What a Family History of Addiction Means

Genetics accounts for about half the risk of developing addiction. Those with a family history of addiction, meaning one or more blood relatives has had a drug or alcohol problem, are at a significantly higher risk of suffering from addiction and other mental health disorders. Children of alcoholics, for example, are four times more likely than other children to become alcoholics themselves. They also tend to suffer from low self-esteem, poor academic performance, abuse and neglect, and other issues at higher rates than other children.

Avoiding the Avoidable

Fortunately, genes aren’t all we pass on to our children. Environment, upbringing and parenting style make up the other half of a child’s addiction risk and are, at least to some extent, within our control. Since we cannot yet reliably predict the risk for developing addiction, you best serve your child by preparing them for all eventualities. Just as you would talk to them about their risk for diabetes or heart disease, having your own series of “genetic counseling sessions” with your child can help safeguard them against addiction.

Explain the Facts. Educate your child about the nature of addiction so they know what they’re up against. Addiction is a chronic, progressive disease that rewires the brain’s response to drugs and alcohol. There is no “cure” for addiction, but there are various medications, support groups and therapies that can help people recover.

There’s no need to make threats or attempt to scare your children into abstinence. Addiction is a health issue, not a moral failing or character flaw. Since approaching it with blame or shame may drive them closer to drugs and away from open conversation with you, skip the judgments and stick to the facts.

Meet Them Where They’re At. Conversations about drugs and alcohol should start as early as elementary school and no later than middle school, when children are first exposed to the concept and your influence still reigns supreme. Roughly one in 10 13- to 14-year-olds has used drugs or alcohol, a number that increases exponentially by the time children reach 17 or 18 years of age.

For younger kids, use television shows, movies and news stories to start a discussion about the harm drugs can cause. With older kids, ask open-ended questions about how they feel about drug use and what their friends are experiencing. Let them set the depth and pace of the conversation – this way, if they aren’t ready to talk now they’ll know they can come to you later.

Be Bold. Whether you believe it’s realistic or not, make it clear that while experimentation may be acceptable in some families, your children don’t have the same luxury. The “just say no” approach isn’t always effective, especially with teens, but it’s the best advice when addiction runs in the family.

Even if your child isn’t willing to abstain from drugs and alcohol permanently, encourage them to hold off as long as possible. Research shows that teens who begin using drugs before age 14 are at greater risk for addiction than those who delay their first use until age 21 or older.

Strengthen Their Defenses. With drugs and alcohol, knowledge only goes so far. The reality is teens who know better don’t always do better. A more effective alternative to “just say no” is bolstering your child’s emotional, physical and spiritual defenses against addiction. A child that knows how to cope with stress and has high resilience and self-esteem will be less likely to self-medicate with drugs than a child that lacks these skills.

A warm and caring home environment, where children feel they can share their feelings, where family time is cherished, and where kids are met with praise and unconditional love, encourages open conversation. There are many ways children can socialize without using drugs or alcohol, such as joining a club or team sport. If they go to parties, help them find ways to fit in without drinking or using drugs (e.g., by practicing ways to say no and having excuses ready if they need to leave). Kids who pursue their passions and volunteer to serve others are more likely to have a sense of meaning and purpose in their lives, steering them away from negative influences.

Get Involved. If your child isn’t talking to you, you can be certain they’re talking to someone, who may or may not provide accurate information or have their best interests in mind. From the pre-teens on (if not earlier), your child should know your rules about drug use as well as the potential consequences for violating a rule. Kids who clearly understand their parents’ expectations, and whose parents set a good example by following their own rules, are less likely to use drugs.

Particularly when addiction runs in the family, stay alert to additional risk factors such as poor academic performance, having friends who use drugs or going through a period of high stress. Just as you would take your child to the doctor for an infection or cold, talk to a substance abuse counselor, treatment center or other health care professional if you think your child may have a drug problem.

‘Why Me?’

Having a family history of addiction is not your child’s fault, but neither is a genetic propensity for obesity, depression or cancer. Still, what we inherit becomes our responsibility – and is, in a sense, a blessing that can put your child on notice that the rules of engagement with drugs and alcohol are different for them.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of mental health and addiction treatment centers that includes Promises, The Ranch, Right Step, The Recovery Place, The Sexual Recovery Institute, Malibu Vista, and Spirit Lodge.

Among the first tasks of early recovery is getting a job. This is a critical step in rebuilding confidence, repaying debts and achieving goals but it also means having a steady flow of cash – something that used to be closely tied with drug use. Here are a few tips to help you safeguard your sobriety while regaining your financial stability:

Broaden Your Personal Inventory. As part of your recovery from addiction, you may have taken a personal inventory. As part of your financial recovery, you need to take an honest look at your assets, debts and expenses. The process may be discouraging so have a plan in place for dealing with negative feelings to guard against relapse. Ask a friend or family member to take inventory with you and stay focused on improvements you can make in the future rather than dwelling on past mistakes.

Separate Needs and Wants. Regardless of how much debt you have, your sobriety isn’t served by ignoring genuine needs for self-care. Neither is it served by fulfilling your every desire in an effort to numb emotions or get a short-lived fix. The difference can be subtle. You need food and companionship, so invite a friend over for a home-cooked meal, even if what you want is a night out on the town.

Create a Budget. The addicted mindset is, “I want what I want when I want it.” To combat the desire for instant gratification, create a detailed budget and monitor your spending. There are a number of books and computer programs that can walk you through planning a budget. If it helps you stay motivated, set aside a small amount of money for a nice meal or short vacation when you reach your financial goals.

Store Money in a Safe Place. Saving for the future is an important part of any budget, but one that can be especially problematic for recovering addicts. The most obvious issue is that saving money can be difficult when you’re used to living dollar to dollar and are trying to dig your way out of debt. If you’re not accustomed to having money lying around, having a nest egg can also be a temptation to spend it on drugs or alcohol. If money is a trigger for you, consider storing it where it isn’t easily accessible to you – with a trusted spouse or parent or in a bank account (preferably with no ATM card) – at least in the early stages of recovery.

Draw on the Available Resources. People who get hooked on drugs or alcohol early in life, often in their teens or early 20s, may have never learned basic money management skills. Others learned the skills but as a result of learning and memory deficits brought on by addiction, have forgotten how to manage their lives effectively.

As with every other aspect of recovery, you don’t have to manage your finances on your own. Some treatment centers offer life coaching, which often includes financial planning and real-world skills training. There are also money management seminars, community courses and financial counselors that can provide guidance. There’s even a pre-paid debit card designed to help recovering addicts make smart money choices and rebuild their loved ones’ trust.

Beware of Compulsive Spending. It takes time to develop new habits and coping skills. It’s not surprising then that some recovering addicts go back to what they know: excess. With an empty space in their lives where drugs used to be and more cash than they ever had during active addiction, some begin over-spending, gambling or engaging in other potentially addictive behaviors. Even though they’re sober, their addictive patterns have not changed; they’ve simply taken a different form. This type of cross-addiction is a sign that you need more support in your recovery.

Stay Alert to Relapse Signs. Whatever your financial status and goals, your recovery must come first. As life gets busier and more stressful, check in with how you’re feeling day to day. There are various apps and programs that can help you monitor your moods and warn of an impending slip. In particularly stressful times, bulk up your support by attending additional meetings or calling a friend or sponsor.

As part of your recovery, you’ve focused on your relationship with family, your relationship with old friends and your relationship with yourself. Don’t jeopardize your recovery by neglecting another critical relationship: your relationship with money.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of addiction treatment centers that includes Promises Treatment Centers in California, The Ranch outside Nashville,The Recovery Place in Florida, Malibu Vista, Spirit Lodge, and Right Step. You can follow Dr. Sack on Twitter @drdavidsack.

Fortunately, we are on the precipice of a new era in addiction research – one that is determined to learn from the success of AA/NA and find out why 12-Step recovery has been effective for so many addicts.

Service Key to Long-Term Recovery

A new study by Maria Pagano, PhD, associate professor of psychiatry at Case Western Reserve University School of Medicine, sheds light on the science behind the directive to “carry the message to others” in Step 12. Using data from Project MATCH, Dr. Pagano found that recovering alcoholics who help others:

• Reduced alcohol use

• Increased consideration for others

• Did more Step work

• Attended more meetings

This latest study adds to a body of research Dr. Pagano has been instrumental in building over the past decade. In a 2004 study, she found that 40 percent of the alcoholics who helped other alcoholics during their recovery successfully avoided drinking in the 12 months following treatment, whereas only 22 percent of those that did not help others stayed sober. In a 2009 study, Dr. Pagano showed that 94 percent of alcoholics who helped other alcoholics during the 15-month study period continued to do so as part of their ongoing recovery. These helpers experienced the added benefit of lower levels of depression. Interestingly, research shows the benefits of service accrue to adolescents as well as adults.

The Helper Therapy Principle and How it Works

The helper therapy principle, embodied by AA/NA, holds that when a person helps another person suffering from a similar condition, they also help themselves. How? In large part, by minimizing selfishness and entitlement and restoring the capacity for empathy that was overtaken by addiction. Beyond making the addict feel good, helping others combats egocentrism and self-absorption, which are common perpetuators of addiction.

“Being interested in others keeps you more connected to your program and pulls you out of the vicious cycle of extreme self-preoccupation that is a posited root of addiction,” says Dr. Pagano.

Service also guards against isolation, providing the addict with a broader sense of purpose and belonging. Fellowship with other addicts, both veterans and those new to recovery, reminds the recovering addict how far they’ve come (and how easy it is to fall back into old patterns). These bonds create a certain sense of responsibility to stay sober as a role model to others.

Altruism is empowering. Some have even referred to a “helper’s high,” the feeling of warmth and gratitude felt by those who do for others. After months or years of feeling useless and ashamed, the addict discovers that they can make a positive difference. Giving back builds the addict’s confidence to set and accomplish goals. Perhaps it is this feeling of self-efficacy, combined with staying occupied in healthy pursuits, that reduces cravings for drugs and alcohol.

Endless Ways to Serve

Many recovering addicts are willing and able to serve, but don’t know where to start. Will any kind of service do? Dr. Pagano is trying to answer this question in ongoing research. While helping other addicts may be the strongest medicine, it appears that helping anyone, whether inside or outside of AA/NA, is beneficial for long-term recovery. Here are a few ways to give back:

• Share stories of your personal experience in recovery with other addicts, whether in AA/NA, at a treatment center or informally

• Commit to doing meeting chores (such as making coffee or setting up for a meeting) or a specific service position within AA/NA

• Call members to remind them about meetings

• Welcome newcomers

• Become a sponsor

• Volunteer in a homeless shelter, soup kitchen or other community service activity

• Help a friend, neighbor or family member in distress

Just as you don’t have to serve others to be part of AA/NA, you don’t have to be part of AA/NA to serve. Anyone can do it, at any stage of recovery, and the benefits start to accrue immediately. Service doesn’t cost anything and the options are endless; there is always someone in need.

Helping others is key to living a long, happy life, not only for addicts trying to hold onto their sobriety but also anyone interested in living a better life. If you’ve had any exposure to 12-Step recovery, you probably don’t need a study to tell you that it’s wise to get out of your head and get busy helping others. But for those who need scientific evidence to get mobilized, here you have it.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of addiction treatment centers that includes Promises Treatment Centers in California, The Ranch outside Nashville,The Recovery Place in Florida, Malibu Vista, Spirit Lodge, and Right Step. You can follow Dr. Sack on Twitter @drdavidsack.

Given all the buzz about the biological roots of addiction, it may come as a surprise that it’s not necessarily having a long line of addicts in the family or an “addictive personality” that sets a recovery effort up for failure, but more to do with your willingness to get real about your disease. Here are five signs your recovery is headed in the wrong direction:

#1 Refusing to Ask for Help

While some people recover on their own, the vast majority cannot stop using without a strong network of family or friends, a trusted therapist or some other form of support. Refusing to reach out for help, whether that includes inpatient or outpatient treatment, counseling or self-help support groups, is often a sign that long-term recovery isn’t going to be a reality.

Perhaps your refusal is more subtle. You seek out support but then routinely ignore the wisdom of other people who have been where you are. For example, you may tell yourself, “Others lack the willpower to be around the people, places and things that remind them of their past drug use but I can handle it.” Or you may go off your medication to treat a mental health disorder even though your therapist and others have warned you that this dramatically increases the risk of relapse.

Recovery is more than a decision not to use drugs or alcohol; it is a new way of life. Coping with anger and irritability, grieving the loss of drugs and alcohol as your primary coping mechanism – all of these take a great deal of effort at a time when you may feel you have nothing left to give. That’s where others will gladly lift you up, if you let them.

#2 Continuing to Search for a Quick Fix

For many addicts, the pattern of searching for a quick fix for every problem is difficult to undo. Drugs were a reliable and immediately gratifying escape from life’s challenges, even though the high was short-lived and carried consequences of its own.

But recovery requires deep personal exploration and a willingness to identify and process the underlying issues. Although medication can aid in recovery, it is not by itself a long-term solution. Going to rehab or therapy can be immensely healing, but not if you’re just going through the motions. In other words, scrap the quick-fix mindset or run the risk of experiencing only a hint of what addiction recovery can offer.

#3 Making Excuses for Unhealthy Behavior

When you don’t do the hard work of recovery, the underlying issues will find ways to come to the surface, each time with a new disguise. You may not self-medicate with drugs but you may numb your emotions with food, dive into romantic or sexual relationships too early in recovery, or compulsively shop or gamble to get a rush. Because these behaviors provide relief at a time when you’re in desperate need, denial will set in once again and you’ll seek out ways to justify them.

In some cases, the excuse-making may be less obvious. Perhaps you feel nervous about attending self-help meetings so you come up with reasons not to go (e.g., “I don’t like the people there”). Or you work your recovery program but stop taking care of yourself through diet, exercise, and finding fun and creative outlets to enjoy life in recovery. While there is no right or wrong way to recover, you must actively confront excuses to stay sick in all their various forms.

#4 Believing that Your Recovery Is Doomed to Fail

Whether you’re a 12-Step supporter or not, there is great wisdom in the principle of “one day at a time.” Recovery is a process that ebbs and flows. Sometimes it’s easy to stay sober, sometimes it’s a painstaking, minute-by-minute battle. While it’s natural to second-guess yourself at times, believing that your recovery is doomed, or that life will never be as good as it was while using drugs, is “stinkin thinkin” at its worst.

It’s true, drugs were fun (for a while) and recovery is hard (for a while). But if you talk to people in long-term recovery you’ll hear endless testimonies of how recovery is possible even in the most dire and seemingly hopeless situations and how wonderful life can be without drugs or alcohol.

#5 Thinking You’re Cured for Life

One of the most common mistakes in recovery is taking short-term success as a guarantee of a long-term cure. Sure, they say addiction is a chronic disease. Sure, people relapse even 10 to 20 years into recovery. “But I’m different.”

This type of complacency or over-confidence often leads back to drug use. You start romanticizing your drug-abusing days and convince yourself you can use in moderation or switch drugs of choice without awakening the sleeping beast of addiction. Recovery often gets easier over time, and working a program takes on different meaning many years in. But as a chronic disease, you’ll need to remain in tune with your feelings and relapse triggers and continue making healthy choices even when you feel invulnerable.

So, take stock of your own recovery. Is it secure, or is it in jeopardy? In any given moment, it’s one or the other. You’re either working your program or you’re taking small but significant steps back into old patterns. By checking in with yourself regularly, you can ensure that you don’t veer too far off course.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of addiction treatment centers that includes Promises Treatment Centers, The Ranch drug rehab outside Nashville,The Recovery Place in Florida, Malibu Vista, and Right Step in Texas.

A history of addiction doesn’t necessarily turn Mr./Mrs. Right into Mr./Mrs. Wrong. In fact, addicts who are solid in their recovery can make excellent partners. They’ve waged a courageous battle, spending a great deal of time working to take care of and improve themselves. But before you put yourself in a position to fall for an addict, there are a few things you need to know:

#1 Love does not conquer all.

For anyone considering dating an active addict, it is important to realize that love cannot conquer addiction. Addiction takes priority over everything – you, children, career, financial security, even one’s own freedom. Before diving into a relationship, find out if your prospective partner is actively using drugs or alcohol, or if they display addictive or compulsive patterns in other areas (e.g., gambling, work, sex, food or spending).

If you care about someone in active addiction, help them into treatment and hold off on turning a friendship into more until they’re grounded in their recovery. If they are in recovery, how long have they stayed sober? Are they actively working a program of recovery (e.g., participating in self-help support meetings, counseling or an aftercare program)?

Someone with less than a year sober should stay focused on their recovery program, not dating. This guideline is designed to protect the addict as well as the people they might date. In the earliest stages, most recovering addicts are trying to figure out who they are, what they want and how to be in a healthy relationship. Beyond the first year, the longer someone has maintained their sobriety the more secure you can feel that you’re choosing a partner who is healthy and whole.

#2 Addiction is a chronic, relapsing disease.

An estimated 40 to 60 percent of addicts relapse, according to the National Institute on Drug Abuse. Since relapse is always a possibility, addicts and their partners need to stay alert to their triggers and be prepared to get help when warranted. If you’ve struggled with addiction yourself, be extra cautious – your use can trigger their relapse, and their relapse could spell ruin for both of you. Left unaddressed, relapse can set in motion a roller coaster of chaotic break-ups and reunification that in the long run only exacerbates the problem.

The threat of relapse need not deter you from dating someone firmly grounded in their recovery. It is simply a reality you should be aware of. By educating yourself about disease of addiction, you’ll know what to expect and when to ask for help.

#3 Recovering addicts need support.

Being a loving partner to a recovering addict requires sensitivity and discretion. For example, you’ll likely need to avoid drinking or using drugs around your partner. If you go to parties or events where alcohol is being served, you may need to leave early or offer additional support.

Even if it’s inconvenient for you, you’ll need to make allowances for your partner to go to meetings or counseling sessions, particularly in stressful times, so that they can continue to prioritize their recovery. Short of a relapse, there still may be times when they fall into old habits, such as withdrawing from friends and family or telling lies. You’ll need to recognize these signs and get involved.

#4 You can’t change the past.

Many recovering addicts have done things in the past that result in a criminal record, making it harder to get a job. They may have accrued significant debt, declared bankruptcy or had other financial problems. They may still be working out legal issues and trying to earn their way back into the lives of family and friends. Although these are not necessarily deal-breakers, you need to know that their problems can become your problems. If you can’t accept what was, you may not be the right person to accompany them through what is and what will be.

#5 Know (and take care of) yourself.

You can’t change your partner or their past, but you can control yourself. In any relationship, setting and enforcing personal boundaries is an essential skill. When your own boundaries are firmly in place, you protect yourself from being taken down by your loved one’s illness.

There may come a point in the relationship when you need to ask some difficult questions: Why are you attracted to this person? Is it because of who they are and how they treat you, or do you have a history of being attracted to people you can rescue or fix? To avoid codependency, enabling and other problematic patterns, you may need to seek counseling of your own.

If a partner relapses, it can be difficult to know what lines to draw. You don’t want to give up on a person you love – after all, they must be in there somewhere – but if the relationship is making one or both of you sick despite your best efforts, it may be time to leave. No one can tell you when it’s time to call it quits except you.

Dating a recovering addict can be complicated, but most relationships are. So long as you know what to watch out for, work to ensure you’re both getting your needs met in healthy ways and reach out for help if you get in over your head – in other words, take the precautions you’d take in any romantic relationship – a recovering addict can be an excellent friend and partner.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of addiction treatment centers that includes Promises Treatment Centers, The Ranch drug rehab outside Nashville, The Recovery Place in Florida, and Right Step in Texas.

Like all amphetamines (“speed” drugs), meth creates feelings of euphoria, intensity, and power, along with the drive to do whatever activity the user wishes to engage in. If going to clubs and dancing is your thing, then while you’re high on meth you’re a compulsive dancer, up all night, feeling fabulous, energized, and creative with every thump of music—at least until you start coming down.

Meth is sold legally (with a prescription) in tablet form as Desoxyn, FDA approved for the treatment of ADHD and exogenous obesity. More often, though, it’s cooked in makeshift labs and sold illegally as a powder or rock. The powder form can be snorted, smoked, eaten, dissolved in a drink, or heated and injected. The rock form is usually smoked, though it can also be heated and injected. Widely available in the 1960s, meth faded in the 1970s as controls were tightened on legal production, and cocaine took its place as the new party drug of choice. Crack cocaine dominated the 1980s, along with designer drugs like MDMA (Ecstasy), but in the early 1990s meth made a comeback, and it seems to be here to stay. According to the World Health Organization, meth is now the second most widely abused illicit drug worldwide, trailing only marijuana.

Given the drug’s immense and rapidly increasing popularity, the question naturally arises: Is there such a thing as casual meth use? The short answer to this query is: Only if you’re very, very lucky. The simple fact is methamphetamine is among the most highly addictive substances known to man. Once a person is hooked, getting and staying clean is incredibly difficult; studies show relapse rates in the 90 percent range.

As with all substances, addiction to crystal meth involves:

1. Loss of control over use

2. Continued use despite adverse consequences

3. Preoccupation to the point of obsession

Most crystal meth addicts have a brief period of “casual” or “recreational” use. Usually this escalates rather quickly to abuse, dependency, and addiction. Attempting to use meth (or any other addictive stimulant, such as cocaine) in a casual/recreational fashion is a very bad idea. In fact, it’s a little like playing with matches in a room filled with dynamite. No matter how careful you are, you’re likely to blow the place up—probably sooner rather than later.

Nevertheless, some people will argue that meth is not addictive, and that casual use is not only possible but the norm. Usually this “non-addictive” assertion stems from the fact that meth does not precipitate the physical withdrawal symptoms we see with drugs like alcohol and heroin. However, agonizing physical withdrawal is hardly a prerequisite for addiction. As more than one user has asked, “If it’s not addictive, why can’t I stop?”

One need not look farther than the faces of meth users to understand the drug’s destructive force. Meth causes the blood vessels to constrict, cutting off normal blood flow throughout the body. The result is rapid physical deterioration that is enough to make your stomach turn. Gray, sallow, and wrinkled skin makes users look 10 to 20 years older in a matter of months. Some meth users pick at their skin, believing there are bugs crawling beneath it, causing small sores and scabs all over their bodies. Poor diet, bad personal hygiene, and tooth-grinding produce “meth mouth,” a reference to the broken, discolored, and rotting teeth common among even short-term regular methamphetamine users.

Combine these physical effects with the propensity for violence, anxiety, and paranoia associated with meth use and, no matter how you define it, even one use is neither casual nor recreational. A movie, a dinner out with friends – that’s recreation. You don’t dabble in meth without taking a shortcut to addiction.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of addiction treatment centers that includes Promises Malibu rehab, The Ranch outside Nashville, The Recovery Place in Florida, and Right Step treatment centers in Texas.

Addicts are expert self-saboteurs. Addiction itself is, in some ways, an act of self-sabotage. Rather than dealing with uncomfortable feelings and finding workable solutions, addicts turn to drugs and alcohol, temporarily escaping one problem only to create bigger ones. Here are a few ways addicts continue to get in the way of their sobriety, even years into recovery:

Negative Self-Talk

Inside an addict’s mind runs a soundtrack of self-attacks: “I’ll never get it right.” “I don’t deserve to be happy.” Many addicts suffer from a core belief that they aren’t good enough or don’t deserve anything but the misery they’ve known in active addiction. They accept self-judgments and abuse they would never tolerate from other people.

Often unbeknownst to the addict, these thoughts translate into feelings of hopelessness and defeat, leaving the addict feeling desperate for a high and powerless to resist. Recognizing and intervening in this ongoing negative commentary and substituting more accurate thinking is an essential skill in recovery.

Self-Pity

As Helen Keller famously said, “Self-pity is our worst enemy and if we yield to it, we can never do anything wise in this world.” In moderate doses, feeling sorry for yourself serves a useful purpose in recovery. Many addicts have suffered devastating trauma, both pre-addiction and as a result of their addiction. Grieving for one’s losses can be an integral part of the healing process.

The problem arises when self-pity zaps you of your motivation to recover or turns into resentment, hopelessness or blame. Instead of taking responsibility, self-pity becomes a way to justify blaming others or refusing to take positive action. While self-pity may have served a purpose in active addiction, left untamed, it can jeopardize your recovery.

Ego

“I’m not like these people.” “I can do this myself.” These ego-centric thoughts typically mask deep-rooted insecurities, anxieties and fears. When ego gets in the way of recovery, the addict becomes competitive with others, working harder to be right than to stay sober. As a result, their recovery is superficial and their personal growth stunted.

Isolation

Most addicts know the hazards of isolation in recovery, but the habit is so ingrained that their natural inclination is to withdraw without even realizing it. Isolation fuels loneliness and depression, increasing the likelihood of a return to addictive thinking and behavior. As with many aspects of recovery, the antidote is within your control: Get involved in activities you enjoy and ask for help, whether from family, friends, a support group, sponsor or other trusted source.

Stress

You can’t block all stress from your life, whether you’re in recovery or not, but you can control how you react to everyday stressors. If you take on too much too soon or refuse to say no when you’re overextended, you make yourself more vulnerable to drug cravings and relapse.

Boredom

Another enemy to recovery that is well within the addict’s control is boredom. Meetings and counseling sessions are integral parts of a recovery program, but they aren’t sufficient to make each day fun and fulfilling. To fill the time once spent getting and using drugs, you’ll need to explore new interests, create an enjoyable daily routine and discover what gives your life meaning.

So how can you prevent yourself from getting in the way of your own recovery? The first step is making yourself aware of negative thinking and problem behavior, whether through journaling, self-help support groups, counseling or other means, and taking responsibility for your sobriety. In recovery, you have all kinds of new freedoms, including the ability to turn your inner voice into your biggest supporter. And as the African proverb says, “When there is no enemy within, the enemies outside cannot hurt you.”

#1 Experimenting with Drugs

The only surefire way to avoid drug or alcohol addiction is to refrain from experimenting in the first place. However, as we know from the failed War on Drugs, this “just say no” approach simply doesn’t work. People are curious, bored and in pain, and have always looked to drugs and alcohol to feel better.

Still, understanding your personal risk factors can help you make an educated decision. Do you have a family history of drug or alcohol problems? Have you struggled with depression, anxiety or other mental health issues? If you’re at high risk for addiction, don’t take the chance – invest your energies in finding healthier ways to feel good.

#2 Hanging Around Heavy Drinkers and Drug Users

Surrounding yourself with drug users creates a sub-culture where getting high is acceptable and even encouraged. An occasional drink with friends is innocent enough, but being around people who have few interests outside of partying can be a set-up for addiction. Even if you think your strong values and decision-making skills make you immune to peer pressure, it’s human nature to want to fit in and share interests with the people close to you (hence the popularity of Facebook, Pinterest, and other social media sites).

#3 Isolating Yourself

Social connection is a basic human need. We need other people to support us during difficult times and to witness our lives in happier times. While not everyone can or should be a social butterfly, being a hermit not only puts you at greater risk of addiction but also diminishes your overall satisfaction with life.

Without a social network, you’re more likely to be bored and lack a sense of purpose in life, which are reasons people frequently cite for experimenting with drugs. You may not notice that your drug or alcohol use is getting out of control, but the people who care about you will. Isolating also can be a sign of mental illness, which increases the risk of substance abuse.

Instead of hiding out, keep yourself occupied in more productive pursuits where you’re likely to meet people with similar interests. Take a class, start a new hobby, volunteer in the community – all of these can change your perspective and improve your outlook, thereby shielding you from addiction.

#4 Ignoring Feelings

How do you cope with feelings of sadness, anger and disappointment? Do you ignore them and hope they’ll go away, or do you take steps to resolve them?

If you can’t face your feelings and problems head-on, you’re bound to find some sort of escape. For some, it may be shopping or gambling; for others it may be food, sex or drugs. Using drugs to cope may be a sign that you’re self-medicating an underlying mental health condition like depression or anxiety. Without proper diagnosis and treatment, those suppressed feelings may drive you to abuse drugs or alcohol. Roughly half of people with substance use disorders also have some form of mental illness.

The problem with self-medication is that drugs can only numb the pain temporarily, and in the long run, end up causing more pain. The longer feelings are suppressed, the longer other mental health issues go undiagnosed and unaddressed and the fewer healthy coping mechanisms you’re able to put into practice.

#5 All Work and No Play

People who have difficulty relaxing, being themselves and having fun may depend on drugs or alcohol to put them at ease. Studies show that the addictive mind is one that desperately wants to feel good but derives less pleasure from the things that usually make people happy. Although drug use may seem fun at first, the brain is programmed to gain less pleasure from it over time, setting you up for double the disappointment later on.

#6 Taking Senseless Risks

Some of the brightest, most influential thinkers are risk takers. But we’re not talking about strategic risk-taking. We’re talking about the kinds of risks you later regret. Maybe your thirst for novelty gets someone hurt or your inability to control your impulses ends up irreparably damaging your reputation. Once you’ve reached this point, drug use seems less troublesome. After all, what’s one more risk?

#7 Settling for the Quick Fix

You could exercise to get better sleep, but why? There’s a pill for that. Most of us could benefit from a change in diet to lower our cholesterol, but no need. There’s a pill for that, too. If you’re more likely to pop a pill than change your lifestyle, you’re not alone. It’s the American way. But it’s also the addict’s way.

The quick-fix mentality prevents people from addressing the real issues affecting their physical and mental health. Change requires a shift in thinking. Rather than seeking out immediate gratification, dig deeper to find the underlying cause of your discomfort and consider non-drug alternatives. This may mean occasionally taking the harder path, and perhaps suffering a little in the process.

No one is destined to become an addict. Like diabetes, heart disease and other chronic diseases with a strong behavioral component, you can minimize your risk of addiction by changing how you think and act. Will it be easy, quick or fun? Not likely, but isn’t that the point?

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of addiction treatment centers that includes Promises, The Ranch outside Nashville, and Right Step in Texas.

“I’ll never do that again.”

“I used to be addicted, but now I can limit myself to just one drink.”

Lies are a natural and virtually automatic way of life for addicts. As a result of denial and diseased thinking, addicts (often very convincingly) lie to their loved ones to keep them around, to the world to avoid stigmatization, and to themselves to preserve their drug habit. They lie about the big things and the small things – to feel important, to avoid rejection or judgment, to keep up appearances – until they’ve created a fantasy life that is far more tolerable than their current reality.

The dishonesty, though understandably hurtful to others, serves a purpose in the addict’s life. If they stopped lying, they’d have to quit drinking or using drugs and face a shameful pile of hurt they’ve inflicted on the people they love. That’s quite a load to bear, especially for the addict who is complacent about getting sober or who tries to face their past alone. It’s much easier to hide emotions, keep up the double life and continue using.

Just as food fuels the body, lies drive addictive thoughts and behaviors. For some, relief from the need to lie is the most attractive aspect of addiction recovery. Yet in some cases the lies are so entrenched that they linger long after getting sober.

What Is ‘Rigorous’ Honesty?

In 12-Step recovery, the standard isn’t occasional honesty or attempted honesty, but rigorous honesty. What does this mean?

Rigorous honesty means telling the truth when it’s easier to lie and sharing thoughts and feelings even when there may be consequences. In 12-Step recovery, the requirement is taking a fearless personal inventory and promptly admitting to dishonesty. This means catching oneself in the middle of a lie and correcting it, even if it’s embarrassing.

It isn’t enough to be honest with oneself (Step 1), but addicts must also be honest with their higher power and other people (Steps 4 and 5), including family, health care providers, therapists, peers in a 12-Step group and so on. Steps 8 and 9 require the addict to take active steps toward honesty and the last three steps require practicing honesty on a daily basis.

While it is important to be honest about addiction and recovery, rigorous honesty extends to every aspect of life. It involves not only refraining from verbal lies, but also nonverbal lies (e.g., stealing or cheating) and an awareness of the individual’s own fears, limiting beliefs and unhealthy patterns. It requires authentic relationships that leave room for struggles and failures, setting boundaries, and living in accordance with one’s own values and principles.

Even Honesty Has Limits

Honesty is a building block for lifelong recovery, but even it is no magical cure.

A Process, Not a Destination. It is generally accepted that it takes three to four weeks to un-learn a habit, but it can take significantly longer to form an entirely new habit and embrace it into the fabric of your being. Telling the truth requires ongoing attention and practice even in the face of discouragement and fear about what others will think.

Perfection Is Unrealistic. Addict or non-addict, 100% honesty isn’t always realistic. There are times when despite our best efforts, denial rears its head or we make mistakes. Being in recovery doesn’t mean being superhuman.

Honesty Shouldn’t Hurt. The responsibility of rigorous honesty doesn’t include harsh criticism or cruelty. While it is helpful to acknowledge areas that could use improvement in oneself, it is equally important (and difficult) to recognize positive characteristics.

Likewise, honesty shouldn’t hurt or berate others. When addicts make amends as part of 12-Step recovery, they tell the truth “except when to do so would injure them or others.” Honesty is unhelpful if it is used to make the addict feel good about him/herself or to relieve their guilt, with little consideration for the effect on the other person. Recovery is not an alternate universe – respect, boundaries and social decorum still apply.

Lies Have Consequences. Even if the addict commits to rigorous honesty, there are friends and loved ones who have been hurt along the way. It may take time to earn their trust, respect and companionship again. By consistently following through on promises and working a recovery program, loved ones can begin to see that this time will be different.

Honesty Alone Is Not Enough. Dishonesty can be a sign that the addict is returning to ineffective coping strategies. As they say in AA, “You’re only as sick as your secrets.” While honesty is an essential part of relapse prevention, it is just one piece. Without working a program of recovery, learning new skills and addressing the underlying issues, honesty cannot by itself prevent relapse.

Without honesty, there is no recovery (or perhaps only the type of survival-based recovery that falls far short of fulfilling). It requires a valiant effort but through rigorous honesty, addicts reap a reward that at one time likely seemed utterly impossible: coming to know and love themselves and others, imperfections and all.

David Sack, M.D., is board certified in addiction psychiatry and addiction medicine.  Dr. Sack served as a senior clinical scientist at the National Institute of Mental Health (NIMH) where his research interests included affective disorders, seasonal and circadian rhythms, and neuroendocrinology.  He currently serves as CEO  of Elements Behavioral Health, a network of addiction treatment centers that includes California rehab center Promises, The Ranch in Tennessee, The Recovery Place drug rehab in Florida, and Texas rehabs Right Step and  Spirit Lodge.

Not surprisingly, when an addict gets clean, their “friends” don’t always have their back. In fact, some become downright toxic to their recovery. Here are a few reasons the people you thought were your friends may end up sabotaging your recovery efforts:

• Addiction drives away most of an addict’s true friends.

• Whether they use drugs or not, your friends may not understand the disease of addiction. Even if they want to be supportive, many are in denial or don’t know how to stop enabling.

• Your sobriety spells the end of the friendship. Drug-using pals don’t want to lose a friend, but even more, they don’t want to stop using drugs.

• Your recovery holds up a mirror that shows them the reality of their lives – a vision they may not be ready or willing to see of themselves as an addict who needs help. They may be afraid that you’ll start preaching to them or rat them out to family, friends or law enforcement and put an end to their lifestyle.

• They have tried to quit unsuccessfully. It can be disheartening to see someone else succeed in what they can’t do so themselves.

• They don’t have a drug or alcohol problem, but want to continue to enjoy an occasional beer during a football game or glass of wine with dinner without worrying about their influence on you.

• A romantic partner or spouse may be concerned that your efforts to improve your life will lead to separation, divorce or finding someone else.

Sure Signs of Sabotage

Early in recovery, it can be difficult to separate the supportive relationships from the malicious motives of would-be saboteurs. How do you know when people are toxic to your recovery?

Pseudo-friends and even some family members may discourage you from getting help. They’ll tell you that you don’t really have a drug problem, recovery is a waste of time or relapse is inevitable. They may try bullying you to party with them, or use drugs in front of you.

Others may employ more subtle tactics, such as using your past behavior as leverage against you, holding onto resentments, making it difficult for you to get to meetings or therapy appointments, or belittling your efforts to get well. They may make hurtful comments that play into your doubts and fears or spread rumors among your social or professional circles.

Even non-drug-using comrades can be enablers. People who are unsympathetic to the difficulties of drug cravings may encourage you to meet them at bars, parties or other temptation-filled environments. When family members refuse to work on their own issues, they may stay stuck in old patterns of minimizing, rescuing and enabling without realizing that they are sabotaging the person they most want to help.

Make the Tough Calls

Addicts with toxic relationships must be proactive in taking steps to safeguard their recovery:

Cut Ties with Negative Influences. There is a general rule in recovery to stay away from the people, places and things associated with past drug use. Maintaining relationships with people who drink or use is strongly associated with relapse.

Cutting ties with old friends who continue to use and people who are not supportive of your sobriety is one of the hardest parts of early recovery. This may mean ending relationships with people you have relied on as a source of emotional or financial support, changing jobs if your drug-using circle extended to work, or getting out of an abusive relationship or unhealthy marriage – all of which can have a dramatic effect on your daily life.

These difficult decisions have to be made right up front. At a time when you have already lost your routines, your coping mechanism and your sense of identity, parting ways with your social circle can be agonizing – but it is an important part of creating a new life and ultimately, brings a profound sense of relief when you’re surrounded by people who truly care.

Of course, not all relationships have to end. You can reconnect with people you may have alienated during active addiction and you may have quality friends who are in their own recovery process or who are willing to join you on this journey. Often, family members are willing to grow and change with their addicted loved one by participating in therapy, learning about the disease of addiction and attending Al-Anon or Nar-Anon meetings. One close connection is all that’s needed to build the foundation for a social support network.

Make New Friends. Early recovery is also a time for making new friends and establishing healthy bonds with people who care about you, are willing to confront your addictive thinking and help you get the support you need. Positive friends, which can include people you meet at work, doing sober activities or attending self-help support groups, will not only avoid drug use but will be enthusiastic about your efforts to improve your life and lead balanced lives themselves.

Join Self-Help Support Groups. Groups like Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery and LifeRing offer regular meetings that not only keep you focused on your recovery but introduce you to a group of people who are working toward similar goals.

Whatever it Takes

The people who are most successful in recovery embrace the attitude that they will do whatever is necessary to protect their sobriety. Sometimes this means making difficult decisions and losing people you care about. But in truth, anyone that doesn’t have your best interests in mind was never really a friend at all and has no place in your new life in recovery.

David Sack, M.D., is board certified in addiction psychiatry and addiction medicine.  Dr. Sack served as a senior clinical scientist at the National Institute of Mental Health (NIMH) where his research interests included affective disorders, seasonal and circadian rhythms, and neuroendocrinology.  He currently serves as CEO  of Elements Behavioral Health, a network of addiction treatment centers that includes Malibu drug rehab Promises, The Ranch in Tennessee, The Recovery Place drug rehab in Florida, and Texas rehabs Right Step and  Spirit Lodge.

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