As part of my commitment to working the 12 steps, my sponsor asked me to buy this book
It duly arrived from Amazon yesterday and I started reading it.
The first pages are concerned with some of the neuroscience of dependence and recovery which has been well researched especially in the last 20 years.
Interesting stuff. My sponsor thought it would interest me with my scientific background, and she was right.
Essentially, and I’ve tried to summerise and write in non scientific jargon (when I tried to read some of the original papers by Nutt and some others my brain got scrambled, much too technical and complex)
1.Addictive behaviour can be shown to cause hundreds of changes in the brain anatomy, chemistry, and especially in cell-to-cell signalling, We know, from many studies, that messages passed between brain nerve cells are the molecular basis for learning and memory. Neurotransmitters (chemicals that pass messages between nerve cells) are also heavily implicated in mood disorders and behaviour, Deficiency in, for example. the neurotransmitter serotonin leads to depression, which can be successfully treated by increasing serotonin levels.
2. The brain is amazingly good at adaptation. Called “neuroplasticity” this is an umbrella term for a sequence of processes that occur in your brain over time in response to any incoming stimuli. Your experiences, behaviours, thoughts, and emotions physically change the form and function of your brain. In other words, based on life experiences and repeated behaviours, emotions, and thoughts your brain remodels itself and especially its inter-connections. This is particularly obviously seen when for example a person who is right hand dominant loses their right hand and learns to write with the left.
Are you with me so far ? makes sense to me so far ….
3. Because of neuroplasticity, what you do habitually – both good and bad – literally gets hard-wired in to the structure of your brain. from writing with your non dominant hand, to remembering to check your mirror before you pull out in the car… we all know this yes? when you learn to drive you think about it ALL the time, but with practice it becomes instinctual. I tell this to my trainee doctors, … whilst you are worrying about HOW to examine the heart you will hear nothing abnormal. Only when you have done it thousands of times , so the actions and processes require no conscious thought, is your brain free to pick up the abnormalities. So similarly, repeatedly worrying about finances, catastrophising about mistakes at work, drinking alcohol to relax, placing a bet, using cocaine …. all of it, is laying down hard-wired pathways in the brain.
Equally important as this creating of new neural pathways by repetitive drinking or drug taking is the role of neurotransmitters. e.g. dopamine
4. Dopamine is particularly interesting to addictions scientists because it is the major neurotransmitter manipulated with drug / alcohol use. When something we perceive to be “good” is taken/done , that’s when dopamine is released. Different people need different pleasures and rewards to get enough dopamine. A food addict’s neurones get activated with the bite of a juicy hamburger, Similarly, an alcoholic gets that same rush of dopamine when that first drink is sipped. Dopamine surges produce a euphoric effect that rewards and reinforces the addicts behaviour. Unfortunately this dopamine high gradually becomes more difficult to achieve on the amount of the drug / stimulus they used to take, which is why the addict winds up taking more of the drug than previously to achieve that same feeling. The addict may not realise it but they are affecting the functioning of their brain and altering its chemical structure (through neuroplasticity) to achieve that high.
5. In addition, the manipulation of serotonin, (another neurotransmitter like dopamine but which instead regulates mood) leads to the laying down of behavioural circuits that create irritability and depression when the addict abstains from drug / alcohol / addictive behaviour. Hence the come down described by so many addicts. It’s psychological yes, but it’s also a physically motivated sensation.
6. Your nucleus accumbens (which is part of the limbic system in the brain – think emotions center and memory bank) craves the dopamine hit that it knows goes with what it has learned to be pleasurable (see new pathways laid down that associate alcohol with a nice dopamine rush) The thing is, the first time you do something, the dopamine rush comes after the action. In the future, the dopamine is released earlier and earlier until just thinking about something in anticipation causes a dopamine reward. So, the dopamine released before the action and along the way actually motivates you towards the behaviour, and a bad habit is born.
Every time you follow the same path, a specific pattern is activated and becomes more defined in your brain – it forms a kind of circuit, and it becomes easier to activate the circuit the next time and so on. Pretty soon, the bad habit neuronal pathway becomes the unconscious default, and your brain, wanting to be efficient, just takes the easiest, most familiar route.
By taking advantage of the brain’s plasticity, addiction remodels neural circuits to assign supreme value to cocaine or gin or gambling, at the expense of other interests such as health, work, family, or life itself
Ok. Thats the neuroscience. It makes sense to me in many ways, but It doesn’t however explain why I am an alcoholic / addict and my brother is not. Thats somethings I will need to look into further.
Now I entitled this post the ‘neuroscience of recovery’ becaue thats what I’m most interested in… and I think you can guess how this goes from reading the above …
1. What is learned can be unlearned. Because neuroplasticity is fundamentally present for out whole lives, the brain can make changes to support new, healthier behaviours: basically we can retrain the brain, With intensive therapy and other holistic interventions, esepcially repeated positive behaviour thoughts and actions, we can strengthen the new “recovery” loop within the brain. The brain then learns to enjoy recovery, those things that give us pleasure in our sober lives – family, work, interpersonal interactions. We retrain the brain, by our actions we lay down new pathways that provide pleasure, and thus we are able to make changes.
BUT, the old neural pathways, the old links between addiction and pleasure are still there. This is why complete abstinence from drugs and alcohol is essential to addicts. It doesn’t take much to jump start the old habit. Recovery doesn’t remove the old pathways, it just allows them to fall into disuse and no longer be the ‘go to’ response.
Great, retrain the brain… But HOW ? HOW ! what are we doing to do to replace those big dopmine hits ….. There has been quite a lot of work on this, and some people seem to have studied the brains of recovering addicts in quite extrordinary detail! My research is not complete and not from Google scholar (at the moment) but there is some evidence that storytelling, which is a core tenet of 12 step programmes activates the doapmine system, giving the speaker a powerful boost.
There is evidence for mirroring being helpful in rewiring brains – basically if you hang out with clean and sober people you are more likley to be clean and sober, and that this mirroring of others behaviours also give you a dopamine boost . There is evidence that the love and care recovery communities share has a very positive effect on brain rewiring, but I couldnt really work out how.
I think the main things I came away with from having done a LOT of reading over the past few days is that addicts lay down new pathways in the brain which both cause and result from addictive behaviours. That once those pathways are there the positive hit that comes from even anticipation of the addictive behavior makes it hard to stop. That for lots of good scientific reasons only complete absitence will allow those “bad pathways” to wither away a bit. And that recovery, neuroplasticity in recovery, takes time. And it does take time. I can see that. Im 794 days sober, and my new pathways are still pretty baby.
For me the point of doing the 12 steps now (honestly i do not think I could have started before now) is because I can see that as a process it seems to work. And reading this neuroscience stuff, I kind of undertsand why it works: service, storytelling; mutuality … honesty, vulnerability, hard but laying down new pathways of beheviour that will, in time, become the default ones.