Sober Synthesis

“Addiction, at its worst, is akin to having Stockholm Syndrome. You’re like a hostage who has developed an irrational affection for your captor. They can abuse you, torture you, even threaten to kill you, and you’ll remain inexplicably and disturbingly loyal.” Anne Clendening (Clendening, 2018)

Why Do We “Want” (Crave) Alcohol/Drugs When We No Longer “Like” the Experience?

• Dopamine provides a reward prediction signal that motivates us to “want” things.
• “Wanting” and “liking” depend on separate mechanisms within the brain, which can become uncoupled.
  • Ordinarily, our “wanting” and “liking” systems work together effectively.
  • Alcohol and most drugs of abuse act directly on these wanting and liking systems in the brain and disrupt their proper functioning.
    • One consequence is that the “wanting” drive becomes massively overactive.
• In addiction, intense “wanting” persists even after liking has faded.

Why Can’t I Stop After 1 Drink/Drug Use?

• The dorsomedial striatum (DMS) receives input from the prefrontal cortex and mediates goal oriented action (decision-making). 
• There are two types of dopaminergic neuronal pathways in the DMS.
  • One type is part of the “go” pathway in the brain and the other type is part of the “no-go” pathway. The “no go” or “stop” neuronal pathways become deactivated with heavy alcohol or drug use.
• The loss of our off-switch significantly compromises our ability to think about things and accurately weigh the pros and cons of an action.
• The drinking-withdrawal-drinking cycle further compromises “no go” neuronal activation.
• There is some evidence that genetic predisposition and/or childhood trauma may decrease “no go” dopamine neurons. 
  • Recent research also indicates that lower “no go” neuronal pathways  increases the sensitivity of the “go” neuronal pathway, making us more sensitive to the stimulating effects of alcohol.
• Our off-switch didn’t go away or weaken because we have no self-control. It weakened because alcohol and/or drug abuse changed our brain.

Why Can’t I Moderate Even after Periods of Abstinence?

• Animal research discovered that repeatedly drinking alcohol alongside particular cues may activate certain clusters of neurons to form a LONG-LASTING PHYSICAL MEMORY TRACE in the brain (medial prefrontal cortex). 
  • A memory trace is the physical neuronal cluster linked to a memory. “Cue-evoked reactivation of the memory trace is not something that can be simply stopped by ‘will-power.’ It may even occur unconsciously and still elicit strong feelings of craving.”
• Stages of re-occurrences (relapses)

• Emotional: emergence of negative emotions
• Mental: actively consider using again to relieve the discomfort experienced in the emotional stage.
• Physical: drug and/or alcohol use

Tools

• Prevention Activities
  • Avoid looking at your phone or watching news as the first activity in the morning to minimize early cortisol spikes.
  • Prioritize daily healthy habits: eating a vegetable rich diet; taking vitamins including fish oil, magnesium, vitamin D, vitamin B1 (in early recovery); taking prescribed medications; exercising including aerobic and weight bearing, light exposure (especially in the morning), connection, play, micro-sucs (small activities that you don’t want to do), mindfulness activities. These habits minimize HALT (Hungry, Angry, Lonely, Tired) and the subsequent stress response.
  • Take time to self  reward/recognize progress, especially small changes.
  • Stay connected to healthy people, including LifeRing Meetings

• Intervention activities (have a plan)
  • Engage in a distracting activity (walk, art, journal, knitting, music)
  • Engage in an active stress reduction activity (meditation, yoga, physiological sigh, panoramic vision).
  • Talk about the craving during group and/or with a support person
  • Ride out the urge – Works by fully experiencing the craving, taking control of it, and riding it out until it subsides. 
• Visualize past consequences and future consequences of using (play tape backward and forward) 
• Visualize future opportunities with abstinence (create new tape)
• Recognize the automatic thoughts that accompany cravings and countering them with empowering self-talk.

Proposed questions for thought/sharing:

1. What changes have you made to improve how you recognize and work through cravings and how have those changes supported your recovery/wellness?

2. What are your challenges with recognizing and working through cravings? Any ideas for the future?

3. Have you been surprised by any cravings after sustained abstinence?

Disclaimer

This summary is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed.