I would like to share my experience in addiction treatment. My practice began in 1991 with six heroin addicts. I combined the 12-Step program with a methodology I had personally developed 10 years earlier. The program is a holistic method, which allows addicts to quickly achieve sobriety without the help of pharmaceutical medications, and to rapidly improve his or her mood, so as to remain happy, positive and sober long term.
In 1996 I founded The Marshak Clinic. The clinic rapidly became known as the most successful rehabilitation center. By 2007, more than 2,000 alcoholics and drug addicts had completed our residential program As the two clinic follow-up surveys demonstrated, about 70 percent of our alumni still enjoyed continued sobriety two years after completing the treatment. Many were able to improve the quality of their lives.
I believe that pathological addictions have the same structure as what I call “healthy addictions.” These “healthy addictions” are instinctive behaviors that activate the reward system, which exists in the brain of all animals. They include breathing, food and water consumption, waste elimination, sleep and reproduction. These behaviors support our life and survival, both as individuals and as a species, and have two important qualities similar to those of pathological addictions:
- When we abstain from using the instinctive behaviors for a long enough period, we experience a growing discomfort, which at some point, becomes intolerable.
- Each time we resume the instinctive behavior, we experience a feeling of instant gratification or relief.
A simple illustration of these two principles is shown in an experiment that relates to breathing, hunger or thirst. Attempting to delay the normal cycle of any of the above mentioned behaviors will negatively impact your mood, whereas resumption will alleviate your “distress.”
Try not breathing for one minute; you will experience intense discomfort. Now, inhale; instant relief. The behavior pattern is supported biologically by pain/pleasure neurotransmitters in your brain.
Addicted persons who abstain from drugs feel a similar pain and sense of despair. When an addicted person uses again, he or she will have a similar feeling of instant gratification and relief, as compared to what you felt when you resumed breathing.
I believe that all animals live according to two basic rules that determine their behavior patterns throughout life:
The Rule of Intolerable Pain
When an animal or human suffers physical or mental discomfort, the period of time that suffering can be tolerated decreases as the pain increases. If the suffering — either physical or mental — becomes too great, people chose to end their suffering and commit suicide.
The Rule of Behavioral Imprinting
mental discomfort and then engages in behavior that results in instant gratification, such behavior will be recognized by the brain’s reward system as highly valuable. It will be imprinted into the neural pathways and added to the list of the “SOS tools” that we use in times of trouble. The faster an SOS tool allows us to transition from “dysphoria” to “euphoria,” the higher its ranking on the list. That is why smoking crack cocaine is more addictive than snorting cocaine — the resulting gratification is achieved more instantly. After using a new SOS tool that successfully and instantly alleviates discomfort several times, this behavior pattern becomes instinctive, and from then on, is extremely difficult to control.
The Marshak Method is based on the first rule of addiction, The Rule of Intolerable Pain, and uses two complimentary strategies, biological and psychological, to quickly normalize the brain’s reward system.
First, a biological approach is used to achieve and maintain a baseline state of pleasurable well-being. When anaddicted individual experiences internal comfort, his or her craving for drugs substantially decreases and becomes controllable. Once an addicted person achieves a steady state of internal comfort, his or her whole personality changes. If all of the addict’s previous behaviors were devoted to drug use, in order to achieve short episodes of feeling good, his or her behavioral skills will now be turned extensively to protecting this newly achieved internal comfort.
The biological component includes:
- A special exercise regimen, derived from Hatha and Kundalini Yoga, which over the years, I have personally designed to enhance the mood of my clients and help them sustain the resulting sense of well-being
- Bioactive nutritional supplements that compliment the exercise regimen and enhance the ability of exercise to elevate the mood
- A recovery diet, which is designed to minimize mood swings and elevate energy levels
- Genetic testing that identifies variations in a number of genes which can predict predisposition to addiction
Exercise program — why yoga?
I have been practicing yoga for 37 years, and studying the effects of various yoga styles and exercises on mood regulation. To help addicts attain sobriety and maintain sobriety long term, I have carefully selected the type of exercise that most quickly elevate the mood.
There are three groups of exercise that I use to achieve mood regulation. The first group of exercise helps one feel invigorated and energized throughout the day, and when practiced each morning, puts him or her in a joyful state through which he or she achieves reward from daily activities, such as work. The second group of exercise, usually practiced in the evening, help a person efficiently achieve deep relaxation and tranquility, and then rest, without using tranquilizers such as alcohol, benzodiazepines or opiates. The third group of exercise are designed to relieve and control anxiety. These exercises consist of alternating anxiety-provoking and anxiety-calming exercises that train certain areas of the brain to inhibit endogenous anxiety.
Our experience shows that alumni who continue for two years after completion of treatment, to practice Marshak exercises daily for at least 60 minutes; take their prescribed food supplements; and follow a low glycemic diet; will maintain the elevated state of well-being they have achieved, which is a condition for long-term sobriety. Apparently, two years is enough to stabilize the neurochemistry of the brain’s reward regulation system at the new higher level achieved during residential treatment, even if they then stop the daily routine.
While working to make the Marshak Method more efficient, I discovered that combining bioactive food supplements with the exercise program significantly increases the mood enhancing effects of the exercises. I call this phenomenon “brain building.” It is analogous to bodybuilding. To maximize muscle growth, bodybuilders combine special muscle training with specialized nutritional products that support the increased demand of muscle cells for protein and energy. To maximize brain building, we have a special exercise programs which stimulates neuronal pathways that provide a feeling of reward. When combined with specialized nutritional products — amino acids, fatty acids, vitamin and mineral “feeds” — we maximize reward system performance by providing these neuronal pathways with precursors and facilitators of neurotransmitter synthesis.
Different sets of Marshak exercises stimulate different areas of the brain. Knowledge of brain biochemistry has allowed us to formulate food supplement cocktails which, in combination with the exercises, greatly enhance brain performance.
There is very little doubt that addiction has a strong genetic component. Since 1990, numerous scientific studies were dedicated to identifying a growing number of gene variants that predispose people to addiction. A deviation in these genes can cause a shift in one of the many biochemical reactions in the brain that are responsible for regulation of mood and behavior. The resulting biochemical imbalance can lead to chronic dysphoria and vulnerability to stressful environmental factors, which may result in a person searching for relief and seeking drugs to alleviate the emotional pain. The results of the confidential genetic testing provide information about whether each individual client carries gene variants that can cause mood dysregulation. Knowledge of the client’s genetic profile allows us to identify biochemical or neurological pathways that might be compromised due to genetic factors.
The life of an addicted individual is centered around his or her drug of choice. If the drug is not readily available when needed, a person experiences severe dysphoria and anxiety. Every time an addict feels uncomfortable, he or she depends on the drug to regain the feeling of comfort, just to lose it again when the effects of the drug wear off. The addict becomes a seeker of instant gratification. All of his or her feelings, thoughts and behavioral strategies are aimed at grasping a short-lived state of comfort.
When addicted people transit from an unhappy to happy state of well-being, their personalities change. This transition can be dangerous, especially if it happens fast, as it does during a 28-day residential program at the Marshak Method. As an addicted person attains a higher level of well-being, he or she will begin to remember any of the immoral acts committed in the throes of addiction. This can result in powerful surges of guilt, shame, remorse and repentance. Consequently, these memories can bring back the depression, which in turn, may provoke drug or alcohol cravings. This is why psychological support is so important during residential treatment for 30 to 60 days after clients complete treatment. We help those “emotionally thawing” clients to dissociate themselves from the things they did while using. We explain to them that what they did was not their real nature, but the nature of their disease, in the same way that fever is a symptom of the flu.
We base our psychological support system on the 12-Step program, which I believe has three important features that assist addicts as they transition to and learn to maintain a sober lifestyle. First, the 12-Step program provides great tools for an addict to safely go through the process of remembering his past and dissociating his previous immoral behavior from the concept of self.
Second, the 12-Step program teaches skills of sober behavior; educates addicts in how to recognize early triggers of relapse; and provides aid at times of dysphoria and craving. It also provides an individual with a strong social support group in the form of a sponsor and peers.
The third and most important feature of the 12-Step program is that it engages its members in an emotionally rewarding life style. We found that there are eight behavioral practices in the 12-Step program that increase our client’s state of well-being: practicing religious feelings and prayer; avoiding the instant gratification that comes with offending others; forming friendships; experiencing insight from understanding and relating to the experiences of peers; getting intellectual pleasure from analyzing and understanding life experiences; sharing and experiencing relief from confession; experiencing reward from doing good deeds; and zealousness.
We believe that the deep and detailed explanation of the benefits of the 12-Step program greatly increases the participation and involvement of our clients in the clinic’s program, and thus, enhances the chance that our alumni will go on to live joyful and sober lives.
Respectfully, Dr. Yakov Marshak.
Dr. Jacob Marshak is the founder and program director of the new Wellness Center“Cape House”for alcohol and drug rehabilitation in Cape Cod, MA. He earned his medical degree from Moscow State Medical University, and was one of the first Soviet doctors brought to the United States to learn 12-Step methodology. Dr. Marshak became a Certified Addiction Professional in 1989 after six months of training at Florida’s Heritage Health Treatment Center.
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