Episode 13 – Breaking Down Cocaine
Dr. Ashish Bhatt ❘
With 1.5 million American adults being Cocaine users, Dr. Bhatt breaks down how Cocaine affects the brain and the drug's reputation.
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Hayley: Hi everyone. This is Hayley and you are listening to Straight Talk With The Doc. On this podcast I talk with addiction medicine specialist, Dr. Bhatt, to break down topics on addiction, mental health, and treatment. In regard to today’s topic, a pretty common saying you may have heard is “addiction is a family disease”. Dr. Bhatt, what does that saying mean to you?
Dr. Bhatt: Well, Hayley, addiction tends to be a disease that often resonates with similar individuals. When we talk about relationships, we talk about families. We talk about just genetics. Genetics is one of the biggest influences of if somebody’s going to develop an addiction or not. When we talk about addiction being a family disease, it not only is physically something that somebody can pass down or obtain from family members, but the psychological familial component of it that happens from just being around one another. We do learn behaviors, habits, exposures, based on those around us. It’s a combination of genetic influences and just being around similar types of people. And if your family’s using, it’s firsthand exposure to learning early onset of substance use. That’s a huge risk factor for later development of addiction. It does run together.
Hayley: Yeah, it definitely effects everybody around the addict. And family can be your sisters, brothers, parents, your spouse, really anyone that you have a close relationship with. When you have an intimate romantic relationship, your lives become intertwined like family which can be wonderful. But also destructive if one or both partners are struggling with drug or alcohol abuse. Studies have looked at relationships and divorces and how they’re influenced by addiction. In one study I saw, published in the journal Couple and Family Psychology, substance abuse was listed as one of the most common final straws for couples that divorce. The other two on that list were domestic abuse and infidelity. Dr. Bhatt, in your opinion, how can substance abuse hurt the other partner to the point of being comparable to domestic abuse and infidelity?
Dr. Bhatt: That’s a big question, because I think quickly, you don’t need to be a doctor to draw certain conclusions that substances make us act, feel, and behave differently. Substances hijack our bodies and our minds. When somebody is not just using substances but actually has suffered from an addiction, it effects multiple domains of their life. They stop taking care of themselves. They start acting and behaving in different ways. They detach from their emotional relationship or their intimate relationship. They can start acting angrily or physically abuse towards others. By no means am I saying that people who have addiction have more or less, but what I’m saying is the fact that you add a substance to a relationship, especially if one person’s doing it and it’s not matched by the partner, that’s where you often see these problems arise. You lose trust. You lose faith. The other partner sees inconsistencies and how could somebody then continue to stay in a relationship when your partner is unpredictable? And that unpredictability is coming from a substance of abuse. It can destroy that relationship and definitely, just like infidelity or physical violence, once trust is broken it’s often hard to repair those relationships.
Hayley: It’s interesting you talk about that unpredictability of using substances. Because even if you love that person so much, they kind of become a different person when they’re using depending on the substance.
Dr. Bhatt: Yeah, for sure. I’m going to bring up alcohol here. Because I think a lot of the studies that have been done, have been done with alcohol. I use alcohol because I think it’s one of the most disinhibiting substances that we have out there, and the legal one, the one that’s common. A lot of relationships are often built on similar habits. What do people like to do? If they’re drinking together, it’s one thing. Especially because alcohol is such a dis-inhibitor, a dis-inhibitor for emotions. If you’re angry and you don’t have a filter left because you’re drunk or intoxicated, those feelings come out. People say things that they wouldn’t have said. They’re often very, very offensive or mean and that could lead to physical violence. Not only do you have a pattern of this unpredictability from an emotional and behavioral perspective, but once that compounds and could lead to physical violence, then there’s an imminent danger that exists. A lot of times we do see some significant physical violence occur to others and self-inflicted harm due to intoxication. Definitely becomes compounded variables together and it’s even more destructive.
Hayley: I see how somebody could get maybe more violent or be abusive if they’re intoxicated towards their partner. But in my research, I also saw that you’re more likely to be abused as well if you use. Why is that so?
Dr. Bhatt: There’s a lot of dynamics involved in relationships. In a relationship, it depends if the relationship was founded on them drinking together as a couple or using substances together, versus, again, one using and one not. A lot of animosity develops. A lot of frustration develops. If the person who’s not using consistently is angry with the person who is, then when somebody’s drunk or intoxicated, they’re often going to become the victim because of their own behaviors that are going to trigger that person’s frustration or anger. Because it’s that episode that they hate so much or they dislike so much that’s going to trigger those individuals. The psychology behind it is, that they can also be vulnerable. If somebody is so intoxicated to the point where they aren’t able to behave or act in a certain way, or even defend themselves, they can actually illicit a response where they become the victims. It’s a mixture of all of these things together, where a lot of underlying frustration, anger, is there that’s often the fuel to having that type of violence outburst. And often not just the person who’s drinking, but the person who is the one that suffers from the addiction. That does happen and it’s unfortunate that individuals like that are susceptible to violence.
Hayley: I also want to talk about infidelity a little bit. Sometimes you hear people use being drunk or high as an excuse to justify their cheating. Is infidelity more likely in relationships where drug or alcohol abuse is present?
Dr. Bhatt: It could be. We tend to have intact cognition when substances are not there. Let’s just take it at face value that once you add a substance, those things that you most likely would do in sound mind, you would not do when you’re intoxicated. You might end up doing those things. What ultimately happens, if somebody is having marital issues, if somebody is having some relationships issues, that when they’re using substances they can be placing themselves in situations where they are no longer thinking rationally. Unfortunately, we see a lot of times when people are intoxicated who might not even have a substance use disorder, who might be in a bar, in a restaurant, in a club, where they unfortunately act on their disinhibited states and they make errors in their judgment. When sexual, intimate things of the opposite sex or sexual relationships that would not have occurred by being protected by your intact mind. Well, when people are drunk, unfortunately all bets are off. Things are thrown out of the window. And a lot of times people do end up going to use in relationships when things are not right. They use that as fuel to go out and act on those things. It acts as a rationalizer. If I have a problem in my marriage, or a problem in my relationship, and I kind of use the excuse that the marriage is a problem and because of that marital issue. I’m going to go out and drink. I’m going to go out and drink and then I could be putting myself in a situation that I might compromise myself and my judgment and I’ll act out on certain impulses. We see that happen, unfortunately, all the time. We’re not saying that people suffer from addiction are going to be having affairs or have more infidelity. But definitely the risk is there if you have any substance on board to act in a way that you wouldn’t act normally.
Hayley: Okay, that makes sense. Also when I was reading I saw that there is a link between marital dissatisfaction and alcohol use. Why do you think that might be?
Dr. Bhatt: People who suffer with substance use disorders, they drink often as a coping mechanism. If you’re not happy in any aspect of your life, relationship being a huge part of one, we might drink to just get by. Just to deal. Just tolerate with that dissatisfaction. It’s a vicious cycle. If one person isn’t happy in a relationship or both aren’t happy in a relationship and then they’re drinking as a result of it, well then, we again have the problems that come with the drinking too. The fights, the arguments, the stuff that might be contained when we’re not drinking, lead to further drinking. It is a vicious cycle unfortunately. The dissatisfaction goes up. We see it last though. Obviously, some relationships are built on drinking together. I’ve seen many people who have substance use disorder and both partners are alcoholics. They get by just on the common thread of being alcoholics. When they seek sobriety or become sober, they have to face each other in reality and often the relationship disintegrates. It’s kind of ironic that sometimes the common thread can be the substance of abuse, but then it also can be the common problem. It’s really unique to each relationship.
Hayley: Absolutely. Going back to what you first said, it’s almost like is it the chicken or the egg of am I drinking. Because I’m unhappy in my marriage, am I unhappy in my marriage because I’m drinking? It’s interesting.
Dr. Bhatt: And the fact that that applies to any part of addiction. We know that people who suffer from substance use disorders are getting into more problems as a consequence. Part of the definition of addiction as a whole, or looking at it as a concept, is that it causes problems in multiple areas of your life. Not just multiple, it can be in any major area. But the point is that it doesn’t just have to apply to relationships. I always tell my patients, the more you use, the more problems you’re going to have. I know that sounds simplistic, but it is the truth. I bring that up only because many of the time that we suffer from substance use disorders we are saying, “we’re drinking because of…” “You don’t understand doc I have to do this because of this- I have to because of my wife, or because of my husband, or because of my job, or because of my kids”. There’s always a because of, and yet none of those things have gotten better because I ended up using. If anything, further negative consequences happen. I bring this up only because it doesn’t apply just to relationships. But when we look at the concept of addiction as a whole, relationships being a part of people’s lives, that’s the point of why we say addiction is so destructive, because nothing is preserved. It definitely will affect every part of your life.
Hayley: Like you said, you’ve seen couples who both have used together and that’s kind of what keeps them together. Have you seen that people with a substance use disorder seek out a partner that also uses?
Dr. Bhatt: Yeah, we’ll talk about early relational studies that happen. And those have demonstrated that people, especially when they’re dating, they often are going to date. They’re going to socialize. They’re going to do things because they’re singular at that time. There’s that concept of marriage or being in a relationship as being protective. That’s because there’s multiple things involved there, the dynamics of looking at yourself as you increased your surface area. You’re no longer thinking just for yourself. You have to worry about yourself. You have to worry about your partner and you’re less willing to take risks because you know that now I’m looking out for two people. And I bring that up as when we first get together, that singularity, even though you start developing that relationship, you’re taking that chance. You might want to socialize. You might want to go out and drinking is often a part of it. For many people, it is a social lubricant to actually facilitate certain parts of relationships that might be uncomfortable in the early stages. But as we go along, we see the evolution occur. As people start to look out for each other, then we can see changes occur and our drinking patterns could either change or they could stay the same. Now, like we mentioned before, if people do have substance use disorders though, if it is the common thread, people can look back as that was the origins of the relationship. What started them can end up keeping them together. Again, we see both sides of this. Substance use disorders generally tend to destroy people when one person is doing it and the other person is not, or at least a dissatisfaction. If both are doing it we tend to see similar patterns of usage. But again, each relationship is unique and it paints a different scenario based on the couple we’re speaking of.
Hayley: In the cases of a relationship where one partner is using and the other one is not, what could be some signs that your partner is hiding or trying to conceal their substance use disorder from you?
Dr. Bhatt: When you see changes in behavior, that’s really a first sign. If you know what your partner’s like without being on something, well, when they start behaving differently it raises a red flag. If they start hiding things from you, they’re missing, they stop doing their responsibilities, they stop taking care of themselves. You start smelling, alcohol for example is very evident. But if they’re using marijuana or other things that might be smoked or distinct smells to certain drugs. But what we see generally as it applies for anybody who suffers from addiction, behavioral changes, emotional changes, responsibility, being neglectful of certain things. All of those things are signs that substance use can be the underlying issue. We can dig deeper. There might be more subtle things, but in general it’s those major things that often are the giveaways.
Hayley: Say it’s a situation where one partner doesn’t know that their spouse is using, but then the find a pipe, or the bottles, something serious. Should they confront their partner?
Dr. Bhatt: Confront seems to construct this negative connotation. But it really depends on if it’s the first, second, third time and the level of the trust and the level of openness within the relationship. I don’t believe or suggest that a relationship will be healthy if you can’t ask what something’s about. Now, depending on, again, if it’s the first time, you might not get such a defensive response. You might get somebody who’s forthcoming. It’s always on the way of how you ask it, because if you ask it in an accusatory manner you might not get a very open response. People do get defensive depending on how you ask. But if somebody’s going to ask, and ask, “Hey, I found this. If there’s an issue, I would love to be supportive. If there’s something going on”. Of course, nobody wants to be suggestive, so there’s a bit of a limit on how much you should go into because you don’t want to just automatically assume that they have a problem. But if somebody is hiding pipes, they’re significant paraphernalia, unless there’s some novel collection going on of some other sorts, usually those are signs that somebody is using. I think the short answer is yes. You should ask them in an open minded and less confrontational manner as possible to hopefully illicit an honest response. And that happens not just for a partner. That’s how doctors or therapists or professionals or anybody should ask. Most people don’t want to be asked in an accusatory way especially if they’re hiding something. Because they’re often embarrassed. They’re often feeling guilty. They’re not feeling great about themselves. So, asking in a supportive manner often gets a better result.
Hayley: Because if you come at them angry or accusing, which I understand feeling that way, because you might feel a little bit of betrayal, but they’re probably going to get defensive.
Dr. Bhatt: Betrayal is a good word. Because when you’re hiding anything from your partner, especially if you’re in a relationship where you thought everything was pretty transparent, I mean of course you’re going to feel a lot of hurt yourself. And that’s going to lead to often an aggressive approach. Obviously we’re just making these comments in the event somebody who’s in this situation is listening, that they do try and think before they act. I know it’s easier said than done. I mean that as a human being we all have to struggle with how we monitor our emotions and reactions to unpleasant things. But in a situation like this, hopefully you can take a second to compose and try and put yourself in a situation where you’re going to get the best, honest response.
Hayley: I want to talk about that composure that might be easiest the first time, but if it keeps happening the third or the fourth time where you feel like your partner is lying to you or telling you that they’re going to stop, but you keep finding things. What do you do in that situation?
Dr. Bhatt: Hopefully those individuals have talked about it. Again, when you’re now talking about the second or third time, hopefully they talked about what if it happened again. There’s boundaries and limits that people do set for each other, and often this is where the relationships start to fragment. Often, they’re told or given an ultimatum. “Okay I’ll let you go this time, but if this happens again this is what I’m going to do”. And this is where I think families and loved ones fall into the, “Am I negative reinforcing or enabling because I’ve made some sort of threat or consequence that would occur?” But instead, if they look at rescue mechanisms, ways that we can say, “Hey. If this happens again, maybe we should seek help”. And again, try and paint it in a positive way. Not the relapse or the repetitive use, but that it won’t be a punitive consequence. Now, that’s hard, because sometimes the limits are set that, hey, if somebody continues to act in a certain way that’s so detrimental that it’s unfortunate that they don’t seek out help, or act in the healthiest way. I wish it so easy that, “Hey. The next time you relapse, how about we then go to rehab?” And the next day the relapse and go to rehab or they seek out professional help. My point being is that look out ways to proactively help as opposed to maybe act in a punitive way. Because then you’re not really solving the problem. It may work, but ultimately the goal is to hopefully get this person treatment or help if this person is suffering from an addiction or an underlying mental health condition or both; that’s leading to this usage. Being punitive without corrective is maybe a better way to go.
Hayley: Can you think of some situations where, I know this would definitely depend on the couple and what’s going on, but what are some times where it’s just the right time to walk away?
Dr. Bhatt: I kind of have this rule about safety. Safety tends to be this word that I use for a lot of things. When a human being’s life, or somebody else’s life is in danger, that would really be a time where you need to not have too many options. Other than you need to get out of that situation to preserve yourself and that person. A lot of times, being with each other in a negative state often leads to more anger and more behaviors that could be very destructive to the person using, the person not using, whomever. I think that would really be my barometer. When safety is an issue, I don’t think you should be sticking around at that moment, especially because there’s often not a way to get out of it without somebody getting hurt. That would really be the point that I would use. But that doesn’t mean though, that people can’t get out earlier. You don’t have to wait until somebody is beating the other person up or hurting themselves. I think each individual is going to have their own threshold as to how long they want to stick around. But if it’s negatively effecting you, physically, mentally, often it’s time to just step back a little bit and hopefully the other person can get help and the person who’s the partner in the relationship can get help themselves. There are professional organizations out there that could help both in those situations. It’s hard. It’s unique to each relationship, but safety is my big one in terms of staying or leaving.
Hayley: I think it’s important to also build that trust within yourself to know that if something’s not right. And in your gut, you know you need to leave. Trust yourself to know you’re going to make that decision to walk away if that’s what’s best.
Dr. Bhatt: Yeah, definitely. And it’s hard, it’s hard for a parent. Again, we’re talking about more intimate relationships here in terms of couples, but this applies to anybody. This could be a parent and a child. This could be people who are siblings. This could be anybody that are close together that you have to have certain things that you can uphold. I think you said it well. If you set your threshold and it happens again, hopefully you’re setting up yourself to be able to act on them realistically. Otherwise you’re probably not helping that person. That’s why I was saying before. Whatever consequences or whatever things you implement, make sure you can uphold them. Those things can unfortunately backfire on you if keep making those type of consequences and then don’t go through with them. As we all know, with raising children for example, this negatively reinforces them. This applies similarly in these situations too.
Hayley: On the other side of that, looking at the partner who is in the process of recovery. How can they work on earning back the trust of their partner?
Dr. Bhatt: I think sobriety and working a program, or even just demonstrating that they’re making an honest effort of avoiding that drug or alcohol. It’s very hard to repair certain types of damage, but we see it all the time that couples who see their partners working very hard to work hard on the relationship for themselves as a patient and as a whole. Like I said, once you become a couple, it’s not just a singular person anymore. We’re looking at a family dynamic. And there are bigger consequences because our actions effect more than one person. When a person has lost that trust, they start to see it as, “Hey, this person is caring for us as a unit again, as they care for themselves”. That could include a couple’s children, parents. And usually, hopefully, that’s when somebody’s no longer using that they start to gain that cognitive, positive, proper thinking again, and rational thinking will win out. They can work then on the relationship itself. All of these things contribute to gaining that trust, healing those wounds, and hopefully going back to what kept them or brought them together in the first place. But it starts with removing the agent and gaining sobriety first before you can work on all of those other things. That often starts by getting treatment. If somebody’s strong enough to stop on their own, that’s great and we probably don’t have the statistics of how often that might happen around the world. But the point is, you have to remove the offending agent in order for any healing to take place.
Hayley: It’s so important for both parties to just have patience, because that’s really key here. This whole process of recovery, it takes time. You can’t be sober for a week and expect your partner to forget everything that happened. You just have to be patient.
Dr. Bhatt: Definitely. That patience comes with often understanding this person who does suffer with a substance use disorder has an illness. I know that’s often hard to tease out when we’re family members, because there’s so much intertwined with that concept. It’s easier said than done. Because you see so many things done purposefully and done with willfulness and willingness, that’s hard for people not to say, “Oh my god, this is not the illness talking. This is just him behaving or her behaving this way”. Separating the two becomes very hard because all of those emotions get enmeshed. It’s hard to forgive people or hard to look at it as somebody who’s struggling with an illness or disease. Where if somebody was suffering from cancer, or from a cardiac condition, sometimes it’s easier to digest the consequences that come from that. That’s usually because they don’t affect the other person as much, or the unit as much. I bring this up because that can contribute to the healing, or at least the understanding part that leads to them being more patient to allow the treatment or the recovery to take place. If you look at it with that approach, as opposed to just saying, “Hey, look at this person acting this way and they’re doing this on purpose. And they’re doing this to harm me”. Well then, your patience is probably going to get thrown out the window.
Hayley: That’s true. And although patience is very important, I do want to jump back to what you said earlier, just about safety. You should never risk your well-being if your partner starts acting abusively. Even if you want to support them, your safety is your first priority. You can call the National Domestic Violence Hotline for help 24/7 if you ever need to reach out, and you can also learn more about addiction and relationships at addictioncenter.com. Thank you, Dr. Bhatt. We hope to have you next week for another episode of Straight Talk With The Doc.
Dr. Ashish Bhatt
Throughout his career, Dr. Bhatt has been a leader in substance abuse treatment programs, including administrative and medical directorship positions for inpatient and outpatient programs, detox units, and inpatient residential dual-diagnosis facilities. He is a Board Certified Diplomate of the American Board of Psychiatry and Neurology in both Adult and Child and Adolescent Psychiatry, a Certified Medical Review Officer, and is Board Certified in Addiction Medicine. He has served as the Chief Medical Officer for regional and national behavioral health companies and worked to develop public and private substance abuse and dual diagnosis facilities.