Getting High on Recovery

I keep dragging around what’s bringing me down
If I just let go, I’d be set free
Holding on
Why is everything so heavy?

Linkin Park, “Heavy.”

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The idea that some brains are broken is a myth. Brains don’t become broken. Brains learn as we repeat our experiences and our decisions. Sometimes these experiences and decision cause our brains learn things that are very difficult to un-learn.

We repeat behavior that feels good or for some of us just feels better.

Often we hear in the media and from some addiction treatment proponents that addiction is a disease, like cancer. We hear stories that reinforce the belief that addiction looks like this:

A pleasure-seeking “addictive personality” spirals out of control, “enabled” by friends and family, and eventually hits “rock bottom” in the form of arrest, divorce, or homelessness. She may then succeed in a 12-step program, where she’ll embrace a “higher power,” receive “tough love,” and accept total “abstinence” from substances including antidepressants and drugs that ease withdrawal symptoms. Even if she gets clean, she’ll be an addict forever, and is more likely than not to relapse.

I have been reading a book by Maia Szalavitz , Unbroken Brain (2016, St. Martin’s Press). In the book, Szalavitz writes “We never get out of this ‘It’s a disease or it’s a choice’ debate… But addiction is not brain damage or a pathology like Alzheimer’s. It really is misguided learning.”

Addiction is a learning disorder, a condition where a system designed to motivate us to engage in activities helpful to survival and reproduction develops abnormally and goes awry. Maia Szalavitz

In the book, she defines addiction as “compulsive behavior despite negative consequences” which she further breaks down:

• A person uses a substance and learns that using a particular substance (or behavior) again and again can help soothe some other problems in their life – like depression, trauma, pain from abuse, crippling anxiety, debilitating shame or other private pains.

Addiction is more than a disease. It is not a moral failing. And it’s not the brain being “hijacked” by drugs or by experience. Rather, Szalavitz argues both from her experience and from substantial research that it is a disorder of how we have learned to motivate ourselves:

“What it does show, I believe, is that addiction is a learning disorder, a condition where a system designed to motivate us to engage in activities helpful to survival and reproduction develops abnormally and goes awry.”

The brain’s motivational system is designed to make us persist despite negative experiences, to push through the difficulties of love, parenting and work. This system involves our sense of purpose, what makes us feel alive and what helps us to cope with our discomfort or pain (self-soothing). When this motivational system gets channeled into a destructive activity (like substance use), it can be both destructive and dangerous.

What does the research say about addiction as a learning process?

This is a summary of some of the research on how addiction is a learning process. For more, see the Reference section at the end of this article.

Addiction changes the brain, just like any behavior:

• Addiction is powerful and difficult to change because the reward is so immediate and dramatic (that’s why it is a ‘high.’) Repeated substance use will change the brain, just like any other behavior that we repeat. 
• Anything that gives us pleasure or stress relief can be a powerful learning experience and will “light up” the brain areas that we typically see highlighted by those with a substance use disorder. Whatever is pleasurable is a learning experience.

Addiction reinforces learning because substance use is a powerful reward. But over time, the reward tends to become less and less pleasurable:

• Addiction is both physical and psychological. People do not use because their brains are inherently different or because drugs change their brains, but because substance use is a powerful reinforcer: it feels very, very good (and then later, it feels less good and even bad, but the user continues to use.)

Positive support from friends, family, work and other pursuits can aid in recovery:

• Reinforcement is a powerful factor in the initiation, maintenance, and recovery from substance use disorders. Positive reinforcement from social networks, family, work, and other meaningful activities also support recovery and a return to a more healthy level of functioning.

The brain changes with any repeated activity, behavior or practice (ie: substance use):

• The brain’s neuroplasticity, it’s ability to change based on both reward and continued ‘practice’ enables addiction to become the disorder that it is.
• All experience changes our brains, this is what creates our memories.

Most people who use illegal substances will quit by the time they are 30 years old and they do it because they care about the people they love and their future:

• Most of those who use substances in problematic ways will quit using illegal drugs by around age 30, they usually will quit without professional help, and what motivates them to cut back/quit include: legal concerns, economic pressures, and the desire for respect from self, friends and family members.

For additional research and references see Reference section at the end of this article.

Szalavitz found that substance use helped her to feel okay in the world, in a way they helped her to “lower the volume” of her then undiagnosed Aspergers.

To put the research into plain language, she writes that “With addiction overwhelming changes occur in the brain region involving areas that evolved for things like love and sex and feeding. All these things that are fundamental to reproduction.” Addiction creates very powerful drives, but it does not create complete powerlessness.

“If you want to call it a disease, the kind of disease it is is a learning disease.” Maia Szalavitz

If addiction is unhealthy learning, then how do we “unlearn” our addictions?

Unlearning is a challenge, however, it is important to remember that our brains are flexible and are designed to change. A few keys include maintaining hope, knowing why we want to change our behavior, beginning small, investing time each day to get in touch with our bodies and emotions, honest reflection, persisting in spite of setbacks, having friends and family who support us, and building a life outside our substance use, a life that feels worth our “recovery” is key.

Interestingly, Szalavitz’s book talks a great deal about hope. She talks about her own recovery and how she began handing out clean injection kits in the 1980’s, long before it was government sanctioned. She noticed that rather than being unable to learn or change their behavior, those dealing with substance use were able to change their behavior and attitudes about safer ways to inject.

“Evidence that addicts can learn healthy behavior is crucial, because it highlights the role addiction plays in learning. It’s also incredibly hopeful, because it suggests that addicts can change, provided they have access to the right resources.”

She highlights how hope, respect, care, understanding rather than judgement from family and community are essential to supporting those in recovery to have the best opportunity for lasting change.

For the next article in this series, we will look at a variety of strategies or approaches for helping yourself, or those you care about, in their recovery.

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References

Brodwin, E. (April 25, 2016). The answer to treating drug and alcohol addiction may be far simpler than you think. Business Insider.

Ferranti, S. (April 4, 2016). Maia Szalavitz on a New Way of Understanding Addiction. The Fix.

Goldstein, D. (APRIL 4 2016). Is addiction a learning disorder? Slate.com

Szalavitz, M. (July 17, 2014). Most of Us Still Don’t Get It: Addiction Is a Learning Disorder. Substance.com

Szalavitz, M. (2016.) Unbroken brain. St. Martin’s Press.

Szalavitz, M. (April 5, 2016). The Addictive Personality Isn’t What You Think It Is. Scientific American.

(2017). The National Council for Behavioral Health. National Conference: 2017. Maia Szalavitz: Unbroken Brain: A Different Way of Understanding Addiction (Research and reference pages).

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If you liked this post, you an see some of my related writing:

Recovery and How Each Day is a Beginning

Your Mind Will Give You Many Reasons You Can’t Do It. So What?

Healing is What Happens When You Really Just Want a Cure

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Keep it Real

Photos: josep salvia i boté , Espen Aaeng and Stig Andersen