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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Make Time – by Jake Knapp and John Zeratzky
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We live in an information-saturated world, and we have done for so long now that it’s easy to forget: we did not evolve for this!
It’s easy to say “unplug”, but the reality is:
We also have to actually function in this fast-paced info-dense world whether we want to or not, and we are expected to be able to handle it.
So… How?
Appropriately enough, authors Knapp and Zeratsky present the answer in a skimmer-friendly fashion, with summaries and bullet points and diagrams and emboldened text forease of speed-reading. Who uses such tricks?!
In short, less living life in “default mode scramble” and more about making an impact in the ways you actually want to, for you.
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Gut Health and Anxiety
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I’d like to read articles on gut health and anxiety❞
We hope you caught yesterday’s edition of 10almonds, which touched on both of those! Other past editions you might like include:
We’ll be sure to include more going forward, too!
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Why do women get ‘reassurance scans’ during pregnancy? And how can you spot a dodgy provider?
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Recent media coverage in the Nine newspapers highlights a surge in non-medical ultrasound providers offering “reassurance ultrasounds” to expectant parents.
The service has resulted in serious harms, such as misdiagnosed ectopic pregnancies and undetected fetal abnormalities, according to the reports.
So why do some women choose additional ultrasounds? And how can you tell if you should trust the person providing your ultrasound?
Shutterstock What are reassurance scans?
Reassurance scans are a type of non-medical elective or “entertainment” ultrasound some women seek in addition to their routine first- and second-trimester scans.
Reassurance scans are marketed as a way to “give you peace of mind” about your baby’s development, or to assure you “everything is progressing as it should” if you’re not due for a routine scan.
They’re also called souvenir, boutique or keepsake ultrasounds, because these business typically sell memento packages. These often include so-called 4D images: renderings combined with the fourth dimension of time to show movement.
Some businesses offer gender identification information, sometimes with “gender-reveal” party accessories, as well as audio recordings of the fetal heartbeat.
Why do women get them?
Detailed interview studies have explored why ultrasound images beyond the routine scans are so popular.
Many expecting parents want to learn the fetal sex as early as possible, seek reassurance, see the facial features of their future child and acquire keepsake images.
Others find the routine scans too rushed and impersonal, turning to commercial providers as a more ceremonious and fulfilling ritual.
Some women feel rushed during routine scans. Jordi Mora/Shutterstock Health sociologists have emphasised the positive health impacts of non-medical ultrasound, which can help expecting mothers and fathers bond with their baby.
Some feminists in the 20th century criticised the medicalisation of pregnancy for devaluing “lived experience”. But recent feminist accounts have re-framed non-medical scans as a way for women to get health care that goes beyond clinical utility.
Rather than trivialising the “entertainment” value of these services, some argue obstetricians could learn from the service, thus improving patient satisfaction during obstetric imaging.
What are the risks of these services?
In recent years, the technology to provide detailed scans has become more portable, with handheld, smartphone-compatible ultrasound devices now available.
This, along with the normalisation of sharing ultrasound images on social media, has likely led to more commercial businesses offering these services.
Yet the service is considered fraught with unmanageable psychological and social risk. Providers are usually not trained to counsel mothers or families should a fetal anomaly be suspected.
Professional organisations have denounced these businesses for misleading consumers with false reassurances. As these scans aren’t checked by a clinician, these operators cannot give reliable assurances.
The World Federation for Ultrasound in Medicine and Biology and similar bodies disapprove of souvenir ultrasounds on safety grounds. So too does the Australian Sonographers Association, which represents about 70% of sonographers.
No substantive restrictions on ultrasound devices
Australia’s Therapeutic Goods Administration regulates the supply of medical devices. It registers them, classifies them according to their risk and sometimes attaches conditions to their use.
However, some portable ultrasound scanners approved as low-risk devices carry no specific conditions. Lay consumers could theoretically purchase them, including through the personal importation scheme.
Last year, the TGA de-registered several handheld devices used to detect fetal heartbeats during pregnancy without health practitioner supervision.
The decision followed a post-market review that found expectant parents had been falsely reassured by the devices themselves or by untrained people using them in home settings.
However, no such review has been conducted for portable ultrasound devices.
While removing devices from the register in this manner may limit consumer access, it is not a “product recall” and would not prevent the continued sale of second-hand devices.
These days it’s normal to share ultrasound images on social media. fizkes/Shutterstock Who can perform ultrasounds?
While some specialist health practitioners may perform ultrasounds (such as obstetricians holding a relevant certificate), most diagnostic imaging specialists are sonographers.
To perform medical ultrasounds that are eligible for a Medicare rebate, sonographers must be trained and accredited.
But there is no sonography registration board to receive complaints about sonographers or take disciplinary action against them. This sets sonographers apart from registered health practitioners such as doctors, nurses and pharmacists.
The Australian Sonographers Association has argued sonographers should be regulated by a registration board.
This could make sonographers more clearly identifiable through title protections, ensure poorly performing sonographers are disciplined and allow for consistent national standards.
However, it would not stop unregistered people from providing non-medical ultrasounds.
So how can you tell if your provider is a sonographer?
One clear signal that a provider is offering a non-diagnostic ultrasound is that no Medicare subsidy is on offer.
Australian providers conducting imaging without accreditation must inform consumers of their non-accredited status and confirm no Medicare benefit is payable.
Not doing so would amount to an offence.
How can you report a dodgy provider?
You can make complaints to state-based health complaints bodies. The Health Care Complaints Commission in New South Wales, for example, can investigate complaints about sonographers as non-registered health practitioners and consider the relevant code of conduct.
When a sonographer is found to have acted improperly, or to pose a health or safety risk, these complaints bodies may issue orders prohibiting the sonographer from providing any health services for a specified period.
Australian consumer law is another way authorities may crack down on unscrupulous providers. In 2015, a person was prosecuted in Western Australia after selling identical images to six women who received non-medical ultrasounds in their homes.
Her offences involved making false or misleading claims and accepting money for services not provided.
If non-medical imaging providers make misleading claims, including about the level of clinical reassurance a non-diagnostic scan can provide, you can report them to the Australian Consumer and Competition Commission.
Christopher Rudge, Law lecturer, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Vegan Eager for Milk Alternatives
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It’s Q&A Day at 10almonds!
Q: Thanks for the info about dairy. As a vegan, I look forward to a future comment about milk alternatives
Thanks for bringing it up! What we research and write about is heavily driven by subscriber feedback, so notes like this really help us know there’s an audience for a given topic!
We’ll do a main feature on it, to do it justice. Watch out for Research Review Monday!
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Don’t Do *This* If You’re Over 50 (And Want Better Sleep)
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Dr. Michael Breus, sleep specialist, explains:
Don’t make these mistakes
Dr. Breus recommends avoiding…
- Misusing magnesium: magnesium is a helpful sleep aid but must be carefully monitored. Recommended doses are 250mg for women and 300–350 mg for men, with slight adjustments for hot climates or active lifestyles. Overdosing can cause stomach issues, diarrhea, and dehydration, disrupting sleep. He recommends starting with magnesium glycinate for fewer stomach issues, and later mix with magnesium citrate. Always check supplements to avoid excessive magnesium intake.
- Misusing melatonin: melatonin production declines after age 55–60, making low-dose supplementation (0.5–1 mg) beneficial. He recommends, however, avoiding high doses (3–10mg), and he recommends to take it 90 minutes before bedtime. Melatonin interacts with some medications (including some meds for blood pressure or depression), so consult a pharmacist before use to avoid risks like serotonin syndrome.
- Going to bed too early: going to bed too early disrupts circadian rhythms and reduces sleep drive, causing earlier waking. Now, being an “early bird” is a generally healthy thing, but if you’re already getting up at 5am, say, you probably want your schedule to not continue to creep further forwards until you become nocturnal. Set a consistent wake-up time and count 7.5 hours backward (plus a set time to fall asleep, e.g. 20 minutes, but you’ll know what it is for you) to determine bedtime.
- Excessive caffeine consumption: from the heading, it may seem like a no-brainer, but older adults metabolize caffeine 33% slower on average, prolonging its effects. Dr. Breus recommends to reduce intake with “caffeine fading,” switching to half-caffeinated coffee for a while and then considering transitioning to decaf. He also suggests enjoying increasingly lower-caffeine teas, like black tea in the morning, matcha in the afternoon, and herbal tea at night to reduce caffeine’s impact on sleep.
- Falling foul of serotonin: avoid taking 5-HTP supplements with SSRI antidepressants like Prozac or Zoloft due to the risk of serotonin syndrome.
- Consider checking for physical problems: if you regularly wake up tired and/or groggy (despite having ostensibly had enough sleep, and there not being a pharmaceutical explanation for your grogginess), consider screening for sleep apnea. Home sleep tests are a convenient way to identify and treat this common but often undiagnosed condition.
For more on each of these, enjoy:
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Want to learn more?
You might also like:
How to Fall Asleep Faster: CBT-Insomnia Treatment
Take care!
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Yes, adults can develop food allergies. Here are 4 types you need to know about
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If you didn’t have food allergies as a child, is it possible to develop them as an adult? The short answer is yes. But the reasons why are much more complicated.
Preschoolers are about four times more likely to have a food allergy than adults and are more likely to grow out of it as they get older.
It’s hard to get accurate figures on adult food allergy prevalence. The Australian National Allergy Council reports one in 50 adults have food allergies. But a US survey suggested as many as one in ten adults were allergic to at least one food, with some developing allergies in adulthood.
What is a food allergy
Food allergies are immune reactions involving immunoglobulin E (IgE) – an antibody that’s central to triggering allergic responses. These are known as “IgE-mediated food allergies”.
Food allergy symptoms that are not mediated by IgE are usually delayed reactions and called food intolerances or hypersensitivity.
Food allergy symptoms can include hives, swelling, difficulty swallowing, vomiting, throat or chest tightening, trouble breathing, chest pain, rapid heart rate, dizziness, low blood pressure or anaphylaxis.
Symptoms include hives. wisely/Shutterstock IgE-mediated food allergies can be life threatening, so all adults need an action management plan developed in consultation with their medical team.
Here are four IgE-mediated food allergies that can occur in adults – from relatively common ones to rare allergies you’ve probably never heard of.
1. Single food allergies
The most common IgE-mediated food allergies in adults in a US survey were to:
- shellfish (2.9%)
- cow’s milk (1.9%)
- peanut (1.8%)
- tree nuts (1.2%)
- fin fish (0.9%) like barramundi, snapper, salmon, cod and perch.
In these adults, about 45% reported reacting to multiple foods.
This compares to most common childhood food allergies: cow’s milk, egg, peanut and soy.
Overall, adult food allergy prevalence appears to be increasing. Compared to older surveys published in 2003 and 2004, peanut allergy prevalence has increased about three-fold (from 0.6%), while tree nuts and fin fish roughly doubled (from 0.5% each), with shellfish similar (2.5%).
While new adult-onset food allergies are increasing, childhood-onset food allergies are also more likely to be retained into adulthood. Possible reasons for both include low vitamin D status, lack of immune system challenges due to being overly “clean”, heightened sensitisation due to allergen avoidance, and more frequent antibiotic use.
Some adults develop allergies to cow’s milk, while others retain their allergy from childhood. Sarah Swinton/Unsplash 2. Tick-meat allergy
Tick-meat allergy, also called α-Gal syndrome or mammalian meat allergy, is an allergic reaction to galactose-alpha-1,3-galactose, or α-Gal for short.
Australian immunologists first reported links between α-Gal syndrome and tick bites in 2009, with cases also reported in the United States, Japan, Europe and South Africa. The US Centers for Disease Control estimates about 450,000 Americans could be affected.
The α-Gal contains a carbohydrate molecule that is bound to a protein molecule in mammals.
The IgE-mediated allergy is triggered after repeated bites from ticks or chigger mites that have bitten those mammals. When tick saliva crosses into your body through the bite, antibodies to α-Gal are produced.
When you subsequently eat foods that contain α-Gal, the allergy is triggered. These triggering foods include meat (lamb, beef, pork, rabbit, kangaroo), dairy products (yoghurt, cheese, ice-cream, cream), animal-origin gelatin added to gummy foods (jelly, lollies, marshmallow), prescription medications and over-the counter supplements containing gelatin (some antibiotics, vitamins and other supplements).
Tick-meat allergy reactions can be hard to recognise because they’re usually delayed, and they can be severe and include anaphylaxis. Allergy organisations produce management guidelines, so always discuss management with your doctor.
3. Fruit-pollen allergy
Fruit-pollen allergy, called pollen food allergy syndrome, is an IgE-mediated allergic reaction.
In susceptible adults, pollen in the air provokes the production of IgE antibodies to antigens in the pollen, but these antigens are similar to ones found in some fruits, vegetables and herbs. The problem is that eating those plants triggers an allergic reaction.
The most allergenic tree pollens are from birch, cypress, Japanese cedar, latex, grass, and ragweed. Their pollen can cross-react with fruit and vegetables, including kiwi, banana, mango, avocado, grapes, celery, carrot and potato, and some herbs such as caraway, coriander, fennel, pepper and paprika.
Fruit-pollen allergy is not common. Prevalence estimates are between 0.03% and 8% depending on the country, but it can be life-threatening. Reactions range from itching or tingling of lips, mouth, tongue and throat, called oral allergy syndrome, to mild hives, to anaphylaxis.
4. Food-dependent, exercise-induced food allergy
During heavy exercise, the stomach produces less acid than usual and gut permeability increases, meaning that small molecules in your gut are more likely to escape across the membrane into your blood. These include food molecules that trigger an IgE reaction.
If the person already has IgE antibodies to the foods eaten before exercise, then the risk of triggering food allergy reactions is increased. This allergy is called food-dependent exercise-induced allergy, with symptoms ranging from hives and swelling, to difficulty breathing and anaphylaxis.
This type of allergy is extremely rare. Ben O’Sullivan/Unsplash Common trigger foods include wheat, seafood, meat, poultry, egg, milk, nuts, grapes, celery and other foods, which could have been eaten many hours before exercising.
To complicate things even further, allergic reactions can occur at lower levels of trigger-food exposure, and be more severe if the person is simultaneously taking non-steroidal inflammatory medications like aspirin, drinking alcohol or is sleep-deprived.
Food-dependent exercise-induced allergy is extremely rare. Surveys have estimated prevalence as between one to 17 cases per 1,000 people worldwide with the highest prevalence between the teenage years to age 35. Those affected often have other allergic conditions such as hay fever, asthma, allergic conjunctivitis and dermatitis.
Allergies are a growing burden
The burden on physical health, psychological health and health costs due to food allergy is increasing. In the US, this financial burden was estimated as $24 billion per year.
Adult food allergy needs to be taken seriously and those with severe symptoms should wear a medical information bracelet or chain and carry an adrenaline auto-injector pen. Concerningly, surveys suggest only about one in four adults with food allergy have an adrenaline pen.
If you have an IgE-mediated food allergy, discuss your management plan with your doctor. You can also find more information at Allergy and Anaphylaxis Australia.
Clare Collins, Laureate Professor in Nutrition and Dietetics, University of Newcastle
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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