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Understanding Addiction

How Addiction Hijacks the Brain

Scientific advances over the past 20 years have shown that drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain. As with many other brain diseases, addiction has embedded behavioral and social-context aspects that are important parts of the disorder itself. Therefore, the most effective treatment approaches will include biological, behavioral, and social-context components. Recognizing addiction as a chronic, relapsing brain disorder characterized by compulsive drug seeking and use can impact society's overall health and social policy strategies, reduce the “stigma” of addiction, and help diminish the health and social costs associated with drug abuse and addiction

What Causes Addiction?

The word “addiction” is derived from a Latin term for “enslaved by” or “bound to.” Anyone who has struggled to overcome an addiction or has tried to help someone else to do so understands why. Addiction exerts a long and powerful influence on the brain that manifests in three distinct ways: craving for the object of addiction, loss of control over its use, and continuing involvement with it despite adverse consequences.

For many years, experts believed that only alcohol and powerful drugs could cause addiction. Neuroimaging technologies and more recent research, however, have shown that certain pleasurable activities, such as gambling, shopping, and sex, can also co-opt the brain.

New Insights Into A Common Problem

Nobody starts out intending to develop an addiction, but many people get caught in its snare. Consider the latest government statistics: nearly 23 million Americans—almost one in 10—are addicted to alcohol or other drugs; more than two-thirds of people with addiction abuse alcohol; and the top three drugs causing addiction are marijuana, opioid (narcotic) pain relievers, and cocaine.

Avoiding The Pain Of Withdrawal

Over time, one a person has developed enough tolerance, the ability to experience pleasure from addictive substances is no longer an option. This is due to the brain responds of producing less dopamine or eliminating dopamine receptors. At this point, the addicted individual becomes more concerned with avoiding the horrific pain of withdrawal. The addict is now caught in a never ending quest to “just feel normal.” Once this point is reached, the addict will require repeated doses of the addictive substance every 3 to 4 hours to prevent painful withdrawal. It is no longer about feeling good – that is not an option anymore – it is all about avoiding feeling bad. The mental and physical pain of withdrawal is what drives addicts to do things that they never thought they would in order to prevent being “pill sick.”

What is Heroin?

Heroin is a depressant drug, which means it slows down the messages travelling between your brain and body. Heroin belongs to a group of drugs known as ‘opioids’ that are from the opium poppy. Heroin usually appears as a white or brown powder or as a black sticky substance, known as “black tar heroin.” Heroin comes in different forms including: fine white powder; coarse off-white granules; and tiny pieces of light brown “rock.”

Long-Term Effects:

Regular use of heroin may eventually cause: Intense sadness, No sex drive (Males),  Damaged heart, lungs, liver and brain,  Vein damage and skin, heart and lung infections from injecting,  Irregular periods and difficulty having children (females)

Resources for Medical Emergencies

Appalachian Counseling Centers:

2412 Susannah Street Suite 6
Johnson City TN 37601
423-461-0111 or 423-461-0112

Tennessee Department of Human Resources:

“Tennessee Department of Human Resources is responsible for administering numerous services throughout Tennessee, including Families First, the state’s Temporary Assistance for Needy Families (TANF) program, Food Stamps (now known as the Supplemental Nutrition Assistance Program or SNAP) , Child Support, Child Care Licensing, Child Care Assistance, Adult Protective Services, and Rehabilitation Services.”

Medical Emergencies:

For all medical emergencies, please call 911
Poison Control Centers:
Poison Centers offer free, confidential medical advice 24 hours a day, 7 days a week through the Poison Help line at 1.800.222.1222

Suicide Prevention Lifeline

Call 1-800-273-8255
Available 24 hours everyday

Suboxone Clinic Hotline:

toll-free number at 1-888-287-0471

SAMHSA’s National Helpline

1-800-662-HELP (4357)
Available 24 hours everyday

Additional Reading

Medication treatment options and the expected therapeutic benefits and adverse effects of each treatment Opioid addiction isn't a moral or mental weakness. It's a chronic medical condition that results from changes in the brain in susceptible people. Once narcotic addiction has developed, escaping the cycle of detox and relapse is typically a long-term process. Breaking free of prescription drug abuse takes much more than willpower. Fortunately, medications and counseling can improve the chances of success. Newer drugs like buprenorphine (sometimes combined with naloxone) and naltrexone and traditional therapies like methadone and 12- step programs, are helping thousands of people stay on the road to recovery. Buprenorphine – A Unique Life-Saving Medication. The partial agonist effect of buprenorphine is unique to buprenorphine, and means that at a dose that effectively relieves craving, a ceiling effect prevents the euphoria associated with drug abuse and protects against overdose deaths. Buprenorphine can allow one to regain a normal state of mind – free of withdrawal, cravings and the drug-induced highs and lows of addiction and enable patients to get back to school, work, and family. As a medication-assisted treatment (MAT), it suppresses withdrawal symptoms and cravings for opioids, does not cause euphoria in the opioiddependent patient, and it blocks the effects of the other (problem) opioids for at least 24 hours. If a full opioid is taken within 24 hours of Buprenorphine, then the patient will quickly discover that the full opioid is not working – they will not get high. This 24-hour reprieve gives the patient time to reconsider the wisdom of relapsing with a problem opioid while undergoing MAT. Why is Naloxone Added To Buprenorphine? Naloxone is added to buprenorphine to decrease the likelihood of diversion and abuse of the combination product. Naloxone is not absorbed into the bloodstream to any significant degree when Buprenorphine/Naloxone is taken correctly by allowing it to dissolve under the tongue or in the inside of your cheek. However, if a Buprenorphine/Naloxone tablet is crushed and then snorted or injected the naloxone component will travel rapidly to the brain and knock opioids already sitting there out of their receptors. This can trigger a rapid and quite severe withdrawal syndrome. Naloxone has been added to Buprenorphine for only one purpose – to discourage people from trying to snort or inject it.

Benefits of Buprenorphine Treatment.
Due to its unique pharmacologic profile, buprenorphine has a number of advantages for use as an opioid replacement therapy.
1. Treatment does not require participation in a highly regulated federal program such as a methadone clinic, requiring daily doses.
2. Patients can be treated monthly, on an outpatient basis, in a primary care setting.
3. Patients are seen, evaluated, and examined by a doctor at each visit.
4. Buprenorphine allows the brain to start eventually producing its own natural opiates again and helps heal neurotransmitter and receptor sites.
5. Buprenorphine does not significantly prolong the QTc interval, and is associated with less sudden death than is methadone.
6. Buprenorphine is a partial opioid and methadone is a full opioid.
7. Buprenorphine has less medication interactions.
8. Patients report that they feel less medicated and more normal, on buprenorphine as compared to methadone.
9. Since buprenorphine is a semisynthetic partial opioid agonist, it’s easier to taper off of than methadone.
10. Buprenorphine treats a broader array of pain phenotypes than do certain potent mu agonists and is associated with less analgesic tolerance.
11. Buprenorphine does not cause hyperalgesia
12. Buprenorphine produces less constipation than methadone, and does not adversely affect the sphincter of Oddi.
13. Buprenorphine is effective for treating cancer pain.
14. Compared to methadone, buprenorphine showed lower severity of Neonatal Abstinence Syndrome symptoms, thus requiring less medication
and less time in the hospital. Taking Buprenorphine does not guarantee that a newborn will not have NAS.
15. Buprenorphine causes less cognitive impairment than methadone.
16. Buprenorphine is not immunosuppressive like other full opiate agonists, such as methadone.
17. Buprenorphine is effective for treating neuropathic pain.
18. Buprenorphine does not adversely affect the hypothalamic-pituitary-adrenal axis or cause hypogonadism.
19. Buprenorphine is a safe and effective analgesic for the elderly.
20. Buprenorphine is one of the safest opioids to use in patients in renal failure and those on dialysis
21. Withdrawal symptoms are milder and drug dependence is less with buprenorphine.
22. Buprenorphine has a ceiling effect on respiratory depression and is protective against overdose. The rate of overdose with methadone has increased by a factor of 7 since 1990. This is because there is no ceiling effect with methadone and patients can overdose from “dose stacking.”

Risks/Disadvantages of Buprenorphine Treatment.
While Buprenorphine is a unique, life-saving medication, there is some risks associated with its use.
1. Buprenorphine is a semisynthetic opiate and individuals can become physically dependent. Abrupt discontinuation of Buprenorphine is not
recommended and individuals taking Buprenorphine should taper their dose over time.
2. Buprenorphine should not be taken with other medications that cause central nervous system depression and/or respiratory depression as this
increases the likelihood of overdose. Medications that should not be taken with Buprenorphine include: 1) Benzodiazepines (Xanax, Klonopin, Valium, Ativan, Ambien, Restoril), 2) Alcohol, 3) Barbiturates (Fioricet, Phenobarbital), 4) Neurontin, 5) Lyrica, 6) Phenergan, 7) Marijuana 8) Morphine 9) Heroin, 10) Muscle Relaxers (Soma, Zanaflex, Flexeril), and 11) other opiates.
3. Individuals taking Buprenorphine will need to have periodic labs to monitor liver function.
Methadone. Methadone is a long-acting opioid drug. It activates the same opioid receptors as narcotics, effectively eliminating withdrawal symptoms. Providing the correct dose of methadone prevents opioid withdrawal symptoms and eases drug craving but it does not provide the euphoria.

Benefits of Methadone Treatment
1. Methadone is the best-studied, most effective method of recovery from narcotic addiction.
2. The dose can be slowly tapered off, freeing the person from physical dependence without withdrawal symptoms.
3. Relatively inexpensive.

Risks/Disadvantages of Methadone Treatment. While Methadone can be a life-saving medication, there is some risks associated with its use.
1. Requires participation in a highly regulated federal program with daily dosing.
2. Can cause a prolonged QTc interval (affects cardiac conduction), and is associated with sudden cardiac death.
3. Methadone is a full agonist opiate and can be more difficult to wean off of.
4. Methadone has a number of drug interactions.
5. Methadone causes more constipation.
6. Methadone causes hyperalgesia ( increased pain).
7. Methadone causes a higher severity of Neonatal Abstinence Syndrome (NAS).
8. Methadone must be used cautiously in patients with renal failure and those who are on dialysis.
9. Methadone does not have a ceiling effect on respiratory depression to protect against overdose. The rate of overdose with methadone has increased by a factor of 7 since 1990. This is because there is no ceiling effect with methadone and patients can overdose from “dose stacking.” Naltrexone. Naltrexone (ReVia, Vivitrol) is an opiate receptor-blocking medication used in maintenance therapy for narcotic addiction. Unlike methadone and Suboxone, naltrexone does not activate receptors at all, so it does not reduce opioid withdrawal or craving. However, because naltrexone blocks opiate receptors, a person won't get high if he or she uses drugs while taking the medicine. The drug is usually ineffective by itself, because people can simply stop taking it and get high shortly after.

Benefits of Naltrexone Treatment.
1. Because naltrexone blocks opiate receptors, a person will not get “high” if he or she uses drugs while taking the medicine.
2. Naltrexone is able to prevent relapse.
3. Naltrexone is able to prevent overdose.

Risks/Disadvantages of Naltrexone Treatment
1. Naltrexone does not activate receptors at all, so it does not reduce opioid withdrawal or craving.
2. An individual must stop taking opiates for 10 to 14 days before they can being taking Naltrexone.

Rapid Detoxification.
"Rapid detox" programs claim to accelerate the process of detox and opioid withdrawal by giving large doses of opioid blocking drugs. Some programs place an addict under general anesthesia during the detox process. These programs have not proven to be more effective than traditional methods of detox, and may be more dangerous. Maintenance Therapy After Detox. Completing detox subdues the physical effects of narcotic addiction and opioid withdrawal. But experts say psychological and social factors are the main drivers that push addicts back to using. Stress and situations that remind the brain of the drug's pleasure are common triggers. When drug cravings strike, they can be impossible to resist. Most people who go through detox and short-term counseling will relapse to prescription drug abuse. Studies show that the chances of beating narcotic addiction are better with long-term maintenance therapy with either methadone or buprenorphine paired with naloxone (Zubsolv, Bunavail, Suboxone) . These drugs are used during the maintenance phase of treatment. People on these drugs are still opioid-dependent, but they are often freed from their destructive drug addiction. They can return to work, drive without impairment, and function normally in society. Some people have a high rate of relapse when
maintenance therapy is stopped, and so they remain on the medicines for decades. In others, maintenance therapy is tapered off over months to years.

Anxiety can be both a blessing and a curse. A little bit of anxiety can give us an edge and push us forward to accomplish our goals. Too much anxiety can paralyze progress and incite panic. Too much anxiety can make you focus on a flurry of negative, doom-filled thoughts. Such severe anxiety affects about 19 percent of Americans. In fact, anxiety disorders are among the most common psychological disorders. Consider how anxiety affects your life. Three of the most common characteristics of someone with an anxiety disorder are perfectionism, relying on others for approval and need for control. Whether you suffer from a diagnosable disorder or experience anxiety occasionally, anxiety can wreak havoc on your self-image and daily quality of life.
We have all been there. The good news is, there is something you can do to control anxiety - something more effective than the usual advice to “be positive” or just “stop thinking so much.” The latest research on anxiety suggests innovative, even odd, techniques for coping successfully with recurrent worries and anxiety. Most people can get a grip on things if they take a few minutes to develop a different relationship with their thoughts and feelings. Below is a list of strategies that will help you take control of worry and anxiety.
1. Realize anxiety is natural.
Anxiety is the normal response to perceived danger – the body and mind rev up in readiness for fight or flight by producing adrenaline. This is a natural, beneficial response to stress. Without adrenaline, we can't perform at our best. It is this response that has allowed humans to survive in the world for millions of years. Concern about what others think it's natural, too. Humans evolved as a social species. We depend on one another to survive. Fear of negative judgment helps ensure harmony in the "pack." What inflates these feelings to overwhelming proportions is probably nature and nurture. Anxiety runs in families. Certain
genes create an overly sensitive alarm system. If your parents were highly critical but wary of outsiders – or if you had early humiliating experiences – this could have laid the groundwork for social anxiety.
2. Distinguish fact from fiction.
Worrying is fiction. It is an anticipation of things going wrong in the future. Since the future doesn’t exist, except in your imagination, then worry about a future event is a fiction. Learn to live in the moment and not worry about things that have not even happened yet. Take care of today and tomorrow will take care of its self. One example of a fiction would be: “I have high blood pressure, I’m going to get a heart attack.” This
reaction jumps to an extreme conclusion. However, it does bring up a factual concern. Instead of jumping
to an extreme, you should say, “I have high blood pressure and if I want to avoid getting a heart attack, I
will need to change my eating habits and get some exercise.” While worrying involves fiction, concern is
fact-based and addresses today. When you act on your concerns, you prevent worry and anxiety. When we are anxious, we tend to see the world as very threatening and dangerous. However, this way of thinking can be overly negative and unrealistic. One strategy for helping you to manage anxiety involves replacing “anxious” or “worried” thinking with realistic or balanced thinking. This strategy involves learning to see things in a clear and fair way, without being overly negative or focusing only on the bad. However, it takes time to shift anxious thinking, so be patient and consistently practice these skills.
3. Do not exaggerate.
Everyone has an interior monologue – a constant stream of thoughts that affects mood and energy. Social anxiety feeds on thoughts that exaggerate danger, foresee dire consequences and attribute negative judgments to others. Thoughts like, "This meeting will be a disaster" or "I feel nervous, and it shows" sow seeds from which the whole nasty experience – racing heart, cold sweat – grows.
4. Thinking this way is just habit.
And, like most habits, it can be changed. Tune in to your thoughts. What are you telling yourself when you feel nervous about entering a room, giving a presentation at a meeting, or approaching a salesclerk? Keep a diary to record each situation, your thoughts and level of anxiety you experience. Anxiety producing thoughts are almost always distortions and exaggerations – everyone is staring at me… I always sound like a fool… If I make a mistake, I'll never live it down. The antidote isn't positive thinking but realistic thinking. Examine your anxiety producing thoughts critically and correct them.
5. Your “nerve medicine” is not helping.
When benzodiazepines were first introduced, over fifty years ago, they were considered to be wonder drugs. At present, medical science has discovered that this is no longer the case. Recent studies have shown that benzodiazepines actually cause more harm than good and should not be used to treat anxiety or sleeping disorders. Benzodiazepines work by slowing down the activity of the central nervous system and the messages going between the brain and the body. Because of tolerance, benzodiazepines stop working once they have been used for a long period of time. In fact, the only thing that they do, after long-term use, is prevent benzodiazepine withdrawal. There is evidence that reduction or withdrawal from benzodiazepines can lead to a reduction in anxiety symptoms. High doses of benzodiazepines can result in over-sedation and may produce an effect similar to alcohol intoxication. Feelings of jitteriness, excitability, reduced alertness, and headache are often experienced as the effects of large doses wear off. A very high dose of benzodiazepines can cause: slow, shallow breathing, unconsciousness, coma, or death (more likely when taken with other depressants such as alcohol and/or opiates).
Some of the long-term effects of benzodiazepines include: memory loss, dementia, difficulty thinking clearly, anxiety, depression, lack of motivation, skin rashes, weakness, fatigue, drowsiness, weight gain, sexual dysfunction, difficulty sleeping or disturbing dreams, irritability, paranoia, aggression. A recent study published in the British Medical Journal suggests that benzodiazepine use may promote the development of Alzheimer’s disease. Sleep architecture can be adversely affected by benzodiazepine dependence. Possible adverse effects on sleep include induction or worsening of sleep disordered breathing and loss of recuperative sleep.
Consequently, lack of sleep will make anxiety worse. . A marked increased risk of cancer was found in the
users of sleeping pills, mainly benzodiazepines. Due to these increasing physical and mental symptoms from long-term use of benzodiazepines, slowly withdrawing from benzodiazepines is recommended for many long term users.
6. Recognize false alarms. That fear of your house burning down because you left the iron on has never
come true. That rapid heart beat doesn’t mean you’re having a heart attack; it’s your body’s natural response to arousal. Many thoughts and sensations that we interpret as cues for concern―even panic―are just background noise. Think of each of them as a fire engine going to another place. You’ve noticed them; now let them pass by.
7. Make peace with time.
When you’re a worrier, everything can feel like an emergency. But notice this about all your anxious arousal: It’s temporary. Every feeling of panic comes to an end, every concern eventually wears itself out, every so-called emergency seems to evaporate. Ask yourself, “How will I feel about this in a week or a month?” This one, too, really will pass.
8. Try relabeling.
Symptoms of anxiety and excitement are almost identical. If you feel revved up and think, "I am getting anxious,” it creates a destructive spiral. But if you think of it as “getting excited," you'll feel more prepared and capable.
9. Breathe away anxiety.
One of the worst things about anxiety is the feeling that once it starts it will build uncontrollably. You may notice that when your body is tense, you hold your breath. Focusing on breathing is a common but effective technique for calming the nerves. Where is your breath now, and where is your mind? Bring them together. Listen to the movement of your breath. Does your mind wander somewhere else? Call it back. Concentrate only on breathing in and out, beginning and ending, breath to breath moment to moment.
Calm Breathing: Breathing slowly and deeply from your abdomen eases anxiety. To practice, while lying in
bed, rest your hands on your abdomen. Breathing deeply through your nose to a count of four, let your
abdomen rise as you inhale. Your chest should remain still. As you breathe out – two a count of four – your
abdomen should flatten. Slow your breathing to eight breaths per minute. After you become accustomed to
this kind of breathing, practice it while sitting, standing and eventually in the course of your daily activities. Soon it will feel easy and natural. Then, whenever you start feeling anxious, be aware of your breathing. If it is shallow and rapid, consciously shift to slow abdominal breathing.
Muscle Relaxation: another helpful strategy is learning to relax your body by tensing various muscles and
then relaxing them. This strategy can help lower overall tension and stress levels. It also helps you to be
more aware of when you are feeling stressed.
10. Shift your focus. Anxiety turns your attention inward. You notice your heart racing. You worry that
your hands are shaking. This is certain to increase your anxiety. Instead, focus your attention on the task
itself, whether it's emphasizing key points in the presentation or meeting someone for the first time. If
you're talking to someone, attend closely to what he or she is saying. Think about how he or she might be
feeling and rather than what to say next. If anxiety continues to build, focus on neutral factors… The color
and texture of the carpet… The feel of the papers you’re holding in your hand. Such a shift in focus will
interrupt the anxiety cycle and let you attend to the business at hand.
11. Be willing to experience discomfort.
Some things are worth doing even if you're anxious. You will be amazed at what you can do while still feeling a lot of unpleasant sensations. Sometimes people will noticeyour anxiety; other times, they won't. Either way, you will feel better about yourself if you go ahead and act. Do what you value.
12. Tolerate uncertainty.
This is a tough one. Most people like things to be clear-cut, to know where things stand. Unfortunately, life does not always cooperate. You must eventually face the ugly truth that you cannot control everything. Not everyone will like you. Not everyone will approve of your every actions. Sometimes your best bet is to go with the flow and learn the gentle art of acceptance.
13. Stop People-pleasing.
Relying on others for approval can also lead to anxiety. To stop this over time, pay attention to how you interact with others and the times you people-please. For instance, when do you say yes to someone when you really want to say no? Heighten your awareness and then slowly start to change your behavior. Before attending a function where you’ll likely people-please, think about how you’regoing to react, and do what you’re comfortable with. Here’s the problem with people-pleasing: There’s good news and bad news. The good news is that people don’t really give a damn; and the bad news is that people don’t really give a damn.
14. Practice yoga.
Anxiety usually involves racing thoughts, recurrent worries and a revved-up body. Yoga can help manage all these symptoms by calming both your mind and body. Just the acts of focusing on your breath and mediating have a soothing effect. One yoga practice isn’t superior over another. Studies show that it depends on the anxiety. If there’s significant trauma, research shows that gentle, restorative, feel-good poses are best. If there’s tension in the body, practicing strong poses or poses that take longer can dig into the deep pockets of tension in the body. If there’s trembling and an increase in heart rate, a flow yoga practice helps to release the revved-up anxiety. You can take yoga classes or you can practice yoga at home.
15. Set up some structure.
Idle time often leads to over-thinking and over-magnifying. In other words, if you are not stimulated or busy, you are apt to zero in on trivial things and obsess over them.
16. Tackle distorted thoughts.
You might not realize just how much thoughts can feed anxiety. Blackand-white, all-or-nothing thinking is one example: You see yourself as being successful at 100 percent – and a total failure at 98. Your level of perfectionism defines your self-worth. People who struggle with anxiety tend to talk in absolutes, using words such as always, never, should, must, no one, and everyone.
Should implies that there is a right way to do things, a manual on how to do life. It doesn’t exist. With the
exception of obeying the law and not willfully harming another person, everything in life is negotiable.
Therefore, rigid thoughts are unrealistic. So are insecure thoughts that constantly raise questions such as “what if?”
Fortunately, you can change these thoughts. You cannot be anxious if you don’t allow insecurity-driven
thinking to steer your life. Think of your thoughts as a wheel, if you turn this wheel, you generate sparks –
sparks of anxiety, “What if I fail?” “What if I get sick?” If you stop turning the wheel…the insecurity-driven
thoughts stop. Identify these distorted thoughts and consider how much stress they cause you, then, try to
replace the thoughts with something more balanced. Keep practicing; over time, the balanced thoughts
become automatic.
17. Relinquish control.
Many of us try to control life in an attempt to feel less vulnerable and insecure. We
are insecure about our own abilities to “handle life” now, as it unfolds, moment to moment. Trying to control life isn’t natural, and bracing yourself for potential danger creates both psychological and physiological stress, which only depletes us and leads to anxiety. So the key is to realize and accept that you cannot control life.
18. Revise your reactions.
While we cannot control the world, we can control our reaction to it. It is empowering to realize that you don not have to be a victim of life. Realize that you are responsible for your happiness and your life. You can change yourself.
19. Take your hand off the horn.
You constantly check the weather before a big outdoor event. You replay that clumsy comment you made, wishing you could take it back. And, yes, you honk your horn in traffic. When you desperately try to take command of things that cannot be controlled, you are like the swimmer who panics and slaps at the water, screaming. It gets you nowhere. Instead, imagine that you are floating along on the water with your arms spread out, looking up to the sky. It is a paradox, but when you surrender to the moment, you actually feel far more in control.
20. Trust yourself.
Self-trust is the ability to believe that you can handle what life throws at you. Trusting yourself means dismantling insecurity and taking the risk of trusting ourselves. If you are anxious, your trust muscle has atrophied, and your insecurity has become muscle bound. Strengthen your muscle by taking small risks. For worriers, a minor risk might be to say, “I’m going to risk believing that I can do a good job.”
As you practice this acceptance, your trust muscle will grow, and you will begin to recognize that life can be
handled more spontaneously, as it unfolds, rather than abstractly, in your mind, before anything ever takes
21. Face your fears.
One of the most important steps in managing your anxiety involves facing your fears;
this is called exposure. If you have been avoiding certain situations, places, or objects out of fear, it will be important for you to start exposing yourself to those things so that you can get over your fears in the long
run. However, it is usually easier to start with something that is not too scary and then work up to the things that cause a great deal of anxiety. Start by making a list of feared situations, places, or objects, such as saying “hi” to a co-worker, entering a crowded grocery store, riding the bus, or anything else that you are avoiding. Once you have made a list, try and arrange them from the least scary to the most scary. Starting with the situations that cause the least anxiety, repeatedly enter that situation and remain there until you notice your anxiety start to come down. Once you can enter that situation (on numerous occasions) without experiencing much anxiety, you can move on to the next thing on the list
22. Building on Bravery
Learning to manage anxiety takes a lot of hard work. If you are noticing improvements, take some time to
give yourself some credit: reward yourself! How do you maintain all the progress you've made? Practice!
Practice! Practice! In a way, learning to manage anxiety is a lot like exercise - you need to "keep in shape" and practice your skills regularly. Make them a habit! This is true even after you are feeling better and have reached your goals. Do not let your worries and anxiety stop you from living a full, productive life.

No one sets out to become addicted, but, once it begins to take hold, the effects are more than trivial with consequences that reach far beyond the user. “Addiction is a chronic, often relapsing brain disease.” It involves a mixture of interacting physiological, psychological, and social variables that make it complex, and yet, treatable. Thefollowing are 15 effects of drug addiction you don’t want to experience.
1.) Tolerance
Tolerance is the brain’s way of compensating for the over-stimulation or excessive depressant actions of the drugs. You don’t want to experience a tolerance to the drug
which requires more of it to achieve any desired results and increases as the addiction continues.
2.) Sensitization
Sensitization is the opposite of tolerance and is a phenomenon linked to chronic or high dose stimulant abusers. Sensitization causes the person to experience a
psychotic episode more intense and longer-lasting with minimum stimulant doses after a prior psychotic experience has occurred. It happens often with cocaine and meth users who suffer intense paranoia or tactile hallucinations (“coke bugs”) from increasingly smaller doses that are no-where near amounts used in the past.
3.) Physical Dependence
Physical dependence is an adaptation to the drug’s presence that requires certain levels of the drug be maintained in the body’s system to keep from producing physical withdrawals. People who become physically dependent on drugs need consistent access to them or they become limited in their abilities to perform normal, daily tasks.
4.) Psychological Dependence
Psychological dependence to drugs changes people. Their thoughts, emotions, and motivations for using drugs can become more important than everything else and
their values in life become defined by the constant need to seek, obtain, and use the drugs, regardless of who gets hurt.
5.) Cravings
Cravings are a central aspect of addiction that can last indefinitely for some addicts depending on the drugs they use, the person, and the neuronal adaptations that have taken place. Cravings can disappear for a while and then reappear out of no-where.
6.) Withdrawals
Withdrawals from drugs occur from reducing or ceasing use after a dependency is developed. They are typically, painful and unpleasant physical and/or psychological
symptoms that overwhelm the person with sickness, instability, or psychosis and for some, the more serious complications can become life-threatening.
7.) Psychosis
Taking too much of any psychoactive drug can cause disruptions in cognitive and neurological systems resulting in psychosis such as hallucinations, paranoia, or bizarre behaviors.
8.) Conditioned Responses
The pleasant and reinforcing effects of drugs in the brain’s reward center becomes “hardwired” reminders that place the person at risk of relapse even when they have no conscious desires to use. Addiction increases the number of “triggers’ or conditioned responses the person becomes vulnerable to from simple thoughts, emotions, or associated reminders.
9.) Accelerated Abuse
As addiction to many drugs like opioids, cocaine, or meth continue, many addicts switch to higher potency drugs or alternative routes of administration such as snorting,
smoking or intravenous injection to intensify the effects. In addition to increased tolerance, dependency, and withdrawal potentials, the risks of infections, diseases, and other consequences are exponentially increased as well.
10) Diseases and Infections from IV Use IV use is associated with abscess and bacterial infections, damages to blood vessels and veins, bloodborn diseases like HIV, AIDs, and Hep C, cardiovascular and pulmonary system damages, organ damages from increased neurotoxicity, overdose, and death. According to the Institute of Medicine (US), “Studies have shown that HIV can survive in tap water for extended periods of time.”
11.) Cognitive Impairments
Drug addiction alters brain functions leading to loss of memory, inhibitions, judgment, and ability to focus. These effects cost people their livelihoods through missed education and job opportunities, mistakes in reasoning that leads to harmful, dangerous, or immoral activities and predicaments.
12.) Psychological Disorders
Anxiety, depression, suicidal and emotional instabilities go hand in hand with drug addiction and these effects often outlive the addiction long after the person detoxifies from the drugs. Some become permanently disabling that leave the addict unable to hold jobs, manage or enjoy life, and provide for their basic survival needs. Compounding the issues, many psychological disorders progress or exacerbate other mental health issues.
13.) Lower Quality of Life
Long-term consequences of drug addiction often mean a lower quality of life because the addict tends to lose their motivations, values, productivity capabilities, and possibly, their moral integrity. It’s hard enough to keep up with maintaining the habit, so, other things tend to become second place.
14.) Family Dysfunctions
According to the Institute of Medicine (US),” Drug abuse leads to reallocation of economic support away from the family; lack of participation in family activities, including caregiving; lack of emotional commitment and support for parents and children; and the inability to provide a reliable and adequate role model for other family members, especially children. This impact on the family affects children’s development, learning, and social relations whether or not actual child abuse and neglect occur.”
15.) Overdose
Overdoses occur more often than they are ever reported to any medical provider or authority and what many people don’t know is that non-fatal overdoses can also have life-threatening consequences. Common effects of a non-fatal overdose may include pneumonia, hypoxia, and organ or bodily system failures. Death can occur hours or much later after a dose of drugs is administered. For instance, acetaminophen is an analgesic ingredient in many opiate painkillers and death from acetaminophen toxicity may not occur for up to five days with the effects going unnoticed until it’s too late.