Wasted: An Alcoholic Therapist's Fight for Recovery in a Tragically Flawed Treatment System (40 page)

Mike: And I get that. When I hear that and feel it, it’s like, “Oh, okay, she’s worried.”

Dr. Foote: So that’s a feeling statement in the midst of that communication,
right? You’re not saying, “Why did you drink?” You’re like, “This scares me and I think this way and I don’t like thinking this way all the time.” But if you were fleshing it out further, if I was making a specific request, it might be, “I’d like to talk about ways for me to feel reassured about your drinking.” That would be the request. “Because I get really scared and I’m thinking
about this all the time now. And when you don’t answer, I get worried.” That’s the feeling statement.

Maureen: Tell me what taking partial responsibility sounds like.

Dr. Foote: For this specific situation, “I know that I don’t ever ask you this, and so you wouldn’t even know that I’m feeling upset.” “What could I do to help” would be a sort of generic offer to help.

As
we left the Center for Motivation and Change, I could feel my anxiety lift. The Center gives out cards that outline the key steps to positive communication. I tucked it in my wallet for future use, and here they are:

1. Be brief
   
2. Be positive
   
3. Refer to specific behaviours
   
4. Label your feelings
   
5. Offer an understanding statement
   
6. Accept partial responsibility
   
7. Offer to help
   

• 48 •

THE IMPLICATIONS OF
understanding the power of my intrusive thoughts suddenly became clear to me when we interviewed Dr. Kalivas. During the worst of my addiction, I estimate I visited the emergency department in different hospitals thirty-one times. An
ED
is a place that causes much fear, anxiety and disturbance for me. Was there something about the visit
to the
ED
after my accident that forced an association between that environment and craving alcohol?

Dr. Kalivas put my relapse into context. “You basically encountered a situation that you had encountered many times in your past—the emergency room, and a traumatic episode. You would wind up in the emergency room sometimes due to the alcohol, but sometimes from something alcohol caused.
And that became a very well-learned event you associated with alcohol use. And that acted as a classic trigger.” Dr. Kalivas suggested the accident, combined with my extreme discomfort in emergency departments, activated my reward circuitry.

In the not-so-distant-future, there may be a way to prevent our reward circuitry from being hijacked in the first place. At the University of British
Columbia, Dr. Anthony Phillips is looking at a particular peptide in his research. Put simply, peptides are compounds of amino acids that are the building blocks of proteins, and are essential for many physical functions of the body, including the brain. In this instance an artificial peptide has been created. Unlike treatments to date, the University of British Columbia peptide has the potential
to prevent addiction from ever taking hold. Ongoing research explores the possibility that people who need to take hardcore pain medication for the rest of their lives could be administered this protein and then their pain drugs like OxyContin, without ever becoming addicted.

All of the developments in neuroscience have brought us here, a place where there is a small but critical mass
of drug options available to battle the misery that is substance misuse. But in order for these drugs to become widely available, doctors must be persuaded it’s okay to treat substance use disorder with another substance.

• 49 •

LIKE ANYONE LOCKED
in a cycle of addiction, I’ve asked myself that question hundreds, maybe thousands of times. At the worst point of my addiction, I did come to believe what Bill W. wrote:

“Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this
simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.”
1

While I find so much of what Bill W. has written to be sensitive and compassionate, I struggle with how reductionist this is. I’m not constitutionally incapable of being honest with myself.
I am someone whose environment and genetics predisposed me to developing a substance use disorder. Eight decades after the inception of
AA
, the final part of that paragraph does ring especially true: “They are not at fault; they seem to have been born that way.”

I think back to something Stanford University’s Dr. Malenka said when he was showing me how alcohol causes an insane spike in
my dopamine.

“I’ll bet your dopamine signal, both when you have that first drink but even when you start thinking about it, started looking like this.” He draws a graph with a giant peak. “Our brains did not evolve to handle signals as strong as that, particularly those of susceptible individuals. What I mean by that is, not everybody who drinks develops the kinds of problems you had.
And even with other drugs, not everybody who takes cocaine becomes an addict.”

The science of genetics has begun to offer tantalizing clues as to why people with substance addiction are the way we are.

Dr. Marc Schuckit has studied the genetics of alcoholism at the University of California, San Diego for over thirty-five years. We filmed at his office in San Diego. Dr. Schuckit
believes there are hundreds or perhaps even thousands of genes that impact how the brain responds to alcohol. And each gene at play explains maybe one or two per cent of the risk for developing alcoholism. Alcohol crosses easily into the brain, and almost all neurochemical systems are affected. Dr. Schuckit believes developing alcoholism is due sixty per cent to genetics and forty per cent to environment.

Genetics researchers now concentrate their efforts not on one specific gene that may cause addiction, but on a set of characteristics people inherit that increase or decrease their risk.

“There’s not an overall genetic characteristic for alcoholism,” said Dr. Schuckit. “There are sub-characteristics along the way. And we’re trying to find out how they operate in the environment
so we can we use that for prevention.”

While in his research today Dr. Schuckit focuses on four risk factors—alcohol metabolism, impulsivity, sensitivity to alcohol, and co-occurring psychiatric disorders—he told me the fact that genes played a role in alcoholism became evident half a century ago.

“What was known was some groups don’t have high risks for alcoholism. Such as Asian
people: in the 1960s, it was found that there were several genetic mutations that help protect Japanese, Chinese and Korean individuals because of how they react to alcohol. About forty per cent of Japanese, Chinese and Koreans display a red flushing in their face that’s alcohol-related. The next thing they discovered in the 1960s was that there are people who are really big risk-takers, and impulsive
people who make decisions without thinking of the consequences. And it was fairly obvious from data going way back that if you carry that characteristic, you’re at high risk for alcoholism, for drug dependence, for gambling, and for a whole host of problems.”

Me, impulsive?

As I listened to Dr. Schuckit, my mind slipped back to my childhood. I’m surprised I survived it. As an eleven-year-old,
I remember rummaging around in my friend’s basement while he was upstairs. His parents weren’t home. I found a box of army flares. I ripped it open and held one up. It was covered in decals that said things like, “Danger,” and “Explosive Device.” Next to the release, in giant lettering, was marked “Do Not Pull.” I didn’t hesitate for even a nanosecond. I pulled it. A golden-orange
burst of light filled the room and then that flare took off, zipping, spinning, banging into walls and furniture, whizzing past my head, burning the furniture, filling the rec room with acrid smoke.

There was hell to pay for that one, but it didn’t put a dent in my future impulsivity.

When I was fifteen, my mom ran the sporting goods department at the army base department store.
I even had a part-time job there myself. I was going golfing with my buddies, but didn’t have any golf balls, so I stopped by the store. My mom went to check on something in the back room, and there I stood, right beside the display of golf balls. With a furtive glance to see if anyone was watching, I quickly stuffed a box of balls into my pants, and reached for a second box, when my mom wheeled
around the corner and caught me. She sat down and talked to me about the implications of what I’d done, and how if anyone else had seen me, I’d have lost my job and maybe mom would lose hers too. Did I give a second’s thought to any of this? I can think of dozens of times in my young life where I got into scrapes like this.

As I got older, and acquired more willpower, I managed to control
my behaviour better, but I still did impulsive things. Dr. Bianca Jupp of Cambridge University says this actually worked in my favour; she says we need impulsivity to survive and sometimes succeed as a species. She credits her own impulsiveness with actually getting her to Cambridge. I think back to being the young father of three toddlers, when I decided to quit my government job, which came
with two months of holidays and great benefits, to cash in my pension to fund a private practice. Dr. Jupp is right, there is an upside to impulsivity when it comes to evolutionary biology, but there’s a considerable downside for me. Sometimes, it leads to heavy negative consequences. In May 2015, a few months after my relapse, we flew to Cambridge, England to film for our documentary Dr. Jupp’s experiments
with impulsive rats.

In the scientific world, impulsivity is known as a behavioural biomarker—a highly inheritable trait. “We actually took one rat—we called him ‘Zippy’—and bred him with other impulsive rats and found that the trait tracked over time through the generations,” she said.

Dr. Jupp wants to figure out exactly what it is about impulsivity that puts people at risk of
developing an addiction. She’s designed an experiment to test whether it’s the structure and function of a rat’s brain, which may predispose it to impulsivity, that in turn drives that rat to develop addictive behaviours.

Wrapped in a head-to-toe sterile suit, I followed Dr. Jupp into her darkened lab. She opened several opaque cases, each housing a large rat. She patted the rats and spoke
to them in warm affectionate tones. These rats were supposed to wait for a light to turn on before they poked their noses in for a reward. “What happens with impulsive rats is they fail to wait for the presentation of the light.”

I watched curiously as one rat after another repeatedly poked its nose before the light turned on. I felt an uncomfortable rush of recognition. Dr. Jupp scanned
the rats’ brains, just like I had my brain scanned. And, to be clear, these are rats that had at this point never consumed any drugs. Dr. Jupp discovered all her impulsive rats have one thing in common. “Even before these animals have ever seen any drugs, they already have a reduction in the level of particular dopamine receptors.”

Her work examines one of the essential puzzles of addiction
research. Does substance misuse reduce the level of dopamine receptors, or did something else reduce them
before
drugs were consumed?

The answer is clear as soon as the rats are administered drugs.

“What we see is that these impulsive rats take more drugs and they’re more likely to develop behavioural characteristics typical of addiction. So they compulsively use and abuse drugs.
What was critical about this study was actually showing that this reduction in dopamine levels pre-existed any use of drugs. So, it was a pre-existing behavioural trait and also a pre-existing biological trait.”

Dr. Jupp related this back to my situation. “Mike, it’s highly likely that everyone in your family has a lower level of dopamine receptors.”

Bill W. is right on that point,
at least: it does appear I was born this way. After observing Dr. Jupp’s lab rats, I became one myself. Her colleagues at Cambridge put me through a human version of that impulsivity test. My results were hardly surprising.

“Mike is more impulsive and displays premature responding—what’s known as ‘jumping the gun’—and difficulties with delayed gratification. Understanding that those who
suffer from a substance use disorder are born different changes how we view the addicted,” insisted Dr. Jupp. “I think first and foremost addiction is actually a disease. I’m trying to reduce the stigma, trying to encourage people into treatment. But beyond that we’re really hoping to identify new pharmacotherapies that might potentially treat impulsivity and also potentially treat addiction.” For
me, one of those drug therapies may be Vivitrol. Since my shot, I feel less impulsive. I find I’m a much closer approximation to me at my best. I can honestly say when on the Vivitrol I rarely think of booze. I experience something more like an aversion to it. The irritability and agitation are gone. There’s actual pleasure in being “present,” so to speak, as my brain engages in thoughtful reflection.
The urge to instantly gratify just doesn’t seem to be there anymore.

Dr. Schuckit discovered another characteristic that he believes genetically predisposes one to addiction. “As part of my evaluations of people for the thirty years that I ran an alcohol and drug treatment program, I would ask people with alcoholism, ‘What was it like early in your drinking career?’ And it actually really
surprised me because more people than not said, ‘Oh, I could drink everybody else under the table and I could do that from the first time I started to drink.’

Drinking everyone else under the table has been my badge of honour since I was thirteen. Guys twice my size would admire grudgingly, “Pond, for a little guy, you sure can hold your booze.”

Dr. Schuckit calls people like me
“low responders:” those who can drink huge amounts without feeling it much.