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Relapse and the Brain by Michael Dye

http://www.genesisprocess.org/more-info/understanding-relapse
Relapse and the Brain by Michael Dye

In very simplistic terms, we have two parts to our brains. The first part is the neocortex. It is located in the front of the head and receives and stores information for decision making and remembering. The other part is called the limbic system, which controls all the automatic systems of the body and the emotions. Most importantly, the limbic system controls the survival responses, i.e., fight or flight and freeze. When you feel threatened, these protective responses tell you either to defend yourself or to run away or go numb. The limbic system doesn¹t have a memory like the neocortex. It doesn’t know the difference between yesterday and 30 years ago, which explains why some of our childhood traumas still trigger us so powerfully today. It is the limbic system that is most affected by our beliefs, behaviors and addictions. The limbic system can be negatively programmed through traumatic experiences such as growing up in a stressful or” dysfunctional family”. Basically the limbic systems encourages us to repeat things that give us pleasure and take away pain and avoid things that hurt or have to do with fear. Drugs, alcohol and other compulsive behaviors have programmed the limbic system to avoid the awareness of uncomfortable thoughts and feelings instead of making healthy responses to resolve fear.

Events come through our senses and are fed into various parts of the brain. The limbic system colors or tags these events with degrees of response as either safe or dangerous. If tagged dangerous because of past trauma, either real or imagined, it reacts by creating anxiety or depression. If the event is tagged having to do with survival, the limbic system can create a focused craving for behavior that has been associated with survival in the past. The craving focuses our attention on that behavior until we feel safe or normal again. Thus an addiction is created. Addiction is not about getting high but [it provides] a way to feel normal (free of stress). The conscious mind learns to cooperate with the survival behavior (addiction) and protects it from being challenged by a filtering process called denial. The result is the addictive brain.

The limbic system may have learned that having needs in a dysfunctional family resulted in vulnerability, hurt, abandonment, and isolation. In order to survive day after day in a dysfunctional/threatening atmosphere, a person has to find a system of thought that will allow for survival by removing stress. One way they may have done this is by thinking “I don¹t need anybody”. If I don¹t need anybody, I’m not vulnerable. If I’m not vulnerable, I don¹t get hurt.

(this is what Genesis calls a survival lie.)

Every time a feeling of vulnerability is experienced, fear creeps in and warns, Danger! Feelings of fear and panic signal you to fight, flee, or freeze to avoid possible hurt.

This limbic process responds automatically and subconsciously. Even after the painful or traumatic situation is over, the subconscious still believes that If I have needs and trust other people, I’m going to get hurt and I won’t survive. When trust issues come up today, the limbic system can react with strong emotions as it was programmed . This fear can be expressed in anger/rage, self-gratification and mistrust which creates a survival personality. Your protective personality makes you feel in control (free of fear and stress) by pushing people away. This false sense of control is often achieved through self-gratification or compulsive/addictive behaviors which temporarily removes the awareness of the unwanted thoughts and feelings… The Limbic System controls basically three areas, food, sex and safety. Which is why all our compulsives / addictive behaviors are in these three areas.

To change, you must reprogram your brain by first discovering these false beliefs and then replacing them with the truth. You will realize, for example, why you have been sabotaging relationships by believing that you don¹t need anybody. The truth is you need to trust God and others. The Limbic System will make it very difficult for you to make changes that involve risk (like recovery) unless it feels it is safe. And it’s not safe to take risk alone. Personal change always involves risk.

Even though you’ve discovered false beliefs, uncovered the lies and know a new truth, there is a time lag between what your limbic system believes and what your neocortex has learned. This is called limbic lag, a process that can be anywhere from a couple of months to years, but it will get shorter as you continue to uncover and challenge the false beliefs (lies produced from traumatic experiences) and risk trusting again. You may have fear and panic attacks, but once you go through them without doing the old behavior, your limbic system will say, “Oh, we went through that and actually survived.” The next time you experience the fear it will be less, and you will be able to make a good choice rather than overreacting with a fight , flight or freeze response. Old automatic habits aren’t changed quickly or easily, and are stronger when we’re tired. Many recovering addicts and trauma survivors have programmed the survival part of their brains with thousands and thousands of instances of avoiding unwanted thoughts or emotions choosing not to resolve with their issues, but to take “flight” into their addiction. Over time, this flight pattern becomes an automatic reaction. With a new identity based on new beliefs, you can change that flight pattern and reprogram their limbic system.

Changes happens one decision at a time. No matter what your emotions tell you would feel good to do (drugs, alcohol, sex, food), listen to what your mind knows, and do what is best or right. If you continue to apply this key thought, you will begin to break the limbic patterns, and decrease the time of the limbic lag process.

Drugs and alcohol are anesthetics. They do one thing: they kill pain. It is reasonable to assume that when you give up the anesthetic, you will feel the pain, discomfort and uneasiness. Knowing what to do when this occurs is a critical skill in relapse prevention. Relapse prevention is finding new appropriate ways to respond to painful situations. In order to learn appropriate responses to pain, people with addictions have to allow themselves to feel. The two most common responses to pain are anger and anxiety.

Anger is one of the most common responses to pain. This kind of response becomes normal in dysfunctional families where no one can admit problems or fears. Anger helps us cope with pain by physically making us tense, which causes excitement, releasing adrenaline and endorphins, diverting our attention from the pain. An angry response produces a neurochemical response similar to taking cocaine. Neurochemically speaking the main role of anger is to anesthetize fear.

Most people say that anger makes them feel bad afterwards, but in the moment anger itself makes us feel big, right, strong, aggressive and powerful. Anger is a powerful physical and emotional anesthetic. Heroin is a powerful pain killer. When I ask heroin-addicted clients, How much heroin would you have to do for you not to feel it if I hit you in the face as hard as I could? their answer is always the same, right on the verge of overdosing and dying. Similarly, when a person is really angry, he can be hit in the face and not feel it.

Consciously or subconsciously, we have learned to use emotions such as anger to kill pain and to avoid subconscious, unwanted thoughts, feelings, and memories. Many addicts have an addiction to anger as well as drugs, especially if their role models were rageaholics. Healthy people move towards their pain and face it courageously. Although risk is uncomfortable, we all enjoy the feeling that comes through conflict resolution and a clear conscience. Controlling anger and avoiding things that need to be dealt with takes a tremendous amount of energy. Repressing the awareness of unresolved conflicts leads to exhaustion and resentment.

Anxiety is equally used as an anesthetic to cope with feelings. Though uncomfortable, this emotion releases neurochemicals that cause the body to speed up and avoid depression. Dr. Stiles in his book Thorns in the Heart states that:

Besides making us alert in crisis situations, anxiety has an additional function. It serves as an antidote to emotional and physical pain. Since anxiety is commonly thought of in connection with pain and distress, its pain-masking function may come as a surprise. If anxiety causes emotional pain, how does it also stop it? In modest amounts, anxiety is an effective smoke screen Here¹s where the trouble begins. When we find anxiety has served us well in a particular situation, such as masking pain, we may deliberately use it again. At this point our lower brain begins to record our response. Soon, an imprint, or habit, develops and we have learned anxiety. In time, anything triggering these learned patterns, or imprints, will produce the anxiety responses.

If a person holds on to two, small unresolved resentments which produce anxiety each day, in a year they would add up to 730! How many resentments do you think a person can hold inside as unresolved problems before that person relapses? What we know is this: resentment relapses alcoholics and addicts. As it says in the Big Book of Alcoholics Anonymous: Resentment is the Number one offender. It destroys more alcoholics then anything else; from it stem all forms of spiritual disease.

Relapse is a predictable process. It has identifiable stages, each of which has a distinctive neurochemical basis. The FASTER SCALE in the Genesis Process is a neurochemical model of relapse that identifies specific high risk behaviors for each stage of the relapse process. Before relapse happens, many biological, psychological and social changes affect our neurochemistry. Addicts speed up their avoidance behaviors, increasing anxiety and anger to mask pain. This depletes endorphins, causing hopelessness and exhaustion. In this state of exhaustion, addicts isolate and feel they cannot cope without chemicals.

Every letter in the word FASTER stands for one of the steps in the relapse scale. This scale reflects a progression of strong emotions that mask pain. It explains neurochemically what almost every addict goes through in his descent to relapse. Remember, anger and anxiety release adrenaline and norepinephrine, which speed up the body. After speeding up we get ticked off and then exhausted.

All the steps in the relapse process have one thing in common: procrastination. A problem that was never dealt with begins each state. As you fail to deal with problems, you move down the FASTER scale. Crisis comes at a time when you are least able to deal with it emotionally. The short version of the Faster Scale is speed up> anger > tired > use.
The Faster Scale is a tool that can effectively see a relapse coming a minimum of two weeks before it happens.

1.) Stiles, S. Thorns in the Heart: A Christians Guide to Dealing with Pain.  Washington: Gospel Publishing House, 1994

2.) Anonymous, The Big Book of Alcoholics Anonymous, AA

Reprinted with permission, from The Genesis Process: A Relapse Prevention Workbook for Addictive/Compulsive Behaviors by Michael Dye and Patricia Fancher.

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Addiction

Originally posted by Brain for Business

Addiction: a life long illness not lifestyle choice

Addiction is a major health problem that costs as much as all other mental illnesses combined (about £40 billion per year) and about as much as cancer and cardiovascular disorders also.

At its core addiction is a state of altered brain function that leads to fundamental changes in behavior that are manifest by repeated use of alcohol or other drugs or engaging in activities such as gambling. These are usually resisted, albeit unsuccessfully, by the addict. The key features of addiction is therefore a state of habitual behaviour such as drug taking or gambling that is initially enjoyable but which eventually becomes self-sustaining or habitual. The urge to engage in the behaviour becomes so powerful that it interferes with normal life often to the point of overtaking work, personal relationships and family activities. At this point the person can be said to be addicted: the addict’s every thought and action is directed to their addiction and everything else suffers.

If the addictive behaviour is not possible e.g. because they don’t have enough money then feelings of intense distress emerge. These can lead to dangerously impulsive and sometimes aggressive actions. In the case of drug/alcohol addiction the situation is compounded by the occurrence of withdrawal reactions which cause further distress and motivate desperate attempts to find more of the addictive agent. This urge to get the drug may be so overpowering that addicts will commit seemingly random crimes to get the resources to buy more drug. It has been estimated that about 70% of all acquisitive crime is associated with drug and alcohol use.

Addiction is driven by a complex set of internal and external factors. The external factors are well understood: the more access to the desired drug or behaviour e.g. gambling the more addiction there is.

The internal factors are less clear. Although most addiction is to alcohol and other drugs, addiction to gambling and other behaviours such as sex or shopping can occur. These tell us that the brain can develop hard-to-control urges independent of changing its chemistry with drugs. All addictions share a common thread in that they are initially pleasurable activities, often extremely enjoyable. This results in these behaviours hijacking the brain’s normal pleasure systems so that naturally enjoyable activities such as family life, work, exercise become devalued and the more excessive addiction behaviours take over.

However, not everyone who engages in drug use or gambling becomes addicted to them so clearly other factors are important. These are not yet understood but are now being actively studied. Some people may be particularly sensitive to the pleasurable effects of alcohol, drugs or gambling, perhaps because of coming from deprived backgrounds. In others, addiction may occur because of an inability to adopt coping strategies. Others may have an underlying predisposition to develop compulsive behaviour patterns. Some unfortunate people may have several of these vulnerability factors and there are also genetic predispositions to some of them.

Also a significant amount of drug use is for self-medication, examples include cannabis for insomnia, alcohol to reduce anxiety, opioids for pain control etc. This therapeutic use can escalate into addiction in some people though by no means all. Not all drugs which are used for recreational purposes are addictive. LSD and magic mushrooms seem not addictive at all, and some have a low risk of addiction (MDMA/ecstasy; cannabis). The most addictive drugs are nicotine, heroin and crack cocaine plus metamfetamine (crystal meth) although this is not much used in the UK.

Just because some people – including leading politicians – have used drugs but stopped before they became addicted does not mean that anyone can stop that easily. Starting to use drugs may be a lifestyle choice but once addiction sets in, choosing to stop is very much more difficult if not impossible.

We are beginning to understand how addictions start in the brain. The pleasurable or rewarding effects of addictions are mediated in the brain through the release of chemicals such as dopamine [by cocaine, amphetamines, nicotine] or endorphins [heroin] or both [alcohol]. The pleasures are then laid down as deep-seated memories, probably through changes in other neurotransmitters such as glutamate and GABA that make memories. These memories link the location, persons and experiences of the addiction with the emotional effects. These memories are often the most powerfully positive ones the person may ever experience, which explains why addicts put so much effort into getting them again. When the memories re-occur, which is common when people are still using drugs or gambling, as well as when in recovery/abstinence, they are experienced as cravings. These can be so strong and urgent that they lead to relapse.

A great deal of research has been conducted into the role of dopamine in addiction and we now know that the number of dopamine receptors seems to predispose to excessive pleasure responses from stimulant use. This excessive response is thought to initially occur in the reward centre of the brain – [the nucleus accumbens] – but then move into other areas where habits are laid down. This shift from voluntary (choice use) to involuntary (habit-use) explains a common complaint of addicts that they don’t want to continue with their addictions, and even that they don’t enjoy them anymore, but cant stop themselves. In this sense addiction can be seen as a loss-of-control over what starts out as a voluntary behavior. Thus addiction is not, as some like to suggest, simply a “lifestyle” choice. It is a serious, often lethal, disease caused by an enduring (probably permanent) change in brain function.

We know that personality traits especially impulsivity, predict excess stimulant use and in animals this can be shown to correlate with low dopamine and high opioid receptor levels. Similarly in humans low dopamine and high opioid receptor levels in brain predict drug use and craving. These observations give new approaches to treatment, both psychological interventions such as behavioural control, and anti-impulse drugs such as those used for ADHD e.g. atomoxetine and modafinil, are being tested.

For some addictions, especially heroin, the risk to the addict (life expectancy less than that from many cancers) and to society (from crime and infections), is so high that the prescription of substitute opioid drugs or even heroin itself saves lives and reduces crime. These substitute drugs are methadone and buprenorphine [Subutex]. As well as reducing crime and social costs by removing the need for addicts to commit offences to feed their habit, they also protect from accidental overdose and reduce risk of infections such as HIV and hepatitis. Similar substitute pharmacological approaches exist for other addictions e.g. gammahydroxybutyrate (Alcover) and baclofen for alcohol addiction, and varenicline (Champix) for nicotine dependence.

Another major reason for relapse in addiction is stress. This may work through increasing dopamine release in brain so priming this addiction pathway or by interactions with other neurotransmitters such as the peptide substance P. As antagonists of these neurotransmitters are now available they are being tested in human addictions and may offer an alternative to substitution treatments.

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Once an Addict, Always an Addict?

“Once an Addict, Always an Addict”

This phrase has been widely used to stereotype addicts for many, many years.  It is almost a “common” phrase whenever someone speaks about their loved one being addicted.  This term is also mainly used by those who don’t always understand the recovery process from addiction and what the actual term “addict” references.

Keep in mind that the following is only my own personal opinion on this subject of the use of the phrase “Once an addict, always an addict.”  In my own recovery process, this statement was said to a loved one about me.  I took quite a bit offense to this statement only because it made me feel like there was no hope, that I would always remain addicted to the chemicals produced by my brain during compulsive sexual behavior, and that I would continue to act out sexually the rest of my life.  It also scared my loved one, because they did not know much about the addiction at that time.

In looking at this term, one needs to distinguish between an active sex addict and a recovering sex addict.  An active sex addict, obviously, is one who is not in real sexual addiction recovery and continues to act out sexually.  This sex addict, although in “recovery,” could still be in a minimized state of denial where they see some sexual issues as acceptable that are typically unacceptable to even Christian non-addicts such as viewing pornography (I could spend hours and pages writing about how pornography affects the brain but this post is not about that topic).  The active addict will continue to seek out their high, usually through non-traditional acting out behaviors, until they break through the denial, live in honesty, and finally put a stop to the compulsive sexual behavior.

An addict in recovery, however, is no longer seeking ways to “beat the system” and is either living or trying to live a life of recovery.  An addict in recovery understands that recovery and life is progress not perfection, continuing to progress in their recovery, not continuing to live in their addiction.  When a sex addict finally breaks through the denial surrounding his life and truly gives himself to the program (including practicing rigorous honesty), then they are a “recovering sex addict.”

Furthermore, when one studies the brain scans of addicts versus those of healthy individuals; one can see an obvious difference.  However, with abstinence from drugs and alcohol, one can see through the brain scans that the brain of the addict slowly begins to resemble the brain of a healthy individual.  This healing of the brain will take time and abstinence from addictive behaviors, but it can and will happen.

                   
Brain on drugs                    Brain 1 Year Sober              Healthy Brain

Finally, when a sex addict enters recovery, they are asked to take a Sex Addiction Screening Test (SAST) questionare that is then given to their therapist for them to review and score.  This questionare typically determines if the individual truly suffers from Sexual Addiction and if they do, the individual’s level of sex addiction.  Based on the behaviors from most of my life, I scored a 19 out of 20.  Now that is pretty bad.  But God has used that measure to show me His grace and the miracles only He can peform.  Although most sex addicts don’t retake the test, last year I decided to retake it based solely on my sexual activities in the first 2 years of my recovery.  The results are written below.  In theory, I am no longer a “sex addict” as defined by the International Institute for Trauma & Addiction Professionals (IITAP) based on the six categories that define Sexual Addiction.  I am by no means stating I am cured from sex addiction.  It is my personal belief that I will never be cured, but the disease has been slowed down enough where I can function as a healthy human being.  This is by no way “scientific” but it shows how a life of recovery from sexual addiction can actually be non-addictive and non-destructive.  If we are to become healthy, we must live a life of recovery.  The thumbnail chart at the top left of this paragraph is my score at entering recovery.  The thumbnail chart to the right is my score based on the first two years of working my recovery program.  A healthy sexual lifestyle is possible for all those who earnestly desire it!

As a recovering sex addict, I must always acknowledge the fact that if I let my guard down, I could fall back into the addiction either through a slip or relapse.  In understanding this fact, I realize that I will not always be an addict, but I will always be vulnerable to the addiction.  This being said, the correct term to be used for addicts should be as follows.

“Once an addict, always vulnerable”

I would ask that from now on this phrase be used when speaking to family, friends, spouses, or loved ones of addicts in recovery.  This phrase should also be used when speaking about yourself and your addiction recovery!

Take what you like and leave the rest.