How it works…

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.

Your brain on dopamine…

ttp://www.cdc.gov/nchs/data/hestat/overweight/overweight_adult.htm

We’ve all said it…why doesn’t she just stop drinking?  Why won’t he simply go on a diet?  Would that it were that easy for any of us…For most people, some choices are not choices.

In October 2008, I read an article that I felt was a long time in coming.  It was a small blurb in a local paper about some research that had been conducted at Brookhaven National Laboratories in New York.  Several scientists made the decision to compare advanced imaging studies of the brains of two study groups:  cocaine addicts thinking about cocaine and obese people thinking about food.  The neuronal circuitry of the brains of the subjects in these two groups was similar illustrating that obesity is the consequence of addictive behaviors associated with food just as liver disease is the consequence of addictive behaviors associated with consumption of alcohol. (Volkow, Wang, Fowler, & Telang, 2008)

 Drug abuse and addiction, and … obesity can be understood as resulting from habits that strengthen with repetition of the behaviour and that become increasingly harder for the individual to control despite their potentially catastrophic consequences. Consumption of food, other than eating from hunger, and some drug use are initially driven by their rewarding properties, which in both instances involves activation of mesolimbic dopamine (DA) pathways…The repeated stimulation of DA reward pathways is believed to trigger neurobiological adaptations in other neurotransmitters and in downstream circuits that may make the behaviour increasingly compulsive and lead to the loss of control over food and drug intake…repeated supraphysiological DA stimulation from chronic use is believed to induce plastic changes in brain (i.e. glutamatergic cortico-striatal pathways), which result in enhanced emotional reactivity to drugs or their cues, poor inhibitory control over drug consumption and compulsive drug intake. (Volkow, Wang, Fowler, & Telang, 2008)

 Why do I include this here?  There are three reasons.

1.  It is important for me to convey that addiction is a disease associated with underlying neurophysiologic changes.  But at the same time, addiction is a disease associated with behaviors and attitudes.  As the cited article states, “[addiction] can be understood as resulting from habits that strengthen with repetition of the behavior and that become increasingly harder for the individual to control despite their potentially catastrophic consequences.”  (Volkow, Wang, Fowler, & Telang, 2008)
2. Addiction is more common than most people understand.  There are more overweight or obese adults in America than there are adults at a healthy weight.  Most adult Americans – even those that are successful at dieting – cannot maintain a healthy weight over time.  Chances are, based on the scientific study cited above, two out of three of your friends are participating in addictive behaviors that even a $50 billion annual investment in the weight loss industry cannot overcome.
3. Understanding and learning to modify the behaviors that contribute to reinforcing the pathways associated with addiction is the key to overcoming addiction.  This underscores the importance of the journey to emotional sobriety.  As the literature I will include in this discussion will illustrate, self-awareness is a significant component in the journey of recovery.

The neurotransmitter, dopamine, plays a significant role in normal brain function.  Dopamine plays an important role in adult learning.  Dopamine is also associated with the creation of pathways for compulsive behavior.  Dopamine doesn’t discern that the pathway under construction is healthy or unhealthy, it just knows that it makes your brain feel good and that is justification for repeating the behavior…

Next up:  Hijacking the reward circuit and the animal brain.

Works Cited

Alcoholics Anonymous. (2001). Alcoholics Anonymous (Fourth ed.). New York: Alcoholics Anonymous World Services, Inc.

Alcoholics Anonymous. (1952). The Twelve Steps and Twelve Traditions. New York: Alcoholics Anonymous World Services.

Centers for Disease Control. (2010, 2 25). Healthy Aging: Improving and Extending Quality of Life Among Older Americans. Retrieved 11 17, 2010, from National Center for Chronic Disease Prevention and Health Promotion: http://www.cdc.gov/chronicdisease/resources/publications/aag/aging.htm

Goleman, D. (1994). Emotional Intelligence. Bantam Books.

Goleman, D. (1997). Emotional Intelligence: Why it can mean more than IQ. Bantam.

Volkow, N. D., Wang, G.-J., Fowler, J., & Telang, F. (2008). Overlapping neuronal circuits in addction and obestiy: evidence of systems pathology. Phil Times R Sec B , 363, 3191-3200.