The journey to emotional sobriety
The problem of obesity is not getting better – it is getting worse. Until obesity is treated as the addiction that it is, the problem can’t change. Acceptance that you can’t stop eating and that your will alone is not sufficient to overcome the problem is the first step in finding help.
The link below leads to an interview with Dr. Nora Volkow, Director of the NIDA. In the first few minutes she discusses compulsive eating. At 4:15 she talks about the underlying, neurologic basis of addiction and some of her thinking on the issue of human impulse control:
http://video.nytimes.com/video/2011/06/13/science/100000000862646/nora-volkow.html?ref=science
OUT THERE
Out there
you’ll see it all.
The floating ends will
meet and mend,
and you will be yourself,
your fully formed,
though always changing,
self of selves.
Every clumsy backward look
will pay for itself.
Every tear you’ve cried,
or wanted to cry,
will set your broken bones.
The rips in your heart
will no longer need to be guarded
by steel girders,
banyan tress,
or even rice paper.
Not so much as a
dragonfly’s wing
will you need to cover the bludgeoned place,
to protect the private you
you love so much
and hope to save intact
from what has seemed years
of relentless pummeling.
Go and live and love
in peace, my friend,
for surely there is love to enfold you,
and life to be feasted upon:
your portion is boundless.
Love will be the more
you’ve wanted.
You will know it
when you see it.
You will love yourself
as no lover
has ever had the courage
to love;
and the warmth you’ve wanted
will line your pillowcases,
dance upon your windowsill,
and hide
at the ends of your socks
awaiting your toes.
-Deborah Mears
This change in the designation of addiction from a psychiatric disorder to a chronic neurologic condition represents a watershed moment in medicine. The US is facing an epidemic of drug abuse which the previous approach to addiction management was incapable of addressing. The new designation for the disease has terrific implications with regard to health care funding, management, and potentially success in treatment.
http://www.msnbc.msn.com/id/44147493/ns/health-addictions/#.Tkmz9829eeY
The link below leads to an article on CNN that discusses a recent study that illustrates the relationship between feeling anxious (restless, irritable or discontent) and the use of various substances to ease that anxiety. It underscores how alcoholism/drug addiction/overeating is learned behavior in response to emotional stress.
http://www.cnn.com/2011/HEALTH/08/01/alcohol.anxiety.risky.health/index.html?hpt=hp_t2
So, assuming you are someone who has surrendered to the idea that you are powerless over a given behavior or
situation (drugs, alcohol, overeating, bad relationships, gambling, shopping, sex, etc.) which has caused your life to become unmanageable (Step 1) and you are willing to embrace the idea that something “bigger than you” can help restore you to sanity (relieve you of the cycle of dependency – Step 2) and you are willing to take suggestions regarding this process (Step 3), then you are ready to take the emotional sobriety steps (Steps 4 – 9).
In these steps, you are asked to take inventories of yourself, admit your shortcomings to other people, ask for impediments to be removed and to make amends to people you have harmed.
And, the immediate response is generally: “what does any of that have to do with my eating, drinking or drugging?” The answer is: “Everything.”
A very wise man once said that he spent his life trying to get to the Sears Tower in Chicago using a map of Detroit. Steps 4 – 9 are the Steps where addicts come to accept that it is the “thinking behind the drinking” that leads to the unpleasant outcomes. Step 4 through Step 9 is where we learn to stop, examine our behavior and learn to ask directions from the gas station attendants who have been through the bad neighborhood and know the way out – the folks who spend a great deal of time enjoying the view from the observation deck at the top of the Sears Tower.
From the perspective of the literature in psychology and the disease of addiction, these steps are associated with explanatory style and coping mechanisms. (Seligman, 1990) As I mentioned in my previous post – there are two sorts of triggers for addictive behavior, physical (falling dopamine levels) and emotional (how a given situation is interpreted and reacted to). Steps 4 – 9 address the emotional work that must be done in order to get sober and stay that way.
The Twelve Steps are about self-awareness and metacognition– coming to understand what the emotional triggers are and developing strategies that will help you not react to them. The first few words of Step 12, “having had a spiritual awakening” have a direct link back to the language found in the Big Book of Alcoholics Anonymous which identifies those the characteristics of those who don’t succeed in recovery: “men and women who are constitutionally incapable of being honest with themselves…” (Alcoholics Anonymous, 2001, pg 58).
This must mean that the “spiritual awakening” necessary for long-term sobriety is the result of improvements in self-honesty.
Here is the basis for Step 4 through Step 9. These steps are the process by which someone learns to identify the patterns of thinking and behavior that contribute to the emotional triggers of addiction.
Resources:
Step 1 – Saturday Morning Live – Sandy B.
Step 2 – Saturday Morning Live – Sandy B.
Step 3 – Saturday Morning Live – Sandy B.
Works cited:
Alcoholics Anonymous. (2001). Alcoholics Anonymous (Fourth ed.). New York: Alcoholics Anonymous World Services, Inc.
Seligman, M. (1990). Learned Optimism: How to Change Your Mind and Your Life. New York: Vintage.
Harnessing the Power of Feedback Loops:
http://www.wired.com/magazine/2011/06/ff_feedbackloop/
Wired Magazine June 2011
This article discusses how the brain processes data and learning occurs courtesy of the brain’s reward circuit. There is another interesting article in this issue by Dan Airely, the author of Predictably Irrational. It explains how inherent weaknesses in human decision making are exploited by major marketing companies like Apple, Facebook, Amazon and others…
Happy reading!
Next up: How it works
On Tuesday, June 14, 2011, the New York Times included an article on Dr. Nora Volkow, Director of the National Institute on Drug Abuse. She was highlighted in the context of her role in the US prescription drug epidemic. She had some interesting comments to make about addiction, the reward circuit and dopamine.
http://www.nytimes.com/2011/06/14/science/14volkow.html?_r=1&nl=todaysheadlines&emc=tha210
Happy reading…
The human brain is a prediction generator. Every action initiated, every piece of information stored as knowledge, virtually every thought a human has is related to a prediction – an if/then statement (these are stored like “Microsoft macros” in the human brain to repeat as needed. Consider the number of if/then statements a toddler works 
through in order to perfect the art of human ambulation). The animal brain works in this capacity as well. “If I do X, then I’ll feel good.” Or, “if I do Y, then I’ll feel pain.” Guess what, humans like pleasure better than pain so the things that keep us alive generate a reward in our brain. That reward is a wash of a neurotransmitter called dopamine.
Each time the human organism participates in an activity that supports the longevity of the species the brain is washed with dopamine. Respiration is the single most important function of the human body. The second most important activity an organism can participate in is nourishment. The reward circuit is integral in keeping the human body alive.
Addiction “hijacks” the reward circuit. Through a process of prediction and reward, the human brain begins to see certain substances as acceptable strategies for dealing with life. Things that “take the edge off,” “relieve the stress,” or simply “taste or feel good.” Over time these become conditioned (albeit ineffective) life management skills.
The first step of a Twelve Step program is:
“We admitted we were powerless over [alcohol, drugs, food, people, places, things, situations, money, sex, etc.] – that our lives have become unmanageable.”
Coming to understand that a person in the throes of their addiction is totally powerless over their behavior is an important first step in the recovery process. Addiction is not an absence of will or a reflection of bad judgment, it is a process associated with neuronal pathways in the reward circuit that have been established over time. Addiction is a neurologic disorder. Addicts are as powerless over the cycle of craving that they face as they are over their own breathing. Their addiction is associated with a neurologic phenomena that they will never overcome (which is why people who relapse go crashing back to the depths of their disease). While the craving and response may never go away, addicts can learn how to live their lives in such a way to limit the triggers that set off the neurologic cascade and enjoy normal, highly productive lives. Addicts can learn how to build a defense against the first drink.
I’m proof that it works.
Next up: Your Brain on Stress…
References:
LeDoux, J. (1993). Limbic forebrain structure in emotional memory: Emotional memory systems in the brain. Behavioural Brain Research , 58 (1-2), 69-79.
Sigurdsson, T., Doyere, V., Cain, C. K., & LeDoux, J. E. (2007). Long-term potentiation in the amygdala: A cellular mechanism of fear learning and memory. Neuropharmacology , 52, 215-227.
Zull, J. (2002). The Art of Changing the Brain: Enriching the Practice of Teaching by Exploring the Biology of Learning. Sterling: Stylus.
The Spiritual Experience 