A successful business man who worked long hours in a stressful and demanding job came into the clinic looking for a ‘fix’ for his insomnia, depression and fatigue but our conversation turned towards his alcohol use. He started drinking alcohol at business lunches and dinners, it made him less anxious and more social. His journey had been tough with multiple failures in the past, struggles with his relationships and he found himself seeking alcohol more regularly. He blames a lot of his drinking on the stress from people in his life and negative events in the past. He admits that the amount he was drinking daily had escalated and it had created conflict with his wife, kids and friends. He has had issues with the law after a DUI and suffered injuries from a car accident. We discussed how alcohol is the most socially acceptable drug on the market and is the deadliest drug of all, the third leading cause of preventable death in the United States. Alcoholism is a chronic disease and we discussed how to take steps towards recovery. My intention is to share my conversation in hopes that it may also help someone else.
The neurobiology of addiction is linked to the pleasure and pain centers of the brain. Pain can be physical or emotional and the need to escape it is human. When we use substances such as alcohol, opioids, pain killers, stimulants, sedatives or illicit drugs they attach themselves to the opioid receptors, reducing the perception of anxiety, stress and pain and creates a powerful memory of itself in the brain. Over time, the brain learns to seek this substance to treat anxiety, stress and pain and soon not having the substance causes severe withdrawal effects, magnifying those symptoms, leading to continued use (Dependency). Not only does the brain demand the substance, but it also upregulates the receptors requiring more and more of the substance to maintain the same effect (Tolerance). When we experience happiness or pleasure, it is because the brain releases a reward substance called Dopamine. When dopamine pathways light up our brain it can dispel the negative feelings of sadness, anger, depression, loss, grief and even pain temporarily giving us a ‘high’. Someone who is suffering from emotional pain, physical pain, chronic trauma or genetically inclined to have a deficiency in the dopamine pathways, can experience a heightened sense of pleasure with substances and activities such as alcohol, opioids, gambling, sex, shopping, gaming, social media and illicit drugs to name a few. This can lead to cravings and compulsive behaviors to seek the substance at any cost. (Addiction).
Addiction, dependency and tolerance ignites a state of chronic stress, fight or flight and inflammation. It can manifest as anger, fatigue, depression, anxiety, insomnia, physical pain, hormonal dysregulation, immune suppression, gastrointestinal disruption, cardiovascular metabolic disease and increased toxic burden.
How does one start the journey to detox and recovery? A first step is often a detoxification process under medical supervision to overcome the physical and psychological dependence on alcohol. Detox does not cure alcoholism, it only allows the person to get into the right mindset to pursue true healing. Even after the detox process, medications and medical supervision may be needed to help with mood disorders, cravings and compulsive behaviors. Recovery is a lifelong process. It starts by acknowledging that alcohol has power over one’s life and that this is an addiction, a chronic disease. It may also require ongoing medical attention, medications and counseling in the inpatient or outpatient setting.
How do you ensure long term success? For true healing to begin, it is important to enlist the help of those you trust such as supportive friends, family, counselor, spiritual leader and healthcare providers. Announce the desire to change and create a list of meaningful reasons why change is critical you and your loved ones. Explore your journey, how your actions may have affected others, your own health and your decisions that created the unfortunate circumstances in your life. Reflecting on any shortcomings and making a list of those who were harmed intentionally or unintentionally and make amends when possible acknowledging fault, observing our own actions, facing fears and failures can allow proper processing of pain.
Meditation is a process that can help reframe one’s perspective and allow for clearing of the mind and healing of the body. Individual counseling such as Cognitive Behavioral Therapy (CBT) can help bring insight to how one reacts to negative experiences like losing a job or relationship and build resiliency and coping skills. Group counseling sessions can involve role-playing or acting, props, arts and crafts, music, animal care, guided imagery, or various forms of reenactment of emotional situations from past and recent relationships. Another intervention is Mindfulness Based Stress Reduction (MBSR) which focuses on paying attention to being present on purpose without judgement. Studies on MBSR show that mindfulness meditation stops the avoidance behavior by promoting nonjudgmental acceptance of moment-to-moment thoughts and by interrupting the tendency to respond using maladaptive behaviors such as substance use. Awareness which is cultivated in a mindfulness practice can also help stop the automatic reaction to cravings. Creating awareness is the path to wellness.
Addiction affects the whole community. Cultural bias that projects ethical and moral judgement on patients with addiction keeps us as a society from providing meaningful and lasting solutions. To properly address the medical and social issues facing our community we have to peel the onion on this sensitive issue with compassion, understanding and a comprehensive plan that involves the individual and the whole community.