The draft version of the new DSM – Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released for public comment recently. The DSM is viewed as the bible of the mental health community – used in defining what is a mental disorder by establishing criteria and terminology. Though the changes might appear cultural or semantic, their impact is far reaching – affecting legal matters, industry and government programs and medical and mental health treatment – with a potential of billions of dollars at stake for pharmaceutical companies, insurance and government health plans, doctors, researchers and patiences advocacy groups. It was last revised in 2000, and won’t be finalized until 2013. And controversy is swirling around it. Dr Inaba explains.
Archive for the ‘Compulsive Behaviors’ Category
DSM-5 draft released for comment
Wednesday, March 3rd, 2010
Menthol cigarettes more addicting? and more part-time smokers
Thursday, January 28th, 2010Two recent studies look at menthol cigarettes — whether they are more addicting and more hazardous; also the rise in numbers of part-time smokers. Dr Inaba shares his thoughts.
Transcript (edited):
Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions.
CNS: Smoking is in the news – one story is on menthol and smoking and the other on the rise of the part-time smoker.
Darryl: Well, they are two very separate things, and so we should probably look at each one separately. There are a couple of controversial studies that looked at thousands of smokers and the role menthol played in their smoking – nicotine addiction. For the most part, I kind of agree with those who believe that it’s a contributing factor because menthol is a coolant to the throat. It’s a counter irritant in a way, soothing the irritation of smoke. It makes the smoke feel cooler and therefore I believe that people who smoke mentholated cigarettes smoke deeper thereby increasing the frequency of smoking. If you are a Marlboro, Camel or Lucky Strike smoker, as your tolerance to the nicotine continues to go up you increase your dosage by smoking more and more cigarettes. The nicotine is harsh, nasty tasting and becomes almost unbearable as you get into 2 or 3 packs a day, but addiction is powerful so those who are addicted put up with the harshness and the coughing and the hacking and emphysema and continue to smoke 3 or 4 packs a day. The menthol smoker seems to have less of that irritation so their perception of the damage they are doing to themselves is lessened. As they escalate their dosage by smoking more and more some studies show that they inhale deeper taking more nicotine into their system.
CNS: And carbon monoxide as well.
Darryl: It is important to know that cigarettes contain about 420 different substances. Some of them are carcinogenic, many are irritable. The tars and the resins created by the ignition or the burning process are very nasty. Smokers get a lot more of that deep into their lungs. Menthol sort of offsets some of that negative feeling.
CNS: And there’s probably a psychological aspect too. Menthol is compared to mentholatum, perceived as a relief for a cold.
Darryl: Sort of a medical treatment – The other thing these studies show is the demographic breakdown (racial, ethnic, socioeconomic) of menthol versus non-menthol cigarette smokers. Mentholated cigarette users are much poorer, much less educated and much more likely to be a person of color, Hispanic or African American or even Asian, than smokers of non-mentholated cigarettes.
CNS: I don’t understand the contradiction there or the disparity. It would seem that it would be pretty easy to put numbers together based on targeted studies.
Darryl: Well, that’s the problem. The two major studies mentioned in the report looks at one study of 1300 smokers and finds a disparity in the difficulty in quitting cigarette smoking being much harder amongst the menthol smokers who are more likely to be ethic minorities, less educated and poorer. The other study looked at 13,000 smokers or so and followed them for 5 years and though it did mention that it seemed harder to kick nicotine when it’s combined with menthol, it also indicated that they found no differences in the ability of ethnic, education or socioeconomic groups to quit. So, there is not a lot of agreement on those factors. There is agreement on the disparity on people who smoke mentholated cigarettes. These studies have found that 75% of Anglo or white smokers smoke non-mentholated cigarettes. I’m sorry that’s wrong. 25%….let me say that again. These studies have found that 25% of whites who smoke…. smoke mentholated cigarettes and 75% of African American and Hispanics who smoke ….smoke mentholated cigarettes.
CNS: Well, I’m sure that we each have our individual impressions based on people we have known and our histories, but it’s interesting. Let’s move on to the (January 12, 2010) Wall Street Journal article on the rise of the part-time smoker. We all know, especially those of us that are smokers or have been smokers, that it’s becoming increasingly more difficult to maintain that habit. Up to 70% of Americans don’t allow smoking in their home and about ½ of those are smokers themselves. There is also the pressure by friends to quit and the constant stream of news stories about the really serious health hazards of smoking tobacco. But on to the part-time smoker. The article identifies 5 different categories – social smoking; secret smokers – those that sneak off, so their kids or parents don’t see them, smokers that do so mainly when they are under stress or having emotional issues; and smoking without thinking, which probably covers most people that smoke; and a couple of other categories – those worried about weight loss. Does any of this resonate for you?
Darryl: Well it does and it doesn’t. I think this does describe the different reasons that people smoke but it misses the major point which is that nicotine is the purest form of addiction that any substance offers. Although smokers say it relieves stress, it relieves boredom, it helps deal with diet, and you don’t find a lot of smokers describing that hit on a cigarette as being “ecstatic or euphoric” or asking “just give me this wonderful buzz and high”. When people remember their first cigarette – they remember the negative effects they experienced
CNS: It was bad! It was really bad.
Darryl: They experienced an uncomfortable ness in their brain. They felt nauseous, they didn’t feel good at all and then they hacked and they hewed and that begs the question, “well why continue smoking?” Why did you develop a 2 or 3 pack a day habit? The answer is nicotine – it is pure addiction from the first cigarette. Studies now show that the nicotine level for a cigarette and its effect on dopamine in the compulsive centers of the brain and in the control centers of the brain, which we call the “go switch” and the “stop switch” slowly damage the connective tissues that connects those switches. So beginning with the first cigarette, the ability to control its use diminishes. It’s not the smoker is feeling great or relieving boredom or managing their weight – it’s because the brain can not stop – it now has this compulsion to keep exposing itself to nicotine, that it e needs it and can’t live without it. The part of the brain that says “No, that’s not right…this stuff is killing you…it’s bad for you” cannot communicate to that part of the brain that says keep doing it so people keep using.
I had an experience recently that exposed me to those changes in society you mentioned. I was at a wedding in New Orleans the weekend the Saints won the playoff that would take them to the Super Bowl. Bourbon Street was just jammed like Mardi Gras every night. I was there…ate at restaurants, the bars, everything was just full of the Saints fans wearing all the Saints garments and doing all the Saint chants, but the most amazing thing to me – coming from, California and the West Coast was: …My God, they’re smoking in restaurants! They’re smoking in the bars! They’re out in the streets where you can’t even see each other because there is so much smoke in the air and they’re drinking too. It was a shock today when it used to be common place – you could drink and smoke in the bars and on the streets and now you can’t. It was just strange for me to witness that. So it does validate the fact that society has changed its view on smoking and has created the part-time smoker. You can’t…you don’t want to…you’re embarrassed to smoke in public. You want to be a secret smoker, sometimes hiding it from your own family, your own children. You can’t smoke at home. You can’t smoke in the office. And because of that …people have cut down. I think the article mentioned that in 1980, the average smoker lit 21 cigarettes a day. Over a pack a day was the average and today it is down to 13. But they should know…and all smokers should know that evidence shows that even as few as 3 cigarettes a day will create tremendous health problems including an increased risk of heart attack, stroke, and lung problems, so no level of smoking is good healthy. Although there has been a cut back on smoking, the addiction has not stopped. Even with lower doses, the addiction remains intact. One interesting thing about “part-time smokers” is their association of time and place or environment that triggers the urge to smoke or continue to smoke and when they are away from that environment they are able to stay smoke-free for 3 or 4 days or even a week, but when they return to those environments, they find themselves sliding up and trying to control it, but they light up nonetheless.
There are a lot of experiments done by researchers and reported on by the National Institute on Drug Abuse, using mice and rats and showing that environments were so powerful that when they addicted a rat or mouse to a certain drug addiction – it could be nicotine – but in these cases I think they were using methamphetamine or cocaine, if they took that rat out of the environment to a place with a different floor, different color walls, different furniture, different things around them, the rat didn’t press the lever that would to administer the drug they were testing, like methamphetamine. But as soon as the researches put the rat back in the environment where the rat became addicted, the rodent went straight for the lever and started self-injecting again. So maybe there’s this environmental queuing or triggering that takes place with drugs of addiction and especially nicotine and maybe a change of environment is in order if someone is having problems.
CNS: There’s no question that it’s a complex mix of physical addiction, behavioral conditioning and psychological factors. We’ll talk more about this and about the stop and go switch in later podcasts. One interesting note as we wrap this – I found it interesting that the web versions of these articles contained ads for electronic cigarettes – embedded in the article.
Darryl: That is fascinating! The problem with electronic cigarettes is they contain other chemicals and additives that are damaging and harmful. If they came in a form that was healthier they could be an alternative or way to stop in the future.
CNS: But, as you say, … it is the nicotine.
Darryl: That’s right. Nicotine is the addiction.
CNS: Okay, thank you for listening – if you have any comments or questions, we would very much like to hear them. Your experiences with smoking or with not smoking or with anything else, stop by our website, which is cnsproductions.com and drop us a note. Darryl, thank you. Talk soon. That wraps our pod for today. Thanks for visiting the CNS podcast. Please check back soon for the next in the series and visit our website, www.cnsproductions.com.
Re-evaluating drug laws-taxing, treatment and communities
Wednesday, January 13th, 2010The California State Assembly’s public safety committee approved a bill Tuesday Jan 12 to tax and regulate marijuana in a manner similar to alcohol, proposing to add potentially one billion dollars to California’s deficit-wracked budget. Colorado is consider similar measures, and New Jersey just became the 14th state to allow medical use of marijuana. We look at the long history of governments using addictions, whether substances or processes, such as gambling, as revenue sources … and also issues of treatment, or lack thereof, when of these things become problems… and also an innovative organization in South Dakota working to create a grassroots, community effort to pick up where traditional treatment leaves off.
Transcript (edited):
CNS: Darryl, there are interesting things in the news this week – we have the California legislature about to debate legalizing and taxing marijuana, and a story out of Maryland about the need for a new commission similar to the one we had at the end of Prohibition, looking at the way we deal with our drug laws; also an interesting story out of South Dakota about a new community organization looking at dependency issues as a long-term illness. These things seem related.
DARRYL: The first two are related, I am not sure about one in Sioux Falls, S.D. California, Colorado, and eleven or twelve other states have been moving to legalize, or decriminalize marijuana for some time now. There are huge movements or initiatives, which got momentum from the medical issue of marijuana and now the economic issue. I think basically what’s leading the thing along now is the great potential revenue source it represents for the states.
CNS: Which is of course historically true of alcohol and other drugs.
DARRYL: Any addictive substance, whether it’s a mild substance like nicotine or tobacco, or a strong substance like heroin, that is capable of inducing substance-dependency is always going to be profitable. If you think marijuana will become legal soon so it can be taxed - you might to invest in something small like maybe patenting a name, like Maui-Wowie, or some kind of packaging, or some kind of thing that goes along with marijuana because if it becomes a legal and tax issue, it represents a huge source of revenue. Research indicates that 10 or 20% of those who consume alcohol, consume 80% of all alcohol sold. The individuals who use these substances consume huge amounts and ultimately pay a penalty in terms of taxation which supports the rest of society. I have no illusion that the money will go towards treatment. Here in Oregon, the voters approved gambling, which is a huge addiction, the citizens agreed to legalize it with the proviso that about 5% or 10% of the money would be reserved for treatment of gambling addiction. But when the (economic) downturn happened, the legislature and the people in power didn’t give a darn what the people voted for, they stripped the money for gambling treatment down to 1%, and diverted the other revenues toward supporting the infrastructure and political machinery that seems to be running our country at this time.
CNS: Even though it was written into the law, they just decided to modify it.
DARRYL: Yes, I don’t know how that works, but they do it all the time. When governments declare a state of emergency, they do anything they want, state militia and all that, so I guess the executive and legislative powers can decide what they want to do about anything.
But marijuana is moving rapidly toward taxation, or legalization, or medical use. I think the California legislature is looking at that now, talking about $50 per ounce as the proposed tax, which they say is only one dollar per joint, but that’s a pretty thin joint.
CNS: But if you’re talking about high THC, sinsemilla, or what have you, that’s probably close.
DARRYL: It depends on the user’s tolerance, because you do get tolerance to marijuana, it depends on the social environment where it is used. In Oregon and California where medical marijuana is legal, there are problems in high schools and with our kids. For example, Ashland, Oregon’s high school is voted one of the top ten in the US and the issue there won’t be students having a medical marijuana card, but the fact that students can’t smoke on campus or be in possession of it. So what happens if a student pulls out the card and says “I need it for medical purposes”? It is legal and could present an interesting case.
CNS: I’m sure it will show up. But back to gambling, there was another story recently from Pennsylvania, talking about the amount of revenue that the states are realizing from the legalization of gambling, and their responsibility that to address the addictive qualities.
DARRYL: Gambling is probably one of the most powerful addictions I have seen, it’s a process addiction, like shopping or hoarding, or internet gaming. It has a powerful impact in the most devastating ways. Working in a state that legalized gambling I see individuals who have completely lost relationships, lost their freedom, lost their cars, their jobs, their self-esteem, ultimately their soul and their life. Gambling seems to be even more devastating than alcoholic or heroin addiction. It happens very quick and they have almost no control over their obsession with winning. Its hard for me to understand because I’m a normie when it comes to gambling. I hate to lose and I believe the machines that are legal here, the poker machines, the lottery machines, are adjusted to pay out only so much.
CNS: They’re all programmed … it’s not like a poker game with your buddies.
DARRYL: The electronic slots are programmed to come up near-misses a lot, …almost the three cherries … one little scoot, or three on the diagonal, and it just continues to draw you in more, and people get totally obsessed with it.
CNS: So that’s a psychological manipulation, that’s mean and nasty.
DARRYL: It is even worse than drug addiction where the drug just does it for itself. People smoke, people use heroin and the drug does it on its own. Here we have a whole industry trying to suck you in with all kinds of advertising, branding gimmicks and all kinds of other things. Certainly these are issues that have not been thoroughly looked at; for whatever reason. The biggest problem we have with drug addiction, marijuana, and gambling, is the horrible lack of services. You can legalize anything if there was a huge increase (in funding), and offer treatment on demand. Any time a person with these problems can come forward and enter a very rigorous and very good treatment program. That kind of treatment access would make legalization more acceptable. A society that continues to put few resources toward treatment and a lot of money toward the revenue side doesn’t seem like a fair way to go.
CNS: We are seeing greater usage of the drug courts, also more drug education, substance abuse, relapse and recovery and training in the prison environment. It’s still not enough but maybe increasing a little bit.
DARRYL: It’s wonderful, but I have no illusions. I’m a supporter of drug courts and I think they really work. There is evidence across the country that it is much better than the alternative of just locking people up, and saying stay away from drugs.
CNS: As if you couldn’t get drugs in prison anyway …
DARRYL: We spend so much money on our court system and incarcerating people – providing custodial care of people, and coerced treatment seems to be successful in that it saves our court and prison system so much money. A proposition addressing this was passed in California and resulted in closing two prisons. It was the first time California didn’t build more prisons than educational institutions. That was great, but then the prison union and a lot of people protested because of job loss. Now there is a move to open more prisons. ,
This article from Sioux City ties into that somewhat. There is a community learning what is evidence-based in terms of treatment and also in terms of NIDAs approach to treatment. It is community-based treatment, structured towards community involvement on all levels that promotes the best outcomes. So Sioux City is recognizing now, and I hope all communities recognize, that addiction is a chronic, persistent medical disorder, its an anomaly, a difference in people’s brain, and it affects the most wonderful of all our citizens. So the community – rather than supporting incarcerating, criminalizing, and treating a person as a pariah…. as evil, the community embraces them as someone who might have diabetes or hypertension or asthma, and then provides a community -based intervention, where all parts of the community support that idea, where even the parent of addict says “my son has an illness,” rather than “he’s always been a bad kid”. That goes a long way and I hope the rest of the country does that more and more instead of merely looking at ways to make money legally off of marijuana. And that unfortunately, seems to be where California and other states are going.
CNS: Budget issues, recession issues have had an effect on government services, and as often happens, caused the removal of services that are perhaps the most needed. It is a balancing act — do we need police, or firemen more — it’s a difficult choice. But in terms of issues related to addiction, it continues to be under funded. Are we seeing some movement? Some progress? Or is it still really slow?
DARRYL: I think it is still slow. The latest University of Maryland notes on addiction show that, of the people who need, and want treatment for their addictive condition or substance use disorder, only one out of 29 or so are able to access treatment in any given year. That number has been about the same for many decades. We still have this huge treatment gap in which we are unable to provide enough treatment for those who want it even though treatment has been shown to be so effective in every study ever done. The meta study at the University of Pennsylvania 2005 showed that every treatment study, and they looked at over a thousand, had a positive economic outcome and actually saved society money. Treatment is effective, it compares well with treatment of any other chronic, persistent disorder like diabetes, asthma, hypertension. Now that the Mental Health Parity Act is in effect I have seen some institutions start to either contract out or look at providing more drug abuse treatment. Now that you can’t discriminate against addicts maybe we’ll see some change. We are still amuck in a horrible lack of treatment for people who want it and need it.
CNS: Hopefully it will move forward, and we won’t reverse the trend again, even with our economic difficulties. And we have yet to see how that’s going to be addressed in the health care reform legislation. Thanks Darryl.
Holidays – Guilt, Gambling & Java
Friday, December 11th, 2009People with substance abuse issues often find that the Holiday Season can bring up old wounds – we look at some of the issues around guilt for the addicted person. Also news about treatment for gambling addiction, and a chat about the addictive qualities of caffeine.
Transcript (edited):
Welcome to the CNS podcast featuring Dr Darryl Inaba research director for CNS Productions.
CNS: Hi and welcome once again to the addiction podcast from CNS Productions, I’m Howard LaMere here with Dr. Darryl Inaba. Darryl, in continuing with the holiday motif, we’re talking about guilt as one of the reasons for an increase in addiction during the holidays.
Darryl: I think it’s absolutely accurate. Lynn O’Connor of Wright Institute did a study of women who seem to have more guilt and shame than men. The study looked at addicts and alcoholics entering treatment and measured guilt, shame and alpha-beta pride and found that those coming into treatment suffer tremendous amount of guilt, tremendous amount of shame about they’ve done. They have a low self esteem, low pride in themselves and are on the receiving end of a lot of anger from their families who have seen them make promise after promise only to break them all. Recently I’ve been working with gamblers and I am finding this anger more prevalent in gambler families. During the holidays there is a lot of societal pressure to interact with friends and family – those we might have injured and hurt, so there is going to be a lot more guilt, shame, and feelings of low self esteem, which contribute to the desire to alter your state of conscientiousness. The easiest way for people with compulsive disorders to alter their states of consciousness is to partake in those activities that screen or suppress their feelings of guilt and shame for a while. This desire to feel better leads to more slips and therefore more relapses during the holiday season.
CNS: More so than the rest of the year, just because of the pressure. We’ve talked about drug relapses, we’ve talked about food. Now there’s another topic in the news – caffeine addiction. A report from the surgeon general stated that caffeine was habituating, rather than addicting. I don’t think anyone who drinks coffee would dispute the fact that it’s addicting. I mean I have to have that first cup of coffee in the morning, I try, I try having tea, green tea, which has caffeine anyway and it’s still not the same. I mean, there’s something very addictive about caffeine and so how can anyone say it’s not addictive?
Darryl: Well, it goes beyond denial, there’s certainly going to be denial in terms of any kind of addiction. When it comes to caffeine it’s almost a cultural reticence or a fear that this – the last thing left to alter our states of conciseness – is going to be taken away, or looked on negatively, and so caffeine…
CNS: More guilt…
Darryl: A lot more guilt. Caffeine has remained under the radar for lots of reasons. It’s escaped any crucial examination. We’ve looking at nicotine and other substances like alcohol, but caffeine is probably the last thing we’ll look at with that much scrutiny. Caffeine is defiantly an addictive substance. It’s a xanthine alkaloid, it’s a stimulant, it creates similar, although at much lower levels and intensity, changes in the body as does cocaine, and nicotine and methamphetamine. It affects the same processes in the brain. Scientists have looked at caffeine for a long time and believe that anytime you drink over five hundred milligrams a day of caffeine, your brain and your brain chemistry is altered. Researches see the beginnings of compulsive or addictive tendencies. Above eight hundred to one thousand two hundred milligrams of caffeine a day a person begins to have negative body toxic effects. I’ve always felt that caffeine maybe responsible for a lot more deaths than cocaine and heroin just from the toxic effects it can render to your heart and blood vessels. Caffeine causes distress in those areas of your physiology. As you mentioned, everybody who consumes caffeine, knows about withdrawal when they try to stop. The headache, that pressure headache in the front of your brain can last several months to a year before it finally begins to dwindle and go away. So caffeine is physically addicting, it’s certainly emotionally addicting. I don’t know anybody who realizes that they use caffeine to get stimulated in the morning to wake up, to do their work and to get off on their day. When they take a vacation, take several weeks where they don’t have to get up and do anything – just eat and have fun, they still reach for that cup of coffee automatically, instinctively without even thinking. This is a true, true dependency and a true habituation. So caffeine is defiantly an addictive substance, defiantly something that that we’re going to have to look at in terms of how it’s affecting our health.
CNS: Like the hybridization of marijuana, the proliferation over the last 5 or 10 years of coffee shops that sell really strong coffee, from Seattle to Silicon Valley, we must wonder if it’s related to computers and dotcom and the generation x factor, I don’t know that that’s true but we’re definitely seeing stronger caffeine products.
Darryl: I actually had to detoxify and go into recovery for caffeine addiction some twenty-five, thirty years ago. I found myself unable to go through the day without a cup of coffee in my hand. I had tremendous headaches each morning and they went away with that first cup of coffee. It was better than aspirin or anything else. When I realized my blood pressure was up and my heart had some unusual beats I recognized it was caused by my caffeine dependency and I stopped. Since then, I’ve been in rigid caffeine recovery – no coffee. Unfortunately, no one can totally avoid caffeine. It’s in cold products, aspirin, sodas, chocolates, candy- it’s everywhere. I deal with it in an unusual way. I make coffee for my wife. Ever since I stopped drinking coffee twenty five years ago, I get up the morning before her and make her coffee. Her tolerance increased over the years and now I have an espresso machine. She graduated from Starbucks and is into much stronger Pete’s coffee from San Francisco. There’s no end to where it’s going but you can definitely see that pattern. I’m just lucky that I don’t have a strong desire when I smell it; I have a strong desire in the morning…
CNS: …are you getting something from your nose?
Darryl: Yes, but I have to remind myself that I can’t – otherwise I won’t stop. I’ll have that cup in my hand all day long and end up like I did before.
CNS: Another topic in the news this week is treatment for gambling. Perhaps gambling is not as much of an issue during the holidays as some of these other things we’ve talked about but for people that have an addiction of any sort it doesn’t stop for a holiday. So what’s in the news on gambling?
Darryl: Well, it’s very exciting news. I’ve always believed that it’s not the particular activity or the drug that causes a compulsivity to continue something even though it’s creating a tremendous negative impact on your life. It’s actually the ways the brain differs in certain individuals that conspires to rob them of their control and then conspires to keep them engaged in that activity even though they desperately what to stop. I don’t know if there’s a stronger addiction than gambling. I’ve worked with cocaine addicts and alcoholics and heroin addicts but working with gambling addiction I’ve concluded that it is one of the strongest addictions. Perhaps it is because our society doesn’t place a stigma on gambling. Society labels addicts “problem gamblers” and/or “pathological gamblers”. Pathological gamblers can’t stay away from the action and they bet everything. They loose their home, they loose their vehicle. More people are walking the streets to work and walking around town not because they are alcoholics who lost their license, but because they gambled away their vehicle and any money buy another one. They max out credit, get themselves in terrible debt, and start participating in illegal activities.
With the advent of brain imagining in the 1980’s, researchers found the same type of changes and the same activity in the gamblers brain as they made a bet as they saw in the cocaine addict’s brain or a meth addict’s brain taking a hit. The brain process and the pathways are the same. What I find exciting is that now medicine has recognized that similarity. Medication that was originally developed for heroin addiction and then was found to be effective in blocking craving in alcoholism is also actively helping gamblers. By giving them naltrexone, an opiate antagonist that blocks the opiate receptors from opiates, which blocks a gamblers craving. They are able to remain in recovery and are better able to avoid taking that first bet. This has created a better understanding of what addiction is and opened an avenue for more appropriate and better treatments to help people with this condition.
CNS: It’s exciting that we are finding ways to address these issues but I’m again reminded of 1984, there’s a danger of taking drugs to deal with drugs.
Darryl: Maybe so but in another reality, as I work with addicts, I think it’s a wonderful thing that’s happening. The important thing to focus on is that addicts, especially gamblers beat themselves up wondering why they’re doing what they are doing. Now they are finally beginning to accept, through this whole medical process, that they really have an illness, that they’re not weak willed individuals, they’re not bad, stupid, crazy, or amoral. They have a biological difference that makes them unable to control these behaviors. This helps them to accept that they need treatment and they need to practice recovery better and with vigor.
CNS: Other options are the organic things that we can do. We’ve talked about singing and dancing and other organic things that make us feel good.
To those folks listening, your comments and questions are more than welcome. Stop by the web site www. cnsproductions.com, drop us an email and we’ll address your questions. Darryl, happy holidays once again.
Darryl: Stay warm, Howard, its getting cold.
CNS: Yes it is definitely winter, ok, bye-bye, that wraps our pod for today. Thanks for visiting the CNS pod cast. Please check back soon for the next in the series and visit our website www.cnsproductions.com.
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