Thanks to the current opioid epidemic in the United States, many people are familiar with the term opioids. Further, many know that opioids are drugs, narcotics. Beyond the basics, there’s confusion about opioids meaning. Just what are opioid drugs, exactly?

Imagine a field that is an endless sea of delicate poppy flowers, mostly in reds and oranges but some in purples, blues, pinks, and whites. These beautiful poppies are part of the opium plant and are the origin of many opioid drugs. The well-known legal painkiller morphine is the active ingredient in the plant (Dovey, 2017).

Opioids, then, are drugs that can come from the poppy plant. While this is true, it’s not much of a definition. There’s more to opioids than meets the eye.

Opioids Meaning: Definition of Opioids

Opioids are painkillers you receive with a prescription. Opioids are illegal street drugs. Both types of drugs do the same thing in the body and brain.

The brain and body have built-in opioid receptors, which are protein molecules, on the ends of some of the nerve cells throughout the central nervous system as well as the digestive tract. An opioid is any substance what will bind to these receptors and cause a response.

When an opioids drug—any opioid, prescription or street drug—and the opioids receptors attach, the result is what is often called the “opioid effect” (How Do Opioids Work? Mechanism of Action).

Opioids are a classification of sedative drugs that make people feel good. Opioid drugs in general:

• Increase the sensation of pleasure as pain is reduced
• Can induce euphoria, a feeling stronger than pleasure
• Are prescribed by doctors to reduce pain, both chronic pain and acute pain such as the pain that comes from medical procedures like surgery
• Are sold in illegal forms to people needing the high
• Have a strong potential to lead to dependence, overdose, and even death, and whether it’s heroin or a prescription painkiller like oxycodone, it can happen quickly (Opioids Deaths: Yes, Opioids Can Kill You)

Does a Drug Have To Be from the Opium Plant To Be an Opioid?

Opioid drugs can indeed be derived from poppies. It is from these plants that opiates external to the human body were first discovered by ancient civilizations, about 5,000 years ago. Many different opiates, including morphine, are natural alkaloids from the plant.

While the opium plant is the natural source of opioids, it doesn’t define an opioid because there are other sources, too. Some opioids, such as heroin, are semi-synthetic; which means they are man-made with ingredients derived from the opium plant. Others, like fentanyl, are fully synthetic and contain no naturally occurring opioid substance.

While there are different types of opioids derived from different sources, all have the same characteristic. An opioids drug is a highly addictive, sedative drug that binds to the body’s opioid receptors to reduce pain and heighten the experience of pleasure.

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The physical and emotional effects of PTSD have roots in the traumatic event. In the moment, people respond physiologically as their sympathetic nervous system activates the fight-or-flight response; behaviorally as they react to impulses to fight, run, freeze, or avoid; and subjectively with intense thoughts and emotions. When this response is prolonged or reappears, it can become a trauma- and stressor-related disorder such as posttraumatic stress disorder (PTSD). The physical and emotional effects of PTSD can be profound and long-lasting.

How the DSM-5 Categorizes the Physical and Emotional Effects of PTSD

People experience both physical and emotional effects of PTSD. The American Psychiatric Association (2013) places PTSD effects into specific categories within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These are

• Intrusion
• Avoidance
• Negative alterations in thoughts and mood
• Arousal and reactivity

Intrusion involves unwanted, recurrent memories of the trauma. They can be waking memories, flashbacks, and/or nightmares. Intrusion effects of PTSD cause a great deal of distress.

PTSD often leads someone to avoid bothersome events, people, places, and things. The avoidance effects of PTSD can severely limit someone’s life and can even lead to the anxiety disorder agoraphobia.

Changes in thoughts can include problems with memory, concentration, and a new, negative thinking style. PTSD effects involving mood include persistent negative emotions like fear, horror, anger, guilt, or shame as well as an inability to feel positive emotions like happiness, satisfaction, or love. These cognitive and emotional effects of PTSD can make someone feel detached from the world around him/her.

Hyperarousal is an effect of PTSD that makes someone startle easily, feel jumpy and on-edge, and have a heightened sensitivity to sensory stimulation. Someone experiencing arousal effects of PTSD is typically hypervigilant, always watching for danger. Heightened arousal can make sleeping difficult; sleep deprivation, in turn, worsens the effects of PTSD and prevents healing (Treating Anxiety Related Sleep Disorders).

Additionally, there is a sub-category of PTSD that includes dissociative experiences in which someone feels separate from reality. Dissociation can be but isn’t always part of the effects of PTSD.

Intrusion, avoidance, negative cognitive/emotional changes, arousal, and sometimes dissociation are the official DSM-5 categories of the effects of PTSD. PTSD can also be understood in terms of its physical and emotional effects.

Physical Effects of PTSD

The physical effects of PTSD can be felt anywhere in the body and can include, but aren’t limited to:

• Eating problems and digestive troubles
• Difficulty sleeping
• Headaches
• Fatigue
• Increased heart rate/pounding heart/heart palpitations
• Sweating
• Worsening of existing medical problems
• Pain
• Muscle tension
• Restlessness
• Shortness of breath

Emotional Effects of PTSD

PTSD negatively affects someone’s emotional wellbeing. Emotional effects of PTSD involve:

• Shame
• Survival guilt/self-blame
• Fear of losing control or going crazy
• Fear that the trauma will happen again
• Anxiety
• Depression
• Numbness
• Anger/rage
• Inability to feel pleasure, joy
• Rumination (thinking about, feeling the emotions of the event repeatedly)
• Hopelessness
• Detachment
• Helplessness
• Agitation
• Distrust
• Feeling alone, abandoned

The emotional and physical effects of PTSD can be intense and wearing, making one feel as if he or she is living in a nightmare. The DSM-5 criteria for PTSD warn that it is associated with suicidal ideation and attempts. Therefore, understanding PTSD effects and watching for them in yourself or a loved one can be crucial in getting the necessary help, support, and treatment (How To Help Someone With PTSD).

PTSD’s Effects on Family, Friends

The physical and emotional effects of PTSD can impact how someone interacts with people in their lives. Intimacy issues, work issues, emotional difficulties, cognitive changes, physical problems, intrusion, avoidance, and hyperarousal are effects of PTSD that make life difficult for the person experiencing PTSD as well as family members, friends, and others.

Family and friends of someone experiencing PTSD sometimes find it difficult to know what to do for their loved one. It’s common for family and friends to feel, among other things,

• Discouraged
• Anxious
• Afraid
• Helpless
• Hopeless and hopeful, sometimes at the same time

PTSD support groups, family therapy, education classes, the National Center For PTSD and more exist to support friends and families so they, in turn, can support their loved one experiencing PTSD.

PTSD and its effects have a profound impact on people. While these effects of PTSD can be long-term, they do not have to be a permanent part of someone’s life (Does A PTSD Cure Exist?). With treatment and time, these difficult effects of PTSD can come to an end.

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The United States is in the midst of an opioids epidemic. Beginning in the late 1990s and continuing thorough today, the nation has been in the throes of what “has been called the worst drug crisis in American history” (Nolan & Amilo, 2016).

The country has seen a rapid and extreme increase in opioid use, both prescription opioid painkillers and street drugs like heroin. This increased use corresponds to a skyrocketing opioid-caused death rate. CBS News reports that in 2016 heroin killed more people than did guns. In the same report, CBS states that:

• Fatal overdoses of prescription painkillers (Vicodin, Oxycodone, and more) numbered 17,536
• Deaths from synthetic opioids like fentanyl numbered 9,580, an increase of 73 percent in one year
• Heroin overdoses killed 12,989 people, a 23 percent increase from 2015

These drugs don’t discriminate (Nolan & Amilo, 2016). While whites and Native Americans have seen the biggest rise in death rates, every demographic has experienced a dramatic increase in opioids overdoses.

One reason for the climbing opioid use and death rate is that once someone begins taking an opioid drug, opioid dependence and addiction happen fairly quickly, even after just a few weeks. With dependence and opioid addiction comes the ever-increasing need for greater quantities of opioids.

While the fact that it is easy to get hooked on opioids helps explain why the opioids epidemic in America continues to escalate, it doesn’t explain what is behind the use in the first place. Why are so many people using opioids?

Causes of the Opioids Epidemic

A major cause is that all types of opioids are easily accessible. Many people are using because they can. It’s not difficult to obtain prescriptions, especially given that people seek them legitimately for chronic pain. Prescription painkillers are common, with 200 million prescriptions for opioids filled in 2009 (Foreman, 2014). In 2016, 12 states had more opioid prescriptions than they had people living in the state (Nolan & Amilo, 2016).

In her 2016 CNBC.com report, Dina Gusovsky revealed that multiple factors help explain why prescriptions for opioids are soaring:

• Doctors often get paid by pharmaceutical companies to prescribe opioids
• Pharmaceutical companies downplay addiction risk
• Physicians don’t always discuss dependence and addiction risk
• Patient advocate groups push to get doctors to prescribe pain medications
• Patients see multiple doctors to get multiple prescriptions

The majority of misused and abused opioid prescriptions come from legal prescriptions (Gustovsky, 2016). That said, illicit drugs are part of the opioids epidemic, too. Unfortunately, illegal opioids like heroin are also readily available.

The nation’s streets have been flooded with heroin, largely from Mexican and Colombian cartels (Nolan & Amilo, 2016). Heroin is cheaper, stronger, and often easier to obtain than other street drugs. In their Frontline report, Nolan & Amilo add that people in treatment for opioids addiction have reported that accessibility is one of the primary factors in their heroin use.

Yes, the scope of this opioids crisis is huge. But what are the consequences of this rise in opioid accessibility and use?

Consequences of the Opioids Epidemic in America

The drug problem has a negative effect on individuals touched by opioid use and on the nation as a whole, with serious consequences on both public health and economic welfare.

An obvious problem is the high overdose and death rate. The National Institute on Drug Abuse reports an additional problem stemming from the use of illegal opioids: the spread of infectious diseases such as HIV and hepatitis C due to needle sharing. The same report states that an increasing number of newborns go through a period of withdrawal, called neonatal abstinence syndrome, because they were born dependent on opioids because the mother used during pregnancy.

The economic burden of the opioid epidemic is significant. The National Institute on Drug Abuse found that prescription opioid misuse costs $78.5 million per year in healthcare expenses, lost productivity, addiction treatment, and involvement in the criminal justice system. Note that the figure only takes into consideration prescription misuse, not illicit opioids like heroin.

Opioid Addiction Statistics

A look at additional opioid addiction statistics and other figures further illustrate the overwhelming nature of the nation’s opioid crisis.

• About 80 percent of the world’s opioid supply is consumed in the United States (Gusovsky, 2016)
• 21-29 percent of patients prescribed opioids for pain misuse them, increasing risk of opioid use disorder and addiction (National Institute on Drug Abuse, 2017)
• 80 percent of heroin users first misused prescription opioids (National Institute on Drug Abuse, 2017)
• In 2010, approximately 12 million Americans aged 12 and up reported using prescription painkillers for non-medical reasons (Foreman, 2014)
• From 2000-2014, the overdose death rate from opioid drugs rose 200 percent (Full House Committee on Oversight and Government Reform, 2016)

Without question, the United States is facing an opioid crisis. Knowing why people are using opioids and how they are getting them can help everyone work together to end this dangerous epidemic.

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Research on nicotine and the brain reveals how nicotine affects the brain and provides clues in medical treatments for nicotine addiction.

Effects of Nicotine on the Brain

Research into the effects of nicotine on the brain has shown that nicotine, like cocaine, heroin, and marijuana, increases the level of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure. Scientists have pinpointed a particular molecule [the beta 2 (b2)] subunit of the nicotine cholinergic receptor as a critical component in nicotine addiction. Mice that lack this subunit fail to self-administer nicotine, implying that without the b2 subunit, the mice do not experience the positive reinforcing properties of nicotine. This finding identifies a potential site for targeting the development of nicotine addiction medications.

Nicotine and the Brain: The Role of Genetics

Other research on nicotine and the brain found that individuals have greater resistance to nicotine addiction if they have a genetic variant that decreases the function of the enzyme CYP2A6. The decrease in CYP2A6 slows the breakdown of nicotine and protects individuals against nicotine addiction. Understanding the role of this enzyme in nicotine addiction gives a new target for developing more effective medications to help people quit smoking. Medications might be developed that can inhibit the function of CYP2A6, thus providing a new approach to preventing and treating nicotine addiction.

Nicotine Affects the Brain Pleasure Centers

Another study found how nicotine affects the brain. Dramatic changes in the brain's pleasure circuits were spotted during withdrawal from chronic tobacco use. These changes are comparable in magnitude and duration to similar changes observed during withdrawal from other abused drugs such as cocaine, opiates, amphetamines, and alcohol. Scientists found significant decreases in the sensitivity of the brains of laboratory rats to pleasurable stimulation after nicotine administration was abruptly stopped. These changes lasted several days and may correspond to the anxiety and depression experienced by humans for several days after quitting smoking "cold turkey." The results of this research may help in the development of better treatments for the nicotine withdrawal symptoms that may interfere with individuals' attempts to quit.

Sources:

• National Institute on Drug Abuse

Health effects of nicotine are substantial. Smoking cigarettes, cigars or pipes leads to development of health problems like cancer, emphysema, heart disease. Pregnant women who smoke put their child at risk.

Many Ignore the Dangers of Nicotine

Since 1964, 28 Surgeon General's reports on smoking and health have concluded that nicotine health risks are real and tobacco use is the single most avoidable cause of disease, disability, and death in the United States. Yet, some people still ignore the dangers of nicotine. In 1988, the Surgeon General concluded that cigarettes and other forms of tobacco, such as cigars, pipe tobacco, and chewing tobacco, are addictive and that nicotine is the drug in tobacco that causes addiction (read about: nicotine addiction). Nicotine provides an almost immediate "kick" because it causes a discharge of epinephrine from the adrenal cortex. This stimulates the central nervous system and endocrine glands, which causes a sudden release of glucose. Stimulation is then followed by depression and fatigue, leading the user to seek more nicotine.

Read more comprehensive information on How Nicotine Affects the Brain.

Nicotine Effects 24/7

Nicotine is absorbed readily from tobacco smoke in the lungs, and it does not matter whether the tobacco smoke is from cigarettes, cigars, or pipes. Nicotine also is absorbed readily when tobacco is chewed. With regular use of tobacco, levels of nicotine accumulate in the body during the day and persist overnight. One of the dangers of nicotine is that daily smokers or chewers are exposed to the effects of nicotine for 24 hours each day. Adolescents who chew tobacco are more likely than nonusers to eventually become cigarette smokers.

Addiction to nicotine results in nicotine withdrawal symptoms when a person tries to quit smoking. For example, a study found that when chronic smokers were deprived of cigarettes for 24 hours, they had increased anger, hostility, and aggression, and loss of social cooperation. Persons suffering from nicotine withdrawal also take longer to regain emotional equilibrium following stress. During periods of abstinence and/or craving, smokers have shown impairment across a wide range of psychomotor and cognitive functions, such as language comprehension.

Nicotine Health Risks: Effects of Nicotine on Women

Women who smoke generally have earlier menopause. Pregnant women who smoke cigarettes run an increased risk of having stillborn or premature infants or infants with low birth weight. Children of women who smoked while pregnant have an increased risk for developing conduct disorders. National studies of nicotine health risks in mothers and daughters have also found that maternal smoking during pregnancy increased the probability that female children would smoke and would persist in smoking.

In addition to nicotine, cigarette smoke is primarily composed of a dozen gases (mainly carbon monoxide) and tar. The tar in a cigarette, which varies from about 15 mg for a regular cigarette to 7 mg in a low-tar cigarette, exposes the user to an increased risk of lung cancer, emphysema, and bronchial disorders.

The carbon monoxide in tobacco smoke increases the chance of cardiovascular diseases. The Environmental Protection Agency has concluded that secondhand smoke causes lung cancer in adults and greatly increases the risk of respiratory illnesses in children and sudden infant death.

Sources:

• NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration.
• National Institute on Drug Abuse

Nicotine in tobacco products is a highly addictive drug. Those with nicotine addiction who try to quit often can't deal with troublesome nicotine withdrawl symptoms.

Addiction to Nicotine: You Know It's Harmful, But You Still Smoke

Yes, nicotine is addictive. Most smokers use tobacco regularly because they are addicted to nicotine. Addiction is characterized by compulsive drug seeking and use, even in the face of negative health consequences. It is well documented that most smokers identify tobacco use as harmful and express a desire to reduce or stop using it, and nearly 35 million of them want to quit each year. Unfortunately, only about 6 percent of people who try to quit smoking are successful for more than a month. It's highly likely this group of people is facing nicotine addiction.

Addicted to Nicotine: How Cigarette Smokers Become Hooked

Research has shown how nicotine affects the brain to produce a number of effects. Of primary importance to its addictive nature are findings that nicotine activates reward pathways—the brain circuitry that regulates feelings of pleasure. A key brain chemical involved in mediating the desire to consume drugs is the neurotransmitter dopamine, and research has shown that nicotine increases levels of dopamine in the reward circuits. This reaction is similar to that seen with other drugs of abuse and is thought to underlie the pleasurable sensations experienced by many smokers.

Nicotine's pharmacokinetic properties also enhance its abuse potential. Cigarette smoking produces a rapid distribution of nicotine to the brain, with drug levels peaking within 10 seconds of inhalation. However, the acute effects of nicotine dissipate in a few minutes, as do the associated feelings of reward, which causes the smoker to continue dosing to maintain the drug's pleasurable effects and prevent withdrawal.

(Read Tobacco Facts: How You Become Addicted to Cigarettes for more info on how addiction to nicotine works.)

Nicotine is Addictive

One of the key measures of whether a substance is addictive or not is: when you stop using it, does it produce withdrawal symptoms? Nicotine does and that's one sign that nicotine is addictive. The symptoms include:

• Irritability
• Craving
• Cognitive and attentional deficits
• Sleep disturbances
• Increased appetite

These symptoms may begin within a few hours after the last cigarette, quickly driving people back to tobacco use. Symptoms peak within the first few days of smoking cessation and may subside within a few weeks. For some people with nicotine addiction, however, symptoms may persist for months. (Read: Nicotine Withdrawal and How to Cope with Nicotine Withdrawal Symptoms)

While withdrawal is related to the pharmacological effects of nicotine, many behavioral factors can also affect the severity of withdrawal symptoms. For some people who are addicted to nicotine, the feel, smell, and sight of a cigarette and the ritual of obtaining, handling, lighting, and smoking the cigarette are all associated with the pleasurable effects of smoking and can make withdrawal or craving worse.

While nicotine gum and patches may alleviate the pharmacological aspects of withdrawal, cravings often persist. Other forms of nicotine replacement, such as inhalers, attempt to address some of these other issues, while behavioral therapies can help smokers and others dealing with nicotine addiction identify environmental triggers of withdrawal and craving so they can employ strategies to prevent or circumvent these symptoms and urges.

Sources:

• Benowitz NL. Pharmacology of nicotine: addiction and therapeutics. Ann Rev Pharmacol Toxicol 36:597-613, 1996.
• Bornemisza P, Suciu I. Effect of cigarette smoking on the blood glucose level in normals and diabetics. Med Interne 18 :353-6, 1980.
• U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000.
• Henningfield JE. Nicotine medications for smoking cessation. New Engl J Med 333:1196-1203, 1995.
• National Institute on Drug Abuse

Comprehensive information on nicotine, smoking, tobacco addiction and treatment for nicotine addiction; how to quit smoking.

Through the use of cigarettes, cigars, and chewing tobacco, nicotine is one of the most heavily used addictive drugs in the United States. In a 2005 government survey, 29.4 percent of the U.S. population 12 and older--71.5 million people--used tobacco at least once in the month. This figure includes 3.3 million young people age 12 to 17 (13.1 percent). Young adults aged 18 to 25 reported the highest rate of past month use of any tobacco products (44.3 percent) in 2005.

Statistics from the Centers for Disease Control and Prevention indicate that tobacco use remains the leading preventable cause of death in the United States, causing approximately 440,000 premature deaths each year and resulting in an annual cost of more than $75 billion in direct medical costs attributable to smoking. (Read more information on dangers of nicotine)

Moreover, the declining prevalence of cigarette smoking among the general U.S. population is not reflected in patients with mental illnesses. For them, it remains substantially higher, with the incidence of smoking in patients suffering from post-traumatic stress disorder, bipolar disorder, major depression, and other mental illness twofold to fourfold higher than the general population, and smoking incidence among people with schizophrenia as high as 90 percent.

Sources:

• National Institute on Drug Abuse
• Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness. A population-based prevalence study. JAMA 284:2606-2610, 2000.
• Breslau N. Psychiatric comorbidity of smoking and nicotine dependence. Behav Genet 25:95-101, 1995.
• Hughes JR, Hatsukami DK, Mitchell JE, and Dahlgren LA. Prevalence of smoking among psychiatric outpatients. American Journal of Psychiatry 143:993-997, 1986.

Long-term use of CNS depressants (sedatives and tranquilizers) can lead to addiction. Read more on stopping CNS depressants and treatment for addiction to CNS depressants.

CNS (central nervous system) depressants slow normal brain function. In higher doses, some CNS depressants can become general anesthetics. Tranquilizers and sedatives are examples of CNS depressants.

CNS depressants can be divided into two groups, based on their chemistry and pharmacology:

1. Barbiturates, such as mephobarbital (Mebaral) and pentobarbitalsodium (Nembutal), which are used to treat anxiety, tension, and sleep disorders.
2. Benzodiazepines, such as , chlordiazepoxide HCl (Librium), and alprazolam (Xanax), which can be prescribed to treat anxiety, acute stress reactions, and panic attaks. Benzodiazepines that have a more sedating effect, such as estazolam (ProSom), can be prescribed for short-term treatment of sleep disorders.

There are many CNS depressants, and most act on the brain similarly - they affect the neurotransmitter gamma-aminobutyric acid (GABA). Neurotransmitters are brain chemicals that facilitate communication between brain cells. GABA works by decreasing brain activity. Although different classes of CNS depressants work in unique ways, ultimately it is their ability to increase GABA activity that produces a drowsy or calming effect. Despite these beneficial effects for people suffering from anxiety or sleep disorders, barbiturates and benzodiazepines can be addictive and should be used only as prescribed.

CNS depressants should not be combined with any medication or substance that causes drowsiness, including prescription pain medicines, certain OTC cold and allergy medications, or alcohol. If combined, they can slow breathing, or slow both the heart and respiration, which can be fatal.

Stopping CNS Depressants and Withdrawal Symptoms

Discontinuing prolonged use of high doses of CNS depressants can lead to withdrawal. Because they work by slowing the brain's activity, a potential consequence of abuse is that when one stops taking a CNS depressant, the brain's activity can rebound to the point that seizures can occur. Someone thinking about ending their use of a CNS depressant, or who has stopped and is suffering withdrawal, should speak with a physician and seek medical treatment.

Treatment for Addiction to CNS Depressants

In addition to medical supervision, counseling in an in-patient or out-patient setting can help people who are overcoming addiction to CNS depressants. For example, cognitive-behavioral therapy has been used successfully to help individuals in treatment for abuse of benzodiazepines. This type of therapy focuses on modifying a patient's thinking, expectations, and behaviors while simultaneously increasing their skills for coping with various life stressors.

Often the abuse of CNS depressants occurs in conjunction with the abuse of another substance or drug, such as alcohol or cocaine. In these cases of polydrug abuse, the treatment approach should address the multiple addictions.

Sources:

• The National Institute on Drug Abuse, Prescription Drugs and Pain Medications. Last updated June 2007.

Addiction doesn't only impact the addict, family members need to recover from the addict too.

If there is a dual diagnosis, which is so often the case in addiction, the diagnosis of drug addiction is properly dealt with by removing the substance, but the underlying diagnosis, for example of depression, anxiety or PTSD, may not be dealt with. Recovery is more than recovering from drug abuse. It is also about recovering from the other diagnosis or the symptoms that may have been self-medicated in the first place. And finally, the addict will still need to engage in a full recovery process in order to deal with the emotional and psychological complications that stemmed from their addiction. If they do not accomplish this, they are asking both themselves and their family members to live with emotional and psychological burdens that can keep the family and the individuals within it mired in dysfunctional patterns of relating that get passed along through the generations, commonly referred to as "passing on the pain".

Recovery is equally important for those who have lived in, developed their sense of self, and learned relationship skills in an addicted/traumatized family. Without a rigorous program of treatment and recovery for all concerned, the dysfunctional personality styles and relationships developed in the addicted family environment will tend to recreate themselves over and over again. Sobriety needs to happen on all levels, in all family members; it is an emotional and psychological as well as a physical goal.

Source:

(Adapted from The Process Study Guide, with permission of the author, for Congregational Leadership Training, Detroit, MI - 1/24/06)

About the author: Tian Dayton M.A. Ph.D. TEP is the author of The Living Stage: A Step by Step Guide to Psychodrama, Sociometry and Experiential Group Therapy and the bestseller Forgiving and Moving On, Trauma and Addiction as well as twelve other titles. Dr. Dayton spent eight years at New York University as a faculty member of the Drama Therapy Department. She is a fellow of the American Society of Psychodrama, Sociometry and Group Psycho ¬therapy (ASGPP), winner of their scholar's award, executive editor of the psychodrama academic journal, and sits on the professional standards committee. She is a certified Montessori teacher through 12 years of age. She is currently the Director of The New York Psychodrama Training Institute at Caron New York and in private practice in New York City. Dr. Dayton has masters in educational psychology, a Ph.D. in clinical psychology and is a board-certified trainer in psychodrama.

When Adult Children of Alcoholics have their own families, the dysfunctional tools they used as children to survive an alcoholic parent, may come back to haunt them.

When Adult Children of Alcoholics (ACOAs) enter intimate relationships in adulthood, their feelings of dependence and vulnerability that are an important part of an intimate relationship may make them feel anxious and at-risk again. They may perceive themselves as helpless even if they are not. Beneath the level of their awareness, the ACOA may worry that chaos, out-of-control behavior, and abuse may be looming around the corner because this was their early childhood experience.

When ACOAs enter intimate relationships as adults, they may be so convinced that distress is at hand that they experience mistrust and suspicion if problems are solved smoothly. And so the pattern of strong feelings leading to emotional danger, chaos, rage, and tears is once again reinforced and passed along in a blast of triggered emotions into the present when they belong primarily to the past. At these moments, the ACOA is stuck in and reacting out of the survival parts of the brain, what is getting triggered is a sense memory from childhood with little reason and understanding attached to it. The more advanced parts of the cortical brain where thinking and reasoning take place is temporarily overwhelmed and shut down and they are locked in a reaction that is filled with unresolved emotions from the past that are getting triggered by present circumstances.

Children who have been traumatized by living with addiction become very adept scanners; they are constantly reading their environment and the faces of those around them for signs of emotional danger. If they sense emotions in another person that make them feel anxious, they may lapse into people pleasing in order to alleviate potential "danger." They may have learned as children that if they could calm and please the acting-out parent, their own day might go more smoothly; i.e., they might experience less hurt. Such people pleasing strategies also get carried into intimate relationships in adulthood. The upshot of all this is that ACOAs often lack the ability to live comfortably with the natural ebb and flow of intimacy.

Traumatic Bonds

Those who live in families that are traumatizing often form what is known as traumatic bonds. If someone is unable to escape chronic traumatic abuse, they are more likely to develop both traumatic bonds and PTSD. They may become emotionally numb as part of the trauma defense and their capacity for real intimacy may become disrupted by the regular trauma. The intensity and quality of connectedness in addicted/traumatizing families can create the types of bonds that people tend to form during times of crisis.

Alliances in addicted families may become very critical to one's sense of self and even survival. Alliances can become very intense among children, for example, who are feeling hurt and needy and without proper parental support. Or traumatic bonds may simply get seared into place as family members repeatedly face threatening, frightening and overwhelmingly painful experiences and hunker down in emotional dugouts together until the barrage of explosions passes. As the family member's fear increases so does their need for protective bonds.

Trauma may lead people both to withdraw from close relationships and to seek them desperately. The deep disruption of basic trust, the feelings of shame, guilt and inferiority combined with the need to avoid reminders of the trauma may foster withdrawal from close relationships, social life, or healthy spiritual beliefs. But the terror of the traumatic event, such as living with addiction and the chaotic behavior that surrounds it, intensifies the need for protective attachments. The traumatized person therefore frequently alternates between isolation and anxious clinging to others. Factors that can contribute to bonds becoming traumatic are:

• If there is a power imbalance in the relationship.
• If there is a lack of access to outside support.
• If those who we would naturally go to for caring and support are unavailable or are, themselves, the abusers.
• If there are wide inconsistencies in styles of relating that induce both states of high need/anxiety alternating with high need/fulfillment.

All too often, the confusion in these types of relationships is that they are neither all good nor all bad. Their very unevenness can make the nature of the bond all the more difficult to unravel. In the case of addiction, this is an all too familiar dynamic. The addicted parent, for example, may swing between being attentive, generous and caring to being abusive, neglectful and rejecting. One minute they are everything one could wish and the next they are miserably disappointing. Without supportive interventions - usually from outside the family - these types of bonds become styles of relating that get played out in relationships throughout life. Traumatic bonds formed in childhood tend to repeat their quality and contents over and over again throughout life.

Find more comprehensive information about Drug Abuse and Addiction and Alcohol Abuse and Addiction.

Source:

(Adapted from The Process Study Guide, with permission of the author, for Congregational Leadership Training, Detroit, MI - 1/24/06)

About the author: Tian Dayton M.A. Ph.D. TEP is the author of The Living Stage: A Step by Step Guide to Psychodrama, Sociometry and Experiential Group Therapy and the bestseller Forgiving and Moving On, Trauma and Addiction as well as twelve other titles. Dr. Dayton spent eight years at New York University as a faculty member of the Drama Therapy Department. She is a fellow of the American Society of Psychodrama, Sociometry and Group Psycho ¬therapy (ASGPP), winner of their scholar's award, executive editor of the psychodrama academic journal, and sits on the professional standards committee. She is a certified Montessori teacher through 12 years of age. She is currently the Director of The New York Psychodrama Training Institute at Caron New York and in private practice in New York City. Dr. Dayton has masters in educational psychology, a Ph.D. in clinical psychology and is a board-certified trainer in psychodrama.