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More people than ever before see themselves as addicted to, or recovering from, addiction, whether it be alcohol or drugs, prescription meds, sex, gambling, porn, or the internet. But despite the unprecedented attention, our understanding of addiction is trapped in unfounded 20th century ideas, thinking of addiction as a crime or as a brain disease - and in equally outdated treatment. Challenging both the idea of the addict’s "broken brain" and the notion of a simple "addictive personality," The New York Times Bestseller, Unbroken Brain, offers a radical and ground breaking new perspective, arguing that addictions are learning disorders and shows how seeing the condition this way can untangle our current debates over treatment, prevention and policy. Like autistic traits, addictive behaviours fall on a spectrum - and they can be a normal response to an extreme situation. By illustrating what addiction is, and is not, the book illustrates how timing, history, family, peers, culture and chemicals come together to create both illness and recovery - and why there is no "addictive personality" or single treatment that works for all.

Elizabeth Burton Phillips is a teacher, an ordinary middle-class mother who had always tried to do the best for her children; she never imagined that her identical twin sons, who had been doing so well at school, would become involved in drugs. She was shocked when they were suspended from school for smoking cannabis; but this was just the start of a terrible, unimaginable journey – culminating in the knock on the door in the early hours by the police. They gave her the devastating news that her son Nick had killed himself in despair at his heroin addiction. Since his death, Elizabeth has campaigned tirelessly to make parents aware of the pain and suffering caused to families by drug addiction; and her surviving son, Simon, now drug-free, has contributed his own thoughts to this inspiring and moving book. ISBN 978-0749951726

Anna's Story When I look back I see the journey with our son has been shrouded in substance use for a very long time. Publicly I was in denial, although privately I could see the journey he was on from his late secondary school days. Marijuana was initially his drug of choice. Most likely this was partially used to self-medicate the social anxiety he experienced. Despite this drug use, he managed to pass six School Certificate subjects. My dreams were answered when he gained a university degree. Education had been a significant part of my life. I was incredibly proud when he graduated. I was under no illusion that there was drug use alongside his achievement, but that did not diminish the joy I felt. After a contract job in the city, he left for overseas to undertake work in his chosen field. While he managed to maintain the job, weekends were apparently filled with London experiences, and drug use was part of the experience. Eventually he decided to come home to New Zealand when a business opportunity presented itself. His father had died suddenly several years earlier and I was able to assist him into the venture. He used his ability and skills to make progress. I was always told not to worry when I talked to him about his drug use. Two beautiful children arrived during this time. He was a caring and loving Dad. His settled life as a child growing up with caring and supportive parents was his foundational experience of parenting. In his mid-thirties methamphetamine hit the streets with vengeance. It was expensive but once he had experienced the feeling for this drug, he was able to find the means to sustain his use with money he was able to accumulate. Other drugs supplemented methamphetamine but this one was like no other. It allowed him to feel so much energy, often working days at a time without sleep. He allowed himself to be fooled into believing he achieved more when using it, failing to consider the days sleeping to recover from the days of work. No amount of comment from me, be it warnings, pleading, discussion or boundaries, had any impact on his use. Eventually his partner left with their two children. His use escalated as he experienced the loss of his children on a daily basis, his increasing isolation from non-using friends, and in hindsight, possibly depression. Drug using associates increasingly came onto the scene and methamphetamine was readily available. His life was in chaos, despite the fact he thought he was in control of his use of a variety of substances. I felt completely at a loss to help him, despite my professional life in fields that included mental health. My life became almost unbearable and I waited for the next call on my phone to announce the next crisis. There were many. I believed that I had tried everything. In fact, the main thing I now realised I could have done was swallow my pride and seek support from people who really understood what I was going through. Many people proffered unhelpful advice about tough love (it never works), cutting off all ties (it diminishes hope) and leaving him out on the street. None of that advice was helpful and would have been contrary to what research says would have helped me or our son. Eventually I did talk to family/whānau members who were wonderful support. They made sure I had someone to listen to my fears. My biggest fear was that our son would end up in prison. After being caught with methamphetamine and failing to stop for police he moved through the system, to prison on remand. I learnt a lot about the prison system and the lack of addiction services and rehabilitative options available. The experience did, however, give space to detox, a chance to get the brain circuit back into operation and to work out that there were consequences to his substance use. Over the years I had felt so much shame and tried to keep my fears to myself. I had to swallow my pride in the end and admit I needed support. I had tried to set boundaries, but it was hard to maintain them when I feared the consequences our son would suffer. It was clear that methamphetamine had completely altered our son’s ability to process information. His sense of entitlement was unbelievable. When desperate for money for drugs his manipulation was traumatic. I had my hopes dashed many times. Prison had been my worst fear and when my worst fear was realised, I had to look at caring better for myself. I needed to look after myself and still maintain strong links with him, so he had hope. I needed to be a strong significant adult for his children. Addiction is a complex condition on many levels and requires comprehensive solutions. I found very few people who understood this. Addiction is also a relapsing condition and this must be faced. I would never ever have chosen this journey. It has been hard, and at times almost unbearable. Our son’s addiction has had a significant affect on other family/whānau members. With good self-care, a clear understanding of addiction, faith, a focus on helping others, and the support I now have asked for, I feel strong enough to support our son on his journey and care well for myself. I have developed greater compassion, wisdom and more realistic hope. Just as our son needs to have hope on his journey, I also need to have hope. My love has never diminished for him, despite being tested at times. I have confidence that change is possible wherever there is hope.

Stepping Forward, with acknowledgement to Family Drug Support Australia. This video provides information on the key models of change to help you understand what's going on for the user and their family. Stepping Forward: Session 1 from Christopher Faull on Vimeo.

New Zealander Lotta Dann was in trouble. Her fun drinking habit had slowly morphed into an obsessive hunger for wine. One bottle a night was never quite enough. When she tried to cut down, she found it nearly impossible to have an alcohol-free day. Everyone around could see her drinking, but no one realised what a serious problem it was. She was high-functioning, fun-loving Lotta, not some messy, hopeless drunk. What’s a girl to do when her beloved wine becomes the enemy? Here’s what Lotta did. She stopped drinking and secretly started a blog that charted the highs and lows of learning to live without alcohol. Mrs D was anonymous, honest and, as Lotta would discover, surrounded by people who would help her on her journey, and whom she could help in return. ISBN 9781877505393

Most people who use alcohol and/or other drugs do so infrequently and never become dependent (or “addicted” as it’s sometimes called). On average about 10% of people who use alcohol or other drugs are dependent. The rate is around 6% for alcohol, around 10% for cannabis and around 15% for methamphetamine. But for those who do become dependent, reducing their use, getting off or staying off can be difficult. What happens to the brain on drugs? Regardless of how it is consumed, alcohol and/or other drugs eventually make their way into the brain via the bloodstream. Once there, they affect how messages are sent through the brain. The brain is a massive communication centre passing messages back and forth to regulate what we think, feel and do. The messages are sent by chemicals in the brain called neurotransmitters. Drugs work in various ways. They either increase or decrease the production of neurotransmitters like dopamine (pleasure), noradrenaline (fight or flight) and serotonin (mood); or affect how much neurotransmitter stays active and for how long; or bind to natural receptors to mimic and artificially activate natural neurotransmitter pathways. Reinforcement Every drug affects different neurotransmitter pathways in different ways. Some affect more than one neurotransmitter. But most drugs impact the dopamine system in some way. Dopamine regulates emotion, motivation and feelings of pleasure. It’s the brain’s reward system. Our brains are hard-wired to ensure we repeat activities that are pleasant. When we do something enjoyable we get a little burst of dopamine, which signals to the brain we should do it again. Drugs release much larger amounts of dopamine than other dopamine-activating activities, like eating and sex, so they are more rewarding. As a result, there is a strong internal drive to repeat drug taking. The brain becomes primed to repeat drug taking over and over without really thinking about it. Think about when you really really feel like some chocolate: you can see it in your mind, nearly taste it, you think about it the whole time you are searching in the cupboard to find some, you might even hop in the car to go to the shops to buy a block. Now imagine that ten times stronger or more, and it gives you just a little inkling why some people keep coming back to drug use. Dopamine depletion When large amounts of dopamine are released, the brain has trouble keeping up production and can temporarily run out of dopamine. This is one of the reasons why a day or two after taking drugs a person might seem flat or depressed. Their dopamine supplies have been depleted. After a day or so the brain picks up dopamine production again and mood returns to normal. When dopamine stores are frequently depleted over and over again, the brain can’t cope and starts to shut down some of the structures needed to move the dopamine around the brain. Some of the main dopamine pathways run right through the thinking part of the brain – the prefrontal cortex. When the dopamine system is damaged in that part of the brain, it makes it much harder to think through consequences and make considered decisions, so drug use becomes more automated. When dopamine is depleted from chronic use, a person might feel really flat for months, even when they stop using. This can be a strong motivator to use drugs to feel pleasure again. Withdrawal Our brains are very plastic and, over time, the brain adapts to the different environment created by the introduction of a drug. The brain adjusts to the increases in dopamine and other neurochemicals by reducing normal production. Over time some people who are dependent on alcohol and/or other drugs say taking them just makes them feel “normal”. This is because their brain and body have adapted to effects of the drug. This is known as “tolerance”. If you develop tolerance to alcohol or other drugs, when you stop using you might go into withdrawal. As the drug leaves your system, your body starts to react to no longer having the alcohol or other drugs in your system. Withdrawal is often physically and psychologically uncomfortable and sometimes can be painful. Avoiding withdrawal symptoms is a strong motivator for people to keep taking alcohol or other drugs. A man and his dogs A well-known experiment by Ivan Pavlov in the 1890s shows another way relapse can occur. Pavlov found if he gave hungry dogs food and rang a bell at the same time, over time the dogs automatically started to salivate at the sound of the bell even when there was no food. This is called “classical conditioning”. Like Pavlov’s dogs, when drug use is paired with particular people, places, things or feelings, eventually they can become linked. These people, places, things or feelings create an anticipation of drug use, even when there is no drug around, which can result in a strong desire to use. These are sometimes called “triggers”. Triggers can set off a desire to seek out and use drugs. As an example, people who smoke cigarettes often do so when they are drinking alcohol. Alcohol can then become a trigger for smoking for someone trying to quit. They may go out for a drink and suddenly feel the need to have a cigarette, even if they have been off them for months or years. Other risk factors for drug dependence There are a number of risk factors for developing drug problems. These include: family members with an alcohol or other drug problem – possibly because they have similar genetic vulnerabilities or because of the experience of living with them in shaping thinking and attitudes family members’ or your own mental health problems lack of parental supervision and engagement lack of connection with school or community poor coping skills and emotion regulation skills early neglect, abuse or trauma – which can affect how the brain is wired and also affect thinking and emotional control. The more risk factors someone has, the more likely they are to start using alcohol or other drugs early; the more likely they are to have problems with alcohol and/or other drugs; and the more likely they are to have difficulty cutting back or quitting alcohol and/or other drug use. Is it possible to change drug use? There are quite a few things going on that can make it difficult to give up drugs and stay off them once someone has become dependent on them. Some people have greater vulnerabilities and risk factors than others. The wiring of the dopamine reward system makes it compelling to use drugs, and the damage to the system makes self-regulation more difficult. The brain and body adapt over time to taking drugs and react when the alcohol or other drugs leave the system. And alcohol or other drug use may be paired with a number of triggers that might set off a strong desire to use. We’re all wired a bit differently from birth. We have also had different experiences throughout life that affect how we think, feel and process the world around us. This might explain, at least partly, why some people have trouble with drugs and others do not. You might hear people say drug dependence is a “chronic relapsing brain disease”. Alcohol and other drug dependence can be a chronic relapsing condition, but it’s not technically a disease – there’s no evidence the brain is fundamentally damaged before drug use. The brain disease theory suggests drugs hijack the brain in some way that removes control. But in reality, while the effects on the brain can make it more difficult, people who are dependent on drugs are often able to manage their drug use. We know a number of strategies can substantially change how we think and feel. These include psychological therapies, such as behavioural and cognitive therapies, and some medications. This can provide the extra support that some people who are dependent on alcohol or other drugs need to make changes. Many people make the changes they want on their own with no help and most people who go through treatment do successfully change their alcohol or other drug use. Sometimes it takes a few goes, but the relapse rate for alcohol and other drug dependence is about the same as for other chronic health problems, like diabetes and heart disease. Special thanks to Professor Nicole Lee, Director at 360Edge The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of Family Drug Support Aotearoa. We welcome the views of our professional contributors.

Don’t be fooled by me. Don’t be fooled by the face I wear for I wear a mask, a thousand masks, masks that I’m afraid to take off, and none of them is me. Pretending is an art that’s second nature with me, but don’t be fooled, for God’s sake don’t be fooled. I give you the impression that I’m secure, that all is sunny and unruffled with me, within as well as without, that confidence is my name and coolness my game, that the water’s calm and I’m in command and that I need no one, but don’t believe me. My surface may seem smooth but my surface is my mask, ever-varying and ever-concealing. Beneath lies no complacence. Beneath lies confusion, and fear, and aloneness. But I hide this. I don’t want anybody to know it. I panic at the thought of my weakness exposed. That’s why I frantically create a mask to hide behind, a nonchalant sophisticated facade, to help me pretend, to shield me from the glance that knows. But such a glance is precisely my salvation, my only hope, and I know it. That is, if it’s followed by acceptance, if it’s followed by love. It’s the only thing that can liberate me from myself, from my own self-built prison walls, from the barriers I so painstakingly erect. It’s the only thing that will assure me of what I can’t assure myself, that I’m really worth something. But I don’t tell you this. I don’t dare to, I’m afraid to. I’m afraid your glance will not be followed by acceptance, will not be followed by love. I’m afraid you’ll think less of me, that you’ll laugh, and your laugh would kill me. I’m afraid that deep-down I’m nothing and that you will see this and reject me. So I play my game, my desperate pretending game, with a facade of assurance without and a trembling child within. So begins the glittering but empty parade of masks, and my life becomes a front. I idly chatter to you in the suave tones of surface talk. I tell you everything that’s really nothing, and nothing of what’s everything, of what’s crying within me. So when I’m going through my routine do not be fooled by what I’m saying. Please listen carefully and try to hear what I’m not saying, what I’d like to be able to say, what for survival I need to say, but what I can’t say. I don’t like hiding. I don’t like playing superficial phony games. I want to stop playing them. I want to be genuine and spontaneous and me but you’ve got to help me. You’ve got to hold out your hand even when that’s the last thing I seem to want. Only you can wipe away from my eyes the blank stare of the breathing dead. Only you can call me into aliveness. Each time you’re kind, and gentle, and encouraging, each time you try to understand because you really care, my heart begins to grow wings– very small wings, very feeble wings, but wings! With your power to touch me into feeling you can breathe life into me. I want you to know that. I want you to know how important you are to me, how you can be a creator – an honest-to-God creator – of the person that is me if you choose to. You alone can break down the wall behind which I tremble, you alone can remove my mask, you alone can release me from my shadow-world of panic, from my lonely prison, if you choose to. Please choose to. Do not pass me by. It will not be easy for you. A long conviction of worthlessness builds strong walls. The nearer you approach to me the blinder I may strike back. It’s irrational, but despite what the books say about man often I am irrational. I fight against the very thing I cry out for. But I am told that love is stronger than strong walls and in this lies my hope. Please try to beat down those walls with firm hands but with gentle hands for a child is very sensitive. Who am I, you may wonder? I am someone you know very well. For I am every man you meet and I am every woman you meet. Source: Charles C. Finn. Written in 1966 Accessed from www.poetrybycharlescfinn.com

If you think you or someone you know may be dependent on painkillers, then you’ve taken the right step by looking for information here. This video will help you learn about dependence to the group of painkillers called opioids, and to guide you in finding help to overcome it. What is Opioid Painkiller Dependence? Opioid painkiller dependence can affect anyone and occurs when your body starts to rely on a certain type of painkiller you may have been taking. These painkillers belong to a group of medicines called opioids. If you feel a strong desire to take your pain medication repeatedly, even after the pain passes, or if you find you have been using higher doses to feel relief, then these are signs you are dependent on it. Opioid painkiller dependence can lead to loss of control over how much to take and the inability to stop, even if it hurts people’s health, their job or their family and friends. When the desire to take opioid painkillers becomes so compulsive that it results in these kind of harmful consequences, it can be considered an opioid dependence. What are the opioids in my medication and is my medication an opioid? Opioids are psychoactive chemicals that relieve pain. The pain-relieving effects of opioids are due to decreased perception of pain, decreased reaction to pain, as well as increased pain tolerance. Opioids can also create feelings of euphoria, because they affect parts of the brain that make us feel good. As time goes on, opioid medications can alter the brain’s chemistry, so people begin to feel like they need more and more of the drug just to get through the day. This leads to taking higher doses and an increasing dependence. As they contain narcotic and psychotropic (affecting the mental state) substances, opioids are controlled drugs. This is why most opioids are prescribed by a doctor. Some common opioid painkillers can include codeine, tramadol, oxycodone, fentanyl and morphine. There were 16.4 people per 1000 dispensed a strong opioid in New Zealand in 2015, despite an increasing awareness of the risks associated with opioid use. Who becomes dependent on opioid painkillers? Anyone who has suffered from chronic pain and has been given a prescription for opioid painkillers is at risk of dependence. Men, women, business people, tradies, young and old – all are susceptible. Why do some people become dependent and not others? No one expects to become dependent on opioids, so why do some people become dependent while others don’t? The answer is some people are just more susceptible to dependency than others, for reasons including: Genetics: This means having the tendency to become dependent to opioids in your genetic makeup. So, it’s inherited from a family member. How your body processes a drug: People can absorb medications or other drugs differently because of their individual body chemistry. Psychological or emotional issues: A person’s mental health or emotional trauma can contribute to them using a particular drug or medicine. Environmental influences: The way someone lives their life can play a part in dependence, for example, people can be influenced by those around them to abuse substances, increasing their risk of dependence. Recognising the signs and symptoms of a dependence on opioids Opioid painkiller dependence can affect people differently. The effects of opioids also change the longer you use them, so you may notice the symptoms becoming more extreme as time goes on. It’s important to remember that dependence on opioids is a condition and not something that deserves blame – either blaming yourself or someone close to you who may be dependent. It’s no one’s fault. The following is a list of some general warning signs and symptoms that could indicate a risk of opioid painkiller dependence. It’s not a complete list, so please talk to your doctor if you feel you are experiencing any of these symptoms or are worried about your risk of opioid dependence. Signs and symptoms of opioid painkiller dependence Using more of the opioid to get the same effect Unable to stop or cut down on the use of opioids Often absent from work or school Losing interest in regular activities Losing friendships or marital problems Having sleep problems Getting angry or irritable often Having sexual problems Having an upset digestion (like constipation) Danger of Overdose As well as altering how your body feels pain, opioid painkillers also have an effect on the part of your brain that regulates breathing. For this reason, opioids in high doses can cause dangerous respiratory depression, and even death. It is particularly dangerous to combine opioids with alcohol and sedative medication, as this increases the risk of respiratory depression and death. Due to their ability to cause respiratory depression, opioids are responsible for a high proportion of overdose-related deaths around the world. An opioid overdose can be identified by a combination of three signs and symptoms referred to as the “opioid overdose triad”. The symptoms of the triad are: Pinpoint pupils Unconsciousness Respiratory depression If you suspect that you or someone you know may have taken an opioid overdose, seek emergency help immediately by calling ‘111’ in NZ. Further information on Opiate substitution is available at: https://www.matuaraki.org.nz/uploads/files/resource-assets/ost-and-you-a-guide-to-opioid-substitution-treatment.pdf https://www.turntohelp.com.au/

This UK report looks at the experiences and needs of adults who are affected by the drinking of an intimate partner. It focuses on the tensions, harms and negative effects this drinking can have on a relationship, as well as the support available and the barriers to engaging with, and accessing, these services. It builds on established research into alcohol and intimate partner violence, in order to expand on the issues surrounding relationships and alcohol. It delivers recommendations for policy, practice and further research, targeted at: Government and policy makers; to improve the lives of those affected by the drinking of an intimate partner by enacting policy change. Commissioners, service providers and healthcare professionals; to ensure the services and support delivered is effective. Researchers and academics; to build on the findings from this report and achieve a wider understanding of the experiences of different groups of partners. Report provided by Alcohol and Families Alliance.

Tony Trimingham, CEO and Founder of Family Drug Support Australia, talks about the importance of families, whānau and friends where there is concern about alcohol or other drug use by a family member or friend.