Un-Addiction - Nzinga Harrison

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• The author argues that addiction should be viewed as a chronic medical illness rather than a moral failing. They cite research showing treatment can enable recovery and long-term sobriety for many people with substance use disorders.

• Relapse rates for chronic health conditions like asthma and high blood pressure are similar to or higher than relapse rates for addiction. But we do not dismiss treatment for those other conditions the way we often do for addiction.

• The author became interested in addiction medicine because people struggling with substance use are so marginalized and mistreated by the medical system. They saw their own family members struggle with addiction.

• Through work on a liver transplant psychiatry team, the author saw how people with histories of substance use were discriminated against and denied life-saving treatments, even if they had been in long-term recovery.

• The introduction defines addiction according to the American Society of Addiction Medicine as a treatable chronic medical disease involving interactions among biology, genetics, environment and experiences. Risk is influenced by biological, psychological and environmental factors from both inherited and acquired sources.

• The book aims to change common misconceptions about addiction by presenting research and true stories that contradict what most people have been told. The goal is to view addiction more accurately as a medical condition requiring treatment and support.

• Addiction risk factors come from biological, psychological, and environmental influences that interact in complex ways. Understanding these factors allows one to develop a “Magic Formula” to maximize protective influences and minimize risky ones.

• Examples are given of how biological, psychological, and environmental factors can combine and interact to increase the risk of conditions like asthma or alcohol use disorder. Family history, gender, discrimination, trauma, peer pressures, etc. all play a role.

• Compassion is emphasized as essential for understanding addiction and supporting recovery without judgment. Addiction should be approached like any other health condition.

• The language used to describe addiction and people with substance use disorders is important and can promote or detract from stigma and understanding. People-first language is preferable to defining people primarily by their condition.

• Changing the conceptualization of addiction from a choice to a biological disease is important for improving treatment and recovery outcomes by reducing stigma. Words have psychological power and impact people’s willingness to seek help.

• The passage discusses the importance of using person-first language and avoiding stigma when talking about addiction.

• It provides alternatives to phrases like “substance abuser”, “drug of choice”, “relapse”, etc. that are less judgemental and focus more on the medical aspect of addiction.

• For example, instead of “substance abuser” one could say “person with substance use disorder” to emphasize it is an illness, not a moral failure.

• Similarly, “relapse” suggests the person chose to use again, when really the disorder relapsed. It’s better to say “their substance use disorder relapsed.”

• The overall message is that changing the language around addiction can help reduce stigma and encourage more compassion for those suffering from this medical condition. Using person-first language sees the person, not just the illness.

So in summary, the passage advocates thoughtfully examining our language on addiction to ensure it supports treatment and recovery, rather than perpetuating stigma against those struggling with substance use disorders.

• Vervet monkeys on the Caribbean island of St. Kitts have developed a taste for human alcoholic drinks like cocktails. They stealthily steal drinks left unattended on beaches and tables.

• Some monkeys get heavily intoxicated, stumbling around and passing out. There can be fights over the last sips of drinks.

• Researchers studied over 1,000 vervet monkeys and found some are social drinkers, others regular drinkers, and some abstain completely. About 5% are binge drinkers who could potentially drink to death.

• The psychiatrist uses the example of the vervet monkeys to show addiction patients that biological and environmental factors influence addictive behaviors, not just personal choice. Comparing humans to the monkeys helps reduce feelings of moral failure in patients.

• Genetics research shows around 40-60% of addiction risk is inherited, and the environment accounts for the rest. Addiction traits are passed down families similar to other chronic illnesses like diabetes and asthma.

• Relapse rates for treated addiction are comparable to rates for treated chronic conditions like hypertension and asthma, showing addiction should be viewed similarly as a treatable medical condition rather than a moral failing.

Here is a 60% summary:

• 40-60% of risk for conditions like asthma, diabetes, hypertension is genetic/out of an individual’s control. Lifestyle and medication each account for less than 30%.

• Addiction is at least partially genetically influenced, with 40-60% of risk passed down. Having an addicted parent can biologically impact a person’s risk.

• Addiction is a biological imperative driven by survival instincts, not a lifestyle choice. It involves dopamine and limbic brain systems that can override rational decision making.

• People struggling with addiction often don’t get the support needed to understand and change their condition. Compassion and treatment that provides knowledge/tools can help people take back the 40-60% of risk within their control.

• Chronic conditions like addiction are illnesses, not moral failings, though active addiction can cause harm. Understanding the biological factors can help assign blame to the condition rather than the person.

The passage discusses ways to strengthen self-control and make healthier decisions around substances like drugs and alcohol. It advocates brief practices like deep breathing, mindfulness meditation, and mantras to give the prefrontal cortex time to override impulsive responses from the limbic system. Counting to 10 before acting is also suggested.

The passage describes techniques from Alcoholics Anonymous like “playing the tape” where you visualize the potential consequences of your actions. This creates distance between a physical craving and taking action, allowing better consideration of consequences. These strategies help avoid unhealthy impulsive decisions.

The overall message is that small, simple actions can strengthen self-control and decision making abilities. Giving the prefrontal cortex more time and control can help prevent substance misuse and addiction by making healthier choices. Brief mindfulness or relaxation practices are presented as effective ways to do this.

• The passage discusses the concept of “preaddiction” and how having this term can encourage people to get help before their substance use becomes a serious problem or crisis.

• It introduces the CAGE screening tool, which asks 4 questions (Have you felt you should Cut down? Have you felt Annoyed by criticism of your use? Have you felt Guilty about your use? Have you used substances as an Eye-opener?) to help identify potential substance use issues.

• It then outlines a “Magic Formula” for addressing preaddiction, including steps like cutting use in half, tracking use in a journal, retaking the CAGE test, talking to one’s doctor, and using technology/apps for support.

• The key message is that brief interventions and addressing potential issues early can help prevent substance use from worsening into a full addiction. Having terms like “preaddiction” aim to encourage people to seek help before their situation becomes a crisis.

• It advocates being open about concerns with at least one other person, like a friend or doctor, to help address issues and decrease the chances of problems escalating.

• The passage discusses how to have difficult conversations with loved ones about addiction and setting boundaries. It provides checklists for partners and children of those struggling with addiction.

• For partners, it’s important to clearly define what constitutes a problem and have non-judgmental conversations. Partners should educate themselves on enabling behaviors and set compassionate boundaries for themselves while getting their own support.

• For children, even preschoolers have noticed alcohol/drug use, so it’s never too early to have age-appropriate talks. Ask children about their observations and validate their emotions while providing information about addiction being an illness, different from the person. Explain how addiction can be genetic and how to protect themselves.

• The key messages are having open yet caring discussions, understanding addiction as a disease, setting boundaries to avoid enabling, getting one’s own support, and educating children about risks while fostering compassion. The overall aim is addressing addiction issues compassionately within relationships.

• Vincent Felitti was a clinical professor of medicine who founded the Department of Preventive Medicine at Kaiser Permanente San Diego.

• In 1990, he was presenting the results of a study he conducted at his obesity clinic. Though patients lost weight in the program, many regained it after leaving.

• During medical histories, Felitti discovered that many patients who struggled with weight had experienced trauma as children, like abuse or household dysfunction.

• This led him to suspect a link between childhood trauma and long-term health issues like obesity, heart disease, and addiction. He developed the Adverse Childhood Experiences (ACE) study to research this further.

• The ACE study analyzed surveys from over 17,000 patients. It found strong correlations between traumatic childhood events and risks for things like heart disease, cancer, diabetes, substance abuse, etc. in adulthood.

• Higher ACE scores, indicating more childhood trauma, correlated with worse health outcomes and addiction risks later in life. This challenged the notion that many health issues were solely a matter of personal choice or genetics.

So in summary, through his obesity clinic work, Felitti made the connection between childhood trauma and long-term health risks, which led him to pioneering research on Adverse Childhood Experiences and their impacts.

• Felitti was a doctor who had success helping obese clients lose weight but saw many put the weight back on. He wanted to understand why.

• In interviews, some clients revealed they experienced childhood sexual abuse. Felitti was surprised to find this link between abuse and weight gain.

• Along with CDC researchers, Felitti conducted the landmark ACE study with over 17,000 participants. It uncovered high rates of child abuse and family dysfunction.

• The study showed a strong correlation between higher ACE scores (more childhood trauma) and serious health issues like obesity, heart disease, addiction, etc. in adulthood.

• The results astonished researchers and challenged notions of the happy American childhood. It demonstrated the lasting impacts of childhood trauma on physical and mental health.

• While influential, the initial study was limited by having a mostly white, middle-class sample. Later studies aimed to include more diverse populations and found higher ACE rates among marginalized groups.

• The science behind ACEs shows how childhood experiences literally shape our biology and neuropathways in ways that continue affecting health for life. The brain remains plastic and adaptable throughout life.

In summary, the breakthrough ACE study rigorously documented strong links between childhood trauma and poor adult health outcomes, profoundly influencing our understanding of health and development.

• The passage discusses research into how mindfulness meditation can change brain activity and structure. Brain scans show meditation increases the size of the hippocampus, involved in factual memory, and decreases the volume of the amygdala, involved in emotional memory like fear and anxiety.

• It notes that the brain develops the most during childhood and adolescence. For many, the environment during this critical period is chaotic rather than stable and meeting needs. This affects how the brain and body develop in terms of perspective, chemistry, and stress response.

• Traumatic childhood experiences shape one’s worldview and perspectives into adulthood in maladaptive ways, like seeing the world as dangerous or feeling undeserving. This contributes to substance abuse issues as adults use drugs to cope with constant stress and fear responses developed in the brain.

• The generational cycle of trauma is explained, where children of abusive families often subconsciously recreate similar patterns due to imprinting unhealthy coping mechanisms as normal. Breaking this cycle requires understanding the impact of early life adversity on development and taking control of one’s future.

The passage discusses expanding the Adverse Childhood Experiences (ACE) questionnaire to include additional trauma factors. It tells the story of a patient, Joseph, who experienced many ACEs like sexual abuse, family substance abuse and incarceration, violence, and instability. He developed addiction issues as a result.

The passage notes two missing ACE factors - experiences of racism and an unsafe community. It says discrimination and factors outside the household can deeply impact one’s life. People may relate to feelings of exclusion.

The Philadelphia ACE Project added five questions to the questionnaire to account for community-level stressors particularly affecting urban communities. The new questions ask about feeling unsafe in one’s neighborhoods, witnessing violence, being bullied, feeling unimportant, and unfair treatment due to identity. Understanding these expanded factors can provide more context for people’s challenges and addictions.

• The passage discusses Adverse Childhood Experiences (ACEs) and how having 4 or more is associated with negative health outcomes later in life.

• The author notes they have an ACE score of 5 due to experiencing domestic violence, parental divorce, parental mental illness, parental incarceration, and substance abuse in their household as a child.

• The passage introduces Positive Childhood Experiences (PCEs) as experiences that can counteract the negative effects of ACEs. PCEs include feeling supported by family, a sense of belonging, community traditions, and friend support.

• Having a high PCE score of 6 or more is associated with better mental health and a lower risk of addiction. Even a PCE score of 3 provides some protective effects.

• PCEs can still be developed as an adult through choosing supportive family and friends, community involvement, and fostering a sense of belonging. Maintaining 3 PCEs as an adult can help reduce the impact of childhood adversity.

• The rest of the passage outlines the 7 PCE questions and provides suggestions for incorporating each PCE into adult life through relationships, traditions, communication skills, and finding a sense of belonging.

• Having a solid circle of close friends who support each other is important, especially as people get older. It’s worthwhile to put in the effort to maintain strong friendships.

• Consider each friend’s “love language” - the way they best experience care and support. This could be quality time, acts of service, gifts, words of affirmation, or physical touch. Catering your support to their love language helps them feel loved.

• Identify who your “go-to” friends are for different types of support, like an empathetic listener during hard times vs. someone who can help with practical tasks. Figuring out each friend’s strengths helps you get the right support from the right person when needed.

• Non-parent adults who showed a genuine interest in you as a child, through encouragement, mentorship, etc. can continue to provide support as an adult in the form of guidance, sponsorship, and rooting for your success.

• Having at least 2-3 such caring non-parent adults in your life as a child is a protective factor, while their continued presence can help you navigate challenges later in life.

• Professor Bruce Alexander created an experiment called “Rat Park” at Simon Fraser University to study addiction risk factors.

• Rat Park was an enriched environment where rats could socialize, play, explore, and engage in natural behaviors. It was meant to test the theory that environmental factors play a role in addiction.

• In conventional addiction studies at the time, rats housed in isolated cages (Skinner boxes) would compulsively self-administer opioids like morphine or heroin via lever-pressing. This was used as evidence that drugs were inherently addictive.

• However, when Alexander placed rats in the more natural and social environment of Rat Park, they showed little interest in self-administering opioids, even when the drugs were freely available.

• Just as Rat Park was generating controversial findings challenging the dominant view of addiction, the university abruptly cut funding for Alexander’s research, effectively ending the Rat Park experiment.

• Alexander’s work suggested that environmental and social factors play a major role in addiction risk, beyond just the chemical properties of drugs alone. This challenged the “just say no” approach prominent at the time.

So in summary, Rat Park provided evidence that environmental enrichment can reduce addiction susceptibility in rats, challenging views of the time that drugs alone caused addiction. However, the influential experiment was prematurely shut down.

• The Rat Park experiments challenged traditional views of addiction by showing that environmental and social factors play a major role. Rats in isolated “Skinner boxes” consumed much more morphine than rats housed together in an enriched “Rat Park” environment.

• Bruce Alexander argued that addiction should be viewed as a social and environmental problem, not simply due to the properties of the drug itself. Impoverished environments and lack of social connection can promote addiction.

• Subsequent studies have replicated Rat Park’s findings, showing rats prefer social interaction over drugs. This suggests addiction is related to feeling disconnected, while connection helps prevent and treat addiction.

• The experiments highlight how environmental constraints, like isolation during the pandemic, may increase substance use and risky behaviors. People still desire connection and purpose even while struggling with addiction.

• Rat Park challenges the myth that those with addiction don’t care about themselves. Lacking proper social support and positive environments can make it difficult to resist addiction despite still wanting fulfillment in life. Addiction is a complex problem rooted in both biological and socio-environmental factors.

The passage discusses several myths about addiction:

Myth #1: You have to hit “rock bottom” to change substance use behaviors. The author argues there is no single definition of rock bottom, and pushing someone towards it is dangerous. Recovery is possible without extreme desperation.

Myth #2: It’s impossible to use drugs without getting addicted. The author cites the Rat Park study showing some rats used morphine without addiction in a supportive social environment. Most people would likely use recreationally if drugs caused no harm. Many people already do this with substances like alcohol.

Myth #3: Drug use is always abnormal and detrimental. The author argues drug use can be normal and provide benefits in some cases, such as helping a veteran cope with PTSD or allowing a single mother to work more. The key is changing one’s environment and support system to reduce harm from drugs over time.

Myth #4: Drugs are only problematic once addiction develops. But simply taking drugs away won’t fix issues - one must address the initial purposes drugs served and replace them with healthier coping strategies and social support. Recovery involves more than just abstaining from substance use.

If we don’t create environmental conditions that support recovery from addiction, we are unintentionally increasing the risk of relapse by not meeting basic human needs. Factors like poverty, lack of access to healthcare and education, unemployment, food insecurity, and community stress all impact physical and mental health, including the risk of addiction relapse. Zip code or neighborhood has a significant influence on life expectancy and health outcomes through these social and environmental determinants. Ensuring supportive recovery environments that meet basic needs can help reduce relapse and promote long-term recovery from addiction.

Here are the key points I gathered from summarizing the passage:

• A study linked higher numbers of liquor stores in California neighborhoods to more childhood accidents, assaults, and child abuse injuries. This suggests an interaction between environmental and biological factors that can create a “vicious cycle.”

• Easy access to alcohol, tobacco, and drugs from a young age due to surrounding stores can negatively impact health and lead to substance abuse issues. Lack of safe spaces like playgrounds or after-school programs can also enable riskier behavior.

• Stressful environments like poverty, community violence, and trauma can literally change brain structure and gene expression through epigenetics. This demonstrates how the environment directly impacts biology.

• The Moving to Opportunity study found better health outcomes like lower obesity and diabetes rates for families who moved to more affluent neighborhoods, likely due to differences in stress levels, available resources, and modeling of healthy behaviors.

• In summary, the passage discusses research showing strong links between socioeconomic and community-level environmental factors to both psychological and biological health. This highlights the interconnected relationship between a person and their surrounding environment.

• Your risk of addiction is linked to your environment. If you feel stuck or lack opportunities for socializing, exercising, and entertainment, you may be more likely to turn to substance use. Feeling like you’re “in a Skinner box” can trigger addictive behaviors.

• Drug use is often recreational. Many people use substances without harm. It’s important not to judge others or think you don’t have a problem if you use. Both recreational and problematic use are possible.

• Drug use can have benefits. Substances are used socially and to reduce anxiety for many. The key is recognizing when use crosses into addiction territory and finding healthier substitutes for the benefits sought.

• You’re encouraged to create a crisis coping list of less and more helpful strategies, and a list of 7 ways to shift behaviors and engage differently with your environment each day to lower substance use risk. Small changes like alternate routes or activities can help.

The key messages are about understanding how environmental factors influence addiction risk, avoiding judgments, and making intentional choices to alter one’s environment and coping strategies for healthier outcomes. The goal is recognizing personalized risk factors and promoting well-being.

• Benzodiazepines like Valium were commonly prescribed in the 1960s-70s for anxiety, insomnia, and as a “female tranquilizer” to address societal pressures on women. Valium became one of the most commonly prescribed drugs.

• However, benzodiazepines are highly addictive. Within a decade, 15% of the population had used Valium or similar drugs, and concerns about overprescription and addiction arose. Valium remains addictive even when prescribed for medical conditions today.

• Taking a prescription medication, even if for a legitimate condition, can increase risk of substance use disorder if the medication is addictive like benzodiazepines, opioids, or stimulants. This is an “acquired biological risk” on top of any underlying medical condition being treated.

• While these drugs can effectively treat conditions like anxiety and insomnia, they carry addiction risks that were not fully understood when Valium became popular in the 1960s-70s. Alternatives with lower addiction risk now exist for some conditions.

So in summary, it outlines how Valium was commonly but problematically prescribed in the past, the addiction risks of benzodiazepines, and how prescription medication use can introduce new biological and addiction risks even when intended to treat other conditions.

• Benzodiazepines like Xanax provide fast relief from anxiety by binding to GABA receptors in the brain, but they also come with risks of addiction and withdrawal.

• Their effects wear off quickly, leading to rebound anxiety between doses and the need to take more over time to get the same relief (tolerance). This drives addiction.

• Xanax in particular is very dangerous due to its fast onset and offset, causing cravings and short periods of relief before withdrawal kicks in.

• A story is provided about a college student named Jack who was prescribed Xanax for panic attacks but became addicted after realizing he needed it to manage anxiety and stress from school. He ended up abusing much higher doses than prescribed.

• Benzodiazepine prescriptions increased dramatically from the 2000s onward, possibly leading to more availability for drug abuse. While prescriptions have declined, addictions and overdoses rose, including among teenagers accessing the drugs illegally.

• The risks of benzodiazepines are compared to opioids, both of which can start as medical treatments but carry addiction risks that transform them into problems over time if misused. Careful management of such drugs is important.

• The story outlines the parallels between the benzodiazepine and opioid crises, where both types of medications were falsely marketed as non-addictive but led to surging rates of addiction and dependence.

• Opioids were commonly prescribed for all kinds of pain conditions, from post-surgery to arthritis. This led many people to become addicted after first taking prescription opioids.

• The author describes a case of an elderly man who was on multiple medications, including opioids and benzodiazepines, which placed him at high risk of confusion, overdose and withdrawal issues.

• It’s highlighted that addiction risk comes from biological, psychological and environmental factors interacting with medication use, rather than the medication alone.

• Stimulant medications like Adderall are described as having a low risk of addiction when used to treat ADHD, but still require monitoring given the rise in misuse.

• Three classes of medications - benzodiazepines, opioids, and stimulants - are identified as being particularly dangerous and requiring patients to ask doctors questions before use due to addiction risks.

In summary, the key message is warning about the addictive potential of certain prescription medications, especially when taken improperly or combined with other risk factors, based on lessons from past drug crises. Careful use and monitoring is emphasized.

• Benzodiazepines, opioids, and stimulants all work on the same brain pathways and receptors as alcohol, heroin, cocaine respectively. This can lead people to chase euphoric effects and develop addictions.

• Counseling revealed a woman’s alcohol use disorder was partly due to treating physical pain from running injuries and emotional pain from losing her ability to run. Running activates the brain’s reward system similarly to opioids. Treatment included medication for alcohol use disorder and switching to a lower impact activity.

• Not all medications are necessarily addictive. Some, like blood pressure medications, people physically adjust to but are not at risk of addiction behaviors. Addiction risk is higher for opioids, benzodiazepines and stimulants which can take over people’s lives.

• The Opioid Risk Tool (ORT) screening questionnaire can predict risk of developing a substance use disorder if prescribed opioids, benzodiazepines or stimulants based on risk factors. A higher score indicates higher risk.

• A computer card game called the Iowa Gambling Task showed that abstaining from cocaine for 6 months allowed people’s brains and decision making to recover, choosing less risky options as brain structure improved. This demonstrates addiction is treatable and the brain can recover through abstinence.

• It is important to have open conversations with your doctors about risk factors for substance use disorders, in order to be proactive in preventing problems.

• Most doctors don’t receive extensive training in addiction, so you may need to educate them and give them time to research ways to help lower your risks. Be patient and understanding of any limitations.

• Due to privacy laws, addiction specialists cannot usually share your medical records with other doctors without your consent. You need to verbally share relevant information with all healthcare providers.

• Before appointments, research any chronic illnesses or medications you have to understand risks. Compile lists of these as well as any relevant personal/family risk factors.

• In appointments, share what you learned but don’t say “Google told me”. Approach it as partnership to devise a smart strategy. Request specific steps and resources.

• If urgent, you can have a critical conversation about worries over a current drug/prescription and explore safer alternatives. The goal is open communication to lower addiction risks proactively.

Here are the key points from the passage:

• Adversity increases the chances of developing chronic illness. Exposure to difficult life circumstances like poverty, stress, discrimination, etc. can negatively impact physical health over time.

• Arline Geronimus, a university professor, was studying the relationship between poverty and early childbearing among disadvantaged communities.

• She presented her research at a scientific conference that was also attended by journalists. This led to negative media headlines about her “outrageous views.”

• Some of Geronimus’ students had to drop her class because their parents were unhappy after reading the misleading news articles and did not want to pay for the class anymore.

• Geronimus was surprised by the hostile media reaction, as she had presented similar research at other conferences without issue. The key difference was the presence of journalists at this particular meeting.

• Her research found that in poor rural and urban communities, having children earlier may have health benefits compared to delaying childbearing until older age. This challenged conventional views about the disadvantages of early motherhood.

So in summary, the passage discusses how adversity like poverty and stress can impact health over time. It also provides an example of how Geronimus’ research challenging traditional views on this topic was misrepresented in the media, upsetting some parents.

• Aravah Geronimus conducted research in the 1980s that found teenage mothers had lower infant mortality rates than mothers in their 20s in the same communities. This went against the prevailing view that teen pregnancy was universally bad.

• Her research received significant media attention, with some headlines portraying her findings positively but others criticizing or misunderstanding her message. Planned Parenthood and others publicly protested and demanded her university fire her.

• Geronimus received death threats over her research. She had to reassure her students and explain how the media misinterpreted her work, which was not intended to encourage teen pregnancy but draw attention to broader issues facing these communities.

• Geronimus developed the concept of “weathering” to explain how adversity like poverty, racism, and lack of support accelerated poor health and aging. Later scientific discoveries supported this theory by identifying mechanisms like allostatic load and telomere shortening linking stress to health outcomes.

• Experiencing racism is a physiological stressor that can trigger trauma responses with health impacts like increased risk of cardiovascular disease, substance abuse disorders, and premature aging over time due to weathering effects. Breaking barriers in high-pressure work environments can also increase stress levels and risk of mental health issues or substance use.

• A Black colleague of the author reached out for help as she was struggling with the daily microaggressions and questioning of her capabilities at her senior management job, where she was the only Black person.

• She dealt with covert racism like colleagues saying they couldn’t find minority candidates for senior roles but lower paid roles. Her ideas were dismissed and she faced constant questioning.

• The daily passive-aggressive questions from colleagues about Black culture exacerbated the strain.

• She started drinking more to cope, from an occasional drink after work to with lunch to manage anxiety and prevent lashing out at work.

• Eventually she was having panic attacks. Her mental health and family life were suffering as she was always intoxicated.

• The author saw a direct link between the racial trauma and discrimination at work causing psychological distress and risky drinking.

• They addressed the root cause by connecting her with a culturally informed therapist. Medication also helped reduce anxiety attacks. Her drinking returned to normal levels and she felt more confident at work.

• Highly educated professionals like doctors often assume their education reduces implicit bias, but that is not the case. Implicit biases persist even among educated people.

• The author witnessed implicit racial biases when working at an addiction treatment program. Black patients were labeled as “unmotivated” and “noncompliant” more often than white patients. White patients received more lenient labels and recommendations for extra services.

• The white staff were likely not consciously racist, but unconsciously influenced by stereotypes in media that portrayed black people as aggressive or uncooperative. When black patients expressed anger in therapy, white staff may have found it threatening whereas white patients expressing the same anger received alternate explanations.

• These subtle biases robbed people of color of equitable addiction treatment. The author worked to implement strategies to educate staff and eliminate disparities.

• Discrimination based on other identities like gender, sexuality, or disability can also negatively impact health through increased stress and trauma. Concepts like “REGaLS” (Race, Ethnicity, Gender, Language, Sexuality) and the “three Es” (Event, Experience, Effect) help analyze how discrimination influences health outcomes.

• The story is about an African American man named John Henry who worked building the Chesapeake and Ohio Railway in the 1800s.

• He was known as being exceptionally strong and fast, especially with a sledgehammer. He was said to be the strongest man alive.

• John Henry took on the challenge of competing with a new invention, a steam drill, to see who could drill more holes and crush more rock.

• In the competition, John Henry ended up winning by outperforming the steam drill. However, he collapsed and died from exhaustion immediately after winning due to the immense physical exertion.

• One moral of the story is about the tremendous effort that Black people often felt they had to make to gain acceptance in society. John Henry pushed himself to his physical limit in the competition.

• The analogy is made that today, reactions to subtle discrimination or “microaggressions” can also lead people to overexert themselves physically or emotionally in ways that take a toll on their health and wellbeing over time. People may take on too much stress or pressure in response to trauma.

• The story of John Henry is used to illustrate how discrimination, even in subtle forms, can have serious long-term health impacts through insidious and cumulative effects on the body and mind if not addressed.

Here are the key points about supporting someone who may or may not identify the same way you do from the passage:

• Safe spaces are places where people can escape scrutiny and be themselves without having to code-switch or explain themselves. This includes groups that share experiences as well as just one trusted person.

• When someone comes to you for a safe space, thank them for trusting you, be fully present by listening without judgment, ask open-ended questions, and ask what they need rather than giving advice.

• Avoid re-traumatizing them by criticizing how they handled a situation or making it about you. Respect their personal space preferences.

• If you accidentally caused offense, own it, take responsibility for rectifying it, and commit to open communication going forward.

• You can also support from the sidelines by reassuring the offended party and giving the offender a heads up about potential issues with what they said in a non-accusatory way.

So in summary, the key is providing a judgment-free listening ear, validating experiences, respecting needs and boundaries, taking responsibility if needed, and helping to resolve issues smoothly whether the identities are the same or different. The focus is on supporting the individual seeking support.

• Culture plays a significant role in influencing substance use and addiction risk. It includes both macro and micro factors.

• On a macro level, culture refers to societal customs, traditions, holidays, media consumption, music/song lyrics, and advertising that normalize and promote substance use. Examples given are Thanksgiving, Cinco de Mayo, Super Bowl, country music.

• On a micro level, culture includes family traditions, social circles, professions, and personal identities that are tied to substance use. Examples given are family gatherings centered around drinking, musician lifestyle involving bars/drugs.

• Popular media like TV shows often depict substance use as a normal part of daily life. Advertising aims to make substance use seem appealing, fun and sexy especially to younger audiences.

• Cultural acceptance and promotion of substance use can influence behaviors and increase risk of addiction, especially when starting at a young age. Understanding these cultural factors is important for prevention and treatment.

The key takeaway is that culture shapes norms and behaviors around substance use on both societal and personal levels, which need to be recognized as influencing factors for addiction risk and recovery.

The passage discusses the decision by CVS Health to stop selling tobacco products in their stores in 2014. At the time, tobacco sales generated about $2 billion annually for CVS. However, Larry Merlo, the CEO of CVS Health, questioned whether a healthcare company should be actively selling such an addictive and unhealthy product.

He took the issue to the board of directors. The board deliberated and decided quickly, within 30 minutes, that CVS should clear its shelves of tobacco. They felt it was the right decision for a healthcare company’s mission and values. By removing tobacco, CVS aimed to have a bigger positive impact on public health in the communities it served.

The move was seen as CVS asserting its responsibility to prioritize customers’ health over profits. It prompted broader discussions about the role of corporations in influencing health behaviors and environments. While a bold financial decision, it marked an efforts by a major retailer to take a stand against one of the leading causes of preventable death in the US.

• CVS Health became the first major pharmacy chain to stop selling tobacco products in the U.S. in 2014. This was a major shift as tobacco sales brought in $2 billion annually for CVS.

• Despite dropping these profitable products, CVS Health’s stock price rose steadily in the year following the announcement, showing that focusing on health can also be good for business.

• Research found cigarette sales dropped in areas where CVS had a strong presence after the policy change. About 95 million fewer packs of cigarettes were sold nationwide in the first year, and average smokers in those areas bought 5 fewer packs.

• People who exclusively bought cigarettes from CVS were 38% more likely to quit smoking completely once CVS stopped selling them. This showed environment and access can strongly influence tobacco use.

• The story highlights how cultural and environmental factors beyond individual choice, like where people shop, can significantly impact health behaviors like smoking and addiction. Reducing access to substances in the environment can reduce their use and support sobriety.

So in summary, CVS Health’s decision to stop tobacco sales had meaningful public health impacts by altering the retail environment and cultural acceptability of smoking in certain communities, in turn helping to reduce cigarette consumption and support smokers who wanted to quit.

• Peer pressure can occur at any age, as humans have a strong innate tendency toward herd mentality and following the behaviors of our social groups. This evolved as a survival mechanism.

• Navigating situations where your behaviors differ from the group’s accepted norms, such as abstaining from drinking/drugs, can lead to feelings of isolation and exclusion from one’s social support system.

• When facing pressure to engage in unwanted behaviors, it’s important to prioritize your own well-being, values and recovery goals over gaining approval or acceptance from others. Having a strong support network that respects your choices can help withstand peer influence.

• Some options to consider are explaining your decision calmly without judgment, removing yourself politely from situations where use may occur, or finding alternative activities your whole group can enjoy together. The goal is to maintain important relationships while setting healthy boundaries.

• Due to the powerful drives of herd mentality and need for social connection, coping with peer pressure takes practice and commitment to one’s recovery. But prioritizing self-care and surrounding oneself with supportive people can help overcome this challenge.

Here are the key points from the summary:

• The passage discusses strategies for recognizing situations where one may feel culturally pressured to use substances, avoiding those situations if possible, and planning what to do if avoidance isn’t an option.

• Specific examples given include teenage parties, holiday gatherings with family, and social events like brunch with friends.

• For teenagers, the author recommends having open conversations to get information about parties, setting parameters around supervision and substance use, and creating a safe signal to get picked up if needed. Drug testing is presented as an opportunity for openness, not punishment.

• For holidays, minimizing alcohol availability at family events and having non-drinking activities planned can help avoid pressure. Having sober supporters present is also recommended.

• At social events like brunch, avoiding direct temptation by what you eat/drink, enlisting a supportive friend, and feeling confident saying no are suggested strategies if avoidance isn’t possible.

• The overall message is that with planning, awareness of triggers, and alternatives, one can confidently opt out of substance use even in culturally pressuring social environments. Open communication and having alternatives are emphasized.

• New Year’s Eve has the second highest rate of drunk driving fatalities after St. Patrick’s Day, despite efforts to curb it. Cultural and social norms continue promoting alcohol use during holidays.

• While individuals can’t control others’ behavior, they can make their own choices. The advice focuses on setting limits before events, getting informed about substance availability, practicing refusal responses, and being gentle with yourself during the boundary-setting process.

• Vacations sometimes give people permission to indulge more than usual. To stay within one’s limits while traveling, the suggestions are to decide limits in advance, set clear boundaries with companions, and choose an ally who will help uphold those boundaries if needed through compassionate redirection.

• Cultural and family traditions surrounding substance use impact addiction risk. However, one can create new rituals without drugs/alcohol and rethink societal norms that normalize intoxication in certain situations through small individual choices and supportive responses to others’ limits.

The overall message is that while broader cultural forces shape risks, individuals retain agency over their own choices and can establish healthier norms through preparedness, communication and gradual skill-building in navigating social pressures around substance use.

• Olivia, a woman from an unnamed company, messaged the author asking to learn more about what their company is trying to do.

• The author sent a long message back explaining their viewpoint that addiction treatment needs to address the whole person, not just the addiction diagnosis, as people struggling with addiction often have co-occurring conditions like mental health issues, physical health problems, lack of support systems, etc.

• The current standard addiction treatment model focuses only on the biological/medical aspect but people need lasting support to develop meaning and purpose beyond just short-term treatment programs.

• Olivia responded positively and said the founding CMO could design a model to address all these issues. She wanted to talk further.

• Nine months later, after joining with two other passionate co-founders, Eleanor Health was born with the mission to treat all six pillars of addiction risk for whole-person care, not just the acquired biological risk.

• The company aims to help members improve their physical, mental, social, and overall quality of life through an evidence-based and culturally-sensitive approach.

So in summary, it outlines the author’s conversation with Olivia that led to the founding of Eleanor Health based on their philosophy of holistic, whole-person addiction treatment.

Here is a summary of the key points from the sources provided:

• The sources discuss addiction and relapse rates for various health conditions like high blood pressure, asthma, and colon cancer. One study found relapse rates for high blood pressure and asthma were the same as or higher than addiction relapse rates. Relapse rates for colon cancer within 5 years ranged from 7-42%.

• The Adverse Childhood Experiences (ACE) study was a major research project that uncovered the impact of childhood trauma on long-term health outcomes. It found strong correlations between ACE scores (measuring abuse, neglect, family dysfunction) and risk for chronic disease, mental illness, and addiction in adulthood.

• The ACE study surveyed over 17,000 people and found 64% experienced at least one ACE, with over 20% experiencing 3 or more. It documented correlations between higher ACE scores and risks like alcoholism, drug abuse, depression, heart disease, cancer, chronic lung disease, skeleto-muscular diseases, and suicide attempts.

• The sources discuss definitions of terms like addiction, prediabetes, heritability, and DSM-5 criteria. They provide background on factors like genetics, environmental triggers, and chronic versus acute conditions. Brief interventions from doctors are highlighted as an effective early treatment strategy.

• The key accidental discovery was uncovering the strong relationship between adverse childhood experiences and long-term health outcomes via the large ACE study, which helped establish childhood trauma as a major public health issue.

Here is a summary of the key points about Bruce Alexander’s “A Garden of Eden for Rats” experiment and findings:

• In the 1970s, Alexander conducted experiments comparing rats housed in typical isolated cages (“Skinner boxes”) to those housed in a more natural, social environment he called “Rat Park.”

• Rats in isolated housing developed dependencies on morphine (which can be processed into heroin for human use) when given the option of drinking morphine or plain water.

• However, rats housed communally in Rat Park - which included toys, other rats, space to roam, etc. - did not show the same tendency to use drugs, even when morphine was available.

• This challenged the dominant view that addiction is caused by the properties of the drug itself and suggests social and environmental factors play a major role. Isolated rats used drugs to cope with their barren environment.

• Rat Park provided insight into how stable, healthy social bonds and communities might prevent addiction; it served as evidence against the “just say no” drug education approach focused only on individual responsibility.

• Alexander’s findings supported his “dislocation theory” explaining addiction as a result of isolation from natural social bonds and meaningful economic/cultural roles rather than drug use itself.

So in summary, Alexander’s Rat Park experiment challenged prevailing views of addiction by showing social environment, not just the drug, influences rates of dependency and use in laboratory rats.

Here is a summary of the key points from the sources provided:

• Heroin, fentanyl, morphine, and oxycodone are all opioids but differ in potency and legality. Fentanyl is the most potent and dangerous.

• Around 95% of people who use heroin develop an addiction to it.

• Studies on rats found they almost always chose social interaction over heroin or meth. Social reinforcement plays a role in drug use vulnerability.

• During COVID lockdowns, some turned to increased substance use to cope with stress and isolation. 13% reported starting or increasing substance use in 2020.

• Alcohol use is very common, with 85% of Americans over 18 drinking at some point. However, only around half of illicit drug users are diagnosed with substance use disorders.

• Neighborhood environment, known as your “ZNA,” accounts for around 30% of health outcomes. Factors like segregation, poverty levels, and access to opportunities vastly shape long-term outcomes.

• Life expectancies can vary by over 30 years just a few blocks apart in some cities. Higher density of liquor stores and tobacco outlets in neighborhoods correlates to more substance-related issues.

• Social and community support through groups like 12-step programs can help with addiction recovery. Neighborhood context clearly influences substance use patterns and outcomes.

Here is a summary of the key points from the sources provided:

• In the 1970s, pharmaceutical advertisements in medical journals promoted prescribing medications like Valium to unmarried, single women struggling with anxiety or tension. Valium became immensely popular and widely prescribed.

• Studies found up to 40% of Americans experience insomnia symptoms and about 1/3 will have an anxiety disorder in their lifetime. Anxiety can cause both physical and psychological symptoms.

• Benzodiazepines like Valium were meant to treat short-term anxiety but became widely overprescribed long-term. Valium was the best-selling drug in the US from 1968-1982 due to heavy marketing and promotion.

• Benzodiazepine prescriptions increased by 67% from 1996-2013 while overdose deaths increased 400%. By the late 2000s, Xanax and other benzo abuse was rising, referenced in popular songs.

• The opioid epidemic was fueled partly by overly prescribing opioids for pain. Around 75% of heroin users started with prescription opioids. Overdoses killed over 90 people per day in the US.

• Studies found new mothers were frequently prescribed opioids after childbirth, putting them at risk for addiction. By 2020, anxiety and benzodiazepine prescribing was rising again during the COVID pandemic. Regulators are warning about overprescribing and addiction risks.

• The FDA issued its strongest drug safety warning about the serious risks and potential fatal consequences of combining opioid pain or cough medicines with benzodiazepines.

• One in three American adults with arthritis filled an opioid prescription in 2015, according to the CDC.

• Less than 2% of Americans have a prescription opioid use disorder, according to NIDA.

• ADHD medications do not increase the risk of substance use disorder when used as prescribed to treat ADHD, according to research from CHADD.

• While stimulant abuse is less recognized, experts warn of an emerging “stimulant epidemic” according to WebMD.

• Descriptions are provided for benzodiazepines (sedative class of drugs), opioids (pain relievers), and stimulants.

• A person’s risk for addiction is influenced by both genetic and environmental factors. Running can induce a “runner’s high” by releasing feel-good chemicals like opioids do in the brain.

• The original Opioid Risk Tool was developed and validated in 2005 to help predict aberrant behaviors in opioid patients.

• Researchers at the Icahn School of Medicine sought answers about prefrontal gray matter recovery and cocaine addiction through a longitudinal study.

• The Iowa Gambling Task is a neuropsychological test of decision making that provides insight into brain functions disrupted in addiction and other disorders.

• Around 25% of people who have substance use disorders achieve recovery according to surveys, and there are an estimated 20 million Americans in recovery.

Here are the key points from the article:

• Women often face the “glass cliff” phenomenon in corporate America, where they are promoted to leadership positions during times of crisis or poor performance at a company. This puts them at higher risk of failure through no fault of their own.

• Studies have found that women are more likely to be promoted to leadership when company performance is declining or in a crisis situation. Men are more likely to be promoted during times of stability and increasing profits.

• Taking on a leadership role during perilous times sets women up to potentially take the blame if turnaround efforts do not work out. This hurts their future career prospects even if the challenges were largely outside of their control.

• To dismantle the glass cliff, companies need to make executive promotions more merit-based rather than crisis-driven. They should closely examine whether women tend to be put in riskier leadership situations than men through no choice of their own.

• Leaders also need to be aware of implicit biases that could cause them to see women as a “risky” choice except during times of crisis. More support mechanisms could help women succeed in high-pressure leadership turns.

In summary, the article discusses the “glass cliff” phenomenon where women in corporate America face a higher risk of failure in leadership roles because they are disproportionately promoted during times of company struggle or crisis. It suggests ways for companies to address this issue and level the playing field for women executives.

Here is a summary of the key points from the articles:

• A 2019 study examined social media use and vaping among Florida adolescents. It found high rates of social media use (nearly 90%) and vaping (over 25%) among Florida high schoolers. Social media was linked to increased odds of vaping.

• Studies show that teenagers often overestimate the actual prevalence of substance use among peers. Their perception that use is more common than it is can influence their own behaviors.

• Culture refers to the beliefs, values, behaviors and identities shared by a group of people. As youth integrate into new cultures through outlets like social media and music, they may be exposed to more substance use attitudes and behaviors.

• Analysis found country music contains the most references to drug and alcohol use out of major music genres. However, marijuana references were much more common in 1970s music compared to today.

• Early initiation of marijuana use (before age 14) is linked to higher risks of developing cannabis use disorder and other substance abuse issues.

• CVS Pharmacy decided in 2014 to stop selling tobacco products in their stores due to health concerns. Their stock price increased after this decision rather than declining as some predicted.

• Tobacco use is one of the largest threats to public health worldwide, killing over 7 million people annually including around 500,000 in the U.S. each year. CVS’s decision helped reduce cigarette sales and smoking rates.

• Studies on immigrant populations found that less acculturation into American culture is linked to lower risks of substance abuse for some groups like Latinos and Asian Americans.

• Herd mentality and conformity effects are hardwired in human brains due to evolutionary benefits of group cohesion. This can influence youth behaviors and decision making.

This is an acknowledgments section from the author, Dr. Nzinga Harrison. She thanks many people who have supported her throughout her career and journey in addiction medicine. This includes her siblings for being a support system, friends from high school through medical school, her cofounder and team at Eleanor Health, researchers who contributed to the book, and her husband and children for their love and support. She also thanks those who helped make the book possible, including her collaborating author, Jennifer Keene and her literary agency team, her publisher Jessica Firger and the Union Square & Co. team, and many others who shared their stories for the book. The section expresses deep gratitude to all those mentioned for their various roles in her work helping those with substance use disorders and in publishing this book.