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Insane in the Brain

REMEMBER THOSE old public-service drug announcements featuring a brain and a fried egg? You know the ones: This is your brain, then the image of the egg being fried: This is your brain on drugs. Turns out those ads were fairly accurate, although our brains are likely being poached, soft boiled, or scrambled, depending on what substances we use to cook them.

Most addiction researchers have come around to the idea that addiction is, in part, a brain disease. This is something that twelve-step groups seem to have figured out by instinct and trial and error a long time ago. AA’s second step—”[We] came to believe that a power greater than ourselves could restore us to sanity”—recognizes that the alcoholic or addict is not operating with optimal mental function, and brain scans of alcoholics and addicts do show significant changes to brain function and chemistry. Some people question whether addicts and alcoholics have altered brain patterns even before they start using. Either way, the brains of alcoholics and addicts operate differently from those of other people. HBO’s documentary series and accompanying book Addiction: Why Can’t They Just Stop? New Knowledge, New Treatments, New Hope do an excellent job of explaining and demonstrating the relationship between addiction and altered brain chemistry and function.

My friends and I used to joke about the thousands of brain cells we killed every time we got high or drank until we blacked out. It turns out we were doing more than just deleting brain cells. We were training our brains how to deal with life. This is one reason it is more difficult to treat people who start drinking and using at a young age and why people who come into recovery now are often sicker now than those thirty years ago.

To illustrate, Neal Berger posed the following scenario. A twelve-year-old girl is socially awkward, shy, all those things that go along with being a preteen. She’s facing a stressful social situation, maybe the first day at a new school. She arrives at school, heart pounding. She passes a group of older kids, and one of them says something mean about her pants. The girl is so embarrassed and self-conscious she feels like running home and hiding. Instead of running home, the girl tells a friendly teacher or calls her mom or her older brother or a friend. That person reassures her that her pants look good and the older kids were being jerks and don’t know nice pants when they see them. The girl feels better and gets through the rest of her day, secure in the knowledge that talking about her problems and reaching out to others will help when she’s in trouble.

However, suppose that rather than calling someone, the girl heads behind the nearest convenience store and smokes a joint. Or goes into the school washroom and has a drink. What has she taught her brain then?

Both methods of dealing with stress achieve the same thing: relief. The brain perceives both talking over the problem and getting high as effective. But one method helps the girl to grow and feel more comfortable in the world, and the other one teaches her brain that relief can be found in substances. In her wonderful book Drinking: A Love Story, Caroline Knapp calls this the “mathematics of self-transformation … Discomfort + Drink = No Discomfort.”

When I was being bullied in school or was simply uncomfortable in my own skin, the thought of calling my mother or any other adult never crossed my mind. Not once. By the time I finally took a drink to deal with my social discomfort, my brain was desperate for relief. For the next seven years, I put my brain pathways on a strenuous training program. When I got stressed—excited, happy, upset, or uncomfortable—I dealt with it by getting loaded. The drinking made my behaviour worse and served to isolate me from other forms of support. The chances of my reaching out to an adult or even a friend became much slimmer. I was, after all, a bad kid. I knew it, and I thought most of those around me knew it.

In recovery one hears people talk about how booze and drugs saved their lives, especially when they were younger. Then the substances stopped working and the cure became the disease.

The whole addictive experience may be connected to the phases of brain development. The brain goes through two main growth periods. The first lasts from birth to age five. The second occurs from age ten to twenty-one. This second phase of brain development is “an opportunity to grow more gray matter and, even more important, to organize the electrical and chemical brain circuitry that underlies maturity, self-control, emotional balance, rational decision-making, memory formation, social skills, intelligence, and personality.”* But ironically, during this second stage of brain growth, from ages thirteen to eighteen, the brain is actually shrinking as it gets rid of unused pathways and makes the ones you do use more efficient. In other words, when we don’t develop or make or use of healthy brain connections or patterns, they disappear.

Thus, you have trained your brain that drugs and alcohol are the best cure for dealing with discomfort, and it lets go of other possible pathways. You literally don’t have other strategies available, at least so far as your brain is concerned. I can still remember how astonished I was to find out that talking about my issues with my sponsor and other people in recovery produced a quieter, but still powerful, feeling of release. Sharing, like drugs, is powerful.

This information made my behaviour and feelings after I first stopped drinking more understandable, but the onset of insanity when you’re young is difficult to identify. It seems to merge into the whole teen experience. I was already self-conscious and shy. When I got drunk, those feelings went away. When I sobered up, they came back, worse than ever, requiring me to drink more. This last piece didn’t register very well. I still saw drinking and taking drugs as the solution. I was lucky because, other than a phase when I was fourteen, during which I attempted to become a pothead, and later flings with cocaine and speed, I mostly stuck to alcohol. Younger people who use highly addictive hard drugs, such as meth and crack, do even more radical alterations to their brain chemistry. The stronger the drug, the more powerfully the brain remembers the effect.

Dopamine is central to this whole process. Dopamine is the chemical in the brain that makes us feel good. We get a little hit of dopamine when we eat something good, see something pretty, listen to music, or have sex. When we get drunk or high, our dopamine levels spike. After each spike, our dopamine levels fall, eventually to below the normal level. The following spike doesn’t go quite as high as the one before it. Over time, the rush becomes smaller and the crash that follows becomes deeper. Most addicts and alcoholics have had the deeply disappointing experience of finding that the drink or the drug doesn’t work any more. Often, this betrayal is the thing that precedes someone’s entrance into recovery.

Meanwhile, the brain has been fooled into “thinking” that achieving that high is equivalent to survival (even more so than with food or sex).… Eventually, the brain is forced to turn on a self-defense mechanism, reducing the production of dopamine altogether—and weakening the pleasure circuit’s function. At this point, the addicted person is compelled to use the substance not to get high, but to feel “normal”—since there’s little or no dopamine to be had. (Addiction, p. 59)

In other words, abusing drugs and alcohol destroys our ability to feel pleasure in everyday life when we are not high, which explains why early recovery can feel like such a brutal slog.

The good news is, the brain can be reprogrammed, if somewhat slowly. This lag time is something that the founders of twelve-step programs seem to have intuited. There’s a line in the Big Book of Alcoholics Anonymous about “trudging the road of happy destiny.” They used the word trudging as opposed to skipping or prancing because early sobriety is not for the faint of heart. The length of time it takes for brain damage inflicted by addiction to heal differs based on your early life and on what substances and what quantities of substances you were using. Most experts suggest that if you can make it six months without a relapse, your chances are greatly enhanced. If you can go two years, you are really on the road to long-term recovery. That doesn’t mean, however, you’ll be able to use safely after two years. It just means that much of the damage you’ve done to yourself that can be repaired will have been by then.

Why, then, do people go to self-help programs and stay in them, year after year? The reason is that twelve-step programs not only help to heal brain function, they provide social supports that are uniquely tailored to people in recovery. Programs based on the twelve steps and other types of support, such as counselling and behaviour modification, help people to learn to delay gratification (addicts and alcoholics are notoriously impatient for a quick fix) and to deal with the discomfort often found in everyday life.

Ongoing brain health, not to mention physical and spiritual health, is aided by participation in recovery programs. Also, there are often potlucks. So that’s something.

* Teens Under the Influence, pages 42–43.