Category: Connect

Hi all—

Here’s an announcement before the main act: Please look at the Guest Memoirs page if you haven’t already. The first four memoirs are terrific, and hugely different. I hope that we’ll soon get more, and I hope people will leave comments on those already posted. It may seem hard to “comment” on something autobiographical….but just saying “I get how you must have felt,” one way or another, can mean a lot to someone who has just exposed themselves so openly.

The main act:

I haven’t published a post in a few weeks. I’ve had one part-written since the day after Persephone’s amazing post (see previous), but it remained in note form while I was busy with other things. Those things included my twin 6-year olds. Mama (my wife, Isabel) was in the States for 10 days, doing research (and staying in fancy hotels) while I slaved away here. It was more work than I’d expected, because the boys now go to an after-school daycare, where I need to pick them up, but I never seem to get there without getting lost and ending up in farm country.  So that’s an hour out of my day, getting them to school in traffic is another 45 minutes, Dutch lessons plus practice – 4-6 hours per week, showing up for work at the university once in a while, cleaning up an amazing amount of trash left over from the intense Halloween party we had a couple of weeks ago (fabulous costumes, lots of food and wine, even a fire juggler) but did we have to buy 30 rolls of toilet paper so the kids could have a dress-the-mummy contest? Yet the main time drain was none of the above: it was keeping a lid on the kids. With Mama gone that long, they were bouncing off walls, ignoring my commands, arguing more, breaking rules. So I spent a lot of time disciplining these adorable little buggers…not my favorite parental duty.

Which brings me back to Persephone’s post. The main problem with the 12-step approach, she says, is the freeze on emotional development they seem to demand, intentionally or not. So recovery becomes a way of not moving – it’s static. According to Persephone, the epitome of successful recovery in NA/AA is to sit around with the same people, year after year, sharing stories about how shitty it was being an addict, so that you can REMAIN clean or sober. It’s all about remaining a certain way rather than growing. As Persephone saw it, they tell you that your addiction is doing push-ups in the parking lot, or waiting to leap on you, so the only safe course is to stay here with us – stay being the operative word. And the result is that you continue to define yourself as an addict. In other words, not only the way you govern your life but your whole self-image is frozen in place. This is what you are, and if any change occurs, be warned: it’s going to be a change backward – back to being an addict who’s no longer in control.

Persephone proposed the following: With your behavior, your choices, your capacity to explore, and your self-image all frozen in this way, and with the horror stories of your addiction constantly resurfacing, you are in the same condition as someone with PTSD – post-traumatic stress disorder. What a concept! People with PTSD live with continuous anxiety, denial and avoidance mechanisms, intrusive thoughts, and more, about what happened to them, whether it was a serious accident, a mugging, physical or sexual abuse, rape, getting wounded in a war… And the therapeutic principle for recovery is pretty simple: you have to free yourself from those fears, from the anxiety that it’s still happening or will happen again, by reprocessing the event, with some sense of acceptance. Yes, it happened, but it’s over now. You have to do that before you can move on. Then you shift from a static state to a fluid state, let down your defenses, allow for the unexpected, and find the confidence that you can handle whatever comes.

So here are my kids in a state of anxiety. They’re not old enough to conceptualize how long 10 days will last. As far as they’re concerned, Mama is just plain gone. They love me a lot, and we sure got closer during this period. But their anxiety changed everything! They regressed, they became more moody, aggressive, shut-down, or simply unregulated. And to continue the analogy with NA/AA, I became like their sponsor. Come to Papa when you start to lose it, and then do exactly as I say. Because the thing/person you really want is missing from your life, and you’re in danger of going from bad to worse. My style of parenting changed. Everything became more rule-bound, there were a lot more time-outs, consequences dished out, time deducted from weekend TV… In brief, living with anxiety takes its toll. I knew this as a psychologist anyway – I just got reminded: anxiety diminishes cognitive flexibility and creativity, and it draws attention to the negatives – whether you’re a motherless 6-year old or a boozeless 60-year old.

My kids became dry drunks for over a week.

One of the coolest (but still experimental) treatments for PTSD is to relive the traumatic event while you’re taking beta blockers, drugs that reduce sympathetic arousal. This article describes the approach. So why should that work? Are you just relieving anxiety over time? No, the theory says you are interfering with the maintenance of traumatic memories. Memory strength and endurance depend on a kind of rehearsal process. You have to keep on reliving the memory (at least some version of it) while feeling the emotions that came with it – e.g., the fear unleashed when a trauma occurs, or maybe that stew of shame, anger, and horror that comes with addiction. (I still vividly remember the time I shot the heroin left in “the cotton” from a junkie with yellow eyeballs, broadcasting hepatitis – and I get a jolt of disgust and shame each and every time.) Without that emotional charge, the memory fades…just like other memories.

Memories are encoded in the connections (synapses) between brain cells. You have to reinforce those connections (keep strengthening those synapses) to keep vivid memories vivid. Strong emotions like anxiety activate or facilitate synaptic cascades (e.g., in the amygdala). Anxiety also does the job of connecting novel events to that ball of fear at the core of the trauma, thus extending the synaptic network still further. With beta blockers in your blood, you can relive the memories without the anxiety, allowing the memories to become diluted or dissipated. They start to dissolve and lose their hold on you. Then you can spread your wings and fly, rather than remain frozen with your wings permanently clipped (Persephone’s words, with a nod to Lennon & McCartney). That’s when your emotional world starts to grow again.

According to Persephone, many/most 12-step groups intentionally reinforce a PTSD-like state: Be afraid…be very afraid… Sort of like the opposite of trauma treatment using beta blockers, many 12-step groups seem to kindle the very emotions that cement your already vivid memories of when you were seriously fucked up. Almost like telling scary stories to keep little kids in line.

But sometimes it works: because living with PTSD is one way to keep away from danger. After getting mugged or raped, you won’t go strolling through city parks at night, you’ll stay inside when the parade comes by, you’ll avoid people of a certain type, you might avoid eye-contact with strangers altogether, and you’ll continue to see yourself as a victim or a loser. Not only is that a static state; it’s also an unhealthy state. It maintains anxiety rather than relieving it. You stay clean because you stay scared.

If that’s the solution offered by many 12-step programs – to plug yourself into a static state of PTSD in order to avoid the dangers of relapse – then I can sure see why a lot of people don’t sign on, or stay for a while and then get out. I can see why the notion of a lifetime addict can be a self-fulfilling prophecy. And I can see how people get hurt, sometimes badly hurt, when they try to break free: because they may actually get chastised for wanting to leave their PTSD behind — and that hurts.

For the most serious, interminable addictions, this might well be worth the price. We’ve heard a number of claims to that effect. But for those who do have the capacity to continue growing, leaving their addictions behind and moving on, it doesn’t sound like an ideal solution.

Please note! I’m not trying to rekindle the debate as to the pro’s and cons of AA/NA. Been there, done that. I’m just trying to build a clinical and neural extension onto the perspective of one person – who seemingly reflects the experiences of many others (judging from comments received!) – people who didn’t find what they needed.

Next post, coming in a few days, I’m going to zoom in on the relation between anxiety, memory, and habit formation – both in the development of addiction and in recovery seen as a developmental process — by looking more closely at what’s happening in the brain.

By Persephone…..

(This piece was sent to me by a member of this blog community, and I think it’s incredibly astute and revealing. As a developmental psychologist, I strongly agree that the recovery process should be viewed as developmental, not static. P.S. It’s apparently no longer be-nice-to-12-step week.)

After I had been clean for what one member counted as 17 months, I finally went back to an NA meeting, only to discover that there is such a thing as being held in stasis in recovery — and that I had, myself, been there. I was acutely aware before, but even more by that point, that for many of my 12 step instructors (for lack of a better word) we were supposed to freeze ourselves in that very moment in which we finally realized that we were “diseased” and had decided to devote ourselves to recovery. We were to cling to that moment in time, reaching backwards instead of forward, into the depths of our misery lest we forget it, developing emotionally only artificially via these 12 steps but otherwise staying rather static in some very crucial ways. So, I watched as roughly 30 people recounted, and with the same stories I had observed over 17 months prior, the worst moments of their addiction. Having not been in a 12 step program since getting clean, but rather in trauma therapy (when I had any therapy at all) as well as restructuring my life on my own based around my new-found loves of self-restraint and goal oriented thinking (not to mention just plain having fun), I could only see in these shares shadows of my past. My very sick past, and one in which I was unable to achieve any kind of “recovery”. I could also see exactly what my therapist always warned as dangerous in terms of staying in the moment and forcing oneself to relive past traumas, though my new and healthy brain had already directed me against this sort of thinking. Very far away from this kind of thinking, so why was this not the case in the most well-known substance abuse venue in the western world?

I realized while listening to these shares (over 30) that none of this emotional development had taken place with the members of this particular group. Hopelessness, anxiety, and the common thread that the “disease” was still very present (and quite personified, doing push-ups in the parking lot and lurking around every corner just waiting to flare back into active addiction), even in the relatively normal actions and thoughts these people had experienced that day. They were still experiencing the anxieties and fears I by then had come to associate only with active addiction and very, very early sobriety. Not being trained in psychology but having had my fair share of trauma counseling and the usual smattering of readings about trauma and abuse, I also associated these problems as being almost akin to PTSD, which is almost by definition a state of stasis in which one cannot process or heal from a traumatic experience.

Yet even in my tattered memory, I was acutely aware of what I was taught during my short tenure in NA and the inevitable stint in a 12 step rehab that followed (I say this not to offend adherents to the 12 step method, but to stress that the effect this static-not-developmental treatment had on me was to, well, keep me in my addiction — which for me was synonymous with hopelessness and trauma.). I, and the others, were told that we must essentially live with clipped wings. If we were allowed to ever truly fly, we’d surely be conquered by our own “self-will” and excesses of ego. Anger and hatred (“resentments”, in 12 step parlance) were to be eradicated. How we were supposed to do this without extreme amounts of repression (or a particularly intense spiritual experience) was rather beyond me, and frankly it was my anger that was keeping me going. I consider anger now a useful stage of sorts in my development as a now-recovered person, much like the anger in the often quoted stages of grieving. But no, never in “recovery”. “Resentments” lead to relapse, we were taught. We were to progress only through the steps, despite our various ideological differences with them, but never through normal human emotions. We were all taught that we were faulty, that our brains were faulty from birth, that we were born addicts and must consider our brains to be diseased until the day we died.

We are about to launch a “Guest Memoirs” page, as promised. Here is a description of the project, including details, benefits and risks, and the procedure for publishing your memoir.

Anyone who wishes can share the story of their addiction/recovery with other readers of this blog as well as members of the general public who will soon be able to find it via Google.  The only requirement I ask is that the stories be “true” to the best of your recollections. The length can be anywhere from a paragraph to a couple of chapters. Please feel free to post an anecdote or two, or else notes on an interesting period of your addiction or recovery. You don’t have to tell your whole life story!!!

There will be a comment section at the end of each published memoir, allowing others to reply, reflect, ask questions, or whatever. I will not be editing the memoirs or the comments. I will take a brief glance at each memoir received, mostly to get a sense that it’s appropriate for this feature, before publishing it. However, beware: anybody can write anything in the comment section, so if you have a thin skin, you might want to give this a miss. But I expect very few comments to be offensive. And…if you receive comments that are truly nasty, just alert me by email and I’ll remove them.

I may also comment, and if I do, one of the things I’ll try to do (especially if requested) is to supply a little neuroscience information that might complement your memoir.

I expect that it will do many of us a lot of good to see where others have been. The main thing to keep in mind is that there are a lot of lonely, confused people struggling with their addictions. Just being able to see what others have gone through, and how they have managed to survive and improve their lives (e.g., recover, in part or in full), will be of great benefit to these people. Just knowing that they are not the only ones who have felt what they’ve felt and suffered what they’ve suffered can be a healing process. Rays of light are always encouraged. For those of us who are not in such dire straits, it is always interesting to compare notes!

Your memoir will be anonymous unless you choose to include a name or pseudonym. That’s your choice. So here’s the format I request:

Title (if you like, or just note “untitled” which is fine too).

Name or pseudonym, only if desired.

Keywords: If possibly, please supply 3-5 keywords, so if we ever get around to it we can index the entries for easier organization and access. I think these should include the name of the thing you are or have been addicted to (e..g, opiates, alcohol, stimulants, sex, gambling, eating, or even more specific terms like “”cocaine” or “heroin” — and, of course, multiple addictions are welcomed 🙂 Also include specific programs or treatment approaches that are highlighted in your memoir, such as Narcotics Anonymous, mindfulness meditation, methadone, or whatever. The rest I leave up to you. Perhaps include keywords indicating important features that have been associated with your addiction, such as “lying” or “stealing” or “dealing” or “hospitalization” or whatever.

The memoir: Put the text of the memoir in the email, NOT an attachment. Please do not use special characters. Normal characters like quote marks usually come through fine.

REQUEST:  Will a few of you please send me something in the next week. That way we can launch the memoir page with actual material, which will look a lot better than just a lot of white space.

All emails to me — the memoir itself and any questions you may have — can be sent via the “Contact” box, which you can access via the button at the top of this page. Or else mail to marc@memoirsofanaddictedbrain.com.

You probably didn’t think it was possible. How could this be? It’s scandalous! Providing opioids for the very people who are trying so desperately to get off them. But since this is Week 2 of our be-nice-to-12-step extravaganza, let me tell you the story.

In the comments following my last post, Elizabeth told us of a study (Coan and colleagues, 2006) showing that hand-holding can diminish people’s response to threat. Unfortunately the link only takes you to a brief summary of the study. I went back and read the full version, and this is what happened.

Fifteen women who reported high quality marriages were put into an fMRI scanner, with their husbands and the experimenter remaining outside in the room. The women were shown cues on a screen several seconds before an electric shock was possibly administered to their ankle by an electrode. These electrical zaps are generally only slightly painful (in psychological experiments). But the cue on the screen, coming a few seconds earlier, is bound to make one anxious. Especially because it announces that a shock may come, but it may not. In other words, the subject is in a state of uncertainty and anxiety, waiting to see if the shock will come or not.

This experimentally-induced state of threat or anxiety is, of course, meant to simulate real-life stress. And I think that’s fair enough. Let’s get specific about opiate addicts. Will I be okay? Will I be able to restrain myself today? Or will things get so shitty that I’ll fall off the wagon — again? And if I do, there will be hell to pay when I get home…etc, etc, etc. We all know the drill. Being an opiate addict in recovery is being in a state of anxiety or stress — for much of the time — and the only relief may be…a shot of heroin (or pills, or whatever) OR a visit to your local NA group. That makes you feel better too. That’s why you go.

Little did we know that the group makes you feel better for the same reason (at the cellular level) as a shot of heroin.

Some very prominent emotion scientists have theorized that opioids (made inside our brains) are at the root of human attachment. Mother’s milk is rich with opioid molecules. In other words, nature found a surefire way to soothe the baby with its mother’s milk, using the same chemical formula that’s responsible for the soothing feeling of heroin. Jaak Panksepp theorizes that all social attachment is based on the release of opioids within the brain. Here’s a quote from him, referring to his early attempts to publish this work, cited in a very nice review for the non-scientist:

“When we first tried to publish our paper on the role of opioids in social attachment in three species, we submitted it to Science,” he said. When he asked the editor [why the paper was rejected, he was told], “‘We decided it was too hot to handle. If love and attachment ride on the same system as narcotic addiction, that’s too scary…’ ”

The review goes on to show how parents also get opioids from their kids. They feel great gobs of love and mush because their own brains produce a glut of opiods just at the sight of those sweet little faces. But let’s get back to Coan and colleagues’ experiment.

When the woman in the scanner was holding her husband’s hand, through a little hole in the side of the machine, many brain regions involved in stress or negative emotion showed reduced activation. On some trials, the hand she held was not her husband’s but that of the experimenter, a friendly male stranger. Even on those trials, many of the same brain regions showed reduced activation. Now here’s the kicker: The brain regions that got calmed down by hand-holding (including regions of the ventral ACC, ventral prefrontal cortex, striatum, and insula) are the same brain regions that have a high density of opioid receptors! The authors speculate (and I think it’s very likely) that opioid release is what causes the deactivation of these emotional hot spots. The subjects also reported less unpleasantness when they were holding hands while anticipating the shock. And, get this, the reduction in unpleasantness was correlated with the reduction in brain activity in these hot spots.

Thanks for the opioids, dear.

Elizabeth said in her comment that she heard a lecture by the same researcher, reporting that some of the same neural calming effect was found when the person’s partner was just in the same room with them, never mind hand-holding. So you don’t need to hold someone’s hand to get opioid soothing. You just need someone who cares for you to be in the same room.

In a recent debate on this blog, I argued that a supportive group like NA makes sense as a primary treatment for addiction–not a secondary one. Certainly members of NA or AA see their group experience — with or without hand-holding — to be the most powerful antidote to their feelings of anxiety, stress, loneliness, and all the other negative variants that can lead to relapse. Now we can point to a very concrete, biological mechanism responsible for the soothing function of the group: when you are in close contact with people who care about you (even a little), your own brain releases opioids. And, in a sense, those opioids replace the opioids you’d otherwise be buying on the street.

A final word: this is not some cheap trick the brain is playing on you. Internal opioids are not like methadone maintenance. Opioids have been nature’s way of soothing our pain and our stress, for tens of millions of years of evolution! That’s why we need them. That’s why we like them. NA, and other forms of intimate group experience, help us to get them from our connections to other humans (something we’ve perhaps forgotten how to do) rather than the guy on the street corner.

That’s what nature intended.

I see a lot of comments rolling in on my recent post. That really makes my day. Or night, in this case: it’s currently just after 4 AM. Can’t sleep.

I had an amazing two days in England just now, visiting people who work in one way or another with addiction. My first evening there, spent in Oxford, was with two Australian philosophers who’ve received a large grant to study the identity issues of addicts. Lovely people, but I did not learn much from them. In all fairness, they have just begun to analyze the first wave of data in a multi-year study. Still, I recall JLK’s contention that a high level of abstraction sometimes seems to miss the boat when it comes to addiction.

So let’s get down and dirty.

The following evening I met Peter, who has recently posted comments on this blog. I won’t tell his story – it’s his to tell – but after a three-hour train ride to the north of England, I’m received by a large, smiling man, who lives in a small house that seems to be tilting on its foundations, together with a very large dog and a quiet friendly woman, his partner.

But we didn’t go to his home first. On the long drive through rush-hour traffic I told Peter I’d never been to a 12-step meeting. Hint hint. Would you like to got to one tonight, he asked? Indeed I would. He said we’d be a few minutes late but it didn’t matter. We were on our way to a meeting of one of about 30 NA (Narcotics Anonymous) groups in the region.

We walked in the door of a modern, nondescript building, and approached a group of about 30 or 40 people sitting in chairs in a large ragged circle. Many looked up at Peter as we approached, nodding or smiling. He seemed the granddaddy of the group. He’d been clean and sober for over ten years, a state many of the others could barely imagine. I felt their love and their respect for him. And they looked over at me, some with flickering smiles: who is this diminutive, academic looking fellow, never before seen in these parts? What’s his story? I heard them thinking.

So we sat down at the outskirts of the group and just listened. Through very strong accents from the north of England, their stories found their way into my brain and my heart. These people, mostly men, looked like they’d been through the ringer. Their faces were hard, their endurance carved in the creases around their eyes and the grim holding pattern of mouth and jaw. But there was a softness here too. They listened to each other’s miseries with real caring, with a kind of empathy that doesn’t run out, because if there’d been any limit to it, it would have run out ages ago. Later, I asked Peter what was the approximate range of clean time for the people there that night. He said: mostly under a year or so, some a few months, some a few weeks, some just a few days. I could recognize the last group from their constant sniffling and jerky movements. Everyone there was a heroin addict.

With all my negative presentiments about the 12-step program, I found myself shifting like a boat with no keel. There was something intrinsically good here. And I knew what it was: that old thing variously called friendship, warmth, brotherhood, support, caring. These people cared for each other, and given the degree of their helplessness, what better treatment could you want? That’s why they kept coming back. Their stories were sad, of course they were, full of bitter irony and gut-wrenching failure, self-rebuke, hopelessness tinged with a bit of hope. But there was always a smile there too. Maybe not until the last sentence, at which point the person might look up, his face finally relaxing into a crooked grin, as if to say, I know you know that I probably won’t make it, at least not for good, at least not this time, but you know, I might…

On the way back to Peter’s crooked house, I asked him how many of the people sitting there tonight would stay clean…for a good long time, maybe barring the occasional relapse. He thought for a moment and then said: maybe 30%.

He also explained what some people mean by being a “true addict” – a phrase we’ve recently argued about on this blog. From the perspective of NA or AA, being a true addict means that you could not, simply could not, after trying everything under the sun and the moon, time after time, year after year, could not stop. So these groups were really the only thing left. And sometimes they worked. But even if they didn’t, they probably made life bearable. Peter felt that the “true addict” polemic did more harm than good, magnifying differences rather than commonalities. But at least now I knew what it meant. And I was damn glad I didn’t fit that bill.

I asked Peter a lot of questions that night, and I’ll just mention one more. I asked: why the dogma? Why do some 12-steppers insist that this is the only way…when we all know it’s not the only way? He thought about that one for a while. Then he said something like this: When you’ve been trying that long and failing that long and then, finally, something works, you don’t look around and compute the statistics. You tell everyone who will listen: This is what works. This is the only thing that works. The unspoken part remains “for me.”