Addiction

Dr. Benjamin Rush, a founding father of the United States and a signer of the Declaration of Independence, is credited with first describing alcoholism as a “disease” in 1784. Prior to Dr. Rush’s writings on addiction, drunkenness was viewed as a moral defect and solely a matter of choice. Rush believed that the alcoholic lost control of his behavior or had what he called “an illness of the will”. He identified the properties of alcohol, rather than the individual's choice, as the causal agent. He also proposed that alcoholics could be treated by weaning them off of their addiction using less potent substances (similar to the way that methadone is used for heroin addiction today) and that total abstinence was the only effective cure.

Over a lifetime, many people use substances that have the potential for dependence, but most people do not become dependent. What is it that causes recreational substance use in some people to become uncontrolled, compulsive drug taking in others? The answer may have to do with how our brains respond to pleasure and rewards.

Have you ever wondered why you enjoy certain activities and aren’t particularly interested in others? Things you enjoy are rewarding to you. In other words, they bring you pleasure, a sense of well-being and reduced stress. All thoughts and behaviors have some biological component, and reward and pleasure are no exception. God has created within our brain a system that brings about a pleasurable experience when it is activated. Because we enjoy pleasurable experiences, we are more likely to repeat actions that activate our reward system. Many things can activate our reward system, from food to sex to alcohol and illicit drugs. For instance, food has been shown to increase activity in the reward system by 45 percent, whereas amphetamine and cocaine increase the activity by 500 percent. Commenting on this result, my graduate school pharmacology professor once said, “Cocaine takes your brain to a place it was never supposed to go, a place you will always try to get back to.”

Imagine a person with a dysfunction in his or her reward system that causes the system to be under activated. Things are not as rewarding to that individual as they are to the normal person. In neuroscience we call this condition Reward Deficiency Syndrome. Reward Deficiency Syndrome can result from an inherited genetic abnormality or from environmental factors such as trauma or stress. Research has shown that individuals with Reward Deficiency Syndrome begin to seek out experiences that will increase activity in their reward system. If they experiment with alcohol or illicit drugs, initially they find the pleasurable experience they were seeking. But after some time, which will vary across individuals and substances, a vicious cycle develops in which the consumption of alcohol and/or illicit drugs is no longer a choice or a pleasure but a necessity. The person becomes physically dependent on the substance and must take the drug to keep from experiencing painful and sometimes life-threatening withdrawal symptoms. While the positive, pleasurable state produced by the drug may have motivated initial use, continued use results in another motivation: relieving the negative, painful consequences of not using the drug.

While brain chemistry clearly plays a part, the underlying biological causes of the substance use disorders are much broader than any one neurotransmitter system. The reward system I have described above involves a number of brain structures, including the hypothalamus, amygdala, ventral tegmental area, substantia nigra, and nucleus accumbens. The nucleus accumbens, a structure deep within the middle of the brain, is considered by neuroscientists to be the brain’s central reward center. The cells in this brain structure are activated by the neurotransmitter dopamine (DA). When DA is released in the nucleus accumbens, the results are increased feelings of well-being and reduced stress. Substances such as alcohol, cocaine, heroin, PCP, marijuana, and nicotine all cause DA to be released in the nucleus accumbens, and thus they are potentially addictive. In addition, the neurotransmitters serotonin and GABA (gamma-aminobutyric acid) also appear to play a role in the brain’s reward system. Substance abuse and dependence involve a complex interaction between the physiological effects of drugs on the brain’s reward system and the learning of compulsive patterns of drug-seeking behaviors, both of which have a biological basis.

Research suggest that, much like the other behaviors I have discussed thus far, a genetic predisposition for addiction can be inherited from one’s parents and grandparents. Several studies have found that the child of an addicted parent is about four times more likely than the general population (where the risk is 1 in 12) to develop substance abuse or dependence themselves. This holds true even if the child of the addicted parent is adopted early and subsequently raised by adoptive parents who do not use alcohol or drugs.

As might be expected, a significant amount of genetic addiction research has focused on genes that are associated with the brain’s dopamine system. Alcoholism researcher Ken Blum and his colleagues have shown that a defect in the gene that codes for the dopamine D2 receptor is associated with the presence of substance use disorders. There research found that an individual with such a genetic defect has a 74% chance of developing Reward Deficiency Syndrome. It is important to remember that unlike diseases such as hemophilia, sickle-cell anemia and cystic fibrosis, which are caused by a defect in a single gene, behaviors like addiction are genetically complex and are likely to result from defects in many different genes.

Jesus Center Benefit

For those in the Chico, CA area I will be the guest speaker at the Jesus Center benefit dinner this Saturday, April 17th (6:00pm). My talk will be titled Viewing Mental Illness and Homelessness Through the Eyes of Faith. Here is a link to a local article with information about the event.

Broken Lives

Adultery (infidelity as the media calls it) has been in the news a lot recently. Senator John Edwards, Governor Mark Sanford, Tiger Woods, Sandra Bullock’s husband Jesse James all choose to break their marital vows for momentary pleasure and as we have unfortunately all seen, thanks to the media, proven that the effects of sin are far reaching. The suggestion that an individual only hurts himself through his poor choices is simply not reality (Exodus 20:5; 34:7). Hidden sin is destructive; it undermines relationships and debilitates families. Once exposed, sin produces a violent shockwave that damages everyone in its path. In many instances the resulting physical, psychological and spiritual wounds are so deep that they will be felt for a lifetime. This post is about the results of adultery; an innocent woman and her children whose lives have been broken by a selfish, sinful choice. As I listened to her story, I was reminded of how desperately we need a Savior, and I pray that as you read it, you also will be.

Like all little girls, Susan had dreamed of what her life would be like when she grew up. Those dreams often included the picture perfect family: a handsome and strong husband who would love her forever and beautiful, healthy children that they would raise together. When Susan met Kevin in college, she believed that those dreams were beginning to come true. He was everything she had dreamed of … handsome, strong and athletic. Kevin was part of a college military training program that was preparing him for service after graduation in the elite Navy SEALs.

Although raised in a strong Christian home, Susan was living the “normal” college life of too many parties and too much drinking when she met Kevin who was living the same way. Susan described their dating relationship as “up and down”. “Kevin was very hot and cold. Some days his affection was all consuming. He couldn’t get enough of me, he couldn’t see me enough, talk to me enough or be with me enough. He was also overly jealous. Other times he would ignore me and say ‘I don’t know if really I love you”. Susan’s parents were concerned about her relationship with Kevin and cautioned her against marrying him. “They had seen how he treated me and they also questioned his Christian commitment.” They dated for two years before getting married in their senior year. Susan became pregnant and shortly before they both graduated she gave birth to their first child, a daughter.

After graduation they moved to California so that Kevin could begin training for his service in the Navy. “The first year after graduating was great. I had the husband that ever woman wanted and together we had the perfect family.” After one year in California, the family moved to Virginia, and Kevin began his service. “He went from being home everyday to being gone over 200 days out of the year. He also started to be hot and cold much like he had been when we were dating in college. Sometimes he would call or be home and smother me with love and attention, while other times he was distant and cold. He never missed our daughter when he was away. Once he even told me after being away for several months that he had not missed us. He was drinking heavily and would regularly visit strip clubs with the other men in his unit when he was gone.”

It was during this difficult time in their marriage that Susan became pregnant and gave birth to their second child, a son. Much like their first child Kevin didn’t really want the baby and was absent and distant as a father. “I was so depressed, especially after the birth of our son. Kevin would call and say that he didn’t love me anymore and that he didn’t want to be married. I felt worthless and started blaming myself for our problems. I was also starting to have thoughts about hurting myself, so I called my parents for help.” Susan’s father drove to Virginia and moved her and the children back home. “I stated having recurrent nightmares that Kevin would abandon us; I feared that I would be unemployed and unable to care for my children.” Within the first month of living with her parents, Kevin began calling. “He said he wanted me back. He wanted to fly me to Spain to be with him. When I asked him why he had said such hurtful things before, he just said, ‘I don’t know.’”

Susan’s visit to Spain went well, and when she returned to the States, she and the children quickly moved back to Virginia. Susan told me that during this difficult time she started crying out to God to restore her marriage. “I had moved far from my faith. Since getting married, I had tried several times to get involved with a local church, but Kevin was never supportive. I decided that I was going to give my all to God. I started praying regularly and attending a bible study. I also (wrongly) blamed myself for our marital problems and dedicated myself to being a better wife.”

After a short time in Virginia, the whole family moved to California, so that Kevin could attend the Navy’s language school. “Everything changed for the better. Kevin was always home while he was going to school. He became the perfect family man. He showed more attention to me and the kids. He was drinking less, and we were attending church as a family. I started thanking God; I really believed that my prayers had been answered. God was restoring my family. It was the happiest time of my whole life.” After a year of language school, Kevin left for a six month deployment. “I had to choose whether to stay in California during Kevin’s deployment or move back in with my parents. I wisely chose to move back to my parents’ house. It was Christmas time when Kevin came back. He was like a different person. He was angry, depressed and drinking heavily. He made it clear that he didn’t want to be with our family. After three days, he said he needed some time alone, so he left to go skiing. He was away from us for six months and after three days he left. I now know he went to meet a girl, but at the time, I didn’t know what was going on.”

Kevin moved back to California while Susan and the children chose to stay with her parents. “On the phone everything would seem great. He would say that he loved me and that he missed me. He would visit us about once every six weeks. When he visited, he showed no emotion. He was like two different people.” Susan started getting counseling to help with her depression. She also continued to fast and pray for her marriage. “In desperation, I remember begging God to release me from my marriage. I knew that I couldn’t live like this forever.”

It was soon after that Susan received a call from an old college friend who lived in New York. “She said that she had heard Kevin and I were getting a divorce, and she just wanted to check on me. I told her I didn’t know what she was talking about. She then told me about Kevin’s girlfriend. I immediately called Kevin, and he of course denied that there was another woman. I knew he was lying, so I searched through our old cell phone bills, found a suspicious number and called her. She said that Kevin had not told her that he was married. While she did know about the kids, Kevin had lied and told her that he had a great relationship with them and was a dedicated father. I told the woman that we had a family and she needed to back off. She told me that she loved Kevin and was not going to stop seeing him. I confronted Kevin again after I spoke to the woman and he no longer denied the affair. He just said, ‘What do you want me to do?’ Then he hung up on me.

I had always held out hope that he would change, but it was at that moment I finally realized that he was never going to change. My marriage was over. My nightmare was coming true and I felt worthless. It was the lowest point of my life.”

Soon after Susan filed for divorce, and Kevin did not contest it. “He just walked away like we never existed.” The divorce has finalized 13 months ago, and Susan says Kevin has visited the children sporadically. “He comes around maybe once every couple of months. My four year old son has no relationship with his father. Our daughter who is nine longs to know her father. She gets so excited when she knows he is coming to visit only to be disappointed by his lack of interest and affection. She has problems expressing her feelings as a result.”

I asked Susan how the affair and divorce have affected her. Struggling to speak through a flood of tears she said, “It would have been better if he had died during a mission, at least then we could have moved on. Right now I’m just existing, nothing more. I’m depressed and angry. This has changed my view of God. My faith has been shaken. I can’t pray anymore. I haven’t had a quiet time in six months. I now see God as cold and distant. To me God seems more interested in furthering his kingdom than concerning Himself with the problems in my life. Kevin did us wrong and he walked away with no consequences. We are the ones that are suffering. Why would God allow that?”

I hope that this story has put a more personal face on the devastating effects of adultery. It is important to understand that Kevin openly professed Christ as Savior at one point in his life, yet he was drawn away, enticed by his own lusts and desires. He chose the pleasures of sin over his wife, children and faith. This story demonstrates that sin is an ever-present problem even in the church today. It is time that we, the body of Christ, move away from the “us vs. the world” mentality. This mindset has crippled our ministry to the world and to one another. Instead we need to seek to develop a truly transparent and open community of faith, fully dependent on the transforming power of Christ. In such a community, men and women do not struggle in silence with sinful lusts and desires, but openly share and confess (James 5:16) to a body willing to carry one another’s burdens (Galatians 6:1-2).

Women, Depression and the Church (Part 2)

So what should a woman struggling with profound sadness and depressed mood do to determine the best course of treatment and healing? A good place to start is with a physical by your primary care physician (PCP). During that office visit the PCP can order testing and perform a physical exam that will rule out many other potential disorders that may be causing the problem (e.g., hypothyroidism, Addison’s disease, pancreatic cancer). In addition, the PCP can likely make a referral to a psychologist or psychiatrist who will further evaluate the person once a non-brain related disorder is ruled-out.

If a psychological assessment shows that the individual meets criteria for a diagnosis of major depressive disorder the person should then begin treatment. Treatment may include antidepressant medication and some form of talking therapy (psychotherapy). It is imperative that an individual diagnosed with major depressive disorder receive some form of psychotherapy. Medication alone is typically not effective in fully managing the symptoms of major depressive disorder. In combination, psychotherapy and medication have consistently been found to be a more effective treatment than either alone.

What if a physical illness is ruled out and the person does not meet criteria for a diagnosis of major depressive disorder after a psychological assessment? At this point antidepressant medication should no longer be considered an option and some type of counseling is the most appropriate course of action. Personally, I would recommend some type of pastoral counseling either through the church or a local Christian counselor. Spiritual healing and wholeness only come through an understanding of who we are in Christ. In addition, during a time of psychological distress the person’s friends and family have the opportunity not only to remind their hurting sister of the truths of God, but also to love them, walk beside them, and encourage them. Two sets of verses that I have found helpful in doing this are Philippians 4:11-13 and 1 Peter 1:3-9. These verses teach us that while difficulties and trials (like depression) will come into all of our lives, contentment in Christ is learned through a process of daily submission to God and ever increasing dependence on the great hope laid before us, Jesus.

Women, Depression and the Church (Part 1)

After the birth of our second child Caleb, my wife Julie became co-coordinator of a women’s outreach ministry at our local church. She was on a steering committee of 10women, all of whom were married and had young children. Julie knew all of the women well but quickly found out something she didn’t know, 7 out of the 10 women (70%) were taking antidepressant medication. This came as a shock to us, not because someone would be on an antidepressant medication but because of the sheer number of women in the group taking them.

All of the women in the group were very open about their antidepressant use and the struggles that had lead them to get the medication. Many said that they felt like they couldn’t handle life, that they were overwhelmed having to meet so many people’s needs. They felt like they were not good mothers and wives. They described feeling a lack of fulfillment in their lives, they were exhausted and it was taking a toll on their marriages. One woman said “I couldn’t stand to be around myself”. So they all sought out something from their family physician that would help them feel better about life and themselves.

We all know someone who is taking an antidepressant medication. And I certainly do not want to deny the potential benefits of these medications in individuals who truly need them. But while it is generally accepted that 5% of Americans suffer from clinical depression (women more than men) a far greater percentage of the population is being treated with antidepressants. This dramatic increase in the prescribing of psychiatric medications over the last two decades has caused some in the Christian community to question the legitimacy of depression as a psychiatric disorder and the use of antidepressant medications by those in the church.

In a recent study I conducted to investigate this problem I found that Texas pastors perceived biological causes as more important than psychosocial and spiritual causes for all mental disorders. There was however, significant variability in how much of a contribution the pastors believed spiritual factors influence various disorders. Spiritual factors were perceived to make a significant contribution in major depressive disorder but thought to have little influence in cases of schizophrenia and bipolar disorder. This may result from the fact that depression has a sub-clinical manifestation, as mentioned above, not seen with schizophrenia and bipolar disorder. A sub-clinical manifestation of depression could rightly be perceived by a pastor as resulting from spiritual factors (e.g., guilt over sinful behavior, poor marital relationship). Exposure to these types of sub-clinical problems might cause an over generalization of spiritual influences to all “depression” regardless of the severity. This same type of type of generalization would not be possible in disorders without sub-clinical manifestations like schizophrenia and bipolar disorder.

It is important to realize that being “depressed” or having the “blues” is different than meeting criteria for major depressive disorder. To limit confusion and facilitate appropriate treatment I recommend that an individual not begin taking antidepressant medication unless they have undergone a full psychological assessment (which takes several hours and is usually done by a clinical psychologist) to determine if they truly meet the criteria necessary for a diagnosis of major depression.

Support Group / Bible Study Resources

I am often asked if there is material available for individuals interested in starting faith-based support groups or Bible studies for individuals struggling with mental illness and their families. Two resources that I highly recommend are Dr. Steve Waterhouse’s Depression Recovery According to the Bible and Steve and Robyn Bloem’s Christians Afflicted with Mental Illness. Both of these resources come from pastors who have experienced the pain and suffering associated with mental illness first hand.

Trauma and Suffering

There are five key truths that the scriptures teach us about trauma and suffering. First, that God is present and in control of our suffering. In times of great suffering and pain, we often feel the farthest from God. Where is He? Has He forgotten me? How could He let this happen? This was also the case in the lives of great men of faith in the Bible. Look at David (Psalm 13:1), Jeremiah (Lamentations 3:8) and Job (Job 9:16). Even Jesus at the height of his pain cries out “My God, my God, why have you forsaken me?” (Matthew 27:46) From our limited human perspective, pain and suffering seem contrary to our idea of a sovereign God who is good and loving. We think that God blinked and wasn’t able to stop this traumatic event or He isn’t really a loving God. We forget that Adam chose to sin and that we live in a fallen world, full of suffering. Suffering should not cause us to question God’s sovereignty, as Job so clearly understood (Job 2:10). God is sovereign despite our circumstances. He created all things and He controls all things (Deuteronomy 4:39;
1 Chronicles 29:11; Psalms 103:19; Daniel 4:35; Colossians 1:15-17). He allows us to experience the consequences of sin while remaining fully in control of all things including Satan, who can only bring suffering into our lives if God allows it (Job 1:12; Luke 22:31). God is in control of our circumstances, and He wants to transform us into the very image of His Son.

Secondly, we learn from the scriptures that God is good and cares for us. We have all heard this statement, “How could a loving God allow __________?” Fill in the blank with any horribly traumatic event that occurs here on planet Earth. People often use this statement to argue against not only the love of God but also the very existence of God. But God does love us and that is evident in our redemptive history. The creator of the world made a way for disobedient, powerless creatures to come into an eternal relationship with Him. He is patient and gracious. He became one of us (John 3:16) and then sacrificed Himself for us (1 John 3:16). Self sacrifice is the ultimate act of love (John 15:13). God is indeed good and He longs to be in an ever deepening relationship with us.

In James 1:2, we are told to “consider it pure joy” when we go through difficult times. What kind of strange mental gymnastics does God want me to do? I’m supposed to be happy when I’m in pain? No, not at all. Even Jesus was sad when he went through difficult times -- at Lazarus’s grave, in the garden of Gethsemane, and on the cross. The third truth we are called to recognize is that through our trails and suffering we have an opportunity to draw closer to God. During the easy times we often become self-reliant, forgetting our need for God. It is in the hard times, when our faith is tested, that we recognize our need for complete dependency on Him. James tells us that persevering through the difficult times develops a mature and complete faith (James 1:4). We are ever being conformed into the image of Christ and suffering is a necessary part of that transformation (Romans 8:29; Philippians 1:29; 1 Peter 2:21).

Jesus understands what it is to suffer is the fourth truth. We do not worship a distant, unapproachable God. We worship a God that knows what it is to be human (Hebrews 4:15). He knows what it is to suffer (Hebrews 2:17-18). Just think about Jesus’ life for a moment. He didn’t experience just one traumatic event during His time on Earth. His whole life was full of suffering. The prophet Isaiah told of His suffering hundreds of years before His birth (Isaiah 53:3-5). He was born into unimaginable poverty in a country occupied by a cruel army (Luke 2:1-7). He narrowly escaped a mass slaughtering of children that was ordered because of His birth (Matthew 2:16). He was physically assaulted by Satan (Matthew 4:1-11), persecuted because of His teachings (Luke 4:28-29), thought insane by His family (Mark 3:21), betrayed by His own disciple (Mark 14:43-45), deserted by His friends (Mark 14:50), falsely arrested (Mark 14:56-59), publicly humiliated (Mark 15:16-20; Luke 23:8-12), beaten to the point of death (Matthew 27:26), and then slowly and painfully publicly executed by crucifixion as a common criminal (Matthew 27:33-39). We can take great comfort in the fact that God can relate to us on our level, He understands what it is to suffer.

Finally, our identity is not defined by traumatic events or suffering but is grounded in Christ. God does not see you as a victim. He sees you as His child. The scriptures tell us that as children of God, we were chosen before the creation of the world to be holy and blameless adopted sons and daughters, lavished with grace, redeemed, forgiven, given spiritual wisdom and understanding and marked with the Holy Spirit (Ephesians 1:4-14). We are in Christ! We sit at the right hand of the Father! We have His righteousness! We must not allow tragedy or circumstances to define who we are or how we live. We have His very life within us and we must choose to live out of that truth.