Monthly Archives: March 2015

03/6/15

One Day at a Time

© Field of tiger lilies by elwynn | stockfresh.com

© Field of tiger lilies by elwynn | stockfresh.com

“There may be greater sins than worry, but very certainly there is no more disabling sin.”  (William Barclay)

In his book Running Scared, Ed Welch pointed out how many psychiatric conditions have to do with fear. There was a time, he said, when you were either psychotic or neurotic. “Psychotic meant that your were out of touch with reality and afraid; neurotic meant that you were in touch with reality and afraid.” Today there are many more shades of fear and anxiety. Within the DSM-5, there are 22 distinctly coded conditions just within the section on Anxiety Disorders.

Welch observed how various medications or psychological treatments, such as systematic desensitization, focus on thinking or bodily responses to fear and anxiety. But he suspected there was a deeper reality to our fears and worries. “Listen to your fears and you hear them speak about things that have personal meaning to you. They appear to be attached to things we value.” So to understand fear and anxiety, we have to look at ourselves, and the way we interpret our situations.

Within the short space of nine verses in the Sermon on the Mount (Matthew 6:25-34), there are three commands for us to not be anxious. We are encouraged to not be anxious about our life or about our future. Jesus underlines the pointlessness of anxiety here, while providing good reasons for trusting God. The Theological Dictionary of the New Testament put it this way: “Worry is unnecessary. God has lifted it from man.”

There are also three “therefores” that initiated those commands, whose purpose was to connect the paragraph or passage to what was just said. So the command to not be anxious about our life in verse 25 connects back to what Jesus said in verse 24: “You cannot serve two masters”—God and money. Verse 31’s “therefore”—don’t be anxious about what to eat, drink or wear—proceeds from the discussion in verses 26 through 30 about how God provides for the birds, flowers and grasses.

Look at how God provides for the insignificant things of his creation. The birds never go hungry or thirsty—yet they cannot sow, reap or gather into barns. The wild flowers, which cannot clothe themselves in finery, are more beautiful than King Solomon in all his glory. If God is careful to provide for them, will He not do much more for you? “Therefore do not be anxious, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’”

These worries are what drive the “Gentiles,” those who don’t know or trust in God. When you are anxious, you are forgetting the one whom you serve. Robert Mounce said in his commentary on Matthew: “Worry is practical atheism and an affront to God.” Verse 33 is then the climax of the passage: our first priority should be to seek out the kingdom of God and his righteousness. As Craig Blomberg said: “When priorities regarding treasures in heaven and on earth are right, God will provide for fundamental human needs.”

Worry does not accomplish anything. Anxiety is futile. It cannot add a single hour to your life. The future we try to provide for is not in our hands. “Whatever happens will be under God’s control.”

The final “therefore” then leads us to the logical inference from previous ones. If we aren’t to be anxious about our life, what we are to eat, wear or drink, then we aren’t to be anxious about the future. “Sufficient for the day is its own trouble.” In other words, live one day at a time.

This advice is heavily steeped within the culture and life of recovery. An early AA Grapevine article  (“Yesterday … Today and Tomorrow,” July 1942, vol.2, no. 2) commented that it was not the experience of today that drove people mad. Rather, it was remorse for something that happened yesterday and the dread of what will come tomorrow. “Let us, therefore live but one day at a time.” In “Garden Variety” Sara S. said she was a garden-variety alcoholic. “I know that one day at a time my life is becoming all that God intended it to be.” J. S. R. of Philadelphia commented in “Sidebar,” published in the October 1954 (vol. 11, no. 5) issue:

When I decided to stay sober one day at a time, I had no idea what an impact this would have on my life. As time progresses it becomes obvious that I live one day at a time. This is a very great consolation. No longer do I project bridges into the future, nor am I particularly concerned about yesterday. I do concern myself about today’s effort and sometimes it isn’t a very pretty picture; however, with proper training along simple lines as advocated in the very essence of AA, I have no fear.

Leon Morris observed that when an individual lives one day at a time, they defeat anxiety. A shallow thinker might conclude from Matthew 6:33 (But seek first the kingdom of God and his righteousness, and all these things will be added to you.) that a believer will have a smooth path through life. But that is not what Jesus is saying. All people have trouble. But there is “all the difference in the world between facing the problems we meet with firm faith in our heavenly Father and facing them with anxiety.”

This series is dedicated to the memory of Audrey Conn, whose questions reminded me of my intention in seminary to look at the various ways the Sermon on the Mount applies to Alcoholics Anonymous and recovery. If you’re interested in more, look under the category link “Sermon on the Mount.”

03/4/15

Chasing Ghosts

© : Vera Kuttelvaserova Stuchelova | 123RF.com

© : Vera Kuttelvaserova Stuchelova | 123RF.com

Jay Joseph, a licensed psychologist, has written extensively on the failure of researchers to find scientific evidence that even one psychiatric condition has a genetic basis. In “The Crumbling Pillars of Behavioral Genetics,” he followed the history of failed predictions by Robert Plomin, a genetics researcher, who claimed repeatedly that we were “at the dawn of a new era” in molecular genetics; that “genes associated with behavioral dimensions and disorder are beginning to be identified;” that “within a few years psychology will be awash with genes associated with behavioral disorders.” So far, Plomin and other researchers have got nothing.

Despite the hope that the Human Genome Sequencing Project would “revolutionize the understanding, diagnosis and treatment of most human disorders,” acknowledged polymorphisms (common gene variants) for psychiatric conditions are still nonexistent. In “Still Chasing Ghosts,” Evan Charney said: “Not a single polymorphism has been reliably associated with any psychiatric conditions nor any aspect of human behavior within the ‘normal’ range.” Instead, researchers in psychiatry see schizophrenia and other psychiatric conditions as “multifactorial complex disorders,” meaning that they are caused by a complex interaction of multiple genes and environmental risk factors.

Within an editorial announcing that changes to the journal Neuropsychiatric Genetics, S.S. Farone et al. proudly announced that their journal “has become a leading venue for the publication of high quality research on the genetic basis of neuropsychiatric phenotypes.” But they also acknowledged: “It is no secret that our field has published thousands of candidate gene association studies but few replicated findings.” Joseph commented that in a practical sense, these results are a secret. After the initial results are hyped in the media, the replication failures rarely receive the same media attention. See “The Reproducibility Problem.”

The public has been misled by sensationalized reporting in the popular press, often in concert with leading researchers, to believe that genes for the major psychiatric disorders have been found.

Reluctant to believe the foundational heritability estimates were wrong, genetic researchers have instead hypothesized there is “missing heritability.” Proponents of this position argue that genes (heritability) are present, but cannot be identified (are “missing”) because each gene has such a small effect. So small in fact, that its effect cannot be identified by standard genome-wide association studies (GWAS). Joseph noted that by the summer of 2011 this failure to discover genes underlying psychiatric disorders led 96 of the leading psychiatric researchers to publically plead for potential funding sources to not “give up” on GWAS.

As Joseph pointed out in “Five Decades of Gene Finding Failures in Psychiatry,” the belief in “missing heritability” ignores the possibility that previous conclusions from family, twin and adoption studies could be wrong, all the while assuming that the genes have to exist. Despite evidence that many people diagnosed with “schizophrenia and other psychotic disorders are impacted by trauma, abuse, and other adverse experiences,” there continues to be an almost exclusive focus on “the genetic and biological bases of psychosis.” He suggested that although some researchers claim that several genes for the major psychiatric disorders have now been discovered, “these claims are likely to suffer the same fate as similar non-replicated claims we have heard for decades.” He then quoted John Horgan, a science journalist, who said that since 1990:

Researchers have announced the discovery of ‘genes for’ attention-deficit disorder, obsessive-compulsive disorder, manic depression, schizophrenia, autism, dyslexia, alcoholism, heroin addiction, high IQ, male homosexuality, sadness, extroversion, introversion, novelty seeking, impulsivity, violent aggression, anxiety, anorexia, seasonal affective disorder, and pathological gambling. So far, not one of those claims has been confirmed.

Evan Charney and Jay Joseph (Twin Studies and the “Nonreplication Curse”) described a new methodology, the genome-wide complex trait analysis (GCTA), which has been developed to replace the problems with GWAS. Like a typical GWAS, GCTA scans hundreds of thousands of polymorphisms of thousands of persons. But it does not identify which SNPs [single-nucleotide polymorphisms, common types of genetic variation] are responsible for a trait. Rather, it estimates the total genetic variance by comparing the genetic profiles of a large group of unrelated people. “In other words, it can produce a ‘finding’ of genes even when no specific genes are identified.”

Joseph indicated the GCTA method, like the GWA studies, is based upon two faulty assumptions: 1) the validity of heritability estimates for human behavioral traits and 2) that twin studies and adoption studies have established the genetic basis of psychiatric disorders.

Charney noted that the twin study methodology has been critiqued for making faulty assumptions, like assuming that the environments of MZ (identical) twins were no different than those of DZ (fraternal) twins. In fact, several studies have shown that MZ twins have more similar environments than DZ twins. The equal environment assumption was shown to be false. This environmental difference means that: “trait similarities ascribed to the greater genetic similarity of MZ twins might in fact be due to greater environmental similarity, significantly inflating heritability estimates.” In The Journal of Mind and Behavior, Joseph commented that:

Conclusions in favor of genetics based on twin studies (as well as family studies) were confounded by environmental factors, suggesting that the twin method should have been discarded as an instrument for the detection of genetic influence.

Charney suggested that chasing these “polymorphisms of tiny effect,” in ever-larger studies involving hundreds of thousands of persons, “is the last gasp of a failed paradigm.” It is like chasing ghosts. “Do we really want to squander our time and resources chasing ghosts?”

03/2/15

Pulling the Addiction Trigger

© Imageegami | Dreamstime.com

© Imageegami | Dreamstime.com

When you pull the addiction trigger, the disease of addiction fires off addictive thinking, automatic addictive or drug seeking behavior, and a craving or urge that pulls you toward high risk situations. (Terence Gorski)

The term “trigger event” is used to describe what turns on the addictive thinking, drug seeking behavior, or the craving (a strong need or drive) to be involved in high risk situations (See “The Yin-Yang of High Risk Situations”). Using the metaphor of a loaded gun, Gorski said addiction in early recovery is very much like holding a loaded gun—with a hair trigger.

The problem is that events and circumstances act as powerful triggers for some people, while they have no effect on others. What can be even more confusing is that some days a circumstance can activate a powerful trigger. But on other days the same situation does nothing to pull the trigger and activate the craving.

Mistakenly, triggers are often seen as only external to the person. So the focus in managing triggers becomes one of identifying and avoiding external situations related to drug use and drinking. But triggers can be internal as well as external. Gorski defined a trigger event as “any internal or external occurrence that activates a craving (obsession, compulsion, physical craving, and drug-seeking behavior).” By internal occurrences he means thoughts or feelings. External occurrences involve the five senses: sight, sound, smell, taste and touch.

For these events to become triggers, they have to be connected to the person’s use of alcohol or drugs. The trigger is stronger if the event happened just before or while using. This is what makes needles, when drawing blood, a trigger to the IV drug user. Years ago I knew someone who couldn’t listen to “The Wall” by Pink Floyd in early recovery because he always did so before when he was high.

Gorski then said there were three phases in “disempowering” a trigger. Phase 1 was Avoidance. Here the person is to make a list of the most powerful triggers associated with his using and avoided them. The ubiquitous recovery mantra to avoid people, places and things (PPT) associated with addiction fits here.

The second phase was to gradually re-introduce some “trigger” events, along with good recovery support. This would not include returning to a bar where you used to drink. But it could mean going to a restaurant or party where alcohol will be served. There could be a local bar and grill that is known for its wings. Going there in early recovery is not a good idea, but with support later on might be acceptable. Maybe try getting takeout a few times first.

Alcohol is such a part of our society, total avoidance would mean a very sheltered and limited life. “Therefore, in order to lead any kind of normal life, gradual introduction is necessary.” There is an Italian restaurant, with an attached sports bar near a local N.A. meeting. After the meeting, some members go there for pizza; others don’t. This gradual re-introduction is just that—GRADUAL. And it shouldn’t be practiced when the person’s sobriety is unstable. Stress or instability in sobriety means that phase 1 avoidance should be instituted.

The third phase is extinction, meaning that the using trigger’s ability to activate a craving is eliminated or extinguished. A woman habitually sat in one particular barstool at home when she drank. In early recovery she learned to avoid sitting there, because it activated her “stinking thinking.” Through repeated times of sitting in the barstool when doing other things like drinking her morning coffee and reading a book, paying her bills, etc. she extinguished sitting in the barstool as a trigger event of her cravings to drink.

This is a process of retraining your mind or desensitizing it to what used to be stimuli (triggers) to get high. You may recognize the principles of operant and even classical conditioning incorporated within Gorski’s process of disempowering triggers.  But these principles alone aren’t always enough to bring about successful extinction of a trigger. The above comments drawn from Gorski’s article suggested this—when the sporadic nature of some triggers was mentioned. “Without a clear understanding of the psychobiological dynamics of a trigger event, the only way to learn to [manage] them is through trial and error.” Why is this?

I’d suggest that humans are psychosomatic unities of body (soma) and soul (psyche). See another article, “We Are But Thinking Reeds,” for greater discussion of this concept. Existing within the soul are not only the internal events of thoughts and feelings, but deeper desires, wants and loves. In recovery you see this expressed by the phrase “I want what I want.” The ‘psychobiological dynamics’ of a trigger event engages these desires as well as the thoughts and feelings.

Disempowering triggers can extinguish the reinforcement pattern of the thoughts and feelings to the external event, but they cannot eradicate the deep desires. One of these desires is the “loaded gun” of wanting to get high. Here is where self-control in recovery comes in—learning to not act on the thoughts and feelings that stem from it; not giving into the desire to get high. At best, this desire will go into hibernation. Practicing a program of recovery will help keep it there.

I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. This is one of a series of articles based upon the material available on his blog and website.