In the last two posts – one by Persephone and one by me – we talked about the possibility that 12-step treatment offers a “static” rather than “developmental” approach to recovery. Persephone argued that certain features of 12-step practice kept the addict or alcoholic in a frozen state of heightened anxiety, much like PTSD. My last post was an attempt to extend and articulate some of Persephone’s points. I was really taken with the similarities between her idea of “static recovery” and PTSD, and I provided information about traumatic memory maintenance in support.
But today I want to take a different approach – and I think it provides a real reconciliation between the pro and con positions on 12-step recovery. The point I want to make is that any and all recovery has to be developmental in nature. Pure stasis simply cannot correspond with recovery.
The term neuroplasticity has been bandied around a lot. Norman Doidge seems to think he invented the concept, or at least brought it into the limelight, but it’s been around for ages. Dr. Eric Kandel of Columbia shared a Nobel Prize in 2000, reflecting decades of research on how the brain changes when learning occurs. In a nutshell, Kandel showed that the connections among neurons – synapses – must change physically if memories are to be formed. He showed this at a molecular level, validating Hebb’s famous insight from the 40s: What fires together wires together. Well all the neural change that takes place when we learn and remember things is really just neuroplasticity.
Neuroplasticity is strongly amplified when people are highly motivated to change, probably because of the strong emotions that come into play and focus one’s attention. In her wonderful book, Barbara Arrowsmith-Young describes the many cognitive exercises she devised for herself, in order to overcome her very severe learning disabilities. They worked. She went from a high-school student who could not comprehend history, who even had a hard time understanding simple sentences, to a writer and teacher who has set up roughly 70 schools for learning-disabled children in North America. Barbara, whom I met in Australia last year, has a delightful phrase for neuroplasticity dedicated to replacing bad habits with good ones.
What fires together wires together, and what fires apart wires apart!
(I don’t actually know the origin of this phrase, but I like it.)
In 1993, Mogliner and colleagues looked at the brains of people who had been plagued with webbed fingers. That means that some of their fingers could not operate separately – they functioned in total unison. After surgery was performed to allow the fingers to move independently, these authors looked at changes in the (somatosensory) cortex. What they found was that the synaptic wiring of neurons in the corresponding brain regions had changed substantially, just weeks after people started to control their fingers independently.
The parallel with addiction seems striking. You “learned” your addiction through neuroplasticity, which is how you learn everything. You maintained your addiction because you lost some of that plasticity. As if your fingers had become attached together, you could no longer separate your desire for wellbeing from your desire for drugs, booze, or whatever. Then, if you did 
indeed recover, whether in AA, NA, or standing naked on the 33rd floor balcony of the Chicago Sheraton in February, that means you got your neuroplasticity back. Your brain started changing again – perhaps radically. You started to separate one set of desires from another and to act on them independently. And just as in Mogliner’s study, your brain began to regrow its synaptic patterns – to allow the change to take place, to hold onto the change, and thereby to permit a new degree of personal freedom.
The take-home message is simple: All recovery is developmental. Without developmental change in mind and brain, you would stay exactly the way you are.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
Excellent piece. Insightful and potentially very valuable thesis.
Problem is if I separate alcohol from being my source of stress relief and ease, what else might work? I’ve found nothing that does, except other drugs. Maybe I have to try harder at meditation. Or maybe if I stay alcohol free I’ll find the stress isn’t as great (i.e. the alcohol, both phsyiologically and in terms of impact on my behaviours and thus on my life) increases stress. I’m not sure I can ‘just live with’ the stress, but maybe that’s the third way that has to be.
John,
I have also used to “decrease stress” or at least attempt to relieve it. What has worked for me is nothing less than a complete lifestyle change, including exercise (yoga, walking, swimming, biking) healthy diet, no isolating and meditation is a big one. I also let go and have fun. Once I got into the “routine” it is actually really easy to keep it up. I started by taking a 1/2 hour walk first thing in the morning. I guess my neuropathways are making different routes now.
Kathleen thankyou for taking the time – what you say rings very true from my previous clean experiences – I’m going to try again!
JohnC–I personally found exercise to be the best help possible, which also helped me realize I’d never had a physical outlet before, having never been a sports-type of person. I started small, with walks, then gyms, then rather intensive training. Soon, I was (and still am) surrounded by people on a daily basis who don’t drink or use drugs, not because they ever had problems with them, but because the desire to be healthy, aware and well is too high a priority to risk messing with with flooding your body with substances. Plus, after a good training session, the stress is just gone. Or at least put into perspective.
I hope that helps, I was once in your position, and didn’t see much other way out either.
Hi John. You’ve got some excellent responses already, but let me add my own two cents. All three options seem to have some logic to them. (1) Yes, it is possible to live with stress without drugs or booze. It does take practice, but once you start to get it, the stress comes and goes like weather. You watch it come and you let it pass. But (2) it’s also true that stress can be greatly reduced, and you’ve gotten great suggestions from others on how to proceed. Also see “My Y” in the guest memoirs — a beautiful piece on how physical exercise can help you battle cravings. (3) The third option of course is to keep using and/or drinking. But you’re certainly right that that increases the net amount of stress in your life. Temporary partial relief gives way to the very stressful burden of carrying your addiction forward for more days, weeks, months, years…. I’ve been there. Many of us have. Perhaps see my previous post on self-medication vs. self-destruction. (https://www.memoirsofanaddictedbrain.com/connect/self-medication-or-not/) That summarizes my view. Thanks for joining in and using the blog as a source of help.
Changing habits is difficult because of the wiring you talk about Marc, and that’s why so many people avoid change and even avoid thinking at all about themselves, their beliefs, and their actions (http://bit.ly/UfdMdE). Scott Peck reminded us years ago that life is difficult, but some people do everything in their power to avoid that difficulty.
But for those who are interested, here’s my experience with changing habits: I stopped beating on myself when I behaved in a way I didn’t want to, and began just noticing–and thinking about how the unwanted behavior made me feel. After a while, I’d start to notice sometimes what I was doing WHILE I was doing it. Then, little by little, I’d begin to realize what I was GOING TO do before I did it, and that’s why I’d start to really have a choice. Not that the old behavior doesn’t want to come back from time to time, but it’s almost funny when it does. I feel as though I’m dealing with a willful kid.
JohnC: It’s not necessarily a matter of learning to put up with the stress, it’s a matter of discovering ways to reduce it without alcohol. I found out through therapy and through AA that a lot of the stress I felt wasn’t realistic. It was a great relief to find out that I’m not responsible for whether the sun rises in the morning and sets in the evening.
Carolyn … YES to noticing. Anne Wilson Schaef wrote, “Noticing is the basis of intimacy” … and I’ve never forgotten it. To keep our awareness and attention on something for more than an instant … to really apprehend it … is a basis of sanity. I find that when I train my mind to notice, there are a few seconds of simple lucidity — my entire attention is focused on simply perceiving and receiving an impression of an unavoidable reality — and after that, the thoughts, emotions, memories, associations, beliefs, etc., etc. come flooding through … and clear perception is *gone*. But it *was* there, for an instant …
That instant, and all it implies, is what I cling to for sanity, and for a wise way to guide myself through a crazing moment when I think I’m losing it. I remind myself that my mind has been that clear (plasticity in practice, and recognizing a reality), that I’ve been that clear and strong before, so I can be that way again.
Easier said than done, heh 😉 As you say, Carolyn, “I feel as though I’m dealing with a willful kid.” ~ In a way, yes, you are (hence the understanding that addiction has its own developmental process).
We somehow have to *unlearn* addiction, if we can … unlearn each step we took to arrive at addiction (and some of those steps are very, very small, and sneaky … and deeply interior) … and we have to *notice* each step so we don’t fall ass over teakettle back down to the bottom of the stairs 😉 …
Unlearning … and learning anew, all in the same instant. I’ve noticed how very much like a puppy’s nose my mind is. It just wants to sniff *everything*. I was such a snoop as a kid — into drawers, closets, and medicine cabinets; attics and basements and anywhere one could read; fridges and boxes and my Nana’s letter-writing desk that was shaped like a kidney and had a special chair. Its drawers were curved; the fourth one always stuck, so she’d know I’d been snooping … but she didn’t mind; in fact, she had two ‘treat drawers’ that were always stocked with little goodies from the elegant stationary store she volunteered at, like glittery pens and doodle pads …
I’ve been training my thoughts in directions like that — into memories of bliss, because those moments *did* happen, and they suffused me for life — they are there now, they are real — as real as all the horror I’ve known — and I’m coming to understand that the feeling they evoke is the bliss I’ve been seeking all along.
They were serene, and so simple … and safe. Warm, and warming (I live with some serious glitches in basic metabolic function, like maintaining a warm enough body temperature … and one of my imperatives for feeling bliss is to be *warm* ~ this is central to any imagery I work with). Nana’s apartment. Wherever I was, Nana was *home*. Soft-wattage table lamps, breakfast and tea and the radio news in her little kitchen nook. Nana was safety, mac ‘n’ cheese, blankies, and books. Magazines! ~ All of it: joy. Nana was love.
All of it: in me. Of me. THIS HAS BEEN. I’m remembering moments like these so often now, and *focusing* on them. Noticing them and the feeling of them — what this feeling does through me as I deepen my awareness of the memory.
To notice an authentic, quiet, pervasive feeling of bliss — to know that this feeling is real *because you have even once felt it* and it is still with you right now — and to know that this simple feeling is a basis of sanity … one step at a time.
The whole process of stepping away from the crazed, and into the sane, one step at a time …
There’s a gentling that happens. It’s not like the crazing is any easier to experience … but I am getting better at catching it with awareness and easing its panic. ~ It’s a very interior process; silent; it’s caught my attention, and I’m noticing it.
I see a clawing, infant hand. It is NEED.
What step do I take now?
What do I do with this NEED?
Now?
… That’s how minute some of my steps have become. To remain with my NEED for a second or two — long enough to say, ‘Breathe…’ to myself, and to breathe — and then to begin to look. At the NEED.
It always looks like an infant, whose little hand, somehow, is clawing up to my face. Clawing at air.
I’ve not been a mother, by choice. I mourn this, still, and was wise in my choice.
I’m learning how to mother now. To mother myself: to care enough about my own life that I will tend and sustain it. Love it.
Mothers — and all who tend to infants — have to notice, notice, notice. Constantly. They have to monitor and scan. Always train an eye on the child. Be present, be present, be present … See what is, see what is, see what is …
So do we when we begin to wrangle with our nemesis, addiction.
I see my own addictive ‘archetype’ as that clawing, infant hand. The image invokes a certain fisting in my chest and solar plexus. I sense it as something between discomfort and pain. I don’t like it; it doesn’t feel good. I have to do something about it.
I’m training myself to think like a mother, to notice like a mother. A good enough mother. Perfection = bullshit! … and if there is love, responsive bonding, between the mother and infant, perfection’s already present.
So, what if my infant has freed an arm from her blanket, and her little hand is clawing in my direction? What do I do?
… That’s the moment I’m working with, intensely, right now. How do I respond to my NEED.
… Phew! 😉
Gosh, Jaliya, yes!
I, too, have used visualization of being in a safe, warm place to fight unwarranted anxiety. And I’ve imagined myself as a baby with myself as an adult taking care of that baby. I’ve done a lot of work to get to a place that’s pretty comfortable most of the time.
P.S. Putting more pepper (red and/or black) in your diet may help warm you up physically.
Absolutely beautiful. Thank you, Jaliya. I love your Nana! What a warm, safe place to retreat to when the world gets crazy. Love endures.
Janet
Wow, Jaliya. What a deep introspection you’ve invited us into. The mothering/parenting of oneself seems crucial. Sometimes I also see it as befriending myself. As if I’m saying: it’s ok, pal, take it easy on yourself. It’s not the end of the world. As Carolyn says, above, the world seems to go on without our meticulous support.
Also, there can be immediate perception — what you call bliss — even in the murky times, when thoughts, feelings and associations are filling in all the cracks. It’s like seeing/participating in a windstorm rather than a moment of calm. You can still sit back and watch it and smile.
Great response, Carolyn. I checked out the link you pasted, and I’m not at all surprised. Conservative thinking has something directly in common with remaining addicted at the brain level too. Let’s call it an easy way out of ego fatigue. Remember my posts about that? Effortful thinking uses up neural resources, especially in the dorsal anterior cingulate cortex (dACC), which is responsible for weighing choices, reevaluating options following errors, and other aspects of self-regulation. One way to beat ego fatigue is to devolve to low level thinking, which means more automatic stimulus-response type thinking, which involves the ventral PFC, not the dACC. That’s when you vote Republican or keep drinking. (For some, a Republican win might instigate drinking 🙂
What you say about your own recovery really hits home for me. You are actually starting to see the “net” outcome rather than the immediate outcome. And it’s not what you want. As that evaluation gets more and more ingrained (and begins BEFORE rather than during or after the addictive behaviour), you really have the opportunity to change, to recover.
I wonder if, at that point in one’s development, quitting becomes in some sense the least effortful choice, and using becomes the more effortful. I’m serious. Because when you start to focus on the future, keeping on using really feels like self-harm. I mean it’s no longer an abstract inference — it really feels that way. It doesn’t feel good anymore. When your fingers are no longer webbed, it becomes “easier” to control them independently than to continue to control them as a unit. This may be an important insight into how brains grow.
There may be some real pain involved in unfamiliar ways of thinking. I ran across a study recently claiming that mathophobes feel actual pain (http://bit.ly/VqZCdB), a pain that I myself feel when trying to solve math problems. So maybe that concept applies to other areas of brain use.
I’ll always remember the first sentence of Scott Peck’s “The Road Less Traveled”: “Life is difficult.”
But Peck also told us that suffering the pain of taking the difficult path eventually makes it easier to travel that road, and eventually even makes it impossible to live any other way.
Lots of interesting things to ponder Marc. I find this perspective very compelling. The role that half lives of drugs, length of substance use as well as the combined use of alcohol and drugs (as well as age, gender) and experiences that traumatize can play in all of this further complicates the ‘developmental’ processes. What contributes to change and what delays/complicates it? How does emotion contribute to or styme cognition here?
I’ve spent most of my career pondering these questions. I’m not sure I’ve made much progress. But I have come to the conclusion that the complexity you refer to is irreducible. Little things can matter a lot, and big things can often be sloughed off…momentum might be a good way to summarize/symbolize the effects of all these complexities working together.
Excellent post, Marc. I agree that neuroplasticity is currently a popular term for a concept that has been around for decades — simply, that that brain changes and develops as we learn new things. And conversely, the brain’s neural pathways (synapses, I think, in your terms) get increasingly deeply entrenched as we repeat the same habits and addictions year after year. Change becomes increasingly difficult the deeper and stronger the entrenched synaptic connections become. As addicts and alcoholics, we first have to want change badly enough, and it is then that can we begin to form new, healthier neural pathways (synaptic connections) and thus the entrenched ones become weaker.
I also know of Barbara Arrowsmith-Young and have actually worked indirectly with her, so I was fascinated to learn that you’ve met her.
I believe Arrowsmith-Young used the analogy of a dog running through the forest, using the same path over and over. The more well-worn the path, the easier it is for the dog to use the same old pathway rather than forge a new one. It takes repeated, conscious effort and desire to form a new pathway. There needs to be motivation and incentive to do so, and often that initial motivation to change is the hardest part for the addict. I like what Carolyn Kay said, above, that first of all, the addict has to notice and be aware of the habits before indulging them before any change can be made.
But one thing that still puzzles me to a certain extent is that my recovery was not developmental, but spontaneous. Literally overnight, I was no longer an alcoholic. I changed my thinking instantly, and it did not take a slow, developmental process to entrench the new synaptic connections. However, I was aware that the those connections were weak, and I had to strenuously work on them to strengthen them — that’s why I attended AA for several months following my spontaneous recovery. Or perhaps all my years of relapsing were actually part of the developmental process? I’m still a bit confused over this aspect of spontaneous recovery versus developmental recovery.
“Entrenched” — beautiful word, Charlie 🙂 It reminds me of the saying, “A rut is simply a grave with open ends.”
About your experience of spontaneous recovery, it’s also been said that “history is the gradual instant.” (Anne Michaels, in *Fugitive Pieces*). Sometimes I think that history is actually, in part, cascading forward, like gems on a string … At some point a circle is closed; the beading’s complete. You wake up one morning, … and your mind’s been changed.
Maybe synaptic connections are like that …
… one step at a time …
… and one day, in one moment, something of your history has completed itself; you’ve been doing so much work, one step at a time … and then NOW. 🙂
So beautifully put, Jaliya! I love your simile of gems on a string cascading forward. Yes, perhaps, through all the years of addiction and relapse, one is still trying hard to form new synaptic connections, new neural pathways, and then one day, suddenly, the connection clicks in and sticks. Perhaps development is happening even while in addiction. I wish I had better words to describe this.
These are beautiful images, and they try to help us differentiate falling into a rut from arriving full circle at the end of a learning process. The paradox remains, though, that any learning process that’s been completed can serve as a rut. So, if you are to remain rutless, the circle must never be complete!
I particularly like the image of “cascading forward…”
Hi Charlie et al. The way thoughts and actions become entrenched, through a self-reinforcing process, is one of the most fascinating issues in development. But that process is responsible for all the habits we form, including addiction of course, and personality itself seems to stabilize and become crystallized in the same way. I have modeled this self-stabilizing process as gutters forming in the garden. Each time it rains, that water is more and more likely to flow through a path that’s already there. And each time, the water dredges that path further, so next time it’s even more likely to flow through it. In some fields of physics and math this is called self-organization. And yes, it makes habits more and more difficult to change with time — so you have to ride that other surfboard, the one that wants to break free.
As for your “spontaneous” recovery, Charlie, well I agree that previous relapses had already set you up for that. Each relapse, and the thoughts and feelings that came with it, changed your synaptic pathways in one way or another. Then, the big change could happen suddenly. Sudden change is not alien to development. Many developmental changes happen like an avalanche rather than a slow shift in the course of a river. Falling in love, or falling into a depression, are other examples. The best model for that may be the “tipping point,” a very natural phenomenon.
I just ran across this:
Switching Off a Specific Brain Region Can Alter Ingrained Habits in Rats (http://1.usa.gov/Yi8LHJ)
(National Institute of Mental Health) Ingrained habits in rats can be quickly broken—and reestablished—by targeting and switching off a specific site in the brain’s prefrontal cortex using a technique known as optogenetics, according to an NIMH-funded study…
[The study showed that control] of a small part of the prefrontal cortex can change whether or not habits are expressed. An old habit can be blocked abruptly, and a new habit can override it. But if the new habit is then blocked, the old habit returns, thus lending credence to the notion that old habits die hard.
In addition, the fact that habitual behavior can be altered if [infralimbic (IL)] activity is disturbed suggests that the circuitry in this region of the brain is coordinating on some level with other brain regions that directly access circuits involved in behavioral flexibility, as well as addictive behaviors.
Although the optogenetic technique is too invasive to use in humans, it does have implications for potentially disrupting destructive habits. Targeting this specific region of the brain could lead to better ways of controlling addiction disorders or mental disorders in which habitual behaviors are out of balance, such as obsessive compulsive disorder.
Carolyn, that’s fascinating!
This really does look interesting. I am determined to put aside some time for reading, and this is very near the top of the list. Also on the list is a recent study showing heightened activity in the dACC when people are trying not to do something, rivaling activity present when they are trying to do something effortful. Sound relevant?
This is fascinating, Carolyn! Thanks for posting.
thanks Carolyn – yes, you are right, I need to go back to these basics. My stresses are not major, they just feel that way when they’re happening. Thank you again
Just to share, here’s another study in the news: http://www.thefix.com/news#justin4208 (with more here: http://medicalxpress.com/news/2012-12-block-memories-ptsd-drug-addiction.html#jCp).
It is very interesting, and I realize this is extremely tangential to Marc’s piece, but this undoing of memories type of research does raise some interesting thoughts. Any thoughts, Marc?
Wow kind of reminds me of “Eternal sunshine of the spotless mind”
I went to a really interesting NLP workshop a couple of weeks ago. The guy running the workshop gave a potted history of NLP and “performed” some NLP exercises to demonstrate how effective it can be. The workshop was designed to help military personell suffering from PTSD and was being sold as an alternative to CBT and other kinds of psychological interventions.
I found the whole thing absolutely fascinating, I have always had an interest in NLP, and found myself joining in enthusiastically. We did some exercises for cravings, pain and confidence, all them worked pretty much straight away on me and I left wanting to find out more.
I started to read a couple of books I bought some time ago and found lots of interesting stuff which kind of confirmed some of the things I have been thinking about recently. Much of the recent research around interventions in the addiction field is fairly inconclusive when comes to which particular intervention works best. CBT, 12 step, person centred counselling, psychotherapy, none of them seems to perform particularly well when it comes to delivering outcomes like becoming and staying drug free. However what does appear to work particularly well, being the factor that most people report as making a difference, is the “therapeutic relationship”, between worker and client.
Now this is not something new, the founders of NLP noted this years ago when they were working with Fritz Perls, Milton Erikson, etc. They found that significant change occurred during therapy more as a result of the attributes of the therapist rather than as a result of the intervention. They called it modelling human excellence. For me this makes a lot of sense, most of the changes I have made and most of the changes made by people I have worked with have almost always been as a result of pro-social modelling. Stuck in some kind of rut (a grave with open ends) until someone has demonstrated another better way.
I like a good metaphor and one that springs to mind is;
As we grow up our brains develop a whole suite of maps. Many of these become deeply ingrained, like the route we take to work every day. We follow that route over and over, ending up more often than not stuck in traffic, where once it was quick and easy. We keep doing it until one day someone suggests a different route along roads that have been newly built. Left to our own thinking would we know about this new route? Would we take the risk and try it?
Yes, that’s a great metaphor. The way behaviour becomes automatic is highly relevant to addiction. But there’s more to it. Compulsivity is hard to define precisely. But I think it is the triggering of a motor plan — like calling your dealer, or going to the ATM to get money for copping — that takes on a life of its own. In other words it’s the last step before thought turns into action. Then, when you do try to fight it you find that it’s got all this momentum. Then you struggle with yourself for a while, and finally you end up taking the traffic route you’ve taken so often before, partly just to relieve the tension.
As for NLP, I don’t know much about it at all. I think the principle is that you interfere with habitual ways of thinking and feeling engraved in the prefrontal cortex, but at the same time you strengthen connections between the hemispheres — so you get some dissolution of habit strength but also a new shot at self-regulation. Anyway, I’ve also often heard it said that it’s the quality of the therapeutic alliance that predicts results in any psychotherapy contest. Those words of wisdom would serve well to put water on the fiery debate that keeps springing up about AA, pro vs. con, in this blog for example..
I don’t really know if I believe that training the brain is as effective as they say it is. Because the brain only adapts to what you train it for. If you play a game that requires spotting birds in a particular time frame over and over, you get better at it. The thing is, you only get better at spotting birds over and over. You don’t get better at spotting birds while you’re driving, for instance. So I would put more effort into compound brain training, as opposed to targeting particular motions.
John Bond | http://www.nobleglass.net
Maybe so. But learning also generalizes. Generalization is one of the most important and well-studied phenomena in human learning.
Still, what you say may apply most seriously when people move from an inpatient setting back to their day-to-day world.
PS. It’s hard to reply to comments on older posts. Hope you catch up with our current stuff!