Caring about our future

Asperger Personalities, Addiction, and Rehabilitation

It is well documented that, compared to the general population, some individuals with Asperger personalities respond differently to medication. It is commonplace to hear these individuals referred to as being ‘wired differently’.

Some of the medications prescribed  to help with obsessions or perseveration, and/or with associated depression and anxiety, include SSRIs such as Paxil, Prozac or Zoloft. In individuals with stereotyped movements, agitation and idiosyncratic thinking, low dose antipsychotics such as risperidone are also frequently prescribed.  But, for some individuals, these medications have been known to produce the complete opposite effects to those intended. 

Bearing these uncommon responses in mind, when we consider AS personalities who have become addicted to drugs or alcohol, the question arises as to whether these personalities become chemically dependent or whether they are more locked in to the repetitive behaviour pattern.   The obsessive characteristics linked with these personalities lend themselves very readily to repetitive cycles of behaviour which are also apparent in dependent behaviour. 

If we assume that AS personalities are displaying cyclic behaviour rather than true chemical dependence, then it should prove relatively easy to support them into removing the dangerous substances eg alcohol or drugs from their systems, and without the same level of distress that someone dependent on the substance might experience.  The remaining obsessive habit, however, then becomes a behaviour management issue.  Of course, this may not be an either/or situation, as there may well be dependence combined with cyclic behaviour patterns.

Special interests are a recognised part of the AS personality, and where this interest is focused on a useful activity, this sometimes forms the basis of earning a living for that individual eg IT specialisms.  When the special interest is self injurious or anti-social in some respect then the activity is viewed as requiring some sort of intervention – which may take the form of: medication; education; punishment; or rehabilitation. 

When an AS personality becomes aggrieved about something, quite often, the focus of his/her complaints will be the person who is closest to her/him.  This may be Mum, or the primary carer, or it may be a sibling.  Whoever it is will bear the brunt of repeated tirades about the particular topic.  This can become extremely distressing and also wearing, and, if there is no understanding of how the AS personality’s anxieties escalate, the situation will continue indefinitely. 

Because of the tendency towards obsessive and ritualistic behaviours, when anyone engages with the AS personality to discuss their ‘problems’, the conversation inevitably becomes cyclic and as it does, with each cycle, the individual’s anxiety will get higher and higher.  In this event, the cycling must be stopped, whether the problem is resolved or not, otherwise it just ends up with everyone feeling anxious and yet no further forward.

Having established all the above facts, the question then arises about support strategies that involve repeated self assessment in relation to: resentment towards others, disempowerment, physical well-being; mental well-being.  The likelihood is that, at any one of these points, an AS personality may become fixated and engage in cyclic thought and conversation patterns which are difficult to shift, and which only serve to escalate the anxieties.

The introduction of set rules will suit the AS personality very well as they tend to work well within a structured environment, but these rules must be applicable in the long term as well as the short term.   In addition, it is really important to ensure that the individual has heard and understands what is being asked of her/him.  There is a tendency towards: literal interpretation of language; not always hearing the complete sentence (which may reverse the intended meaning); only seeing things from a personal perspective.  Therefore, all these possibilities must be considered by the support services and double checked each time a directive is given.

Because AS personalities can experience behavioural difficulties that are also displayed in dependent behaviour, this can create confusion when attempting to use differential diagnosis, as one symptom may mask another.  Unless the staff in rehabilitation centres have met an individual before s/he acquired their addiction, it is very unlikely that they will be able to discern what has produced the behaviours they are observing.  The natural assumption would be that all the maladaptive behaviours are a result of the dependence.  Only when the person is on the road to recovery ie clean for a period of time, will it become apparent that some behaviours have not reduced or vanished as might have been expected.  Then it becomes necessary to look more closely.  But if no-one knows what they are looking for then life can become very frustrating for everyone involved.

Personal Empowerment Therapy: Dr Dawn Heather

www.dawnheather.typepad.com

www.dawnheather.com

email:

dawn@dawnheather.com

Addiction and Recovery

Drug dependence and alcoholism have high profiles these days, with more crimes being committed under the influence, and often to finance a habit.

It is estimated that 50 million people worldwide use some form of drug regularly, whilst 1 person in every 13 are alcohol dependent in UK alone.   

There are also many people in recovery, and many different treatment approaches – 12 step and non-12 step methods, and alternative therapies.

What causes some people to become addicts and not others is a popular topic for debate, with a variety of opposing viewpoints: 

‘Whether a person is genetically or bio-chemically predisposed to addiction or alcoholism is a controversy that has been debated for years within the scientific community. One school of thought advocates the Disease Concept, which embraces the notion that addiction is an inherited disease, and that the individual is permanently ill at a genetic level, even with those experiencing long periods of sobriety.

Another philosophy argues that addiction is a dual problem consisting of a physical and mental dependency on chemicals, compounded by a pre-existing mental disorder (i.e. clinical depression, bipolar disorder, or some other mental illness), and that the mental disorder needs to be treated first as the primary cause of the addiction. This treatment philosophy is commonly referred to as Dual Diagnosis. A third philosophy subscribes to the idea that chemical dependency leads to "chemical imbalances" in the neurological system, which would be a substance induced imbalance.’

How people are introduced to drugs and alcohol, resulting in their addiction or dependence, is fairly well documented. For some, the dependence begins through experimentation, often at social events, with recreational drugs or alcohol.  However, a small percentage of these individuals have an underlying emotional need for a buffer between their conscious minds and the reality of their lives, and drugs or alcohol can provide an escape into an altered state of consciousness for them, relieving the pain and/or anxiety they have had to endure.

It is true to say that many addicts and alcoholics wish desperately to beat their habits, and often try a range of methods to help them achieve these goals.  But, in the situation where reality contains memories that are excruciatingly painful, and the alcohol or drug of choice relieves that pain, then is it not inevitable that, when they kick the habit, they will only end up returning to it with a double sense of failure?

Alternatively, as I believe happens in some cases, their minds will not allow them to kick their habit and they will sabotage themselves, regardless of the support mechanisms provided.

 

Whenever we experience trauma, our minds have the ability to devise unlimited ways of protecting us, take Multiple Personality Disorder (more accurately entitled Dissociative Identity Disorder) as an example.  Or, more commonly, traumatic amnesia, where the mind blocks out any memory of the event.  Dissociation is an extremely effective method of dealing with extreme situations, it’s how individuals are able to continue functioning despite terrible injuries, or pain, both physical and emotional.  Whilst the body is experiencing something horrendous, the mind separates itself in order to survive.

If survival is paramount, then it may seem a contradiction in terms to state that our minds can make us engage in self-injurious behaviour in order to protect us, but phobias, for instance, begin as protective behaviour such as avoiding something perceived as dangerous.  However this behaviour can increase over time to a point where life becomes incredibly limited.

Take the example of the adult with agoraphobia.  As a toddler in the pushchair, she was frightened by a dog shoving its face in at her.   The message is clear to her ‘dogs are scary, therefore dangerous, danger must be avoided’ – so all dogs are dangerous, therefore any places where there are dogs should be avoided.  As she grows older she avoids certain streets, for fear there might be a dog. 

The avoidance becomes a habit and, as years go by, the dog is forgotten, there is just an intuitive knowledge that some places must be avoided.  So, the trigger for the fear is buried, and life may be manageable by just not going to certain places or doing certain things.  However,  the next stressful event triggers the fear response and, as she tries to rationalise it, she knows that some places are to be avoided but she can’t remember why, so, in that case, it would be best if all places were avoided, just to be safe. 

To others the behaviour seems irrational, for the individual it is extremely limiting to lifestyle, and the attendant anxiety is a significant health risk. So, you can see that, ultimately, protection can create a danger of its own.  Even when the original event is remembered, the logical mind can make no sense of the extreme anxiety (it was only a dog), but only by dealing with the original issue can this anxiety and fear response be resolved – and we all need help to do this, we can’t do it on our own.

My point is this, where extreme trauma or years of abuse of any kind have occurred, a mind can bury the event and dissociate from it completely in order for the person to lead a relatively normal life.  Sometimes, however, people are not able to dissociate so easily, or there may be so many associations or triggers that complete dissociation is impossible to sustain.  In this situation, they will need some additional help to forget, and often alcohol or drugs provide the solution.

 

We all, addicts and non-addicts alike, know that these things are not good options long term, but if escape is paramount then the most common interventions, such as anti-depressants and counselling, will not be sufficiently immediate or powerful.  Consequently, the underlying need combines with habitual escape, creating an extremely complex and volatile set of behaviour patterns.  Distraction techniques, such as participating in organised events, are helpful when attempting to withdraw the drugs or alcohol, but without the emotional support they may leave an individual exposed and extremely vulnerable.

Alright then, what is the solution I hear you ask.  Well, my response is speculative but based on existing evidence.  We already have evidence to show that clinical hypnosis can help people reach a position of sufficient emotional security to identify any distressing life experiences which have been buried.  We also have evidence that Post Traumatic Stress Disorder (PTSD) can be effectively treated with EMDR (Eye Movement Desensitisation and Reprocessing).  Why then are we not incorporating these methods into recovery programmes, so that the emotional need for the buffer is removed?  This would establish a much stronger position for them to tackle breaking the ‘habit’ (which, incidentally, is a learned behaviour, and, like any learned behaviour, can be over-learned).

I watched Monty Don’s project with real interest, and it was really heartwarming to see people finding themselves, and achieving in ways that they hadn’t done before.  What would be even more useful in future, in my opinion, is if each individual could be offered the opportunity of Hypnotherapy and EMDR to help them deal with their demons once and for all. I believe this would greatly reduce the failure rate, which is approximately 33% at present, but ideally would be zero.

Personal Empowerment Therapy: Dr Dawn Heather, Camborne Complementary Healing Centre: Tel: 01209 711504

www.dawnheather.typepad.com

www.dawnheather.com      

email:

dawn@dawnheather.com