4-26-2008

Brian: During our call in show we will be taking in all your calls of interest in areas dealing with alcohol and drug addiction, and today I do have my co-host back with me, Jill Mattingly, after several weeks of absence.

I was so glad to have you back, I missed you tremendously.

Jill: Well, thank you.

Brain: And we also have Dr. Neil Johnston back with us again, back at the mike, and we’re going to be talking about some very interesting topics today. We’ll going to be talking about relapse triggers and cravings, how people begin as they move into addiction, how various people, places and things begin to cause them to crave for their drug or drink of choice.

Jill: Well, thanks for that great intro, Brian. I am really happy to be back. You know, I just want to say out there to the people listening, thank you for our prayers and support, our family went through a real difficult time. You know, spending time, almost a week in the hospital, with my father, and he is, safe to say, doing very well. I am sure he is listening today, that’s why I wanted to say, “Dad, I am so glad you’re home and you’re doing well.” And, I hope everybody out there is doing well today. We are going to talk about something really interesting and if you want to start listening to some of the things we even we talk about in our day addiction treatment program, there, Breakthrough Addiction Recovery, this portion called Relapse triggers and Cravings is a part of the Matrix Model, in which we teach during the day addiction treatment, and Brian, actually, is one of the main instructors, if you will, on this and other licensed personnel, and really, I thought this would be a really neat approach for the radio show, is to start bringing up some information that it’s not cookie cutter, addiction dependency is not cookie cutter, you cannot say, “oh, here’s what happens in everybody and this is what the outcome will be.” It is just not like that and Dr. Johnston is going to throw in his two cents, with that, I’m sure.

Neil: I’m sure eventually I will. I’d like to add if there is anybody out there has stories of their own recovery process, things that have gone on that were relapse triggers for them, that they learned to overcome, we’d love to hear about it. Please call in and let us know.

Brian: Yeah, and that number there is 770-226-0920 and also outside the area is 1-888-920-2665. We’d sure like to here your success story!

Jill: Right! This is a call-in show and so just to introduce this whole section on relapse triggers and craving, one of the things I always heard is that successful recovery involves rewiring the brain. That is an interesting statement and if you want to understand how we come upon that statement, I want you to stay tuned today. Really, there is another way to approach it, too, is just looking at an addiction or dependency is actually a hijacking of the brain and the behaviors that occur are because the substance has produced different behaviors in response to things that are happening, you know, in or outside of the life of that person. And that by combining the evidence-based addiction treatment, prescribed medications, a willing and compliant patient, the brain can actually heal and recover and rewire, if you will.

Brian: I like the way you put it too, and many ways when a person continues to use that medication, it changes all kinds of neurochemistry balance in the brain and so where it is a normal process when without being influenced by alcohol and other drugs, the brain just functions perfectly and it begins to do the things normally a brain is supposed to do but when we start infusing with alcohol and drugs, those neuro-chemical balances get all messed up and as a result there is a kind of a rewiring of the re-circuitry.

Jill: Exactly.
Neil: And all that depends on the individual’s genetic makeup and what their circuitry was to begin with. That’s why you have people who can use cocaine once, set it down and never use it again, or can easily get off of a substance, while another person has a very huge struggle with it.

Brian: Absolutely. And you know, one of the things we talk about, relapse triggers, maybe we ought to give them a definition of what a trigger really is. A trigger is a stimulus that has been repeatedly associated with a preparation for or the anticipation of either alcohol or other drug uses. Now, it is really interesting to note, usually when you talk about these kind of relapse triggers, those are those ‘external relapse triggers’- the people, the places, the things, the events, but you know it’s really interesting, too, is not just the external relapse triggers, but I was talking to my group about the problems about emotional relapse triggers: pain, anger, fear, even celebration, excitement, happiness, experiencing a positive tone, like a graduation. Those are also internal emotional relapse triggers and those are the ones we carry with us wherever we go.

Neil: And much more harder to control. You can control who you have to deal with; where you go, you can’t control all these…exactly what you’re feeling.

Brian: Absolutely.

Jill: Right. And you can’t control the people around you, especially if you come from, you know, if you’re in a setting or family or anything like that, that is actually cues up all those emotional tumultuous times and so you come to a place where, how do you escape that? And this is where you come in, Brian.

Brian: Well, not really escaping, I don’t think. It’s more like, how do I cope with it? And sometimes, it is.

Neil: Uh-huh. But sometimes it is escaping.

Brian: Like, I’m saying, you have to kind of, maybe escape or maybe the better word is: avoid.

Neil: Yeah, yeah.

Brian: Avoid.

Neil: Move out of your family’s house is kind of the problem.

Brian: Kind of hard if your father depended upon them.

Jill: Yeah, that’s true. I mean, not getting a divorce is a good thing, but, you know, understanding that the person closest to you could be your trigger.

Brian: Well, you said it perfectly, right there. You know, so many times, Jill, people in addiction treatment, when they come to day addiction treatment, they’ll say, “well, you know, Brian, I’m trying to stop drinking and my wife still drinks a glass of wine, but she doesn’t have a problem with.” And that is a real challenge because we have to understand that there, as Dr. Johnston just said, there are some people that can drink two or three glasses of wine or maybe a glass of wine and be perfectly fine with it and never have a problem. Those are the users of alcohol; and then you have other individuals who, because of their chemical makeup in their brain, they just can’t do that.

Jill: Well, what about this trigger: when you are actually just sitting around with, you know, friends, and drinking a glass of wine. However, the wine relapse triggers another type of drug use, such as cocaine or, you know, some other type of, you know, tendency to go a little bit further into the web.

Brian: Well, I think that sometimes when we talk about cross-addiction, and again, a lot of times I think only that occurred, and Dr. Johnston can help me with this, but most of the time, if a person is drinking wine and then thinks about cocaine, usually it is because they’ve already had cocaine use in the past and one of the major reasons that that occurs is because that particular drug, the alcohol and the cocaine, follows the same pleasure pathway of the brain, and therefore, it can probably stimulate a thought-process in that particular addiction.

Jill: Well, I just want to bring up the number again, because I feel like there are people listening right now, and they’re thinking right now about their relapse triggers, 770-226-0920. If you want to call and talk a little bit about what relapse triggers you. Now, you may not have a problem with alcohol, you may not even have a problem with any type of drug addiction, but there’s many substances and behaviors that are not exactly the best thing for you if you take it to an extreme, so Dr. Johnston, were you going to talk about some relapse triggers that happen for you?

Neil: I’m happy to share a story, I was going mention first, that, you know, when you’re looking at some of these relapse triggers, one of the most classic ones is: coffee in the morning, cigarette in the morning; cigarette with the coffee, and then evening times: a cocktail and a cigarette. Those are common drug-drug interactions.

Personally, I stopped smoking in November of last year after being an utter fool and started smoking after I’d become an M.D. I consider myself one of the stupidest people on the planet for that, but, it was definitely apparent to me a couple of weeks ago after I had been on a long trip to visit a terminally ill relative that I got home from a long drive, was tired, was frustrated, and that was one of my relapse triggers to smoke and one of the ways, one of the times when I never liked to smoke was after I ate, which is unusual, most people eat and then like to smoke. Not me, so I knew that if I wouldn’t have something to eat, I wouldn’t want to smoke anymore, so that was my way of sort of dealing with it and preventing myself from popping open that carton of cigarettes. There are other simple things. I mean, people get attached, even the process of fixing up their dose of heroin or opening up the box of cigarettes, the ritual of use becomes very important that anything associated with that can lead to it.

Brian: Well, you know, it’s very interesting that you say that, Dr. Johnston, because many of the clients tell us something to that nature, is that, it’s not sometimes at certain points, the actual using, it’s the [inaudible], it’s the idea of getting the drug, it’s the idea of preparing for the drug that really is the high and not the using, itself. It’s all the preparatory things that go along. It’s very interesting how that seems to replace the actual use.

Jill: And if you continue to listen, we are going to get into a lit bit of neurophysiology, and neurophysiology very clearly explains why the ritual can be just as addictive and you can be just as dependent on it as actually the drug use itself. I know, let’s just talk about coffee making. When I make that coffee, that’s just as joyful as the first cup.

Okay, alright, we’re coming down to a break, thank the Lord! And, uh, we’ll be right back, stay with us. 770-226-0920.

Jill: Welcome back to the Breakthrough Addiction Recovery Hour. This is Jill Mattingly, and my co-host today, Brian Fujii, and we also have our psychiatric director, Dr. Neil Johnston, and we are talking about relapse triggers and cravings and how it pertains to addiction and dependency on alcohol and other drugs of addiction.

Now, when I say drugs of addiction, we just left that segment talking about caffeine and nicotine and both of those have something in common with all the other drugs and the alcohol that we’re talking about and that is the change in brain chemistry and what happens in the brain with repeated exposure to these substances. So, what I thought we would do in this segment is take different types of drugs of addiction or even alcohol and talk a little bit about the relapse triggers and cravings that are unique to those different substances, but before we do that, looks like we do have a caller, name is Charles in Atlanta. Hey, Charles, how are you today?

Charles: I’m fine, how are you?

Jill: I’m doing wonderful, thank you for calling Breakthrough. So…

Charles: Yes, I wanted to ask a question on addiction, and it has to do with a spiritual component to it. In other words, let me give you an example, for instance. Sometimes, I think addiction can to like, chemical dependence, can be not the primary thing, it can be what people are using to, using as an anesthetic to kill an internal sense of pain that they might have in their soul, say from a spiritual consequence to sin, for instance. Where they get involved in something that’s, you know, kind of morally destructive and it brings spiritual consequences within their soul and it gives them a sense of tormenting pain and so they turn to alcohol or drugs to kill the pain on the inside, you know.

Brian: Charles, you’re right on target, you know, I hear a lot of that in my own addiction treatment with a lot of clients and, you know, a lot of the folks deal with what you call guilt and shame, when they’re drinking, drugging and the issues that they’re dealing with; they’re feeling about the fact. Maybe they’re breaking some moral values that they feel that are very important to them. And, as a result, they drink as a way to anesthetize or even numb the pain. You know, most of the time, people drink alcohol, they just want to numb the pain. They don’t want to deal with it. And you’re exactly correct. Unless they deal with that guilt or that shame or that frustration or that feeling that they’re being unfaithful to their spiritual values. Many people do use alcohol and drugs as a way to escape.

Charles: One thing, though. Have you ever dealt with it in terms of deliverance.

Brian: In what way do mean that, by deliverance?

Charles: Well, I mean, like, some people will go to church and they’ll have elders and people pray for them and then they’re looking for a spiritual cleansing from God, you know. In Christianity, that’s a common thing, it’s even taught in the bible about, say, deliverance from demonic spirits, for instance. People can have this sense of torment from that and people have obtained that deliverance spiritually in their soul and therefore the addictions are no longer needed because the pain’s gone, if it’s a spiritual thing, you see what I’m saying.

Jill: Yeah, and at Breakthrough, we also look at that as a part of the support system. Having a spiritual program is a very intricate part of your support system, and I belonged to a church in the past where we did practice deliverance and we saw people freed from different addictions and bondage; breakage from bondages to those things, and that was for them, the way that they were able to come out of it and it matched their belief system and hopefully they were getting help in other ways such as cognitive therapy for other issues and possibly medication if they were having problems with anxiety and depression. I mean, all of these things can be a part and not everybody is going to jump up and say, “Oh, that’s for me, right there!” but there are people that I have seen that work for and so, I’m right with you, Charles, it’s a huge component to overcoming problems in your life and many people, that’s how they view this.

Charles: I’m very, very, very interested in your perspective on that. Is there some way I can communicate with you through the website, maybe?

Jill: Absolutely, and if you do communicate through us, I think that you can go to any of our web addresses. Is that not right, Brian, and you can get right through to us.

Brian: That website that we have is BreakthroughAddictionRecovery.com.

Charles: And the lady’s name was…?

Brian: Jill Mattingly.

Charles: Okay. Ms. Mattingly. Okay.
Jill: Charles, thank you so much for calling today and I just hope you have a wonderful day.

Charles: Thank you very much.

Jill: And so back to talking about the different types of relapse triggers and cravings, and the first thing that we were going to discuss was stimulants. Now, stimulant use has very particular types of relapse triggers. So Brian, take it away.

Brian: Well, you know, again, a stimulant would be like, something like cocaine or methamphetamines, and those are very powerful, powerful stimulants, and some of the areas of relapse triggers that can really cause people to look at using cocaine and methamphetamines is the fact of when we take a look at relapse. For example, if a person uses alcohol, that can be a trigger that may also produce some cravings for some additional cocaine or methamphetamines. One of the interesting things that the Matrix Institute has done with some studies about cocaine use and also alcohol. This is a pretty interesting statistic, that if a person uses alcohol and is addicted to cocaine, that there is an 800 percent chance that the person will relapse and begin using cocaine again, and that is a pretty significant number and so that is even using alcohol in a casual way and not in an alcoholic way, but just a casual way. And again, helping people to remember the fact that the cocaine stimulation, the alcohol stimulation, those, I know that the alcohol is a depressant but I am talking about that passes through that pleasure path with the very same pleasure pathway that the cocaine does. It stimulates that same area of the brain and as a result, it really causes individuals to have those cravings. Another issue like we talked about in the very beginning is drug-using friends. That certainly would be a tremendous trigger. Being around people that are using cocaine or methamphetamines, you know, it’s another thing, we talk about alcohol. This probably is more difficult for a person to try to stop using alcohol than maybe even cocaine or methamphetamines, you say, well, how can that be? Well, the main fact is that if you’re trying to stop using cocaine or methamphetamines, you’re not going to go around to the places where cocaine and methamphetamines is being used. But you can’t even go and get gas or go to your grocery store without seeing alcohol. You can’t even turn on the TV without seeing some kind of use of alcohol being done. So, the idea that it could be a tremendous trigger just by the fact of it, first of all, it’s legal, and secondly, it’s so accessible.

Jill: That’s incredible. And once again, I want to give out the number again, Brian. 770-226-0920 because we are a call-in show and if you have any comments or anything else that you would like to get in on the conversation, please call us. We’re talking about relapse triggers and cravings right now, and how stimulant, now define stimulants: that’s cocaine and methamphetamines, caffeine is a stimulant, and so these are the things that a lot of times you will see yourself tripping over these relapse triggers to use these substances.

Brian: And again, you know, when you talk about a stimulant in contrast to something that is more of a depressant, like alcohol is a depressant, but to use that, most people are trying to get even a greater high than a normal high that you would get, say, from, just like alcohol. It gives you a greater dopamine release, and that’s why it’s so difficult because so many times, they’re not just getting a feeling of well being, they’re getting an extra euphoric punch that makes them feel very, very good. So, uh, to kind of wrap it up a little bit on this one area that one of the cues, which is very interesting, an amount of stimulant, say like, cocaine, when they were using intranasally, just at the same time that ATM machines were being introduced and many people actually began getting triggered by seeing an ATM machine. Why? Because the fact is, in the past, if you used up your money, you were done for the weekend.

Dr. Johnson: That was part of their ritual.

Brian: That was part of the ritual and so now they now actually saw an ATM machine, well that means, “Hot dog! I’m out of money, but I’ve got a magic money machine right here and I can use all weekend.” So it’s amazing how something that…

Jill: ATM machines can trigger someone to use?

Brian: Yeah, can trigger for someone to…and even an idea of an exit…an exit ramp where people normally go to get their cocaine can be a big one.
Jill. Well, it looks like we’re coming down to the end of the segment. We’ll talk a little bit more about the stimulant relapse triggers and cravings when we come back. 770-226-0920. Stay with us.

Jill: Hey, welcome back to the Breakthrough Addiction Recovery Hour, my name is Jill Mattingly.

Brian: And I’m Brian Fujii.

Jill: There it is! And we have Dr. Neil Johnston with us today. So good to be back in the chair at the mike. Feels really good, you know how this is so much fun to do on the weekend, even though it takes an hour to get here. Anyways, I hope you are listening in. We’re talking about relapse triggers and cravings today and actually, if you’d like to go our website, BreakthroughAddictionRecovery.com. There’s a lot of information. Chock full of everything you could imagine and if you want to look a little bit more into what we’re talking about, you’ll probably be able to find some of this, or at least a link. 770-226-0920. We want you to call in. We want you to get in on the conversation.

Brian: Yeah, I want to hear their stories, I’m sure there’s a lot of people out there that has been….

Jill: Stories of what relapse triggers YOU.
Brian: And also how they overcame it because obviously there’s a lot of folks out there that has been able to take the challenge on and beat it.
Jill: Right and, you know, we are listening out different things that are relapse triggers for different types of drugs, alcohol; however, you may have something very unique and if you want to call in and let us know. And, I’m over here, Dr. Johnston is looking at me, I know you want to say something, go ahead.

Neil: Yes, I had a comment relating to Charles’ question earlier with regards to spirituality and drug addiction. I want to make it clear to everyone that addiction does not mean that you are not right with God or that you are somehow a bad person by any means. An example of that is a century or two ago people thought that epilepsy was demon possession. It’s not been that long since that we thought that schizophrenia was demon possessions. We now know clearly that these are medical illnesses, and addiction is the same way. Now, don’t get me wrong if you’re still listening, Charles, there’s no question that the spiritual approach and the spiritual support and God’s healing can be helpful to people with every kind of illness, whether it would be an addiction or whether it would be cancer or something of that nature, and that’s more of the approach that we would be taking a Breakthrough. We’re not going to be proponents that you have some sort of faith healing or things of that nature. We’re going to use everything at our disposal to help people with recovery and there is a place for your personal religious beliefs in that.

Jill: And I agree with you, Neil, and I think what I wanted to have Charles understand is that there are people that that was the breakthrough if you will, for them, is to go through that type of ritual or to go through something within a counseling scenario and it put them over onto that other side in terms of their recovery.

Neil: And I agree, but if someone is sitting out there listening to us, do not for a second think that we think that you are a bad person or religiously out of line or what not. This is a medical illness that there are medical addiction treatments for.

Jill: And that’s what makes Breakthrough Recovery so different is because we do have a medical approach as well as the cognitive behavioral approach and the Matrix Model and the day addiction treatment that Brian is doing, and we’re still on trigger and cravings.
Neil: I want to add real quickly that guilt does not make someone less likely to relapse or less likely to use. Guilt makes it works. That’s a negative emotion that makes people want to use and numb that emotion. So, even when people slip up, I tell, ‘Okay, that was yesterday. Focus on today and forward’, so I don’t want anyone sitting at home feeling guilty in anyway that will get back to the relapse triggers, but I think we have a caller.

Brian: Yeah, we got David from Atlanta. You got a question, David. Welcome to The Breakthrough Addiction Recovery Hour. You have a question on casual marijuana use. How can we help you?

David: Well, listen. Not necessarily a question on casual use, I used marijuana for twenty years but in the last six weeks, I have given it up. You know, just briefly, I smoked cigarettes for a long time and I’ve been hypnotized to break the cigarette addiction that I thought I had, but when I did that, my marijuana use increased, and I’ve since married and had a family and that’s what is really driving me, I guess to, it was a real struggle. I think what along the lines what I heard you say and I have listened to your program a couple of times and I enjoyed it. Just to not have it, like you were saying, I want nothing more than to, there’s a guy living inside of me that just wants to be high all the time, but the fact of the matter is if I don’t have it, I don’t necessarily have a physical craving for it, but if I have it, I would certainly smoke it without a doubt. But, along the same lines that you were talking about, I use alcohol on a daily basis, you know, I drink a lot of beer and I, you know, I’m what I like to refer to as the worst kind of alcoholic, I’m a functioning alcoholic. I go through my day-to-day activities pretty successful, you know, without, you know, many, what I would consider without any problem. Obviously my wife would have something different say about that, but you know, I go through my day-to-day routine and I do it while I start drinking at noon every day and I go to bed at 9 o’clock every night and, basically….

Neil: Well, David, this is Dr. Johnston talking and you said earlier that you have this person inside that would definitely use and be high all the time if you could.

David: No doubt!

Neil: That is what we were talking about, your cortex of your brain, if you will, that’s the upper layer, the most recent developmental layer in humans has been hijacked by the pleasure centers in your brain that want to use both the marijuana, the cigarettes and the alcohol and it does sound like you have problems with all three, perhaps.

David: Oh, there’s no doubt and along the way, of course, you know, as you state, you know, I have used all sorts of different drugs along the way, you know, and I’ve experimented with all of them, I would venture to say, but, you know, again, it’s a conscious choice to do it and when you say, you know, it’s matter of who you surround yourself with, I know that the pleasure still available is…you know, I try not to associate myself with those people because if I do, if I get presented with that, that’s just makes the temptation that much greater.

Neil: What makes you want to quit now, David?

David: Again, I have a family and my wife detests the whole idea of any of it.
Neil: And you don’t want to lose them.
David: You know, and I love my children, I have beautiful children and now I want the best for them but I would never intentionally do anything to bring detriment to my family and that’s where the whole outside pressure came from my family.

Neil: David, I would really encourage you to take a look at website and we do free evaluations at Breakthrough so that you can come in and talk with us about how we might be able to help you out and…

David: Yes, I did. I went to your program. I’ve thought about it before. It’s an interesting idea of treating it medically, the alcohol, you know…

Neil: That’s right. Well, it’s absolutely essential that we treat that medically because if you were to stop the alcohol use immediately, David, you could actually die from withdrawals.

David: And again, I probably consumed, you know, a minimum of a dozen alcoholic beverages a day for the last twenty years.
Neil: Yeah, you would definitely want medically supervised drug and alcohol detoxification.

David: You know, and again, I don’t know when you start to talk about relapse triggers and things like that, it seems to me that I don’t make a conscious effort to start drinking every day, it’s just part of the routine at this point, you know, and then, and it’s…

Jill: Well, you know, David, first of all, I just want to commend you because you really have entered into a place where you see that this is not working for you and you’ve made this phone call and that is really one of the first steps that you can make towards actually getting a hold of this and like Dr. Johnston, I want to encourage you. Look at the website, call us on Monday, come on in, we’ll sit on the couches, we’ll talk a little bit about what’s going on and try to give you a way to look at yourself moving through this and out of this but right now, Dave, we are coming to a break, but I want to just thank you so much for this call. You have probably helped many people. Our office number, 770-734-8091 if you want to give us a call. And David, have a wonderful day. I hope to here from you next week.

Brian: Good luck.

Neil: Take care, David.

Brian: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Brian Fujii, and Jill Mattingly is my co-host, and with us is Dr. Neil Johnston, our Director of Psychiatric Services at Breakthrough Addiction Recovery and today we continue….

Jill: Today is Draft Day. NFL Draft Day. I just have to tell everybody…

Brian: Oh, who cares, Jill.

Jill: Hey, but no, wait a minute! Wait a minute! We’ve got the third pick. Atlanta has the third pick. If you want to call in and talk about that, Ill talk to you about that.

Brian: What a perfect lead-in, because she says ‘Draft’ and I’m talking about alcohol addictionrs.

Jill: Oh, okay, well that’s not too good, then.

Neil: We’ll get to steroid addiction on another day.

Brian: You know, we’ve been talking about how relapse triggers and again defining relapse triggers, any particular people, place, or thing, or maybe even an emotion that causes a person to want to drink or to use their drugs of choice and we were talking initially about stimulants, which was alcohol, something like cocaine and methamphetamines and now let’s take a look at the some of the issues that are related to alcohol. You know, alcohol is one of the most common of drinks of addiction and we know because of its commonalities that it’s being addictiond, as well as people becoming dependent on it almost daily, and one of the key interesting things about one of the relapse triggers that causes people that struggle with alcohol is their negative affective state, now the affected state are emotions. Now, it’s interesting to note that especially anger and depression are one of the key causes for relapse for alcohol and you know, when you think about the fact that alcohol already is a depressant, and people continue to use alcohol as a way to fight depression, I find that to be a very interesting situation because it seems like it only exacerbates the problem. It makes it worse.

Neil: Yes it does, very sad. Cyclically downward spiral.
Brian: And yet it only gives them that little buzz and a lot of times what I hear my clients telling me is I just gotta have that, just to get that buzz-on, just to feel okay, and I keep asking, okay, why do you need anything just to feel okay because most of us in life, you know, we have good balances, somehow, we don’t need to have stimulants or alcohol to make us just feel okay.

Neil: That’s why I’m at Breakthrough is because many folks in that situation have an underlying medical health problem that needs to be addressed along with the alcohol. So, if you’re in that situation that you’re having to use a substance to feel “normal”, that’s a real sign that you need some help.
Jill: And, you know, that’s a slow journey. You have to uncover that, you have to get to the correct addiction treatment for that and then we address that. But, what comes first is very hard to determine. Did the dependency create the problem or the problem created the dependency. You know, when I think about relapse triggers for alcohol, that internal anger/depression is interesting, but I think about just sitting down to watch TV and seeing commercials for alcohol. You know, I remember when they changed the rules and they couldn’t show a person actually drinking and putting alcohol to their lips and drinking it. So, every beer commercial, every liquor commercial does not show people actually putting it to their lips, if you haven’t noticed that.
Neil: Well, if you’ve noticed the one for Di Soronno Amaretto, and a very handsome bartender gives the very sexy woman the drink and she’s finished and she doesn’t let him take it away and she licks the gorgeous ice cube.

Jill: Oh, that’s right. That’s as close as they can come.

Neil: And, you know, that brings in the association with sex and drugs, as well.

Brian: Oh, absolutely.
Neil: That often times go together using alcohol to feel less anxious, more sociable as a social lubricant. Obviously, everyone probably realizes that alcohol causes people to do things sexually that they might not otherwise do. Some people use stimulants to enhance sexual pleasure and all of these are being awarded through a dopamine pathway in the brain and so they do become associated and they’re hard to separate at times.

Jill: Well, I tell you what. I mean, this, it goes so deep, here. We can just uncover one layer after another and talk about these relapse triggers and cravings, it looks like, though, we are coming to the end of the segment, so, uh, stay with us. We may not talk about the sexual part of this but we will continue to talk about relapse triggers or cravings. 770-226-0920. Dr. Johnston, just don’t look at me like that, okay? We’ll be right back.

Brian: Welcome back to the Breakthrough Addiction Recovery Hour, my name is Brian Fujii, and Jill Mattingly, my co-host, and Dr. Neil Johnston, our Director of Psychiatric Services, and today we have been talking about relapse triggers and cravings, what a comment at the end of that show.

Neil: I would just like to say that my lawyer will be contacting Jill very soon. Ms. Mattingly had been trying to get me to talk about stimulants and sex earlier and then when she said that we weren’t going to be discussing it at the next segment, I gave her a dirty look, not a lascivious one, so, just so we understand where we’re at, here.

Jill: Yes, I forget we’re on radio, you know, they can’t see our faces, so, anyway, we had a good giggle in the break there, but we were talking about alcohol and the relapse triggers and cravings that go along with alcohol and I brought up the thing about the commercials on TV and how, I mean, I cannot even imagine if you are trying not to partake of alcohol and just turning on a football game and all of the beer commercials and everything that is associated positively with the drinking and how that is such is a strong pull for us in our society.

Brian: You know, one the things that a lot of the clients in our program do a lot of traveling. In fact, business owners, executives and they travel a lot. You know what they tell me the biggest trigger is? Delta Crown Room.

Jill: What is Delta Crown Room?

Brian: Or, flying first class. Where they go to those particular rooms where they can get free liquor, you get into first, they said, “what do you want?” and it’s a tremendous challenge for individuals who do a lot of traveling and who have those high flyer miles and to be able to fly and do their business without having alcohol literally flowing across your lap since they’re sitting next to the window, I’m assuming it’s going past them or if they’re sitting in the aisle. That’s a real challenge. If you imagine, you know, if chocolate was your addiction and you had to work inside of a bakery all day long, can you imagine what that would do for your thoughts?

Jill: Well, what struck me is we have many clients that have tried other addiction treatment facilities, the ones that you go into the mountains for 40 days and there’s no alcohol, there’s no relapse triggers, there’s no problems. They come through and they have to fly back to Atlanta and they end up relapsing right there in the airport because it is so plentiful and available after they’re supposedly, you know, cured from their alcoholism.

Brian: Well, again, and you see that other piece, too, and not only is it those special Crown Rooms or first class but where are all the bars located? At the gates. So, I mean, this is, that’s why we’re saying, I believe it is far more difficult to try to come off of alcohol addiction and dependence than just about any other because it’s everywhere and it’s challenging them at every point because it’s in their awareness.

Neil: Well, it’s one of the reasons that the Feds cracked down on cigarette advertising so that you don’t see that on television anymore and, and here on the radio, you see it on print and that’s it.

Jill: Yeah, that was back in the 60’s, wasn’t it? I remember the Winston commercials when I was really little.

Neil: Yeah, I was only two.

Jill: Oh.  Okay, we won’t go there. But we want to go into just a little bit more before the end of the show. Heroin, an opiate addictionr, some of the main relapse triggers that they or a person who that is struggling with that might feel. The first one that jumps out at me is stress, and, of course, heroin or any type of opiate is going to calm that down and so I can see how stress would be a main trigger for most people and also for alcohol. The five o’clock after work, you know, the stress, you need the stress relief. So, that’s a huge trigger across the board is what I can see.

Brian: Well, again, you know, the fact that the way that the studies have shown, these are actually, opiates and alcohol, it is kind of descending order, so when you take a look that for alcoholics, it’s anger and depression, the number one reason for individuals to relapse on opiates. Again, opiates are any type of, even prescription medication, like your pain medications, of course, heroin is illegal, but the idea is that we also have things like Oxycontin, Percocet, Loratab, those particular are also opiate-based medications.
Neil: And much more addictiond now than heroin.

Brian: Absolutely. Right, And we see this so much and so we understand and we have people in our program and the kinds of jobs that they carry have a lot of stress and it’s interesting when you hear this, ‘Well how much do you take?’

‘I don’t know, I just try to keep it just so the stress level is at a manageable. So you’re talking sometimes, what 10-15-20 pills a day they could be, and they’re not even sure how much they’re taking.

Jill: Exactly, and what it looks like is coming down to the end of the show, there is so much more to talk about. We want to talk a little bit about marijuana, as well as the other prescription medications. But next week….

Neil: We can do part 2 next week.

Brian: Yeah, next week.

Jill: Yeah, next week, I think what we’ll do is we’re going to connect this into some of the recent brain research and how these relapse triggers work. What’s going on in the brain to make these relapse triggers work.

Been a great show, you guys. I have enjoyed this.

Brian: Look forward to seeing our clients and our listening audience next week and we hope you have a wonderful weekend and thanks for listening.

Neil: Take care.