Alcohol withdrawal can be extremely unpleasant (see here for an overview). Symptoms vary from person to person, but most people will experience some negative symptoms of alcohol withdrawal if they try to stop drinking after long term use.
Mild to moderate symptoms include headache, nausea, vomiting, insomnia, rapid heart rate, abnormal movements, anxiety, depression, and fatigue. Severe symptoms of alcohol withdrawal include hallucinations, fever, and convulsions (known as DT’s or delirium tremens). Most people undergoing alcohol detox do not require hospitalization, but in severe cases, hospitalization may be necessary (1). Since their introduction in the 1960s, benzodiazepines have been the drug of choice for treating severe cases of alcohol withdrawal.
Benzodiazepines, or benzos for short, are a class of psychoactive drugs that work to slow down the central nervous system by activating GABA receptors. This provides a variety of useful tranquilizing effects. Aside from relieving symptoms of alcohol withdrawal, benzodiazepines are also commonly prescribed to treat insomnia, muscle spasms, involuntary movement disorders, anxiety disorders, and convulsive disorders.
The most common regimen for treating alcohol withdrawal includes 3 days of long-acting benzodiazepines on a fixed schedule with additional medication available “as needed.” (2)
The two most commonly prescribed benzos are chlordiazepoxide and diazepam. Chlordiazepoxide (Librium) is preferred for its superior anticonvulsant capabilities while diazepam (Valium) is preferred for its safety against overdose with alcohol. Short-acting benzos like oxazepam and lorazepam are less frequently used for treating alcohol withdrawal (1).
Compared to other drugs, benzos are the safest and most effective method for treating difficult alcohol withdrawal. However, benzodiazepines do come with their own potential for dependence and abuse. Ironically, symptoms of benzodiazepine withdrawal are quite similar to those of alcohol withdrawal. Tapering off dosage is the best way to prevent serious withdrawal symptoms. To avoid such complications, benzodiazepines are only recommended for short-term treatment of alcohol withdrawal.
Benzos can be very useful for helping long terms alcoholics deal with the difficult withdrawal symptoms that can accompany the detox period. Just be mindful so as not to find yourself right back where you started.
1. Williams, D., McBride, A. (1998) The drug treatment of alcohol withdrawal symptoms: A systematic review. Alcohol & Alcoholism. 33(2), 103-115
2. Saitz, R., Friedmn, L. S., Mayo-Smith, M.F. (1996) Alcohol withdrawal: a nationwide survey of inpatient treatment practices. 10(9), 479-87
There’s a specific issue that keeps coming up with nearly every addiction client I work with who is in early recovery. Regardless of whether they’re trying to stop unhealthy alcohol or drug use, sex or gambling behavior, or anything else, this issue keeps returning. It doesn’t even seem to matter if this is their first attempt at addiction recovery or if they’ve already been here many times before.
The issue: Shame about a desire to return to old behaviors and stopping their recovery.
At the Matrix Institute on Addiction where I see some clients, they call this “The Wall” suggesting that it usually comes right after a relatively easy period of recovery in which clients are self-assured and confident that they’ve got their addiction beat. “The Wall” is supposed to be marked by anhedonia, depression, severe cravings, irritability, and more fun stuff like that. After the wall is the promised land of long-term recovery. By identifying the specific stages of recovery addicts are supposed to gain more understanding of their process and experience less shame. I love the Matrix method, but I see things a little differently. The way I see it, “The Wall” is far from a single point in time, but is instead part of a larger pattern I like to call Rubber-band Recovery.
Rubber-band Recovery in Addiction
I’m sure everyone reading this has at some point played with a rubber band, stretching it and letting it snap back to its original state or pulling it between two fingers and playing it like a string (another name for this approach could be String Recovery, but that might get confused with theoretical physics and we don’t want that). When pulling the rubber-band one way, its internal structure pulls back, trying to get back to its natural state. The body can be thought to do the same when placed under chronic alcohol and drug use in addiction – it has a slew of internal processes that work hard to keep the body in its natural state, at homeostasis. Naturally, due to the pharmacological mechanisms of alcohol, cocaine, methamphetamine, marijuana, and many other drugs, these systems usually fail at setting everything back to normal especially during the use itself, which is why we get high. However, their work in a body that consumes drugs on a regular basis is obvious – reductions in the production of specific chemicals (like relevant neurotransmitters), changes in the structure of the brain itself (like producing less receptors or even removing some from the brain’s cells), and production of chemicals that combat the drugs’ actions.
All in all, the body and brain of a long-time, chronic, heavy user of alcohol and drugs are different from the body and brain they started with in important ways that specifically relate to their alcohol and drug use. They are like the stretched rubber band, similar but obviously not the same as it was in its relaxed state.
Individuals in early recovery from addiction essentially experience what happens when that taut, stretched, rubber band is let loose. Hurrying up to get back to its natural state, to homeostasis, it releases all that pent up energy and rushes through its original state, overcompensating and stretching a bit in the other direction. For the addict in early recovery, this is the process of withdrawal. As we’ve spoken about numerous times before when discussing withdrawal, a brain that has reduced its own production of dopamine because of large amounts of methamphetamine that flood its dopamine reserves will still be left with very low dopamine when the crystal meth stops coming in. Low dopamine will bring about many effects that look exactly like the opposite of a methamphetamine high – a large appetite, low energy, and reduced movement and motivation. For heroin addicts, the drug that’s caused them to feel no pain and become constipated will cause their bodies severe pain, diarrhea, and trembling when it’s removed from the equation. Some withdrawal is actually life threatening due to the extreme changes in body chemistry and structure that happen after long term use. In addition to all of the direct effects of the drugs and alcohol, those internal processes that have been working hard to counteract the effects of the drugs (they’re called “opponent processes” by some addiction researcher like Dr. Christopher Evans from UCLA) are still turned up to 10 and are going to take a little time to get back to their original state as well. All in all, that leaves addicts feeling pretty crappy to say the least during withdrawal, the worst part of early recovery from addiction.
But like that good old rubber-band addiction recovery than quickly turns around. Having overcome the worst part of withdrawal, addicts in early recovery often experience joy, confidence, energy, and clarity they probably haven’t felt in a long time. That along with the environmental influence of loved ones who are extremely happy to see an addict quit (especially the first time around) give those in very early recovery a feeling of great well being and happiness, like a nice pink-cloud they get to ride on for a bit. Remember, the rubber band is moving back in the direction it came from during active addiction and it’s likely that brain processes are doing a little overcompensating the other way now too, turning down those opponent processes and flooding the brain with the chemicals it’s been missing.
But alas, this little turn doesn’t last too long and back we go into the darker place of negativity, low energy, anhedonia, and more. But instead of calling this stage “The Wall,” I understand it as one of the inevitable turns in what is sure to be a back and forth, seesaw like trip of recovery ups and downs. Periods of confidence in our ability to overcome our demons are followed by others that make us feel week and irritable. The good news is that just like with a rubber-band, each successive cycle on this seesaw gets a little less intense, which means that confidence, elation, depression, and anger turn into comfort, contentment, and ease – our new homeostasis. After a ride like that most addicts really need a little rest and when we reach this stage (no matter what it looks like specifically for each person), long-term recovery feels like the norm instead of an effort. This is the real end goal of recovery – a state of being that feels normal and that doesn’t involve unhealthy alcohol or drug use, sexual acting out, or gambling.
At the end of the rubber-band game we get back to just a good old unstretched rubber-band, and it feels good. In the process, it makes little sense to feel guilty, or ashamed, at all the intermediate stages. They’re part of the game of recovery and they’re essentially impossible to avoid completely. Intense cravings come during specific parts because of internal, biological, and external, environmental influences. Being ashamed of that would be essentially the same as being ashamed of extreme hunger when you haven’t eaten in 5 hours and see a commercial for your favorite food – silly and useless. I can guarantee that the rubber band doesn’t feel ashamed about they way it behaves when snapping back…
Addicts and others with mental health issues continuously feel as if they need to hide their problems as well as hide from them. But an ongoing west-coast (U.C.L.A. and U.S.C.) study with a group of mental health patients suggests that hiding may be the wrong approach.
The participants in the study, all successful individuals with ongoing mental health problems who seem to be stable and productive are being examined for the specific factors that make them defy the stigma so closely linked with mental health problems. Doctors, lawyers, and CEOs are all part of the group and have all figured out ways to work with their mental health issues and succeed in life.
Mental Health Problems, Addiction, and Stigma
We’ve written before about the dilemma of mental health disclosure and I’ve talked over and over about the notion that stigma is one of the major obstacles to addiction treatment and recovery. This study’s preliminary results suggest that indeed, taking ownership of one’s problems and figuring out how to best function with the characteristics each of the holds has allowed these individuals to succeed where most psychiatrists and psychologists would have expected them to fail – in high-pressure, high-stakes, positions of power.
The relevant metaphor I share often, especially to those who attend our A3 Academy sessions is this:
Imagine that two people you know drive two very different cars. One owns a Toyota Prius, one of the most efficient cars on the market with lots of storage and convenience. The other drives a Lamborghini Gallardo, one of the world’s fastest cars with an engine that makes your whole body shake and a body that reminds everyone of speed and sex. If tasked with giving the two a little guidance on taking the drive between Los Angeles and San Fransisco you would probably give the two very different suggestions…
To your Prius owner-friend you would tell that they should feel free to bring a suitcase and that the entire trip will likely require less than a full tank of gas, making the trip very cheap and economical. However, it’s likely going to take him 7 to 8 hours each way so he should leave early to not waste the day on the road. At least he won’t have to stop for gas. But the Lamborghini driver has a very different trip ahead of him, one that likely includes 2-3 stops for gas but, assuming no speed-traps or traffic, he can still probably make it to San Fran in 4 hours flat. He’s also not likely to be able to bring anything along except for an overnight bag and even that is only true if he’s not bringing anyone on the trip with him.
Unless one comes to the table with judgements about fast versus slow, or gas-efficient versus gas-guzzling, driving I think that few would suggest that I am somehow stigmatizing the cars or their owners in this story. Instead, I am offering a pretty objective description of their most likely and appropriate functioning. But when talking about people, feelings and stereotypes often get in the way.
Overcoming Mental Health Problems
This study from UCLA and USC in collaboration with The Veteran’s Administration shows us that in reality it is likely that, even for those with mental health problems, the real key is to figure out what the requirements of the “machine” you’re driving are and then plan your life accordingly. For Ms. Myrick, one of the participants in the study, that meant a high powered detail oriented job rather than a hiding spot on her favorite couch at home. Still, the researchers have identified a set of common characteristics they’ve written about. Many of the study’s participants do the following:
Adhere to a medication regimen
Often check their thoughts and perceptions with those around them
Actively control their environment, sometimes with the help of a therapist.
Some avoid travel, or crowded, noisy places while others prefer not to be alone.
Stay away from illicit drugs and alcohol.
Overall, it’s obvious that their mental health diagnoses have made them very aware, and thoughtful, about daily activities that most people disregard. Still, with a specific regimen and some help, they’ve all managed to succeed.That regimen might include medication to control attention problems, delusions, or depression; it seems to certainly include some outside perspective when it comes to big decisions; it may also include some regular exercises (physical and mental) to control anxiety and other related emotional responses.
I believe that identifying your own recipe for success is key to success, that believing in your ability to succeed is necessary, and that plotting the course between here and the future is helpful if you’re trying not to get lost. That’s not stigma, it’s practicality.
What influences college students’ decisions about whether to drink and how much?
Do friends peer pressure them?
Do they do it because they are bored?
Do they drink to relieve depression or anxiety?
Researchers recently tried to answer these questions by surveying college students…
65% of the participants reported having at least one drink in the past three months. It was astonishing that the typical number of drinks in a week was 10.5 and on a weekend was 7.3 average drinks. These numbers included drinkers and nondrinkers and was the average (meaning around half the people had more drinks as those had less). This indicates that college drinking is far more extreme than drinking happening outside of the college setting.
3 main influential factors for someone’s decisions in college drinking and to what extent:
You can tell a lot about a person by watching their friends, so watch who you surround yourself with. Those who think favorably of drinking tend to think they can drink more before reaching intoxication and also tend to hang out with others who do the same. However, these people are the ones that need the most intervention yet are the most difficult to change.
Those who socialize with a wide variety of people typically are lighter drinkers and tend to respond better to treatment immediately as well as have fewer problems further down the line. The heavier drinkers benefit more from motivational interventions focusing on their attitudes toward drinking.
Regardless of stereotypes, ethnicity, weight and gender did have an effect on any of these findings. It was peoples’ closest friends that were the most significant factor in influencing all aspects of college drinking.
Examining the Unique Influence of Interpersonal and Intrapersonal Drinking Perceptions on Alcohol Consumption among College Students. Journal of Studies on Alcohol and Drugs. Volume 70, 2, March 2009
In a recent post the notion that “loss of control” is an addiction myth was raised by our contributing author, Christopher Russell, a thoughtful graduate student studying substance abuse in the U.K. Though I obviously personally believe in control- and choice-relevant neurological mechanisms playing a part in addiction, this conversation is a common one both within and outside of the drug abuse field. Therefore, I welcome the discussion onto our pages. I’d like to start out by reviewing some of the more abstract differences between my view and the one expressed by Christopher and follow those with some evidence to support my view and refute the evidence brought forth by him.
Addiction conceptualization – Philosophical and logical differences and misinterpretations
One of the first issues I take with the argument against control as a major factor in drug addiction is the interpretation of the phrase “loss of control” as meaning absence, rather than a reduction, in control over addiction and addictive behavior. Clearly though, one of the definitions of loss is a “decrease in amount, magnitude, or degree” (from Merriam-Webster.com) and not the destruction of something. Science is an exercise in probabilities so when scientists say “loss”, they mean a decrease and not a complete absence in the same way that findings showing that smoking cigarettes causes cancer do not mean that if an individual smokes cigarettes they will inevitably develop cancerous tumors. Similarly, the word “can’t” colloquially means having a low probability of success and not the complete inability to succeed. Intervention that improve the probability of quitting smoking (like bupropion or quitlines for smoking) success are therefore said to cause improvements in the capacity for quitting.
Next, Christopher wants scientists to identify the source of “will” in the brain but I suggest that “will” itself is simply a term he has given a behavioral outcome – the ability to make a choice that falls in line with expectations. In actuality, “will” is more commonly used as a reference to motivation, which while measurable, isn’t really the aspect of addiction involved in cognitive control. Instead, what we’re talking about is “capacity” to make a choice. The issue is a significant, not semantic one, since the argument most neuroscientists make about drug abuse is that addicts suffer a reduced capacity to make appropriate behavioral choices, especially as they pertain to engaging in the addictive behavior of interest. If someone is attempting to get into a car but repeatedly fails, we say they can’t get in the car (capacity), not that they don’t want to (will). Saying that they simply “don’t” get in the car doesn’t get at either capacity or will but instead is simply descriptive. I don’t believe that science is, or should be, merely descriptive but instead that it allows us to form conclusions based on available information.
That there is a segment of individuals who develop compulsive behavioral patterns tied to alcohol and drug use and who attempt to stop but fail is, to my mind, evidence that those individuals have a difficulty (capacity) in stopping their drug use. Their motivation (will) to quit is an aspect that has been shown to be associated with their probability of success but the two are by no means synonymous. It is important to note, and understand, that the attribution for the performance should not fall squarely on the shoulders of the individuals. We humans are so prone to making that mistake that it has a name, “The fundamental attribution error,” and indeed, individuals who show compulsive, addictive, behavior do so because of neuropharmacological, environmental, and social reasons in addition to the complex interactions between them all. But no one is disputing that and in fact, the article used by Christopher to point out the notion of a “tipping point” in addiction directly points out that fact in the next paragraph (Page 4), which he chose not to reference or acknowledge.
“Of course, addiction is not that simple. Addiction is not just a brain disease. It is a brain disease for which the social contexts in which it has both developed and is expressed are critically important… The implications are obvious. If we understand addiction as a prototypical psychobiological illness, with critical biological, behavioral, and social-context components, our treatment strategies must include biological, behavioral, and social-context elements.” (Lashner, 1997)
Lastly, Christopher’s philosophical musings are interesting, but they seem to stray away from trying to find an explanation for behavior and instead simply deconstruct evidence. In a personal communication I explained that while most addiction researchers understand that addiction, like most other mental health disorders is composed of a continuum of control ranging from absolute control over behavior to no control whatsoever (with most people fitting somewhere in the middle and few if any at the extreme ends), categorization is a necessary evil of clinical treatment. The same is true for every quantitative measure from height (Dwarfism is sometimes defined as adults who are shorter than 4’10″) to weight (BMI greater than 30 kg/m²). I think it’s equally as tough to argue that someone with a BMI of 29.5 is distinctly different from an individual with a BMI of 30 as it is to argue that there is no utility in the classification. Well, the same applies for drug addiction, although some people categorically object to classification and believe it has no utility or justification.
Now for the evidence – “Choice” and “control” are not the same as “will”
Some people quit, even without help – Christopher and a number of the people he cites in support (Peele, Alexander), suggest that because some people do stop using that it can’t be said that there is a problem with any individuals’ capacity to stop. The problem with that argument is that it supposes that everyone is the same, a fact that is simply false. As an example I would like to suggest that we compare cognitive control with physical control and use Huntington’s Disease (HD or Huntington’s Chorea) as an example.
HD patients suffer mental dementia but the physical symptoms of the disease, an inability to control their physical movement resulting in flailing limbs often referred to as the Huntington Dance, are almost always the first noticeable symptoms. Nevertheless, HD sufferers experience a number of debilitating symptoms that originate in brain dysfunction (specifically destruction of striatum neurons, the substantia nigra, and hippocampus) and that alter their ability (capacity) to control their movements and affect their memory and executive function leading to problems in planning and higher order thought processes. So, while it is true that most people can control their arm movements, here is an example of individuals who progressively become worse and worse at doing so due to a neurophramacological disorder. There is currently no cure for HD but some medications that help treat it no doubt restore some of the capacity of these patients to control their movements. If a cure is found it would be difficult to say, as Christopher suggests of addiction, that the cure does not affect the capacity of HD patients to control what they once could not. I chose HD for its physiological set of symptoms but a similar example could easily be constructed for schizophrenia and a number of other mental health disorders (including ADHD and drug addiction). Importantly, cognitive control is a function of brain activity, activity that can become compromised as the set of experiment I will discuss next show.
An experiment conducted at UCLA (1) has shown that cocaine administrations reduced animals’ ability to change their behavior when environmental conditions called for it. Even more meaningful was the finding that once animals are exposed to daily doses of drugs, the way their learning systems function is altered even when the drugs themselves are no longer on board and even when the learning has nothing to do with drugs per se.
In the experiment, conducted by Dr. David Jentsch and colleagues, monkeys were given either a single dose (less than the equivalent of a tenth of a gram for a 150lb human) or repeated doses (1/8 to 1/4 of a gram equivalent once daily for 14 days) of cocaine. The task involved learning an initial association between the location of food in one of three boxes and then learning that the location of the food has changed. We call this task reversal learning since animals have to unlearn an established relationship to learn a new one.
Obviously, the animals want the food, and so the appropriate response once the location is changed is to stop picking the old location and move on to the new one that now holds the coveted food. This sort of thing happens all the time in life and indeed, during addiction it seems that people have trouble adjusting their behavior when taking drugs is no longer rewarding and is, in fact, even troublesome (as in leading to jail, family breakups, etc.).
In the experiment, animals exposed to cocaine had trouble (when compared to control animals that got an injection of saline water) learning to reverse their selection when tested 20 minutes after getting the drug, which is not surprising but still an example of how drug administration can causally affect an individual’s ability to make appropriate choices. As pointed above, the most interesting finding had to do with the animals that got a dose of cocaine every day for 14 days. Even after a full week of being off the drug, these animals showed an interesting effect that persisted for a month – while their ability to learn that initial food-box association, they had significant trouble changing their selection once the conditions changed. Remember, this effect was present with no cocaine in their system and with learning conditions that had nothing whatsoever to do with cocaine.
If that’s not direct evidence that having drugs in your system can alter the way your brain makes choices, I don’t know what is.
Another study conducted by Calu and colleagues with rats found similar (or even more pronounced) reversal learning problems after training the animals to take cocaine for themselves, clarifying that it is the taking of cocaine and not the method that causes the impairments.
Another entire set of studies has shown that stimuli (also known as cues or triggers) that have become associated with drugs can bring back long-forgotten drug-seeking behavior once they are reintroduced. This was shown in that Calu paper I mentioned above and in so many other articles that it would be wasteful to go through all the evidence here. Importantly, this evidence shows that drug associated cues direct behavior towards drug seeking in a way that biases behavior regardless of any underlying will. My own research has shown that animals who respond greatly to drugs (nicotine in our case) likely learn to integrate more of these triggers than animals who show a reduced response, indicating once again that these animals bias their behavioral selection towards drug-seeking more than usual. While we have more studies to conduct, we believe that genetic differences relevant to dopamine and possibly other neurotransmitters important for learning (like Glutamate) are responsible for this effect.
While we can’t do these kinds of experiments with people (research approval committee’s just won’t let you give drugs to people who haven’t used them before), there is quite a bit of evidence showing an association between trouble in reversal learning and chronic drug use in humans (see citation 3 for example) as well as research showing very different brain activity among addicted individuals to drug-associated versus non-drug cues (like seeing a crack pipe versus a building). All this evidence suggests that drug users are different in the way they learn generally, and more specifically about drugs, than individuals not addicted to drugs. When it comes to genetics, we know quite a bit about the association between substance abuse and specific genes, especially when it comes to dopamine function. As expected, genetic variation in dopamine receptor subtypes important in learning about rewards (D4 and D2) has been revealed to exist between addicts and non addicts. Without getting into the techniques and analysis methods involved in these genetic studies, their sheer number and the relationship between substance abuse and other impulse disorders points to a direct relationship between drug use disorders (and possibly other addictive disorders) and a reduced capacity to exert behavioral control. Less capacity for control is what researchers have found sets addict apart from non-addicts.
Summary, conclusions, and final thoughts
In closing, there are undoubtedly imperfections about the ways we diagnose addiction (drug addiction and others). It would probably be nice if we could figure out a way to incorporate what we know about the continuous nature of the disorder with the need for clinical delineation of who requires addiction treatment and who doesn’t. Addiction researchers are far from the only ones who wonder about this question though (the same issues are relevant for schizophrenia, depression, and nearly every mental health disorder) and I am certain that better and better solutions will emerge.
However, the discussion of stigma in this context needs to allow us to discuss the reality of addiction without having to resort to blaming and counter-blaming. If I describe the Toyota Prius as being slow but incredibly efficient I am no more stigmatizing than if I describe a Ferrari as being incredibly fact but wasteful in terms of fuel. The same applies, or should apply, to health and mental health diagnoses – Just because an individual is less able to exert cognitive control over impulses should not by definition call into question their standing as a human being. We are complex machines and by improving our understanding of the nuts and bolts that make us function we can only, in my opinion, improve our ability to make the best use of our capabilities while understanding our relative strengths and weaknesses. Any other way of looking at it seems to me to be either wishful (I can do anything if I want it badly enough) or defeatist (I will never be anything because I’m not good at X) and neither seem like good options to me.
1) Jentsch, Olausson, De La Garza, and Tylor (2002): Impairments of Reversal Learning and Response Perseveration after Repeated, Intermittent Cocaine Administrations to Monkeys. Neuropsychopharmacology, Volume 26, Issue 2, Pages 183-190
Teens raised in affluent homes display the highest rates of depression, anxiety, and drug abuse according to a recent article in Monitor on Psychology, the APA‘s monthly magazine.
One of our recent posts dealt with some of the issues unique to teens and drugs. In addition to the issues we’d already mentioned, the article named a number of reasons for the high prevalence of mental-health issues among affluent teens. Among them were an increasingly narcissistic society, overbearing parents, and an common attitude of perfectionism.
Each of these reasons are likely contributors to the prevalence of mental health and drug abuse issues among upper-middle-class (and above) teens. Still, as far as I’m concerned, the main take home message of the article is this:
Money truly doesn’t buy happiness – Rich teens and drug use.
While drug abuse research often focuses on the lower socioeconomic strata these recent findings indicate that being financially stable offers little in the way of protection from some of the most common psychological difficulties.
Thankfully, the researchers cited in the article gave some simple advice to parents:
Give children clear responsibilities to help around the house.
Take part in community service (to unite the family and reduce narcissism).
Reduce TV watching (especially of reality TV shows that glorify celebrity and excess).
Monitor internet use.
Stop obsessing about perfect grades and focus instead on the joy of learning for its own sake.
I couldn’t agree more with these recommendations. Having taught a number of classes myself, I have witnessed the ridiculous inflation in students’ expectations of top grades. I think it’s time we turned attention back to the family and reintroduce some of the basic skills that many addicts find themselves learning much too late… Often in recovery.
I don’t normally like sharing this kind of stuff, but I think that if the point of the blog is be truthful, I need to cover all bases. When it comes to depression and drug use, I have personal experience with the connection.
When depression hits – Drug use and self-medication
I don’t always wake up ready to take on the day.
I know that what I’m doing is important, and I know that if I keep going I’ll be successful. Still, sometimes I wake up and feel like there’s really no point; like getting out of bed is useless and that I’m doomed to be nothing. Read the rest of this entry »