This Fleshy Hunger

In our sister blog Inside the Alcoholic Brain –  http://insidethealcoholicbrain.com/

I had a comment posted on one of the blogs about the pain and heartache that one person had faced as the result of her partner’s addictive behaviour.

The person who posted mentioned her ex partner who is a sex addict as well as alcoholic/addict. It really moved me what the person, who posted anonymously, said in her comment.

I identified with the breaking of her trust and her heart by the unacceptable behaviour of her ex.

Addicts can leave a wake of destruction, lies and deceit, broken promises and broken hearts. In the Big Book of AA it looks at the effects of the life with an alcoholic as akin to having had a tornado wreck havoc in  your life, with the alcoholic often causing so much wreckage  without fully realising it.

This comes across strongly in this post, which I use below, as it was posted publicly and the person was also anonymous.   I use this post to help me and help others understand more fully the damage addiction, especially sex addiction can cause others.

I failed to mention something in my reply, below, which I will now add.

I know where her ex partner is coming from because I too am a sex addict.

I have never admitted that to anyone other than my wife. I have been in recovery ten years but have only realised in the last 15 months or so that I too suffer from sex addiction, in addition to alcoholism, substance addiction, chronic attachment disorder and PTSD.

sex-addiction-eye (1)

Even now I find it difficult to be honest about my sex addiction. It seems to me much more shameful than saying I am a chronic alcoholic or addict.

Maybe that is irrational but I am just trying to be honest.

If any addiction could embody and illustrate the conditional love I was reared with it is my sex addiction.

As I mention in my reply to the post below, in sex addiction somewhere in one’s personal development the brain gets fused in a manner so profound that close intimate human affection can often be just about the most terrifying experience because we don’t really know what the hell it is.

If one has not experienced unconditional love in their primary attachment relationships to a primary care giver, e.g. one’s mother, then the brain may not develop in the same way as with unconditional love – it will be a brain that has distress and a excess of stress chemicals and a deficit in oxytocin,  the “love/cuddle” chemical of human bonding.

Intimacy can be frightening in the extreme.

The human heart is born to beat a beat of love and to have an automatic approach to the love of other humans. In fact we are not singular – we are born into the world as “I and one other”, as we would die otherwise, we need to be reared as we are helpless alone.

So when the heart is naturally moved towards a love attachment which is inconsistent, ambivalent, alternatively available then dismissive and distant, then the most basic survival instinct is impaired, warped, and love of the most basic fundamental type can be mixed with fear and stress chemicals with distress.

Love is the most  fundamental “glue” in the  brain and human development so when it is not consistently given it can have profound effect on the developing infant brain.

Some would say that being conditional it is  not real love but it is as close as some got. “Love” for some often had love mixed with or outweighed by fear, or oxytocin by stress chemicals in the brain.

While a child is looking to receive their love and “cuddle” chemical, that of oxytocin but it is not always available, in that it is shrunk away in the brain by stress chemicals. This reduces oxytocin and the heightened stress chemicals reduce this oxytocin even more.

I grew up then looking for “love” – this oxytocin but unfortunately it is not straight forward. This search is for a conditional loves as it is all I knew, it is not for a fullsome healthy unconditional love but for a “love” that will alleviate our distress and increase our oxytocin. I searched for this thing, this “love” in  sexual acts.

Sex, and reproduction, are fundamental to the human species so it is another “survival instinct” that gets impaired in the addiction cycle – in fact all addictions involve the usurping of systems essential for survival – eating, sex, money, motivation etc and all addictions take over the reward/motivational region of the brain.

Sex addiction does the same – this is also why we see cross addictions as different addictions all activate this same reward/motivational part of the brain.

Back to sex addiction, I grew up through puberty to adulthood with this  now constant battle in my heart between two chemicals that interact to help us survive via our human relationships and communities. Now they interact in the way most opposite to healthy survival. The compete and fight and are conditional on the behaviour of the other.

The are two partners in a dance of destruction. Their neuro-chemical offspring is dopamine – the chemical of wanting (needing). The battle between stress and oxytocin results in a pathological wanting (needing), peaks of dopamine when distressed with dopamine increase reflect the need to take action to relive distress. .

Distress is the result of never finding relief in human relationships, in human bonding, in healthy relationships, so healthy human love and bonding is replaced by the need relieve the inherent distress in an activity which guarantees a reduction in stress. In an activity guaranteed to increase in oxytocin. Sex with another human being, a fleeting physical intimacy.

That is a role oxytocin has, to reduce stress/distress (and control dopamine)  via human contact. If that contact was never there fully it never played a role in our survival. Instead we have to find this oxytocin elsewhere, like alchemists, outside healthy human bonding.

I found it via a different  type of “love”. A so-called love making when it was really an approximate transient glimpse of intimacy, or the opposite of intimacy in fact, a refuting of intimacy, instead simply a transient increase in our love making chemical. It feels like a yearning for something always beyond one’s reach but something that feels somehow essential and has to be got.

A fleshy hunger.

But these fleeting “intimacies” didn’t work, it wasn’t enough to still our hearts and reassure us, it was a temporary harbour in a storm of distress.

When it calms, I was left with the receding tides of shame, shame and more shame. It wasn’t enough, I wasn’t enough. And the distress cycle begins again.

Every time I searched for this love I ended with less than before.

Anyway here are the comments.

“I discovered that he had been seeing a secret drinking/ sex partner the entire time, one 5 years older that his daughter who, by cultural standards, was not attractive. The phone I finally looked at showed that, in addition to worshiping him as a senior co-worker, she was a great devotee of 50 Shades and all night activity. I had noted only a lack of interest in me – which I attributed to his passing age 50. The crafty extremes he went to to hide this affair from me while cutting as close as possible the encounters he had with the two of us was completely out of character in terms of the persona he showed me. Still, I have felt stupid for the extent of my trust.

Reading this and Part 1 have offered me great comfort. He was definitely denied affection in his youth, and is definitely a late stage alcoholic, but is tested for drugs frequently by work. Sex does not show up in lab work, I guess. Thanks for this very helpful post.”

Part of my Reply –

“thank you Anonymous for your honest post – can I also suggest this post Looking for love in all the wrong places –http://insidethealcoholicbrain.com/2015/07/02/looking-for-love-in-all-the-wrong-places/ – which looks at how lack of attachment in childhood to a primary care giver has dire consequences in terms of later adult relationships – where sex is used instead of intimacy – it is also probably more common than mentioned, the cross addiction of sex and other addictive behaviours like alcoholism – anecdotally I know it to be an issue in recovery for many. There is often a migration from one addiction to another mainly because we generally use and have used external means to regulate negative emotions and negative self schema. We probably have done so one way or the other since childhood. Emotional relationships for some are terrifying, full of angst, conflict etc and have not been straightforward, unconditional love relationships like many people have experienced. In fact relationships with sex addicts often have an element of conditional love about them as this is generally how addicts have grown up to understand relationships, as being conditional, if you do this I will do that, type thinking. I give you this and you give me that etc etc Sex addiction runs very deep as it is linked to an impaired ability to form loving, healthy relationships throughout one’s life and the relationships in a sex addict sense are often abusive, often in a dominant/domineering sense. The sex addict brain can often fuse what should be affection with arousal. Often “good looks” are not that much of an issue, it is often what the person “can do” sexually that is the main consideration. What sort of “fix” that they can offer. Sex does show up in labs in the sense that sex addiction activates the same brain areas as any other addictions and similar neurotransmitters like dopamine. A fascinating thing however is that sex gives one a “shot” of oxytocin which is the “love/cuddle” brain chemical and which is there in major amounts during caring for a child and in human bonding, in attachment to another human being. In sex addicts this might actually be the so-called “hole in the soul” the “love” drug we have all been looking for. So the sex addict brain has been fused to confuse human affection with arousal as oxytocin is activated and prompts the addict to want more of what he/she does not have in great supply namely oxytocin. Sometimes addiction seems like it is a compulsion to “replenish” chemicals one is deficient in, e.g. natural opioids and heroin abuse. I hope you continue to have the compassion you seem to have through your understandable hurt and upset – it sounds like a real rollercoaster you have been through. He is a very very sick (mentally) sick person like all addicts of one hue or the other. The problem also is that we sometimes are the last to see how sick our behaviours can be. Forgiveness is maybe a long way off, but in the end this heals the pain of the past more than anything else. It helps you just as much if not more than the person who has really hurt you. Hope this comment helps you too. Paul

Distorted Thinking!!

We have a new page!!.

This page will look at the myriad of cognitive distortions and preservative (and deluded) thinking that appears to be part of the condition of many different addictive behaviours.

 

 

So far in this blog we have looked at how altered stress systems effect emotion processing and regulation and how this results in the increasingly compulsive need to use substances and behaviours to regulate subsequent negative emotions and affect.

Now we will be looking at the third strata of this disorder of addictive behaviour, that of distorted preservative thinking. Perseverative thinking is when someone gets an idea or thoughts in their head and just can’t get them out.

It is commonly shared in 12 step meeting show we have a problem with our thinking and hence our decision making. We find this to be true for us also.

Some addictive behaviours have their own specific cognitive distortions such as with gambling and eating disorders in addition to a more generalized pattern of cognitive distortions associated with all additive behaviours and psychopathology more generally.

Unlike those who feel cognitive distortions cause psychopathology we believe cognitive distortions are the consequence of impaired stress systems and emotion dysregulation which implicate a hyperactive amgydaloid region of the brain.

We feel that persistent negative and distorted thinking is the direct consequence and manifestation of stress and emotion dysregulation. It is how stress and emotion dysregulation manifests  in thought processes; these thought processes obviously worsen this stress and emotion dysregulation and vice versa.

In recovery by addressing either stress, negative affect or our distorted thinking we automatically deal with the other factors.  Hence distress is at the heart of our addictive behaviour.

If we reduce our distress we reduce stress reactivity, the effect of negative emotions and their manifest distorted thoughts.

Hence addictive behaviour is a three level ( tri strata) disorder of stress hyper reactivity, emotion dysregulation and distorted thoughts, all interconnectedly reactive.

 

 

In other words, the thinking of addicted individuals seems to be “fear-based” or distress prompted which leaves perception and reaction to it rather it distorted.

Along with these thoughts there is a reciprocal increase in stress chemical reactivity and increasingly impaired e motion regulation and processing of emotions.

Hence these unregulated negative emotions act with heigthen stress reactivity and spiraling distorted thinking to increase relapse vulnerability.

As a result we believe that distorted preservative thinking, thinking that persists and gets increasingly distorted,  is a part of the aetiology of addictive behaviour.

Equally we believe it is the consequence of a distress state activated by a hyperactive amgydala which increases stress reactivity, emotion dysregulation and then distorted thinking in a viscous circle.

We believe, based on our own research and experience of recovery that this is viscous circle is a common feature of all addictive behaviours.

 

Recovery is a Journey from the Head to the Heart (and back)!

PART 2 

So what does this low HRV mean for the recovering alcoholic?

I have explained this to show that HRV is directly connected to areas of the the brain implicated in stress and emotion regulation.

If, via recovery practices, we can still our beating heart, become serene as well as clean, it will have neuroplastic effects on our brain and the regulation of emotion and stress.

Equally if we meditate and alter the functioning of areas implicated in this study such as areas of the medial PFC and cingulate gyrus we improve our control over our heart. Ultimately if we can learn to relieve the inherent distress at the heart of addiction we can recovery function of not only the heart but also of areas in the brain which interact with the heart in producing heart rate variability.

So ultimately we need only to know how to quell a distressed heart via prayer, meditation, loving others.

If we can do so, we improve our emotion and stress regulation.

But do we need to do this if we have been in recovery long term?

Let me give you an example of allostasis in action.

In an allostatic system like addiction there is stress dysregulation coupled with reward dysfunction (I believe there is a pre-morbid allostasis in those addicts who have experienced abuse, trauma and insecure attachment also which means there is a stress and emotion dysregulation from an early age which leads to a heightened reward sensitivity which means we start to regulate negative emotions from an early age via impulsively  using or consuming stuff we really really like, or seem to like more than healthy people, to make ourselves feel better).

These adolescents at risk also have low HRV and the effects of alcohol have a pronounced effect on HRV.

This sets the chain of addiction in action from the start for many addicts.

So when we decide we want something this leads to a feeling of pathological wanting and then needing simply because we have altered reward systems as they are linked to our “out of kilter” stress systems .

Buying something in the store, if thwarted, soon becomes a life and death like struggle. Ever had that feeling?

I remember a 75 year old recovering person with 30 odd years of recovery  sharing in a meeting how she went to a store to get something, to find that something wasn’t there, so she was instructed to drive somewhere else to get that something, and when she got there they didn’t have it, so she had an argument with them and then with her husband in the car, then off to another store which did not have the something either, then back home on the internet, found a online store that stocked the something and ordered it.

It arrived the next day because she paid a lot of money for it to arrive the very next day! When it arrived she found that she had not only completely forgot about ordering the something but did not really want the something even. So off she sloped to apologise to her husband for being so emotionally abusive and immature over the something on her way to the Post Office to post back the something that she never really wanted in the first place!!?

This is also my head still, even after a few years of recovery. It is not as bad it was, by a long shot! It does, however, get distressed, I become impulsive and  want, need, that thing now!!! On occasion.

So I think this is one area recovery people always need to be aware of. Wanting stuff.

As it can lead to pathological wanting fairly quickly – then people get in the way of those things and we get angry, frustrated, distressed, our emotions overwhelm us or we are mean to our fellow human beings all because they are getting in the way of the thing I really really want.. NEED God damn it!…

We lose our emotional sobriety.

When we have either got it, regardless of the the human or emotional cost, we often find we do not want it or never really wanted it…that much….

Not compared to the cost of getting it!?

How do we solve this problem? We let go, we calm down, talk to someone, express our feelings, try to establish a transient homeostasis, let our stress systems subside and start again, trying to managing these chaotic brain systems.

Amends time.

If you are like that you have a low HRV and a stress/emotion regulation problem and probably always will.

But if can be manged and it can vastly improve. Then one day we learn that it is in living with our hearts forefront to our decisions and not our heads that brings lasting everyday happiness.

That is why in recovery we travel from our at times over zealous heads to our hearts. The wisdom and direction and basis of our decision making lives their not in our heads. It is not to say we do not use these wondrous instruments but we incorporate the help of our hearts in activating the reasoning of the brain.

Solve the heart issue, and the rest comes.

 

Neural structures associated with HRV

Over the past several years however a number of human neuroimaging studies have appeared in which researchers have explicitly examined the brain structures associated with HRV. In the present paper we provide a meta-analysis of eight published studies in which HRV has been related to functional brain activity using either PET or fMRI

The goal of this meta-analysis was to identify areas that were consistently associated with HRV.

In the overall analyses three regions show significant activations One region in the medial PFC (MPFC) is the right pregenual cingulate (BA 24/32).

Brodmann Cytoarchitectonics 24.pngBrodmann Cytoarchitectonics 32.png

 

Another MPFC region is the right subgenual cingulate (BA 25).

Brodmann Cytoarchitectonics 25.png

The third region is the left sublenticular extended amygdala/ventral striatum (SLEA). This region extends into the basolateral amygdalar complex, and also covers the superior amygdala (central nucleus) and extends into the ventral striatum.

 

 

More generally, the pgACC/rmPFC correlation with HRV in our meta-analysis suggests thatthis region is part, and the most reliably activated part in studies to date, of a descending “visceromotor” system that controls the autonomic nervous system and possibly other responses (neuroendocrine) based on emotional context.

The meta-analysis provides supportfor the idea that HRV may index the degree to which a mPFC-guided “core integration” system is integrated with the brainstem nuclei that directly regulate the heart. Thus these results support Claude Bernard’s idea that the vagus serves as a structural and functional link between the brain and the heart. We have proposed that this neural system essentially operates as a “super-system” that integrates the activity in perceptual, motor, interoceptive, and memory systems into gestalt representations of situations and likely adaptive responses. These findings suggest that HRV may index important organism functions associated with adaptability and health.”

References

1. THAYER, J. F., AHS, F., FREDRIKSON, M., SOLLERS, J. J., & WAGER, T. D. (2012). A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health.Neuroscience and biobehavioral reviews, 36(2), 747-756.

How it (Mindfulness) Works? (Part 3)

“Mindfulness Training Ameliorates Addiction by Targeting Neurocognitive Mechanisms

In the third part of this excellent review paper  (1) we look at the empirical evidence is presented suggesting that MBIs ameliorate addiction by enhancing cognitive regulation of a number of key processes.

EMOTION REGULATION

When individuals are unable to marshal effective problem-solving to resolve a stressor, lack of a favorable resolution may lead to deployment of emotion regulation efforts to manage the emotional distress elicited by the stressful circumstance. Neuroimaging research has provided evidence for a reciprocal, dual-system neural network model of emotion regulation comprised of a dorsal brain system (e.g., dlPFC, dACC, parietal cortex) subserving top-down cognitive control, and a ventral brain system (e.g., amygdala, striatum) subserving bottom-up emotional impulses (133135). Top-down engagement of proactive cognitive control mechanisms regulates negative affect and attenuates the effects of emotional interference on cognition (135138), and is associated with increased activation of PFC which in turn attenuates amygdala activation (139, 140). Research suggests that dysregulated emotional reactions occur when the reciprocal balance between the relative activation of bottom-up and top-down neural circuits becomes tipped in favor of bottom-up processes (141). A number of studies suggest that mindfulness training may counter this imbalance and augment emotion regulation [for reviews, see Ref. (78, 142)] by restructuring neural function in favor of context-dependent top-down control processes. For example, Goldin and Gross (143) demonstrated that individuals with elevated negative affect at baseline who later received mindfulness training exhibited increased emotion regulatory capacity coupled with greater recruitment of attentional control resources and reduced amygdala activation during exposure to negative, self-relevant stimuli. Thus, by enhancing top-down cognitive control over emotional responses in a context-dependent fashion, MBIs may reduce drug use precipitated by negative affective states.

Importantly, MBIs provide training in cultivating a state of mindful awareness and acceptance of the extant emotional response as a precondition for emotion regulation. While acceptance of aversive mental experience may itself result in reduced negative affect (144), mindfulness training may also exert downstream facilitative effects on cognitive regulation of emotion following the acute state of mindfulness. For instance, mindfulness training may promote cognitive reappraisal, the process by which the meaning of a stressful or adverse event is re-construed so as to reduce its negative emotional impact (125). One theoretical model posits a multi-stage process of mindful emotion regulation (1, 145). According to this model, during an adverse experience mindfulness practitioners first disengage from initial negative appraisals into the metacognitive state of mindfulness in which cognitions and emotions are viewed and accepted as transitory mental events without inherent veridicality. Subsequently, the scope of attention broadens to encompass a larger set of previously unattended information from which new situational appraisals may be generated. By accessing this enlarged set of contextual data, present circumstances may be reappraised in an adaptive fashion that promotes positive affect and behavioral activation. For instance, a newly abstinent alcohol dependent individual might reappraise an affront by a former “drinking buddy” as evidence of their need to build new, sober relationships. In support of this model, recent studies indicate that mindfulness during meditation predicts enhanced cognitive reappraisal (146), which in turn mediates the association of mindfulness and reduced substance craving (147). This context-dependent use of prefrontal regulatory strategy represents a “middle way” between hypo- and hyper-activation of cognitive control resources, thereby preventing resource depletion and untoward rebound effects.

Speculatively, this “mindful reappraisal” process may involve spreading activation in a number of brain networks. Generating the state of mindfulness in the midst of a negative affective state may activate the ACC and dlPFC (148, 149), which could facilitate metacognitive monitoring of emotional reactivity, foster attentional disengagement from negative appraisals, and regulate limbic activation. In so doing, the acute state of mindfulness may attenuate activation in brain areas that subserve self-referential, linguistic processing during emotional experience (e.g., mPFC) while promoting interoceptive recovery from negative appraisals by increasing activation in the insula (113). Metacognitive disengagement from the initial negative appraisal may result in non-elaborative attention to somatosensory information, thereby facilitating the set shifting process of cognitive reappraisal, as brain activations shift from posterior to anterior regions of cortex centered on the node of the OFC. During this process emotional interference is attenuated while alternate appraisals are retrieved from memory and evaluated for goodness-of-fit to situational parameters and demands (150).

The effects of mindfulness-centered regulation of negative emotion might be measured with a standard emotion regulation paradigm [c.f. (137)], in which participants are instructed to use reappraisal to reduce negative affect in response to exposure to aversive visual stimuli [e.g., images from the International Affective Picture System; (151)]. In this task paradigm, mindfulness practitioners may exhibit enhanced reappraisal efficacy, as evidenced by reduced self-reported and psychophysiological responses to aversive stimuli on reappraise relative to attend trials. In that regard, a study employing ERP analysis found that when compared to controls, meditators exhibited significantly greater reappraisal efficacy as evidenced by significantly larger attenuation of brain activity during reappraisal of stressful stimuli in centro-parietal regions subserving attentional and emotional processing (152).

STRESS REACTIVITY

In addition to pro-regulatory effects on emotion, mindfulness training may facilitate neurocognitive regulation of the effects of stress on the autonomic nervous system. As addicts in treatment develop dispositional mindfulness through mindfulness training, they may be more able to engage prefrontal cortical modulation of the sympathetic “fight-or-flight” response via parasympathetic nervous system activation of the “vagal brake,” resulting in increased HRV and heart-rate deceleration in the face of stress or addictive cues (153, 154). Thus, increasing dispositional mindfulness may be reflective of greater neurovisceral integration and flexibility in the central autonomic network (67). This network is comprised of neuroanatomic and functional linkages between central (e.g., PFC and ACC) and autonomic (e.g., vagus nerve) nervous system structures which coordinate the self-regulation of attention, cognition, and emotion while exerting regulatory influences over perturbations to visceral homeostasis (155), such as those that might be evoked in abstinent substance dependent individuals exposed to stressful and/or substance-related stimuli. Mindful individuals may have greater capacity for contextually appropriate engagement and subsequent disengagement of neurocognitive resources in response to the presence and absence of stress and drug-cues. Such autonomic flexibility (156) engendered through mindfulness training may help persons in recovery from addiction adapt to situational demands without succumbing to a stress-precipitated relapse.

This hypothesis is consistent with evidence of the effects of mindfulness on neural function in dlPFC and ACC (149, 157), key structures involved in central autonomic regulation of HRV via downstream influences on the amygdala and hypothalamus (158, 159). Congruent with such findings, MBIs increase parasympathetically mediated HRV to an even greater extent than relaxation therapy (160,161), and decreases sympathetically mediated indices of stress (8), including blood pressure (162), heart rate (163), skin conductance responses (161), and muscle tension (164). These effects of mindfulness-centered regulation on autonomic function may result in improved ability to manage substance cue-reactivity. In support of this hypothesis, a Mindfulness-Oriented Recovery Enhancement intervention for alcohol dependence increased HRV recovery from stress and alcohol cue-reactivity (7). Congruent with this finding, relative to their less mindful counterparts, alcohol dependent individuals with higher levels of dispositional mindfulness exhibited greater attentional disengagement from alcohol cues which predicted the extent to which their HRV recovered from alcohol cue-exposure levels (67). Lastly, persons participating a mindfulness-based smoking cessation intervention who exhibited increased HRV during mindfulness meditation smoked fewer cigarettes following treatment than those who exhibited decreased HRV (165). Thus, addicts who develop dispositional mindfulness through participation in MBIs may become better able to regulate appetitive responses by virtue of enhanced neurocognitive control over autonomic reactivity to stress and substance cues.

The effects of MBIs on cognitive regulation of autonomic cue-reactivity might be measured with a stress-primed cue-reactivity paradigm, in which participants are first exposed to a laboratory stress induction [e.g., aversive IAPS images, c.f. (7); or the TSST, c.f. (132)], then exposed to substance-related cues (either in vivo, imaginally, or images of alcohol or drugs), and finally asked to use mindfulness skills to downregulate the resultant state of autonomic arousal.

References

1. Garland, E. L., Froeliger, B., & Howard, M. O. (2013). Mindfulness  training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. Frontiers in psychiatry, 4.