ORTC Articles

What is fetal alcohol syndrome?

Fetal alcohol syndrome (FAS) is a set of mental and physical problems that can develop when a fetus is exposed to alcohol in the womb, and it is one of the leading and most preventable causes of developmental, behavioral, and learning disabilities. The National Council on Alcoholism and Drug Dependence (NCADD) estimates that 4,000 to 12,000 babies are born each year with FAS and many thousands more with less-disabling fetal alcohol effects (FAE). Though estimates range widely, 40,000 to 375,000 babies exposed to illicit drugs through maternal use are born each year. These statistics do not include nicotine exposure, which also has negative health effects on the fetus.

What causes fetal alcohol syndrome?

Drinking during pregnancy causes FAS. Women who drink heavily (an average of five drinks per day) can have babies with withdrawal problems, abnormal reflexes, sleeping disorders, and other problems. Those who drink less (one to two drinks per day) and those who smoke during pregnancy are likely to have babies with low birth weight. The amount of damage caused by maternal alcohol use depends on the timing and amount of alcohol consumed. Studies have shown conflicting results related to effects on the fetus exposed to minimal or occasional drinking.

What effect does alcohol and other drug use have on a fetus?

Physical symptoms of FAS include growth deficiency, dysfunction of the central nervous system, and facial abnormalities. Cognitive and other effects can include developmental delays, intellectual impairment, behavior problems, and difficulty with coordination, attention, memory, learning, impulse control, problem solving, speech, and hearing. These symptoms cannot be reversed. Children with FAE display some but not all of the symptoms associated with FAS.

Personal Recovery Story

“Abstinence is the best policy because we don’t know how much damage even one drink can do.” —Sasha, mother of son with FAS

Can fathers cause fetal alcohol syndrome?

Research has shown that exposing a male rat to alcohol can alter the growth, behavior, and reproductive functions of that animal’s descendants. This is true even when the mother rat is free of alcohol and other drugs. Male rats consuming alcohol had fewer offspring than alcohol-free rats, and the offspring that did survive were smaller, experienced more behavioral and hormonal disturbances, and had lowered immunity to disease.

At least one human study notes a relationship between fathers’ drinking in the month before conception and the birth weight of their babies. In the study, “regular drinking” was defined as consuming at least two drinks per day or consuming about five drinks or more on a single occasion at least once a month. Infants whose fathers drank regularly weighed less than infants whose fathers were occasional drinkers. These results occurred regardless of the mother’s alcohol, tobacco, and marijuana use during any period of the pregnancy.

Alcohol consumption is just one paternal behavior that can affect the life of a newborn. The safest policy is for both men and women to abstain from alcohol and other drugs while they are trying to conceive a child. It’s true that researchers disagree about how much alcohol a woman can safely consume at conception and during pregnancy. Even so, many women who want children choose to abstain completely. When men make the same decision, they not only create a supportive bond with their partners but also affirm their intention to bring a healthy child into the world.

Shared abstinence is one way for men and women to say, “We are going to commit to each other. We’re going to have a child. And for the child’s sake, we’ll both give up drinking.”

How can you deal with the guilt and shame of causing fetal alcohol syndrome?

Many women experience guilt and shame after the birth of a baby with FAS or FAE. In the past, you may have dealt with shame and guilt by drinking and using drugs, but this only deepens feelings of worthlessness.

Shame is an especially bad problem for people in recovery. If you have feelings of shame that you have not addressed, you are at risk for relapse. You’ve worked hard in early recovery, but to maintain your ongoing recovery, you’ll need to keep working the Twelve Steps. Step Four and Step Five are particularly helpful when dealing with issues of guilt and shame. Recovery is the process by which you will be restored to a more fulfilling life with fewer emotional hardships and freedom from addictive behavior.

Remember to work the Steps, utilize your sponsor and sober friends for support, and go to meetings. These things will help you let go of shame and guilt, and develop and maintain a healthy, happy outlook where you can enjoy the freedom and peace of sobriety.

Drunk driving and fatalities

According to the U.S. Department of Transportation, almost one-third of drivers convicted of driving while intoxicated (DWI) had previous DWI convictions. Many of these crashes resulted in a death. If you have been previously convicted of a DWI, there’s a good chance that you could be convicted again, and a good chance that you will be involved in a crash resulting in a fatality.

What are the legal and financial consequences of repeat DWI convictions?

Many states have enacted laws that impose harsh legal and financial consequences on drivers with previous DWI convictions. These consequences include the following:

• suspension or revocation of driver’s license
• impounding of the driver’s vehicle
• installation of an ignition interlock system that prevents the vehicle from starting if the driver’s blood alcohol level is above a predetermined limit
• an imposed alcohol assessment, which may result in a requirement to get treatment
• a mandatory minimum prison sentence or a community service sentence

How can you avoid driving while intoxicated?

Many people in early recovery relapse when they put themselves in a high-risk situation without realizing or preparing for it. That’s why it’s so important to identify dangerous situations.

If you’re not sure if a situation is high risk, talk to your sponsor or others in recovery for guidance. If you can’t avoid a high risk situation, give yourself permission to leave if it becomes threatening or uncomfortable. You don’t need to test yourself in the presence of alcohol or other drugs. You’ve taken that test before. You may have escaped without relapse before, but in the end the risk is never worth the potential outcome. Sometimes even an event or situation that seems safe can turn out to be dangerous. Before you attend any event or get into an unknown situation, give yourself permission to leave when you need too.

Make sure you have reliable transportation or a method to leave right away, if that’s what you need to do. You may not have driving privileges as a consequence of your chemical use. But you can still avoid being trapped at an event by talking to your sponsor beforehand or making sure a friend can pick you up.

Develop a relapse prevention plan to make sure you protect your ongoing recovery. This will also help protect against the harsh consequences of legal liability and lives lost that may result from driving under the influence.

Recovery Action Step

Create a relapse prevention plan by answering these questions:
1. What are some of the high risk situations you know you will encounter? 2. How will you manage these situations?
3. Which people can help you identify and prepare for these high risk situations?

Discuss your answers with your sponsor and recovery support group. They will help you create a plan to deal with these situations and negative emotions.

Web resources

MADD

MADD is a nonprofit organization with more than six hundred chapters nation wide. Its mission is to stop drunk driving, support the victims of this violent crime, and prevent underage drinking. MADD’s website offers a search tool to find state-by-state laws on alcohol consumption and driving. If you are a victim of drunk driving in need of assistance, please call MADD’s toll-free help line.

What is acceptance?

Acceptance is facing and coming to terms with what is. As a recovering person, learning acceptance is an important part of your Twelve Step recovery. When you learn acceptance, you’ll let go of judgments that block you from seeing and coming to terms with an honest view of yourself and others.

Daily you face the opportunity to accept or reject the reality of that particular day, with all the good and bad moments it will bring. Your present circumstances include who you are, your work, where you live, your responsibilities, what you do for fun, the family and friends that you surround yourself with, and many other situations and choices.

On some days, things go great: your co-workers respect you, you get a phone call from a good friend, a teacher lets you know that your children are doing well in school, your spouse or partner makes a special effort to cook you a great dinner. On other days, your car breaks down, your children come home after curfew, there’s been a restructuring at work and your job is changing suddenly, and, on top of everything else, your spouse or partner tells you he or she is not satisfied with the relationship. You might instinctively respond to tough situations by denying or resisting the change, problem, or loss. You probably want the problem resolved quickly and want to go back to those days when everything seemed nearly perfect.

Even your newfound recovery brings changes that you are struggling with. You don’t know what to expect, and you may feel continually off balance at first. There will be losses and problems. Perhaps you are just realizing that your child’s grades are falling, that the car has needed fixing for months, and that your spouse may have a few of his or her own problems. These losses may come snowballing down in the next few weeks, or they may reveal themselves slowly over the next few years. Problems may stabilize briefly and then resurface. Facing all these realities may seem more than you can bear, and yet it’s essential that you come to terms with what is.

While this act of acceptance has much to do with acknowledging and accepting your present circumstances, it doesn’t mean tolerating any form of abuse. While you accept others for who they are without judgment, don’t allow them to abuse you, emotionally or physically.

What are some barriers to acceptance?

Some people, especially those who belong to Twelve Step groups, sometimes talk about addiction as a combination of two problems: the using problem and the thinking problem. While the using problem refers specifically to physical and medical issues resulting from substance use disorders, the thinking problem focuses on areas that are roadblocks to acceptance: irrational thoughts, unmanageable feelings, and self-defeating behaviors that bring on substance use as well as result from it.

Major barriers to acceptance include:

• Conflict. You have conflicts with those who do not think, act, or feel as you might wish.
• Self-pity. You feel sorry for yourself due to your circumstances, which you consider unfair.
• Expectations. You expect others to live up to your standards. When they don’t, you often become angry and resentful.
• Loss. You may blame others, become fearful, or become lonely when you suffer the loss of a dream, an important relationship, or something else that does not turn out as you had hoped for.
• Relapse. You don’t heal your old wounds, which can lead to relapse.

How do you overcome these barriers and achieve acceptance?

By letting go of character defects that hold you back, you come to accept your powerlessness over others and realize you can only change yourself.

The following are definitions of acceptance that are frequently heard among those who have transformed their lives in recovery:

• “Acceptance is gratitude.”
• “Acceptance is love.”
• “Acceptance means forgiveness.”
• “When I accept something, I receive it willingly.”
• “Acceptance means being at peace with something that once deeply troubled me.”
• “Acceptance is the answer to all of my problems.”

Theologian Reinhold Niebuhr expressed the essential meaning of acceptance in the well-known Serenity Prayer: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

In these few but powerful words, nearly everything necessary for finding true acceptance—letting go, tolerance, powerlessness, surrender, and faith in a Higher Power’s guidance—is conveyed with a poetic eloquence that has lived throughout modern times.

According to the Serenity Prayer, you ask your Higher Power to give you the ability to accept people and things as they are; you cannot be the master of anyone or anything but yourself. Wisdom comes from making and acting on that distinction.

What are the rewards of acceptance?

According to the Big Book of Alcoholics Anonymous, you will know a new freedom and a new happiness; you will not regret the past nor wish to block it out through shame and guilt. Despite your addiction and the pain you may have caused others and yourself, you can know serenity and peace through acceptance.

What is AIDS/HIV?

Acquired immune deficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV) and is one of the most deadly sexually transmitted diseases. HIV enters the body through blood, semen, or vaginal secretions, destroying white blood cells or lymphocytes (T cells) in the body’s immune system—cells that help fight infection and disease.

The function of these cells is to protect the body from viruses, bacteria, and parasites. When the body detects any of these, it sends white blood cells to attack the infection, trying to keep the body healthy. When someone has HIV/AIDS, the immune system begins to break down, as HIV infects the T cells. As the virus grows in these cells, the white blood cells don’t work as well, and eventually the immune system is destroyed. People with the HIV virus may show no symptoms for many years. They may not even be aware that they have the virus, and can unknowingly infect others. Treatment for AIDS, in the form of new medicines, has improved in recent years. However, there is still no cure for the disease.

The Centers for Disease Control and Prevention (CDC) estimates that over one million Americans currently have the HIV virus. Years ago, certain groups were considered high-risk groups that were most likely to acquire and spread the disease. But today it is recognized that HIV, like other sexually transmitted diseases, is related to high-risk behavior, and that anyone engaging in those behaviors will have a greater chance of contracting HIV. These high-risk behaviors include sharing needles while using intravenous drugs and having unprotected sex with an infected partner.

How can you get HIV?

HIV is spread by an exchange of body fluids such as blood, vaginal fluids, and semen during sexual contact with someone infected with the virus. You can also get HIV by sharing needles and/or syringes (primarily for drug injection) with someone who is infected. HIV can be transmitted through a blood transfusion using blood from infected donors. But today this is uncommon because in most countries blood is screened for HIV antibodies.

Babies can get HIV from their HIV-positive mothers who pass on the virus through fluids exchanged during pregnancy or childbirth. In some cases, babies can even get HIV by breast-feeding from HIV-positive mothers.

What are the risk factors for AIDS/HIV if you are using?

As a group, those of us in recovery have a higher HIV/AIDS risk because we may have had unprotected sex while drunk or high, or we may have been exposed to infected needles. If you relapse, be aware that users can get HIV/AIDS by using a “dirty” needle to inject drugs or by sharing “works” (such as a spoon or a cotton ball) that have been used by an infected person.

Some people think HIV is common only in certain high-risk groups such as drug users and in the gay community. But, in truth, anyone can get HIV/AIDS because it is spread when people act in high-risk ways. Your behavior, including maintaining your sobriety, will determine your risk for HIV infection.

How can you get tested for the HIV virus?

The only way to know if you have HIV is to take an HIV blood or saliva antibody test. (An antibody is a protein produced by the immune system as a response to a foreign agent in the body.) If your blood or saliva shows HIV antibodies, then you have the virus.

If you think you might have been exposed to HIV, you should be tested for the virus. Typically you will take an enzyme immunoassay (EIA) or the rapid HIV antibody test to see if your blood, oral fluid, or urine shows the HIV antibody. If you test positive, the results are confirmed using a second test such as the Western blot. A negative reading on the first test (the ELISA or EIA) means either that you are not infected or that not enough time has passed since the HIV virus entered your body to cause it to produce the HIV antibodies that the test looks for (six to twelve weeks is the usual time frame). The CDC recommends you get tested at least every six months, then continue to get tested for a year after you have stopped high-risk behaviors, because the virus may not show up on tests immediately after infection.

Don’t let shame or anxiety keep you from getting tested for HIV. We may find it embarrassing to admit that we have had unprotected sex, shared needles, or acted in ways that put us at high risk for HIV infection. Rather than shaming ourselves for these actions, we should hang on to our self-esteem and realize that in the past, addiction impaired our judgment. We are not our disease, and our judgment can greatly improve now that we are sober. Our best approach is to take responsibility for our actions, make amends, learn from our mistakes, and move toward a healthy lifestyle.

Guidelines for lowering your HIV risk

• Stay clean and sober. Be aware that a relapse could put you in a position to engage in high-risk behaviors. Don’t ever share needles, syringes, or other equipment (“works”) used for injecting any type of drug, steroid, or vitamin, or for tattooing or body piercing. Many people have been infected with HIV, hepatitis, and other diseases this way. The virus from an infected person can stay in a needle and then be injected directly into the next person who uses the needle.
• Abstain from sexual intercourse or engage in a mutually monogamous relationship with a partner who has been tested and does not have the HIV virus.
• If your sexual behaviors place you at risk for STDs, correct and consistent use of the male latex condom can reduce the risk of transmission. However, no protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD. The more sex partners you have, the greater your chances of getting HIV or other diseases passed through sex.
• Don’t share razors or toothbrushes because of the possibility of contact with blood.

Living with AIDS/HIV

HIV especially affects recovering people as a group. Even if you are not HIV positive, you probably know someone in recovery who is. Perhaps friends of yours have died of AIDS. Dealing with the reality of living with HIV or AIDS can be extremely challenging, but regular medical care and proper medications can help HIV patients extend their lives. With advances in new medicine, HIV can be managed as a long-term chronic disease, often for decades.

Fortunately, the medical community has made significant progress in treatment of AIDS, and patients are living longer with less difficulty than ever before. If you are HIV positive, you can immediately take a number of important steps to protect your health. First, see a doctor, even if you do not feel sick. Try to find a doctor who has experience in treating HIV. Have a TB (tuberculosis) test done. You may be infected with TB and not know it. Undetected TB can cause serious illness, but it can be successfully treated if caught early. Staying sober is one of the best things you can do for your health. Alcohol, illegal drugs, and nicotine can weaken your immune system. Have a screening test for sexually transmitted diseases. Undetected STDs can cause serious health problems. It is also important to practice safe-sex behaviors so you can avoid getting STDs.

While HIV is not a death sentence, many people who are HIV positive suffer from the anxiety and fear that they may develop severe, debilitating symptoms. If you are HIV positive, you may worry about rejection by family and friends, and those fears may lead to isolation and despair. How can you cope with these feelings? You might want to find others in your Twelve Step support group who are also HIV positive and want to share their experiences, successes, and fears.

If you are HIV positive, your task is to live as healthily and happily as possible while being treated, and to remain optimistic that medical science may soon offer you better treatment. Many recovering people living with HIV find that the spirituality they have learned through Twelve Step programs helps them live to their fullest potential—physically, emotionally, and spiritually.

Especially if you have a stressful health issue like HIV, working the Twelve Steps can help you get past emotional barriers that could restrict your ability to live fully. To be able to move past HIV, it will be helpful to revisit the Twelve Step concepts of powerlessness (Step One) and realize that a Higher Power (Step Two) can help restore us.

Where can you get help for AIDS/HIV?

To find out where to go in your area for HIV counseling and testing, contact your local health department or the Centers for Disease Control and Prevention (CDC) National AIDS Hotline. For more information about HIV/AIDS education and prevention contact the American Red Cross.

The Twelve Promises of sobriety describe the benefits you will gain if you work very hard on the Twelve Steps. Interestingly, they do not mention alcohol or other drugs at all. Instead, the Promises describe the joys of living a mature and healthy life of recovery—a joyous state that is the reward you will earn for ongoing abstinence and hard work.

What are the Twelve Promises?

The Big Book passage on pages 83–84 outlines the promises of sober living. The Twelve Promises of sobriety say you will

1. Know new freedom and happiness
2. Not regret the past nor wish to shut the door on it
3. Comprehend the word serenity and know peace
4. See how your experience can benefit others
5. Sense feelings of uselessness and self-pity disappear
6. Lose interest in selfish things and gain interest in others
7. Let self-seeking slip away
8. Feel your attitude and outlook on life change
9. Let go of fear of people and economic insecurity
10. Know how to handle situations that used to baffle you
11. Realize that God is doing for you what you couldn’t do for yourself
12. Understand that the Promises of sobriety will always materialize if you work for them

What do you need to do to enjoy the Promises?

The Promises are a gift. Some may come very soon, and others may materialize over time. Be patient and look around you at the Promises coming true for others. Ask what work they did to get there. With the help of your sponsor and others in your support network, you will get there. For example, sharing your story with others is a powerful way to come to terms with your past, viewing today’s struggles not as trials or tribulations as you did before, but as lessons that you are learning from. Listen carefully to the next speaker at an AA meeting and see what Promises they have come to enjoy.

You may have heard the phrase “working a good program” in treatment or in your Twelve Step group. What exactly does that mean? You’ll know it by how you feel. When you feel centered because you aren’t acting out of ego and selfishness, when your interior life is steady, and when you can respond to daily living with maturity—you’ll feel that you’re working a good program.

What is methamphetamine?

Methamphetamine is part of the amphetamine family of drugs. It is a prescription drug, but is also synthesized in illegal laboratories. It is a highly addictive stimulant that can have serious effects on a user’s physical, mental, and social well-being. It is also known as speed, ice, chalk, meth, crank, and crystal. Methamphetamine is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol and is taken orally, intra-nasally (snorting), by needle injection, or by smoking.

Like cocaine, meth creates an intense, immediate high for the user. While the high from cocaine is relatively short-lived, the meth high is much longer, lasting up to six hours.

What are the physical consequences of using meth?

Methamphetamine use can cause serious health problems including memory loss, aggression, violence, psychotic behavior, and heart problems. Chronic methamphetamine abuse significantly changes how the brain functions. Long-term methamphetamine abuse has many negative health consequences, including extreme weight loss, severe dental problems (“meth mouth”), anxiety, confusion, insomnia, mood disturbances, and violent behavior.

The intoxicating effects of methamphetamine can also alter judgment and inhibition and lead people to engage in unsafe behaviors, including risky sexual behavior. Abusers of meth who inject the drug may share contaminated needles, syringes, and other injection equipment. HIV, hepatitis B and C, and other infectious diseases can be contracted and spread through these behaviors.

The American Psychiatric Association (APA) uses the term “stimulant use disorder” to define a pattern of meth or other stimulant use that leads to significant physical, interpersonal, medical, or work problems. Stimulant use disorder is rated as mild, moderate, or severe based on how many criteria are met. A person diagnosed with stimulant use disorder can also be classified as in remission, or what is commonly referred to as “in recovery.” Those with stimulant use disorder should receive treatment, and those who identify themselves as addicts often find the skills and support to stay sober through peer support groups like Narcotics Anonymous.

Addiction is considered a brain-based disease characterized by abnormal drug-seeking behavior that leads to impaired control over one’s drug use. Addiction means a person will continue using alcohol or other drugs despite the harm it does to their health, family, work or school, and relationships. An addict may experience withdrawal symptoms (physical pain, fatigue, depression, trouble sleeping, irritability) if he or she stops using, and may need to keep using just to feel normal. “Curing” addiction is not a matter of willpower or moral strength any more than is curing diabetes or cancer. Like diabetes and cancer, addiction is considered a chronic disease which is beyond one’s control and fatal if left untreated.

How does meth use affect a co-occurring mental health disorder?

Co-occurring disorders, or dual disorders, occur when a mental health disorder, like depression or schizophrenia, is present along with addiction, alcoholism, or other substance use disorders. Screening for co-occurring disorders should be part of any good assessment or treatment plan.

Chronic methamphetamine abusers may experience paranoia, hallucinations, or other delusional thoughts. This can resemble signs of paranoid schizophrenia or other illnesses and can make it difficult to distinguish between a substance use disorder and a mental illness.

How does meth use affect the brain?

Methamphetamine affects the neurotransmitter dopamine. Dopamine is the brain’s “feel good” chemical, and part of its “reward” system. Methamphetamine stimulates the brain, making the user feel more energetic and alert, driving him or her to use more and more to repeat the effect. This significantly changes the way the brain functions, including motor function, learning skills, and trouble with emotions and memory. Chronic methamphetamine users who enter treatment face a number of challenges in “re-training” their brain to process emotions and memories the way they used to.

Is addiction to methamphetamine treatable?

Yes. Detoxification and withdrawal from meth, which is an amphetamine, can take several weeks. Medical treatment for meth addiction is interdisciplinary and works on several levels. One effective method of treatment is the Matrix Model, developed by the Matrix Institute of California. The model is backed by over thirty years of research.

Contingency management interventions provide incentives in exchange for engaging in treatment and maintaining abstinence. Such interventions have also been shown to be effective. At this time, no medications have been approved to treat methamphetamine addiction; however, this is an active area of research for the National Institute on Drug Abuse (NIDA).

Addiction won’t go away, like a cold or the flu. It is a chronic disease, meaning you have it all your life. However, by staying sober and getting ongoing support, recovering people live normal, healthy, productive lives.

Web resources

There are many resources out there. The websites for the following organizations were chosen for their usefulness and user friendliness.

National Institute on Drug Abuse (NIDA): This government organization is dedicated to addiction research and education. Through its website you can access up-to-date publications about many different drugs of abuse as well as emerging trends.

Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA is part of the U.S. Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities. Its website offers information and resources about preventing and treating addiction and mental illness.

Matrix Institute on Addiction: Learn about the Matrix Model of treatment for substance use disorders at the website for the Matrix Institute.

Why is trust important to recovery?

As alcoholics and addicts we needed the help of others to offer encouragement, support, guidance, and medical treatment to begin recovery from a substance use disorder. Seeking that help requires trust. As you work on your ongoing recovery and go to Twelve Step meetings, you may wonder how people will react and what they will think of you. Trusting your sponsor, your recovery group, and your Higher Power is integral to your recovery. Without trust in others, you’re on your own again. Trusting those with more recovery experience than you will help give you perspective and objectivity, especially in early recovery.

How can you build trust in relationships?

To build trust, start with a willingness to be honest. Tell another person your feelings and thoughts—even if it is difficult—and remember to be a good listener in return. Engage in heartfelt conversations and talk about what makes you happy, your goals and dreams. Go on outings and share your interests and hobbies with another person.

If you often feel anxious and find it difficult to trust new people, counseling may be beneficial for you. Sometimes incidents from our past can make us suspi­cious of others, unwilling to open ourselves up to hurt or rejection, and unable to trust. Group therapy may be especially helpful because you can hear and iden­tify with the stories of others, learn to be sympathetic, and become comfortable enough to admit your own struggles. Stress management techniques, such as breathing exercises and meditation, can also help to reduce the anxiety you may feel around others.

How can healthy eating and exercise benefit your recovery?

Now that you’ve been through treatment for addiction to alcohol or other drugs, you’re learning to protect your environment, stay away from triggers, and work the Twelve Steps to address emotional and spiritual issues. Right now your focus is on staying clean and sober, going to meetings, and working the Steps. But as you progress in recovery, you’ll want to focus more and more on improving your physical health. Nutritional therapy and exercise can help you heal your body and rebalance your brain chemistry, making you feel better, which will reduce your risk of relapse or an eventual return to use.

How does addiction cause imbalances in your body?

Different drugs of abuse damage our bodies differently. Opiates (codeine, heroin, and morphine) affect the gastrointestinal system, causing constipation. Using stimulants (such as crack, cocaine, and methamphetamine) leads to decreased appetite, weight loss, and malnutrition. Users may stay awake for days, causing dehydration and electrolyte imbalances. Marijuana use can increase appetite, and long-term users may suffer from obesity.

Alcoholism causes deficiencies in vitamin B6, thiamine, and folic acid, resulting in anemia (low blood count) and neurological problems. Alcohol intoxication impairs the liver and the pancreas, causing an imbalance of fluids, calories, and electrolytes. Excessive alcohol use can also result in permanent liver damage, seizures, diabetes, and severe malnutrition.

In addition, alcoholics and drug addicts, especially those with eating disorders such as anorexia and bulimia, often suffer from a lack of vital amino acids and other vitamins and nutrients. This can cause deficiencies in important brain neurotransmitters that govern mood and emotion.

What can you do to improve your health?

Create a healthy diet: To develop healthy eating patterns, focus on a low-fat diet that includes protein, complex carbohydrates, and dietary fiber. A balanced diet consists of foods from these groups:

 Nuts and legumes

This group includes peas, beans, lentils, peanuts, walnuts, and almonds. Small, moderate servings of these foods help reduce the risk of cardiac problems, strokes, and diabetes.

 Fish, poultry, and eggs

These foods provide protein, less saturated fat, and more unsaturated fat than red meat does. Studies have shown that people who replace red meat with chicken and fish have a lower risk of heart disease and colon cancer. Eggs are high in cholesterol, but consumption of up to one a day does not appear to have adverse effects on heart disease risk (except among diabetics). They do slightly raise cholesterol levels but provide other nutritional benefits.

 Dairy or calcium supplement group

Foods in this group, which include milk, yogurt, hard cheese, cheese spread, and cottage cheese, are rich in calcium, protein, and vitamins. Companies often enrich or fortify milk by adding other vitamins as well.

Recovery Action Step

1. Write down what you eat in a typical day.

2. If you don’t eat a balanced diet of foods from the groups above, write down how you can change your eating habits to include some of these foods.

Supplements and proper hydration often play a key role in healthy eating as well. If irregular eating habits have caused you to be deficient in certain vitamins, taking supplements such as B complex, zinc, and vitamins A and C will help. Dehydration is also a common problem during recovery. Make sure you drink enough fluids. A minimum of forty-eight to sixty-four ounces of water per day is recommended.

See the following for additional ways to maintain a healthy, balanced diet:

Lower your saturated fat

Red meat includes beef, pork, and lamb. Both red meat and butter contain saturated fat, which raises cholesterol levels in the blood and raises the risk of heart disease. To reduce the risk of these problems, eat lean (low-fat) red meat sparingly.

 Lower your refined carbohydrates

A diet high in refined carbohydrates (including white bread and white rice) can really raise the levels of sugar in your body and cause medical problems. Also, a diet high in starch (including potatoes and pasta) is associated with diabetes and heart disease. Overall, white rice, white bread, potatoes, pasta, and foods with sugar do not provide much nutritional value and should be used sparingly.

 Eat on a regular schedule

As active addicts, we often forgot what it was like to be hungry. Instead we interpreted this signal as a drug craving. If you feel strong drug cravings now, you might just be hungry. Eating on a regular schedule will help prevent cravings induced by hunger.

 Engage in physical recreation

Together with healthy eating, physical recreation can help you improve your overall well-being. So go ahead and make physical activity a part of your everyday life. It can help you feel better and improve your health. There are many fun things you can do to be active by yourself or with family or friends. Find recreational activities you enjoy. Go for brisk walks, ride a bike, or work in the garden. Identify a mix of activities that will keep you moving and active. If you are not used to being active, start out slowly and work up to thirty minutes a day. Add more activities for longer periods of time as you begin to feel more fit, or add some vigorous activity.

Physical activity can:

• make you feel more energetic
• help you sleep better
• lower your chance for relapse or an eventual return to use
• improve your mood and decrease depression
• lower your blood pressure
• improve your blood cholesterol levels

Always consult your doctor before beginning a new exercise or fitness plan. Build up your activities slowly. Doing too much too soon could hurt you in early recovery, especially if you have not been active. Following are some tips for exercising:

1. Engage in thirty minutes of activity a day that makes you breathe harder than you normally do.

2. Use your muscles regularly. Find activities that strengthen and tone your body. For example, take a fitness class, swim, run, or lift weights.

3. Get involved in sports or activities that improve your balance, such as yoga, Pilates, dance, martial arts, or other sports.

4. Make sure you stretch before and after physical activity.

What is a blackout?

People often confuse the word “blackout” with passing out. These are two different things. A drinker can pass out (go unconscious) from drinking too much alcohol in a short period of time. A drinker can even pass out during a blackout.

A blackout, however, is a period of amnesia. It can take place over minutes, hours, or even days in which the drinker is awake and active but later remembers nothing. During a blackout the drinker may or may not appear drunk to others.

If you have experienced a blackout, you remained conscious and may have participated in emotionally charged events—as well as more mundane events— that later you cannot remember. During a blackout some people have driven a car, walked a dog, and gotten ready for bed—all without any memory of having done any of those things.

A blackout is not forgetting what happened. A blackout involves not being able to remember what happened. This is because during these periods of amnesia, the drinker’s brain is not always able to form new memories.

Studies have found that the occurrence of blackouts is a powerful indicator of alcoholism.

What causes a blackout?

No one knows exactly how or why blackouts happen. What is known is that heavy drinking and/or alcoholism can cause a blackout. In fact, blackouts are a worldwide standard symptom of early-stage alcoholism. In general, a blood alcohol level (BAL) of .20 percent is enough to trigger a blackout. This seems like a large amount. But lesser amounts of alcohol, such as three or four ounces of hard liquor, might be enough to produce a blackout in some drinkers. Alcohol and antidepressants taken together can also produce a blackout.

What are the negative consequences of a blackout?

Many alcoholics come out of a blackout to discover a wrecked car, an untended house, or bruises on their body. Some have come out of a blackout and found that they had hurt others or even committed a murder.

Blackouts can aid the denial that alcoholics already experience. During a blackout drinkers can’t remember what happened, so they don’t have to immediately deal with the consequences of their actions. Even when others describe their blackout behavior in detail, they may still remain in denial, claiming that the described behaviors are untrue or exaggerated.

Alcoholics’ denial is further assisted by blackouts because, thanks to this temporary amnesia, they often remember only the good, fun parts of being intoxicated and have no memory of how badly they behaved. To them, it’s as if the blackout never happened. That space of time is an empty chalkboard.

What is codependency?

Recovery from addiction means dealing with challenges that are unique to the disease of addiction. For example, in Step One you admitted powerlessness over alcohol and other drugs. You stopped drinking and using, and you turned your life over to a Higher Power. You may now have a sponsor, be attending Twelve Step meetings, and living by the words of the Serenity Prayer one day at a time. But more challenges remain. One of the major issues you may be facing as you move ahead is codependency.

You may have been participating in a codependent relationship for quite
a long time without being aware of it. Once you are aware of your codependent behaviors, and take actions to deal with them, the chances are better that you’ll begin to create healthy, fulfilling relationships.

Several decades ago, the word “codependency” referred mostly to people whose lives had become unmanageable due to living with an alcoholic. Since that time, the definition of the word has broadened. Melody Beattie, in her best-selling book Codependent No More, defines it this way:

A codependent person is one who has let another person’s behavior affect him or her, and who is obsessed with controlling that person’s behavior.

A child can be codependent. So can an adult, a spouse, lover, brother, sister, grandparent, parent, professional, client, or best friend. Alcoholics and addicts often have codependency problems—even in recovery.

What are the symptoms of codependency?

If you are taking care of others and trying to please them while not taking care of yourself, you likely have problems with codependency.

Codependents tend to ignore uncomfortable feelings, such as those that arise when a parent’s or significant other’s drinking is out of control. The reality of the situation is not expressed. As a result, codependent people find themselves in relationships where honest communication is hardly possible. Codependents often carefully choose their words to manipulate, control, and please others, or to cover up unpleasant situations.

If you experience feelings of martyrdom and low self-worth, and have a hard time having fun, you’re probably in a codependent relationship. Sooner or later, these negative feelings lead to resentments, anger, and depression.

There are as many symptoms of codependency as there are situations for it to develop. Some of the other major symptoms are as follows:

• denial
• obsessing
• overreacting
• not reacting at all
• approval seeking
• substance use disorder
• fear of abandonment
• becoming overly vigilant

In short, codependent people have a core belief that they can change someone else’s behavior, and they spend much of their time rescuing that person from his or her responsibilities.

Despite the negative actions and attitudes that severely impact a codependent’s self-image, many former codependents have changed their lives by letting go of old behaviors and developing healthier ones.

How does addiction create codependent relationships?

Although you are in recovery, you might be in a relationship with someone who is abusing alcohol or other drugs. Many who are in this situation become an addict’s caretaker: they take care of the addict’s responsibilities and rescue the addict from trouble. Consequently, caretaking enables addicts to continue using without suffering the consequences of their behavior, such as missed days at work, missed appointments, and accidents.

The book Co-Dependents Anonymous bluntly states, “Codependence is a dis- ease that deteriorates our soul.” The fact is that addiction can end up destroying the self-worth of addicts and codependents alike. Those who are in a codependent relationship with an addict almost never know what to expect from that person.

Besides the unpredictability, a codependent’s environment is stressful and often incomprehensible. Codependents begin to “walk on eggshells” around the ad- dict, feeling that the only way to survive is to stay on guard, hypersensitive to shifts in the addict’s moods and behaviors. Sooner or later, living with an addict wreaks emotional havoc mentally and physically on a codependent person, whose life revolves around the addict’s wants and needs.

Yet some codependents can’t imagine leaving an addict without a great deal of fear: “If I leave him, I’ll be all alone.” They end up convincing themselves that they can’t live without someone and will die if that person is no longer in their lives. Some even tolerate abuse in order to stay in the relationship.

Of course, you should never tolerate abuse. If you are in an abusive relation- ship, there are ways you can exit from it now.

What can you do to establish more healthy relationships?

A good first step out of codependency is to stop caretaking. True caring means knowing when not to give in to another person, and learning how to say no. As you detach yourself from unhealthy attachments with others, you create balance in your life. In well-balanced relationships, people spend moderate amounts of time together and alone; each is dependent on the other, but independent too; there is giving and receiving on both ends, as well as the freedom to be assertive without feeling responsible for everything.

Although the word “codependency” is relatively new, the symptoms are not. Human nature has been wrestling with codependency throughout the ages. One of William Shakespeare’s most memorable lines is “This, above all else: To thine own self be true.” Perhaps that phrase alone captures the essence of a codependent’s challenge: you must learn to stop looking for personal happiness in other people. When you no longer focus intently on others, you come to realize that wellbeing can be found in one place only: within yourself.

Ultimately, by honoring and loving yourself, you will find self-acceptance while acknowledging that your life does not belong to others. You will come to accept that you are not here to live up to someone else’s expectations. You will admit that you are powerless over other people and circumstances that you’ve tried to control for so long.

Establishing boundaries is crucial to developing healthy relationships. To avoid repeating old behaviors, set limits on what you’ll do for others and what you’ll allow them to do for you. This is not selfish behavior. In the end, clear, firm boundaries benefit you as well as others. Recovering codependents commonly establish boundaries such as these:

• “I will not allow anyone to physically or verbally abuse me.”
• “I will not rescue people from the consequences of their alcohol abuse or other irresponsible behavior.”

The following are more tips for establishing healthy relationships:

• Don’t let your anger or another person’s anger take control of your life.
• Set specific goals, both short-term and long-term. For example, what do you want to have happen in your life this week, month, and year? What problems do you wish to solve? What would you choose to do for a career? Remember, goals give us direction and purpose.
• Exercise your body through physical workouts, even mild ones; exercise your mind by getting interested and involved in the myriad activities going on around you.

How can you avoid codependency if you are living with an addict or alcoholic?

Avoiding codependency is difficult if you live with an addicted person, but it can be accomplished if you work at it.

First, think about how you’d live your life if you were not involved with an addicted person. What would you do? Next, consider what you would rather be thinking about if you weren’t dwelling on this other person and the problem. The fact is, we can act as if we are not enmeshed in an addict’s life and the cycle of turbulent, sometimes violent events that addiction creates. Instead, we can act as if we’re moving ahead toward a fulfilling life for ourselves.

For example, we can begin by behaving as if we do not secretly believe that we are able control other people. Step One of Al-Anon is about admitting powerlessness over others and surrendering to a new way of looking at our lives.

Practicing detachment from the addict is key to leaving the dark forests of codependency behind. Even then, old behaviors can spring out of nowhere and throw you off balance. But you can regain your footing by focusing on your wants, your needs, your rights, and your decisions. Rather than needing to please or control others, focus on validating your own feelings. It is through this new outlook that you can eventually let events and people be as they are, and get on with the business of living, staying true to yourself and the life you have been given.

Web resources

There are many resources out there. The websites for the following organizations were chosen for their usefulness and user friendliness.

Al-Anon or Alateen

Al-Anon is a recovery group for adults affected by alcoholism. Alateen is a recovery group for teenagers who are affected by others’ alcoholism. Alateen groups are sponsored by Al-Anon members, who help adult families and friends of alcoholics recover from the effects of living with the problem drinking of a relative or friend. Their website and hotline will help you find a meeting in your area.

Nar-Anon

Nar-Anon is a Twelve Step fellowship group for the family and friends of drug addicts. Their website offers information on meetings, events, and online support group forums.

Alcoholics Anonymous

The official AA website offers member guidelines, questions and answers, and a welcome message for newcomers.

Co-Dependents Anonymous (CoDA)

Co-Dependents Anonymous is a worldwide fellowship of men and women who gather to share their common and individual problems of codependency, and the solutions that they have found, following a program based on the Twelve Steps. Their website offers news, a calendar of events, and searchable meeting contacts by state.