The Way of Recovery is Not Alone – Part 1

Written by Geoff Kane, MD, MPH. Posted on

Addiction damages what matters most. Body, family, career, and citizenship are frequent casualties of the compulsive use of alcohol and other drugs. How human behavior becomes so self-defeating and how affected individuals change for the better has been described from many perspectives. Two sources we might expect to have differing views about recovery actually illumine the same path.

Science and spirituality both point to positive interpersonal relationships as treatment for addiction. Many therapeutic factors contribute to recovery, but healthy human connections are fundamental. This Addiction Medicine Update presents a scientific point of view; the next Update, a spiritual one.

Neurobiology of Addiction

Lower centers of the central nervous system (limbic system, brain stem, and spinal cord) give rise to a great deal of human behavior, and these lower centers routinely function independently of higher centers (cerebral cortex). Simple behaviors that don’t require conscious thought include reflexes, breathing, and body language. More complex behaviors can also occur without conscious thought; eating and sexual expression, for example, are driven by centers in the hypothalamus (brain stem). Our thoughts often influence these instinctual (automatic) actions, but sometimes we behave contrary to our intentions—like me ordering a dessert right after deciding I don’t need it.

Consumption of all addictive chemicals increases dopamine in the nucleus accumbens (limbic system), causing pleasure and/or relief from displeasure. Pleasure and relief represent, respectively, positive reinforcement and negative reinforcement, which can train (condition) primitive regions in the central nervous systems of vulnerable individuals to reenact the behaviors that led to the mood change (dopamine increase). Thus, obtaining and using addictive substances become automatic actions that may be cued or triggered by intake of a little of the substanceor by circumstances (people, places, things, feelings) previously associated with use of the substance.

Not only may addictive behaviors occur automatically, but individuals with active addiction may also choose alcohol and other drugs over, for example, family. We may not be conscious of it, but dopamine (and/or the anticipation of dopamine) is motivating. During active addiction, addictive substances increase dopamine levels far more than healthy, more conventional rewards such as preserving love relationships and personal safety. This leads to distorted thinking and actions that go against the addicted person’s own values.

Neurobiology of Recovery

Addiction changes brains and behavior for the worse, creating the unfortunate urge to use addictive substances no matter what. This drive cannot be eliminated. It is neutralized, however, when individuals with addiction—who can’t trust their own logic and behavior—invite structure and support that blocks or discourages access to the substances they are addicted to. Examples would be entering a treatment center to get recovery started and then not carrying cash or a credit card after discharge.

Positive interpersonal relationships, both inside and outside of formal addiction treatment and recovery groups, promote ongoing recovery. They change brains and behavior for the better by enhancing resilience. Resilient individuals are better able to alter their lifestyle and relationships to avoid reactivating compulsive substance use.

To develop at all, human brains must interact with more mature brains. Throughout life, when we share our experiences and feelings with respectful and validating others, we further integrate emotions and conscious thought. This improves what scientists call affect regulation, making us better able to adapt, cope, and make fewer self-defeating choices.

Too often, individuals in active addiction isolate rather than initiate connections. When they do reach out to others, biology helps foster their recovery.

The NCADD Addiction Medicine Update provides NCADD Affiliates and the public with authoritative information and commentary on specific medical and scientific topics pertaining to addiction and recovery.