why, even in cases where incidence of disease is approximately similar in men and women when other factors are controlled for (age, lifestyle, medical history, etc), the disease course and response to treatment may vary considerable. For a strong example of this, see for example:
- The well-known: Heart Attack: His & Hers ← most people know these differences exist, but it’s always good to brush up on what they actually are
- The less-known: Statins: His & Hers ← most people don’t know these differences exist, and it pays to know, especially if you are a woman or care about one
Nor are brains exempt from his…
The female brain (kinda)
While the notion of an anatomically different brain for men and women has long since been thrown out as unscientific phrenology, and the idea of a genetically different brain is… Well, it’s an unreliable indicator, because technically the cells will have DNA and that DNA will usually (but not always; there are other options) have XX or XY chromosomes, which will usually (but again, not always) match apparent sex (in about 1/2000 cases there’s a mismatch, which is more common than, say, red hair; sometimes people find out about a chromosomal mismatch only later in life when getting a DNA test for some unrelated reason), and in any case, even for most of us, the chromosomal differences don’t count for much outside of antenatal development (telling the default genital materials which genitals to develop into, though this too can get diverted, per many intersex possibilities, which is also a lot more common than people think) or chromosome-specific conditions like colorblindness…
The notion of a hormonally different brain is, in contrast to all of the above, a reliable and easily verifiable thing.
See for example:
Alzheimer’s Sex Differences May Not Be What They Appear
Dr. Gottfried urges us to take the above seriously!
Because, if women get Alzheimer’s much more commonly than men, and the disease progresses much more quickly in women than men, but that’s based on postmenopausal women not on HRT, then that’s saying “Women, without women’s usual hormones, don’t do so well as men with men’s usual hormones”.
She does, by the way, advocate for bioidentical HRT for menopausal women, unless contraindicated for some important reason that your doctor/endocrinologist knows about. See also:
Menopausal HRT: A Tale Of Two Approaches (Bioidentical vs Animal)
The other very relevant hormone
…that Dr. Gottfried wants us to pay attention to is insulin.
Or rather, its scrubbing enzyme, the prosaically-named “insulin-degrading enzyme”, but it doesn’t only scrub insulin. It also scrubs amyloid beta—yes, the same that produces the amyloid beta plaques in the brain associated with Alzheimer’s. And, there’s only so much insulin-degrading enzyme to go around, and if it’s all busy breaking down excess insulin, there’s not enough left to do the other job too, and thus can’t break down amyloid beta.
In other words: to fight neurodegeneration, keep your blood sugars healthy.
This may actually work by multiple mechanisms besides the amyloid hypothesis, by the way:
The Surprising Link Between Type 2 Diabetes & Alzheimer’s
Want more from Dr. Gottfried?
You might like this interview with Dr. Gottfried by Dr. Benson at the IMCJ:
Integrative Medicine: A Clinician’s Journal | Conversations with Sara Gottfried, MD
…in which she discusses some of the things we talked about today, and also about her shift from a pharmaceutical-heavy approach to a predominantly lifestyle medicine approach.
Enjoy!
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Gut-Positive Pot Noodles
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Everything we consume either improves our health a little or worsens it. Pot noodles aren’t generally the healthiest foods, but these ones sure are! There’s quite a range of fiber in this, including the soluble fiber of the noodles themselves (which are, in fact, mostly fiber and water). As a bonus, the glucomannan in the noodles promotes feelings of fullness, notwithstanding its negligible carb count. Of course, the protein in the edamame beans also counts for satiety!
You will need
- ½ cup konjac noodles (also called shirataki), tossed in 1 tsp avocado oil (or sesame oil, if you don’t have avocado)
- 2 oz mangetout, thinly sliced
- 1 oz edamame beans
- ¼ carrot, grated
- 2 baby sweetcorn, cut in half lengthways
- 1 scallion, finely diced
- 1 heaped tsp crunchy peanut butter (omit if allergic)
- 1 tsp miso paste
- 1 tsp chili oil
- 1 tsp black pepper, coarse ground
- 1 tsp peeled-and-grated ginger
Method
(we suggest you read everything at least once before doing anything)
1) Layer a heat-resistant jar (mason jars are usually quite resistant to temperature changes) with the noodles and vegetables.
2) Combine the peanut butter, miso paste, and chili oil, black pepper, and ginger in a small bowl. Pour this dressing over the layered vegetables and noodles, and screw the lid on. Refrigerate until needed.
3) Add hot water to the jar and stir, to serve. If you prefer the vegetables to be more cooked, you can microwave (without the lid!) for a minute or two.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Making Friends With Your Gut (You Can Thank Us Later)
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- 10 Ways To Balance Blood Sugars ← today’s recipe makes a perfect high-fiber, low-carb starter, per the hacks here
- Capsaicin For Weight Loss And Against Inflammation
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Ginger Does A Lot More Than You Think
Take care!
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Calm Your Mind with Food – by Dr. Uma Naidoo
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From the author of This Is Your Brain On Food, the psychiatrist-chef (literally, she is a Harvard-trained psychiatrist and an award-winning chef) is back with a more specific work, this time aimed squarely at what it says in the title; how to calm your mind with food.
You may be wondering: does this mean comfort-eating? And, well, not in the sense that term’s usually used. There will be eating and comfort will occur, but the process involves an abundance of nutrients, a minimization of health-deleterious ingredients, and a “for every chemical its task” approach. In other words, very much “nutraceuticals”, as our diet.
On which note: as we’ve come to expect from Dr. Naidoo, we see a lot of hard science presented simply and clearly, with neither undue sensationalization nor unnecessary jargon. We learn about the brain, the gut, relevant biology and chemistry, and build up from understanding ingredients to dietary patterns to having a whole meal plan, complete with recipes.
You may further be wondering: how much does it add that we couldn’t get from the previous book? And the answer is, not necessarily a huge amount, especially if you’re fairly comfortable taking ideas and creating your own path forwards using them. If, on the other hand, you’re a little anxious about doing that (as someone perusing this book may well be), then Dr. Naidoo will cheerfully lead you by the hand through what you need to know and do.
Bottom line: if not being compared to her previous book, this is a great standalone book with a lot of very valuable content. However, the previous book is a tough act to follow! So… All in all we’d recommend this more to people who want to indeed “calm your mind with food”, who haven’t read the other book, as this one will be more specialized for you.
Click here to check out Calm Your Mind With Food, and do just that!
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Quit Drinking – by Rebecca Dolton
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Many “quit drinking” books focus on tips you’ve heard already—cut down like this, rearrange your habits like that, make yourself accountable like so, add a reward element this way, etc.
Dolton takes a different approach.
She focuses instead on the underlying processes of addiction, so as to not merely understand them to fight them, but also to use them against the addiction itself.
This is not just a social or behavioral analysis, by the way, and goes into some detail into the physiological factors of the addiction—including such things as the little-talked about relationship between addiction and gut flora. Candida albans, found in most if not all humans to some extent, gets really out of control when given certain kinds of sugars (including those from alcohol); it grows, eventually puts roots through the intestinal walls (ouch!) and the more it grows, the more it demands the sugars it craves, so the more you feed it.
Quite a motivator to not listen to such cravings! It’s not even you that wants it, it’s the Candida!
Anyway, that’s just one example; there are many. The point here is that this is a well-researched, well-written book that sets itself apart from many of its genre.
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