In my private practice my path is to remove obstacles blocking my patient's path to reaching their full potential. Many of the people who walk thru my door are in various stages of either substance abuse, substance dependence and other issues that take on the appearance of an addiction. I am very careful to refrain from labeling my patients as I find labeling is not helpful and only adds to the feelings of shame most of my patients are already experiencing from their inner critical voice.

In working with my patients one issue continues to bind them together and that is their inability to set healthy, flexible boundaries. Many of the self proclaimed addicts I work with also admittedly suffer from issues surrounding their codependence.  As a result many would describe themselves as typically having very unhealthy interpersonal boundaries. Those of us raised in dysfunctional families often find the concept of healthy boundaries to be a revelation in our recovery. One of the first steps I introduce to my clients on their path to recovery is how to develop and implement boundaries. In doing so the first statement I teach them is as follows:

No is a complete sentence...

In helping my patients develop healthy interpersonal relationships I have received much feedback from my clients. They are often some of my most influential teachers. Below is a list that I have created and edited over the years that I have been informed has been helpful to my clients. Many items on the lists you may recognize from your own past. The purpose of the list is to simply bring consciousness and awareness to your own personal "operating" system and ask yourself if you identify with any of the statements have they proved to be obstacles in your pursuit of happiness?

Signs of Unhealthy Interpersonal Relationships
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• Telling all.
• Talking at an intimate level at the first meeting.
• Falling in love with anyone who reaches out.
• Being overwhelmed by a person – preoccupied.
• Acting on the first sexual impulse.
• Being sexual for your partner – not yourself.
• Going against personal values or rights to please others.
• Not noticing when someone else displays inappropriate boundaries.
• Accepting food, gifts, touch or sex you don’t want.
• Touching a person without asking.
• Taking as much as you can get for the sake of getting.
• Giving as much as you can give for the sake of giving.
• Allowing someone to take as much as they can from you.
• Letting others direct your life.
• Letting others describe your reality.
• Letting others define you.
• Believing others can anticipate your needs.
• Expecting others to fill your needs automatically.
• Falling apart so someone can take care of you.
• Self-abuse.
• Sexual and physical abuse.
• Food and chemical abuse.

Recommend readings on boundaries

• Boundaries: When to Say to No to Take Control of Your Life
  By Doctor Henry Cloud and Dr. John Townsend

Thom Kessler, LMFT, RAS
Thom@thomkesslertherapist.com
415-454-8931

​Introducing the Human Brain
The human brain is the most complex organ in the body. This three-pound mass of gray and white matter sits at the center of all human activity—you need it to drive a car, to enjoy a meal, to breathe, to create an artistic masterpiece, and to enjoy everyday activities. In brief, the brain regulates your basic body functions, enables you to interpret and respond to everything you experience; and shapes your thoughts, emotions, and behavior.

The brain is made up of many parts that all work together as a team. Different parts of the brain are responsible for coordinating and performing specific functions. Drugs can alter important brain areas that are necessary for life-sustaining functions and can drive the compulsive drug abuse that marks addiction. The brain areas affected by drug abuse as follows:
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• The brain stem controls basic functions critical to life, such as heart rate, breathing, and sleeping.
• The limbic system contains the brain’s reward circuit—it links together a number of brain structures that control and regulate our ability to feel pleasure. Feeling pleasure motivates us to repeat behaviors such as eating—actions that are critical to our existence. The limbic system is activated when we perform these activities—and also by drugs of abuse. In addition, the limbic system is responsible for our perception of other emotions, both positive and negative, which explains the mood-altering properties of many drugs.
• The cerebral cortex is divided into areas that control specific functions. Different areas process information from our senses, enabling us to see, feel, hear and taste. The front part of the cortex, the frontal cortex or forebrain, is the thinking center of the brain; it powers our ability to think, plan, solve problems, and make decisions.

How does the brain communicate?

The brain is a communications center consisting of billions of neurons, or nerve cells. Networks of neurons pass messages back and forth to different structures within the brain, the spinal column, and the peripheral nervous system. These never networks coordinate and regulate everything we feel, think, and do.

• Neuron to Neuron

Each nerve cell in the brain sends and receives messages in the form of electrical impulses. Once a cell receives and processes a message, it sends it on to other neurons.

• Neurotransmitters—The Brain’s Chemical Messengers

The messages are carried between neurons by chemicals called neurotransmitters. (They transmit messages between neurons.)

• Receptors—The Brain’s Chemical Receivers

The neurotransmitter attaches to a specialized site on the receiving cell called a receptor. A neurotransmitter and its receptor operate like a “key and lock,” an exquisitely specific mechanism that ensure that each receptor will forward the appropriate message only after interacting with the right kink of neurotransmitter.

• Transporters—The Brain’s Chemical Recyclers

Located on the cell that releases the neurotransmitter, transporters recycle these neurotransmitters (i.e., bring them back into the cell that released then), thereby shutting off the signal between neurons.

How do drugs work in the brain?

Drugs are chemicals. They work in the brain by tapping into the brain’s communication system and interfering with the way nerve cells normally send, receive, and process information. Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter. This similarity in structure “fools” receptors and allows the drugs to lock onto and activate the nerve cells. Although these drugs mimic brain chemicals, they don’t activate nerve cells in the same way as a natural neurotransmitter, and they lead to abnormal messages being transmitted through the network.

Other drugs, such as amphetamine or cocaine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters or prevent the normal recycling of these brain chemicals. This disruption produces a greatly amplified message, ultimately disrupting communication channels. The difference in effect can be described as the difference between someone whispering into your ear and someone shouting into a microphone.

How do drugs work in the brain to produce pleasure?

All drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who abuse drugs and teaches them to repeat the behavior.

How does stimulation of the brain’s pleasure circuit teach us to keep taking drugs?

Our brains are wired to ensure that we will repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way.

Why are drugs more addictive than natural rewards?

When some drugs of abuse are taken, they can release 2 to 10 times the amount of dopamine that natural rewards do. In some cases, this occurs almost immediately (as when drugs are smoked or injected), and the effects can last much longer than those produced by natural rewards. The resulting effects on the brain’s pleasure circuit dwarfs those produced by naturally rewarding behaviors such as eating and sex. The effect of such a powerful reward strongly motivates people to take drugs again and again. This is why scientists sometimes say that drug abuse is something we learn to do very, very well.

What happens to your brain if you keep taking drugs?

Just as we turn down the volume on a radio that is too loud, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number of receptors that can receive and transmit signals. As a result, dopamine’s impact on the reward circuit of a drug abuser’s brain can become abnormally low, and the ability to experience any pleasure is reduced. This is why the abuser eventually feels flat, lifeless, and depressed, and is unable to enjoy things that previously brought them pleasure. Now, they need to take drugs just to bring their dopamine function back up to normal. And, they must take larger amounts of the drug than they first did to create the dopamine high—an effect known as tolerance.

How does long-term drug taking affect brain circuits?

We know that the same sort of mechanisms involved in the development of tolerance can eventually lead to profound changes in neurons and brain circuits, with the potential to severely compromise the long-term health of the brain. For example, glutamate is another neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate for this change, which can cause impairment in cognitive function. Similarly, long-term drug abuse can trigger adaptations in habit or non-conscious memory systems. Conditioning is one example of this type of learning, whereby environmental cues become associated with the drug experience and can trigger uncontrollable cravings if the individual is later exposed to these cues, even without the drug itself being available. This learned “reflex” is extremely robust and can emerge even after many years of abstinence.

What other brain changes occur with abuse?

Chronic exposure to drugs of abuse disrupts the way critical brain structures interact to control behavior—behavior specifically related to drug abuse. Just as continued abuse may lead to tolerance or the need for higher drug dosages to produce an effect, it may also lead to addiction, which can drive an abuser to seek out and take drugs compulsively. Drug addiction erodes a person’s self-control and ability to make sound decisions, while sending intense impulses to take drugs.


Thom Kessler, LMFT, RAS
Thom@thomkesslertherapist.com
415-454-8931

​What are the medical consequences of drug addiction?

Individuals who suffer from addiction often have one or more accompanying medical issues, including lung and cardiovascular disease, stroke, cancer, and mental disorders. Imaging scans, chest x-rays, and blood tests show the damaging effects of drug abuse throughout the body. For example, tests show that tobacco smoke causes cancer of the mouth, throat, larynx, blood, lungs, stomach, pancreas, kidney, bladder, and cervix. In addition, some drugs of abuse, such as inhalants, are toxic to nerve cells and may damage or destroy them either in the brain or the peripheral nervous system.

Does drug abuse cause mental disorders, or vice versa?

Drug abuse and mental disorders often co-exist. In some cases, mental diseases may precede addiction; in other cases, drug abuse may trigger or exacerbate mental disorders, particularly in individuals with specific vulnerabilities.

What harmful consequences to others result from drug addiction?

Beyond the harmful consequences for the addicted individual, drug abuse can cause serious health problems for others. Three of the more devastating and troubling consequences of addiction are:

• Negative effects of prenatal drug exposure on infants and children.

It is likely that some drug-exposed children will need educational support in the classroom to help them overcome what may be subtle deficits in developmental areas such as behavior, attention, and cognition. Ongoing work is investigating whether the effects of prenatal exposure on brain and behavior extend into adolescence to cause developmental problems during that time period.

• Negative effects of second-hand smoke.

Second-hand tobacco smoke, also referred to as environmental tobacco smoke (ETS), is a significant source of exposure to a large number of substances known to be hazardous to human health, particularly to children. According to the Surgeon General’s 2006 Report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, involuntary smoking increases the risk of heart disease and lung cancer in never-smokers by 25-30 percent and wp-30 percent, respectively.

• Increased spread of infectious diseases.

Injection of drugs such as heroin, cocaine, and methamphetamine accounts for more than a third of new AIDS cases. Injection drug use is also a major factor in the spread of hepatitis C, a serious, potentially fatal liver disease and a rapidly growing public health problem. Injection drug use is not the only way that drug abuse contributes to the spread of infectious diseases. All drugs of abuse cause some form of intoxication, which interferes with judgment and increases the likelihood of risky sexual behaviors. This, in turn, contributes to the spread of HIV/AIDS, hepatitis B and C, and other sexually transmitted diseases.

What are some effects of specific abused substances?

• Nicotine is an addictive stimulant found in cigarettes and other forms of tobacco. Tobacco smoke increases a user’s risk of cancer, emphysema, bronchial disorders, and cardiovascular disease. The mortality rate associated with tobacco addiction is staggering. Tobacco use killed approximately 100 million people during the 20th century and, if current smoking trends continue, the cumulative death toll for this century has been project to reach 1 billion.
• Alcohol consumption can damage the brain and most body organs. Areas of the brain that are especially vulnerable to alcohol-related damage are the cerebral cortex (largely responsible for our higher brain functions, including problem solving and decision making), the hippocampus (important for memory and learning), and the cerebellum (important for movement coordination).
• Marijuana is the most commonly abused illicit substance. This drug impairs short-term memory and learning, the ability to focus attention, and coordination. It also increases heart rate, can harm the lungs, and can cause psychosis in those at risk.
• Inhalants are volatile substances found in many household products, such as oven cleaners, gasoline, spray paints, and other aerosols, that induce mind-altering effects. Inhalants are extremely toxic and can damage the heart, kidneys, lungs, and brain. Even a healthy person can suffer heart failure and death within minutes of a single session of prolonged sniffing of an inhalant.
• Cocaine is a short-acting stimulant, which can lead abusers to “binge” (to take the drug ma y times in a single session). Cocaine abuse can lead to severe medical consequences related to the heart, and the respiratory, nervous, and digestive systems.
• Amphetamines, including methamphetamine, are powerful stimulants that can produce feelings of euphoria and alertness. Methamphetamine’s effects are particularly long lasting and harmful to the brain. Amphetamines can cause high body temperature and can lead to serious heart problems and seizures.
• Ecstasy (MDMA) produces both stimulant and mind-altering effects. It can increase body temperature, heart rate, blood pressure, and heart wall stress. Ecstasy may also be toxic to nerve cells.
• LSD is one of the most potent hallucinogenic, or perception-altering, drugs. Its effects are unpredictable, and abusers may see vivid colors and images, hear sounds, and feel sensations that seem real but do not exist. Abusers also many have traumatic experiences and emotions that can last for many hours. Some short-term effects can include increased body temperature, heart rate, and blood pressure; sweating, loss of appetite; sleeplessness; dry mouth; and tremors.
• Heroin is a powerful opiate drug that produces euphoria and feelings of relaxation. It slows respiration and can increase risk of serious infectious diseases, especially when taken intravenously. Other opioid drugs include morphine, OxyContin, Vicodin, and Percodan, which have legitimate medical uses; however, their non-medical use or abuse can result in the same harmful consequences as abusing heroin.
• Prescription medications are increasingly being abused or used for nonmedical purposes. This practice cannot only be addictive, but in some cases also lethal. Commonly abused classes of prescription drugs include painkillers, sedatives, and stimulants. Among the most disturbing aspect of this emerging trend is its prevalence among teenagers and young adults, and the common misperception that because these medications are prescribed by physicians, they are safe even when used illicitly.
• Steroids, which can also be prescribed for certain medical conditions, are abused to increase muscle mass and to improve athletic performance or physical appearance. Serious consequences of abuse can include severe acne, heart disease, liver problems, stroke, infectious diseases, depression, and suicide.
• Drug combinations. A particularly dangerous and not uncommon practice is the combining of two or more drugs. The practice ranges from the co-administration of legal drugs, like alcohol and nicotine, to the dangerous random mixing of prescription drugs, to the deadly combination of heroin or cocaine with fentanyl (an opioid pain medication). Whatever the context, it is critical to realize that because of drug—drug interactions, such practices often pose significantly higher risks than the already harmful individual drugs.

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Thom Kessler, LMFT, RAS
Thom@thomkesslertherapist.com
415-454-8931

​This is What Alcohol is Really Doing to Your Body

The drinking of alcohol can affect the body in a number of ways.  While we are very familiar with the outward manifestations of alcohol consumption the short and long-term effects of alcohol use and abuse on the body and brain needs to be acknowledged and addressed.  While these effects are not easily visible, the continued use and subsequent abuse of alcohol can have significant health risks over time.  It is important to understand both the short-term as well as the long-term effects of alcohol consumption.

Short-Term Effects of Alcohol Consumption

When alcohol is consumed approximately twenty percent of it is absorbed rapidly in the bloodstream while the remainder is processed through the gastrointestinal tract.  Once alcohol enters the bloodstream and can be absorbed and diffuse into every major organ because the cell membranes of all the major organs are highly sensitive to alcohol.  The effects of alcohol are dependent on a person’s weight, age and gender.  Additionally, a person’s body composition, overall health and history of drinking also play crucial roles in regards to alcohol’s overall effects on the body.

When people begin consuming alcohol they initially may feel increased relaxation, self-confidence, happiness and sociability, but these can generally progress into more negative behaviors. Alcohol consumption leads to the slowing of reflexes, reduced coordination, impaired thinking, poor judgment, depression, impaired memory, and a decreased ability to control motor functions.  Additionally, alcohol use has been linked to violent behavior and an increase in unprotected sex among young adults. Alcohol also increases the risk of becoming a victim of sexual assault. Alcohol increases the risk of motor vehicle accidents, suicide, injury, domestic violence and drowning.

Long-Term Effects of Alcohol Consumption

When alcohol is continuously consumed over a period of time it begins to affect the body in a myriad of ways. Long term and excessive consumption of alcohol increases the risk of many cancers including liver, breast, esophagus, pancreas, mouth, larynx and pharynx. Alcohol use over time can also cause alcohol dependency better known as alcoholism.  Since alcohol, even in moderate amounts, can cause significant health issues over time, it is important to understand those complications.

For example, excessive drinking can cause fatty deposits to build in the liver, which can cause hepatitis, which can cause the liver to not absorb nutrients.   Cirrhosis of the liver can also take place with excessive alcohol use. Cirrhosis is the scarring of the liver and with the excess of scar tissue can bring forth complications such as jaundice, fatigue and loss of appetite.

Heavy drinking can also have significant effects on the heart.  Some conditions that can be brought on by alcohol abuse include cardiomyopathy, which causes the heart muscle to expand and droop.  Another potentially serious heart condition is myocarditis, which is the inflammation of the heart muscle.  Other complications can include irregular heartbeat, increased cholesterol and greater risk of heart attacks and stroke.

Additionally, excessive drinking can accelerate the rate of bone deterioration and increase the risk for bone fracture and osteoporosis. Calcium is necessary from strong, dense bones and when alcohol is consumed it acts as a diuretic and flushes calcium from the bones making them weaker and more susceptible to fracture. When alcohol is consumed excessively it can also cause cell damage in the central nervous system creating a condition known as neuropathy. Neuropathy causes alternating feelings of weakness, burning, pain and numbness in the feet and hands.

Knowing the dangers of both the short and long-term effects of alcohol is an important tool in the journey of recovery.  Being aware of complications brought on by excessive use physically, emotionally and psychologically can act as a great motivator to pursue the path of recovery. If you or a loved one has a problem with alcohol, give me a call and together we can come up with a plan to help you decrease or become abstinent from alcohol.

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Thom Kessler, LMFT, RAS
Thom@thomkesslertherapist.com
415-454-8931