Know Your Substances
Sold legally in many US smoke shops, this Southeast Asian tree's leaves contain mitragynine, which acts on opioid receptors
What is kratom?
Bill W. and Dr. Bob both came out of this Christian fellowship, whose practices of confession, restitution, and surrender shaped the Twelve Steps
What is the Oxford Group?
Alcohol, benzos, and barbiturates all enhance this same inhibitory receptor - which is why their withdrawals look alike and mixing them is so deadly
What is the GABA-A receptor?
Detox nurses score tremor, sweats, and agitation on this 10-item alcohol withdrawal scale to decide how much medication you get
What is the CIWA (CIWA-Ar)?
When insurance argues about whether you need detox, residential, or IOP, they're arguing over this organization's levels-of-care criteria
What is ASAM (the American Society of Addiction Medicine)?
Nicknamed "gas station heroin," this atypical antidepressant used in Europe becomes a mu-opioid agonist at high doses
What is tianeptine?
A century before AA, this 1840s Baltimore mutual-aid society of reformed drinkers swelled to hundreds of thousands before collapsing into politics and infighting
Who are the Washingtonians (the Washingtonian Total Abstinence Society)?
Running from the ventral tegmental area to the nucleus accumbens, this dopamine pathway is the one every drug of abuse ultimately lights up
What is the mesolimbic pathway (the reward pathway)?
This anticonvulsant is often used off-label as a non-addictive option for alcohol withdrawal and cravings in outpatient settings, working partly through GABA and glutamate modulation
What is gabapentin?
Roughly 9 or more structured hours a week while you live at home, this level of care sits between residential and standard outpatient
What is IOP (Intensive Outpatient Program)?
Street name "tranq," this veterinary sedative is now cut into the fentanyl supply, causes severe skin wounds, and does NOT respond to naloxone
What is xylazine?
One of the first women to get sober in AA, she went public in the 1940s and founded what became the National Council on Alcoholism
Who is Marty Mann?
Chronic drinking suppresses this excitatory glutamate receptor, so the brain makes more of them - and when the alcohol stops, the resulting overdrive drives seizures
What is the NMDA receptor?
Take Suboxone too soon and its high receptor affinity knocks the full agonist off, slamming you into this - sudden, brutal, and worse than the withdrawal you started with
What is precipitated withdrawal?
Marketed as Vivitrol in its monthly injectable form, this opioid antagonist is approved for BOTH opioid and alcohol use disorder - but you must be fully detoxed before the first shot
What is naltrexone?
Known as "krokodil" for the scaly tissue damage it causes, this crudely made opioid devastated parts of Russia in the 2000s
What is desomorphine?
This Akron nun quietly worked with Dr. Bob at St. Thomas Hospital, admitting alcoholics under other diagnoses when no hospital would take them
Who is Sister Ignatia?
Activated by dynorphin, this opioid receptor produces dysphoria rather than euphoria - and George Koob points to it as the engine of addiction's "dark side"
What is the kappa opioid receptor?
Borrowed from epilepsy research, this term explains why each repeated alcohol detox tends to be more severe than the last - the reason relapse #6 can seize when #1 didn't
What is kindling?
Under this 2008 federal law, insurers can't impose stricter limits on substance use treatment than they do on medical/surgical care - the reason denied residential claims can often be appealed
What is the Mental Health Parity and Addiction Equity Act (MHPAEA / "parity law")?
This orexigenic peptide hormone spikes during withdrawal from most substances, driving both drug craving and the intense hunger of early recovery
What is ghrelin?
In a 1961 letter to Bill W., Carl Jung used this Latin phrase - roughly "spirit against spirit" - to describe the craving for alcohol as a low-level thirst for wholeness
What is "spiritus contra spiritum"?
Unusually stable, this transcription factor builds up in the nucleus accumbens with repeated use and lingers for months - a "molecular switch" for long-term craving
What is delta-FosB?
Left untreated, Wernicke's encephalopathy can progress into this irreversible amnestic syndrome, marked by severe memory loss and confabulation
What is Korsakoff syndrome (Wernicke-Korsakoff syndrome)?
This harm-reduction and mutual-support alternative to 12-step programs uses a 4-point framework covering motivation, coping with urges, managing thoughts/behaviors, and living a balanced life
What is SMART Recovery?