thursday, march 24, 2011
The Black Hole of The Gateway’s mental health series Today • The bigger problems with addiction
Thursday, March 31 • Suicide and students
Written by Justin Bell and Darcy Ropchan Illustrated by Anthony Goertz
fter being clean and “sober” for four and a half years, Amy admits she’s having troubles with her eating disorder again. She’s relapsed. She doesn’t know when the urge to binge will kick in and she’ll have to answer the call. Amy (whose name has been changed to protect her identity) will spend anywhere from three to five hours binge eating, then vomiting, when she gets the urge. It’s a compulsion she can’t control, but one that consumes her. She will leave the library in the middle of writing a paper in order to go home and start eating. Amy has been struggling with one form of eating disorder or another for most of her life. She describes symptoms of both anorexia, an obsessive fear with gaining weight, and bulimia, a back-and-forth of binge eating followed by vomiting. For Amy, a sociology student at the U of A, she can
trace her symptoms back to the age of 12, where she thinks two things pushed her into her eating problems: her 10-year-old brother died of cancer, and her family moved back to Canada from Australia. She had also recently entered puberty and gained 27 pounds, pushing her to 142. Amy and a friend, who also hit puberty and gained a few pounds, decided they would try dieting in order to bring them both back to what they considered a healthy weight. While her friend managed to cut back properly, Amy continued to push the limit of what was healthy and eliminated more and more foods from her diet.
volume ci number 42
“[A]t the time, we decided to go on a diet, my first relationship had come to an end, and I took the diet to the extreme. The more I learned, the more I cut out, and the more I changed and manipulated. My parents realized something was wrong before I had any clue anything was wrong.” Amy went on to lose 66 pounds in six months, a rapid change her family couldn’t ignore. She then spent 12 weeks in an adolescent psychiatric ward, where she would return twice more the following year. At one point, Amy was down to a paltry 88 pounds. She describes her bulimia and anorexia in terms clinicians usually reserve for addictions. And while eating disorders are generally classified separately from addictions, the research hasn’t been able to say either way. “Eating disorders are still considered a separate and distinct problem, separate from substance dependence,” said Jody Wolfe, a research associate at the Addictions and Mental Health Research Laboratory (AMHRL) at the University of Alberta. “From a clinical front, they’re still currently seen as different issues. But there’s been a significant amount of research, as well as individual clinicians and treatment providers, that are showing that there are some important similarities and that eating disorders can be treated using some similar techniques used for treating people with substance dependence.” While the research hasn’t quantified eating disorders as a full-blown addiction, it’s important to remember that the clinical description of what constitutes an addiction is a lot narrower than that of the general public. The term itself is a “lay term,” according to Wolfe, one thrown around by people to describe almost anything. From porn and sex, to video games and food, the media and the public have classified many different behaviours as addictive. From a clinical perspective, the exact reason why anyone starts an addictive habit is hard to explain. More and more research is suggesting a connection to the way the brain perceives rewards. An alteration to those perceptions, either by a substance or a behaviour, could lead to more problems. However, addiction itself is a highly complex process. “With problems like addictive behaviours, you’re not going to find one single answer. I think the key thing to keep in mind is [addiction is] a complex problem, multi-determined, and likely there are genetic, environmental, and developmental aspects at play,” Wolfe said. That goes against the common perception that simply because someone had parents who were alcoholics necessarily means they’re genetically predisposed. Environmental factors could play a
“The hardest part is when kids refuse treatment and you know they’re going to go out and use. You don’t want to read the paper, because a couple times you read that so-and-so overdosed or ended up in the hospital.” - Naomi Mitchell Councillor, Alberta Health Services
part in recurring problems, or it could be linked to genetics. “People who might not be related to their primary caregiver, [if] that person is an alcoholic — they may be more likely to develop it themselves,” Wolfe said. But even with the genetic and environmental predispositions, addictions don’t always manifest themselves without triggers. Addictions can be brought on by other mental health issues. Wolfe said that people often show signs of depression and an anxiety before they develop an addiction. But she noted that people with addictions can develop other problems too. “It seems to kind of go both ways. In some cases, people with mental illness may be selfmedicating, or turning to other problem behaviours to cope. People may have started off with a substance-abuse problem and that has led to other mental health issues as a result of those complications. You might get more depressed or become depressed because you realize your life is going downhill because of your substance abuse.” Other than cigarettes, the most common addiction in North America is alcohol. According to a study released by Statistics Canada in 2008, 17.6 per cent of people over the age of 12 in Alberta report heavy alcohol use in the past year. This is slightly above the national average of 16.7 per cent. Those numbers increase when looking at the male population, with almost one quarter of the population reporting heavy drinking in the past year. Gambling, like eating disorders, is an addiction that doesn’t fit into the general category of alcohol and drug addictions. In Alberta, approximately 4.6 per cent of the population has some sort of gambling problem. And those with a gambling addiction are more likely to develop other problems. According to a study from 2008, produced by the AMHR Laboratory, adults in Alberta who are problem gamblers are twice as likely to have a dependency on nicotine, alcohol, or drugs. The number of people like Amy who struggle with eating disorders in Canada
are relatively small, but such disorders can be incredibly deadly. A study from Statistics Canada in 2002 showed that 0.5 per cent of the population had been diagnosed with an eating disorder, while 1.7 per cent had reported symptoms in the past year. However, another study, out of the journal Eating Disorders and Obesity in 2002, found that 10 per cent of people diagnosed with an eating disorder will die within 10 years of its onset, one of the highest mortality rates of any psychiatric illness. Due to its complexity, treatment for addiction isn’t as cut and dry as dealing with other medical problems. For Naomi Mitchell, a councillor at the Health and Addiction Services department of Alberta Health Services, it’s a matter of examining a patient’s entire life to determine where their problem might have originated. And the process can often be lengthy. Mitchell said
patience is a requirement when treating someone with an addiction. “That’s the nature of drug and alcohol abuse. Change is a process — it doesn’t happen overnight. It’s a learned behaviour and they have to unlearn it. Sometimes there are lapses and relapses, for sure. It’s good to see people in our offices because they’re making steps towards their recovery,” Mitchell said. People who suffer from addiction are often perceived to be low-lifes and losers in society, a stereotype that Mitchell said simply isn’t true. Many people suffer from addictions, and when addicts become stigmatized for their problems, it only makes it more difficult for them to get help. Not only do societal views contribute to the negative view of addiction, but celebrities and media also play a detrimental role by glamorizing addiction and the people who suffer it. “You look at Celebrity Rehab with Doctor Drew or Intervention, I think it glamorizes it in a way but also hopefully people will see the impact that it has and that it affects everyone’s lives. It could be a mother, a brother, a best friend — these things do affect people’s lives,” Mitchell said. But trying to help people isn’t always easy. Working with addicts means making connections with people who may continue to use, or even die because of their problems. “The hardest part is when kids refuse treatment and you know
they’re going to go out and use. You don’t want to read the paper, because a couple times you read that so-and-so overdosed or ended up in the hospital,” Mitchell said. “My friends always ask me how I work with these people. I say, the average person who works on themselves and goes through recovery can be a healthier person than most people in their everyday life.” For Amy, she thought escaping back to Australia might help her get a fresh perspective on her eating disorder, but she returned within a year. What she quickly realized was that it wasn’t her family that was the problem — it was her. She came home and eventually sought help, through both psychiatry and Anorexics and Bulimics Anonymous, a 12-step group where she can talk through her problems and get support from others dealing with the same issue. She now classifies herself as a high-functioning bulimic, someone who can hide her problem well enough and deal with the symptoms while leading a normal life. But Amy relapsed back into bulimia last October, and now has to worry about when the urge to binge eat will come up again. “Somebody said it’s like cancer. It’s in remission. There’s always that fear that it’s going to rise up. And you never know if it will or it won’t — you just kind of live your life. I feel like I’m in a place where I have cancer again. I don’t know when I will go into remission or not.”
For more information about addictions, you can visit www.knowmo.ca, a site developed by the Addiction and Mental Health Research Laboratory. You can also go to www.checkyourself.ca to see how your drinking habits could be affecting your health. Anyone who thinks they are suffering from any sort of addiction can get help at the University Health Centre on the second floor of the Students’ Union Building.