The latest issue of the journal Neuron is devoted to research on addiction and how it operates in (and affects) the human brain. This is important research, and the publishers have made this entire issue accessible at no charge to the public. One of the main take-aways is the idea that addiction is not so much as disease as a “hijacking” of the brain systems that ordinarily serve to help us survive and be healthy. The substances themselves produce changes in the functioning of the brain at the cellular level, and those changes unfortunately create a vicious cycle of use, abuse, and withdrawal. They also impair the very processes that ordinarily help people avoid trouble and think their way out of danger. “Executive functioning” is the term loosely used to describe our ability to plan ahead and choose things that may be less pleasurable in the short term but ultimately better for us in the long run. Addictive substances (and perhaps even process addictions) may impair our very ability to think clearly and plan ahead. I’ve certainly never agreed with the old AA chestnut that says, “Your best thinking got you here.” Actually, I’ve always thought it was the opposite – not being able to use your best thinking is what can get you there. (Even in the case of Charlie Sheen!)
I’ve always been a firm believer that, no matter how important it is for addicted people to accept that they do not have control of their using behavior, and no matter how helpful it is to get support and fellowship from others in similar situations, it is counterproductive for people suffering from addictive disorders to dwell on their inferiority as people, or to devalue the accomplishments that they have made in their lives, simply because they were using. That’s one reason I’ve been encouraged about the growth of such alternatives to the traditional 12 step approach as S.M.A.R.T. Recovery, SOS/Save Our Selves, and LifeRing Secular Recovery. I firmly believe that all the meetings in the world will not be enough if the person in recovery does not have a “toolbox” of behavioral and cognitive strategies to deal with urges to use, stresses, restlessness, emotional upset, and the other events that can lead to relapse.
I certainly respect and value the pioneering role played by AA during a time when “drunkards” were considered to be morally bankrupt people, providing much-needed fellowship and support as well as some powerful metaphors to help people disengage from the perceived inner struggle of trying to control one’s drinking by “willpower” alone. But we have learned a great deal in the past 70 years, and there is a greatly expanded toolbox for maintaining an abstinent life for those who have come to realize the need to do so. Additionally, AA can be a valuable source of additional support even if someone is using a cognitive-behavioral approach such as SMART Recovery. The sense of support (especially the feeling of not being alone) can be one of the most useful tools in the individual’s recovery toolbox.
I’m convinced that more research on the brain-level mechanisms of addiction will help confirm some of the impressions I’ve gotten from working with clients:
- The development of addiction represents a misguided version of the functioning of a healthy brain.
- Each addicted person is different, and no one can tell another person how to best handle their sobriety.
- Self-help and empowerment are better tools than self-downing and feeling defective.
Once addicted people finally accept the idea that trying to control their drinking or using is futile, and once they let go of the possibility of attaining and maintaining abstinence by sheer effort (without tools for self-management), they can use that precious human capacity for thinking and planning – our executive functioning – and it can serve as a “higher power” in itself.
It is not “egotism” or destructive pride for a person to take responsibility for is or her own recovery. It is what Albert Bandura called “self-efficacy.” It needs to be supported and strengthened, not disparaged.