12 step program of recovery

The psychic change as continual behavioural change?

When I came into AA I remember hearing the words “the need for a psychic change” which was the product of a spiritual awakening (as the result of doing the 12 steps) and that the 12 steps are a program of action!

The Big Book of Alcoholics Anonymous clearly states this need “The great fact is just this, and nothing less: That we have had deep and effective spiritual experiences* which have revolutionised our whole attitude toward life, towards our fellows and toward God’s universe.”

The question is whether this spiritual change is the result of behavioural change?

As I was told when I came into recovery that if I did not change my actions, and how I acted in this world, my actions would take me back to where my actions had taken me before – back to drinking.

This is the cornerstone of AA recovery; thinking, feeling differently about the world as the result of acting differently in the world, as to when we were active drinkers.

Otherwise one does the same things and ends up in the same places, doing the same things, namely drinking. It is a behavioural revolution; a sea change in how we act.

In line with this thinking, it is we that need to change, not the world.

According to one study (1) which examined whether personality traits were modified during prolonged abstinence in recovering alcoholics, two groups of both recovering and recently detoxified alcoholics were asked via questionnaire to  see if they differed significantly from each other in three personality domains: neuroticism, agreeableness and conscientiousness.

The recovering alcoholics were pooled from self help groups and treatment centres and the other group, the recently detoxified drinkers were pooled from various clinics throughout France.

Patients with alcohol problems obtained a high “neuroticism” score (emotions, stress), associated with a low “agreeableness” score (relationship to others).

In the same vein, low “conscientiousness” scores (determination) were reported in patients who had abstained from alcohol for short periods (6 months to 1 year).

In this study, recently detoxified drinkers scored high on neuroticism. They experienced difficulty in adjusting to events, a dimension which is associated with emotional instability (stress, uncontrolled impulses, irrational ideas, negative affect). Socially, they tend to isolate themselves and to withdraw from social relationships.

This also ties in with what the Big book also says “We were having trouble with personal relationships, we couldn’t control our emotional natures, we were prey to misery and depression, we couldn’t make a living, we had a feeling of uselessness, we were unhappy, we couldn’t seem to be of real help to other people.“

In contrast, regarding neuroticism, they found that recovering persons did not necessarily focus on negative issues. They were not shy in the presence of others and remained in control of their emotions, thus handling frustrations better (thereby enhancing their ability to remain abstinent).

Regarding agreeableness (which ties back into social relationships), the researchers also found that recovering persons cared for, and were interested in, others (altruism). Instead, recently detoxified drinkers’ low self-esteem and narcissism prevented them from enjoying interpersonal exchanges, and led them to withdraw from social relationships.

Finally, regarding conscientiousness, they observed that, over time, recovering persons became more social, enjoyed higher self-esteem (Costa, McCrae, & Dye, 1991), cared for and were interested in others, and wished to help them.

They were able to perform tasks without being distracted, and carefully considered their actions before carrying them out; their determination remained strong regardless of the level of challenge, and their actions are guided by ethical values. Instead, recently detoxified drinkers lacked confidence, rushed into action, proved unreliable and unstable. As a result, lacking sufficient motivation, they experienced difficulty in achieving their objectives.

Recovering persons seemed less nervous, less angry, less depressed, less impulsive and less vulnerable than recently detoxified drinkers. Their level of competence, sense of duty, self-discipline and ability to think before acting increased with time.

 

images (23)

 

 

The authors of the study concluded that “these results are quite encouraging for alcoholic patients, who may aspire to greater quality of life through long-term abstinence”.

However, in spite of marked differences between groups, their results did not provide clear evidence of personality changes.

While significant behaviour differences between the two groups were revealed, they were more akin to long-term improvements in behavourial adequacy to events than to actual personality changes.

This fits in with the self help group ethos of a change in perception and in “taking action” to resolve issues. In fact, 12 steps groups such as AA are often referred to as utilising a “program of action” in recovering from alcoholism and addiction and in altering attitudes to the world and how they act in it.

The authors also noted the potential for stabilization over time by overcoming previous behaviour weaknesses, i.e. in responding to the world.  Hence, this process is ”one of better adequacy of behaviour responses to reality and its changing parameters.”

In fact, treatment-induced behaviour changes showed a decrease in neuroticism and an increase in traits related to responsibility and conscientiousness.

In line with our various blogs which have explained alcoholism in terms of an emotional regulation and processing disorder, as the Big Book says ““We were having trouble with personal relationships, we couldn’t control our emotional natures”  the authors here concluded that  “rational management of emotions appears to be the single key factor of lasting abstinence”

If we want to to recover from addiction we have to change how we behave.  We have to start by following a recovery program of action. 

No by thinking about it, or emoting about it but by doing it!

Action is the magic word.

References

Boulze, I., Launay, M., & Nalpas, B. (2014). Prolonged Abstinence and Changes in Alcoholic Personality: A NEO PI-R Study. Psychology, 2014.

Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.

 

How Far Have We Come In Understanding this “Spiritual Malady” of Alcoholism?

In our previous blog we wondered if some commentators, who have co-occurring disorders may be puzzled at how having a “spiritual malady” could be related in any way to have a co-occurring condition?

This is a pretty valid question?

In fact this may be at the heart of the issue in many cases  of feeling the need to take medication  for so-called co-occurring conditions?

Seeing alcoholism as partly the product of a spiritual malady, instead of the affective disorder I believe it to be, may influence certain AAs to seek additional help for supposed additional conditions when the manifestation of these conditions may actually be part of the emotional disorder of alcoholism?

It is at least worth considering?

For me sometimes there is a confusion with what is perceived to be a spiritual malady?

I do not believe I have the same type of spiritual malady as my wife for example who is an normie, earthling, normal person (whatever that is?) I believe, if any thing I have a super enhanced, at times turbo-charged,  spiritual malady, often fuelled by stress/distress, as the result of my alcoholism.

I do not believe I have the same spiritual malady as other normal people such as those people who were in the Oxford Group.

That is not to say that normal people cannot be full of sin –  a cursory look around the work and it’s events will soon confirm this is the case. What I am saying is that they do not have the emotion dysregulation or fear based responding that I seem to have which often prompts “sin”.

By sin I mean negative emotions that cause distress to me and others.

For example, false pride, intolerance, impatience, arrogance, shame, lust, gluttony, greed. Yes these all create distress.

The spiritual principles of AA and the 12 steps in particular were drawn from the 4 absolutes of the Oxford group, via initially the 6 steps  and the idea of a spiritual malady is also borrowed from the Oxford group.

I have for several years wondered if the spiritual malady described in the Big Book adequate or accurate enough in describing what I suffer from.

I believe others have difficulties in reconciling the spiritual malady of the Big Book with their own alcoholism, addiction and  co-occurring conditions?

Part of the problem may lie in not being specific enough about what   alcoholism is.

It may be that research and the world have not progressed far enough to give a comprehensive account of what alcoholism is. Also the spiritual malady concept of AA has for 80 years helped millions of people recover from this most profound of conditions? So why change it if it’s not broke?

That is a good point? I am not advocating changing anything, I hope AA recovery remains as it is for 80 more years and much more years. I would not change one word in the first 164 pages of the BB.

However, many AAs ignore the spiritual malady thing completely, or do not do the steps, so, in my opinion, they often do not properly understand what they suffer from?

The magic of the the steps is that they seem to reveal  the patterns of behaviour that our actions have prompted over the course of our lives.  Maladaptive behaviours I should add. It helps us see ourselves and our condition of alcoholism and how it effects us and others.

It shows the areas of behaviour and attitudes that can be treated by working the steps. It shows us how our approach to life can possibly be transformed for the better.

For me personally it often showed a pattern of emotional responding to events that do not go my way!!?

As Bill Wilson once wrote we suffer when we cannot not get what we want or others seem to prevent us getting what we want.

My inventory of steps 4/5 showed me that my long lists of resentments were mainly the product of emotional immaturity and responding in an immature manner to not getting my way.

My inventory showed me also that I did not seem to have the facility previously to emotionally respond to the world in a mature way. As the world dominated me.

My recovery has thus since been about “growing up” a bit, however unsuccessful I am in this pursuit on occasion.

I have often written that this inherent emotional immaturity may even be linked to the possibility that the areas of my brain that regulate emotions have not matured properly  as alcoholic seem to have different connectivity, functionality and morphology (size/volume)  in this emotion regulation  circuit/network to healthy normal people.

Alcoholics seem not to be able to fully process emotional information externally, i.e reading emotion expression of faces accurately, or internally reading what emotions we are having, or even whether we are hungry or tired!

So we have issues with emotions and somatic/body feeling states. This is perhaps compounded by most of us having experienced abuse or maltreatment which can also lead to alexithymic characteristics such as not being able to label or describe, verbally, emotional states we are experiencing – although we can be good at intellectualising these emotions – which is not the same as processing them.

Alcoholics and children of alcoholics have a tendency to avoid emotions (use avoidant coping strategies) in fact and to use emotional reasoning when arguing a point.

These emotion processing deficits also appear to make us more impulsive, and to choose lesser short term gain over greater long term gain in decision making. It can lead to a distress feeling state that can make us fear based, perfectionist, have catastrophic thoughts, intolerance of uncertainty, low frustration and distress tolerance, be reactionary, moody, and immature in our emotional responding.

But how has any of this got anything to do with the so-called spiritual malady we are suppose to suffer from?

I believe the spiritual malady mixed with the ancedotal evidence throughout the BiG Book hints at these emotional difficulties as being an intrinsic part of our alcoholism, “We were having trouble with personal relationships, we couldn’t control our emotional natures, we were a prey to misery and depression, we couldn’t make a living, we had a feeling of uselessness, we were full of fear, we were unhappy…”

It was 80 years ago, so our knowledge base has moved on greatly from when the Big Book was written. Hence I believe we should appreciate that this definition of our condition has been updated by research into emotions especially in the last 20 years.

I am happy to say a spiritual malady is what we suffer from, as the steps provide a solution to my emotion disorder by treating it as a spiritual malady but  I do not think it is the straightforward spiritual malady adopted by AA from the Oxford Group, mainly because in the majority of situations I do not choose to sin, the sinning seems to happen to me. In other words it is the consequence of my fear based condition, this affective disorder.

The Oxford Group explain a general spiritual malady that all people can have. I do not think alcoholics are like all people. We are human beings, but extreme versions of human beings. I believe, even when I try my best to be virtuous and holy, I could sin at the sinning Olympics for my country. I am that naturally good at it!

I sin so naturally, effortlessly  and usually without even trying. I believe my so-called defects of character are linked to my underlying emotional disorder of alcoholism.

Sins I believe are the poisoned fruit of fear, often  helped along in alcoholics by false pride, shame and guilt. These defects are related to me being an alcoholic, they are intrinsic to my condition.

In order to illustrate how I believe my spiritual malady is the consequence of my emotional disorder, called alcoholism/addiction first let’s  go back to where this idea of spiritual malady came from.

According to a wonderful pamphlet “What is the Oxford Group”   written by The Layman With a Notebook ” Sin can kill not only the soul but mind, talents, and happiness as surely as a malignant physical disease can kill the body…

Sin is a disease with consequences we cannot foretell or judge; it is as contagious as any contagious disease our bodies may suffer from. The sin we commit within this hour may have unforeseen dire consequences even after we have long ceased to draw living breath…

…Like physical disease Sin needs antiseptics to prevent it from spreading; the soul needs cleaning as much as the body needs it…

Unhappiness to us and others, discontent, and, frequently, mental and bodily ill health are the direct results of Sin.

…Morbidity of mind must affect the physical health. If we can be absolutely truthful to ourselves we can analyse our sins for ourselves and trace their mental and physical effects. Sins can dominate us mentally and physically until we are their abject slaves. We cannot get rid of them by deciding to think no more about them; they never leave us of their own accord, and unless they are cut out by a decided surgical spiritual operation which will destroy them, roots and all, and set us free from their killing obsession, they grow in time like a deadly moss within us until we become warped in outlook not only towards others but towards ourselves….”

One can see how this concept of sin disease or in other words spiritual malady could be and was applied to early AA and incorporated into the Big Book of AA.

However, it is equally stating, I believe, that alcoholics suffer from the same spiritual malady as other people but our spiritual malady has led to chronic alcoholism, this is the manner in which sin has dominated  “mentally and physically until we are their abject slaves”.

In fact the Big book’s first chapters look more at the manifestation of this malady, problem drinking,    than the malady.  It suggests that there is more than this malady, there is also a physical reason for alcoholism- an allergy (or abnormal reaction) to alcohol. So this is a departure from the Oxford Group as it clearly states that alcoholism is more than a spiritual malady.   It is not simply the consequence of this spiritual malady although this malady may contribute.  So is this saying some of us are spiritually ill while also having an abnormal reaction to alcohol?

In the foreword The Doctor’s Opinion suggests  that “the body of the alcoholic is quite as abnormal as his mind.” and  a first mention of a disorder more than “spiritual” is suggested, “It did not satisfy us to be told that we could not control our drinking just because we were maladjusted to life, that we were in full flight from reality, or were outright mental defectives. These things were true to some extent, in fact, to a considerable extent with some of us. (my emphasis)

“The doctor’s theory that we have an allergy to alcohol interests us…as ex-problem drinkers, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account.”

“the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker.”

Here we have an abnormal reaction to alcohol and for some alcoholics a maladjustment to life.

For me this maladjustment to life is not exactly the same as the spiritual disease mentioned in the Oxford Group pamphlet.

All of my academic research in the last 6 years has explored the possibility that this “maladjustment to life” is more than a spiritual malady, i.e. it is not simply the consequence of Sin but the result of abnormal responding, emotionally (which has obvious consequences for sinning) to life.

This emotion dysregulation, as I name it, has consequences for how we feel about ourselves, how we interact with people, how much we feel we belong, how rewarding alcohol and drugs are, how much these substances make us feel better about ourselves (fix our feelings ) and how they turn off the internal critic of maladaptive and negative self schemas.

 

In fact our first “spiritual” wakening was probably the result of drinking as it transformed how we felt about ourselves and the world in which we lived. I know it did for me. In fact, I felt “more me” when I drank, it was like I escaped a restrictive sense of self to be a more expansive, people loving self.  I had a connection with the world I could not generate myself, when sober.

I was a “spirit awakening” if nothing else? It is interesting that a common definition of “spiritual” as it relates to AA, is a sense of connection with others.

As the BB states “Men and women drink essentially because they like the effect produced by alcohol. The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false. To them, their alcoholic life seems the only normal one. They are restless, irritable and discontented, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks—”

For me this section is saying our emotion dysregulation leads to feelings of being “restless, irritable and discontented” which prompt a return to drinking.

The Doctor’s Opinion even offers some classifications of alcoholics “The classification of alcoholics seems most difficult, and in much detail is outside the scope of this book. There are, of course, the psychopaths who are emotionally unstable… the manic-depressive type, who is, perhaps, the least understood by his friends, and about whom a whole chapter could be written.”

This section would appear to be stating clearly that there alcoholics who have other (co-occurring) conditions or conditions appearing as co-occurring?

I contend that alcoholism is an emotional disorder which results in chemical dependency on the substance of alcohol. However in order to treat it we have to first contend with the symptomatic manifestation of this disorder, chronic alcohol use, as it is the most life threatening aspect of this disorder when we present our selves at AA.

What we used once to regulate negative emotions and a sense of self has eventually come to regulate our emotions to such an extent that any distress leads to the compulsive response of drinking. Alcoholics had become a compulsive disorder to relief distress not to induce pleasure.

The “spiritual malady” of the Oxford group seems enhanced in me, I believe I sin more than normal people because of my emotional immaturity and reactivity. My “loss of control” over drinking is also linked to emotion processing difficulties as it prompted  impulsive, uninhibited drinking.

This emotional immaturity is referenced throughout the Big Book I believe.

“… He begins to think life doesn’t treat him right. He decides to exert himself more. He becomes, on the next occasion, still more demanding or gracious, as the case may be. Still the play does not suit him. Admitting he may be somewhat at fault, he is sure that other people are more to blame. He becomes angry, indignant, self-pitying. ”

“Whatever our protestations, are not most of us concerned with ourselves, our resentments, or our self-pity? Selfishness—self-centeredness! That, we think, is the root of our troubles. Driven by a hundred forms of fear, self-delusion, self-seeking, and self-pity, we step on the toes of our fellows and they retaliate. ”

“So our troubles, we think, are basically of our own making. They arise out of ourselves…”

“…Our liquor was but a symptom…”

“Resentment is the ”number one“ offender. It destroys more alcoholics than anything else. From it stem all forms of spiritual disease, for we have been not only mentally and physically ill, we have been spiritually sick.”

For me this is saying that out of my emotion dysregulation  “stem all forms of spiritual disease”.

It then talks of the fear that “was an evil and corroding thread; the fabric of our existence was shot through with it. ”

The list of emotional difficulties continues throughout the Big book’s first 164 pages.

One of the earliest studies on AA members concluded that  they were linked in commonality by two variables, emotional immaturity and grandiosity! I would contend that grandiosity is a part of emotional immaturity. I also contend that our “maladjustment to life” is based on emotional immaturity which is in itself a function of emotion regulation and processing deficits.

A book titled Matt Talbot by Morgan Costelloe has cites this reference –  “American authorities on alcoholism hold that the following psychological traits are commonly found in alcoholics:

> 1. A high level of anxiety in interpersonal relations
> 2. Emotional immaturity
> 3. Ambivalence towards authority
> 4. Low frustration tolerance
> 5. Low self-esteem
> 6. Perfectionism
> 7. Guilt
> 8. Feelings of isolation”

The list is  almost word-for-word identical with one in Howard Clinebell’s
“Understanding and Counseling the Alcoholic” p 53 of the revised edition of 1968 (the original edition appeared in 1956), the only difference being that Clinebell included grandiosity and compulsiveness.

Years after the Big Book Bill Wilson wrote about this emotion immaturity in the guise of discussing emotional sobriety, for me what he is saying that our emotional difficulties are present in long term recovery and need to be addressed – in other words there is more to alcoholism than sinning and drinking. What we are left with after the steps is ongoing and underlying difficulties with living life on life’s terms because we are emotionally immature. This I believe also preceded our drinking, for many of us anyway?

For many recovering alcoholics this may be another unpalatable truth, that they have issues with emotional responding, with being emotionally mature. If further validation is required I suggest a frank conversation with  a loved one, wife, husband, child, parent, etc.

Here is what Bill Wilson wrote ” Those adolescent urges that so many of us have for top approval, perfect security, and perfect romance—urges quite appropriate to age seventeen—prove to be an impossible way of life when we are at age forty-seven or fifty-seven.      Since AA began, I’ve taken immense wallops in all these areas because of my failure to grow up, emotionally and spiritually”. (my emphasis) 

Bill continues “Suddenly I realized what the matter was. My basic flaw had always been dependence – almost absolute dependence – on people or circumstances to supply me with prestige, security, and the like. Failing to get these things according to my perfectionist dreams and specifications, I had fought for them. And when defeat came, so did my depression.”

” Emotional and instinctual satisfactions, I saw, were really the extra dividends of having love, offering love, and expressing a love appropriate to each relation of life… I was victimized by false dependencies…       For my dependency meant demand—a demand for the possession and control of the people and the conditions surrounding me.”

For me this is emotional immaturity, regulating ones emotions and distress via external dependencies on others, demanding in an immature manner that others do one’s bidding?

I would suggest in relation to the issue of co-morbidities that one try to deal with these alcoholism related issues and then see if there are any other to deal with afterwards. For me, as someone who has been treated for anxiety and depression prior to recovery the 12 steps appear to have treated these as emotional consequences of my underlying condition of emotion dysregulation which I call alcoholism.

I think part of the issue is whether doctors, who know in my experience often know next to nothing generally about alcoholism,  can always properly diagnose depression and anxiety in someone suffering from alcoholism?

I also think the issues are complicate because alcoholism have some many similarities to GAD, MDD, OCD, and so on. They all may be similar but different.

This is why we need a satisfactory definition of what alcoholism and addition is? Rather than describing these conditions in terms of the manifest symptoms, i.e chronic substance abuse or, at times, vague “spiritual maladies”.

For example, one variable I believe is slightly different in alcoholism  to other affective disorders is distress based impulsivity which leads to maladaptive decision making, it leads to always wanting more of that…that anything.

These may be specific to addictive behaviours.

It may also be that we feel we have a co-occurring disorder because the underlying distress states prompt similar reactions in various differing disorders.

My distress feeds perfectionism, and catastrophic thinking as with other anxiety disorders like OCD, does that mean I have OCD too?

Maybe or maybe not? My tendency to not  regulate emotions has caused a distress state since childhood, it feeds into perfectionism and many other manifestations like always wanting just one more…?

It is the always wanting one more that makes my affective disorder that of addiction and not another disorder.

My affective disorder via various neural and cognitive – affective mechanisms leads to chronic substance use and dependency of these substances.

GAD, MDD, OCD have different manifestations and different mechanisms.

If we start by trying to recover from alcoholism and addiction and find we still have other issues then obviously address these with outside professional and specialist help.

I believe we can unwittingly complicate our treatment of alcoholism by believing we have (and treating) other conditions we see as distinct from alcoholism but which are in fact part of this condition called alcoholism.

I never fully knew what alcoholsim was until I did the 12 steps. Only then did it become clear what I suffered from?

I have suggested clearly in previous blogs how I think AA’s 12 recovery programme helps specifically with problems of emotion dysregulation.

How the Alcoholics Anonymous-12-step-program of recovery helps with emotional dysregulation

Maintaining Emotional Sobriety (and sanity) via the steps 10-12.

These illustrate how the 12 step programme can help with an emotion dysregulation disorder.

I end, however, with some words from a doctor who seems to be suggesting that AA works because it makes us more emotionally healthy.  For me she is saying how AA treats emotional illness.

An article by Dr. Jacqueline Chang’s paper given to the National Workshop for Health Liaison in York in 1998 and published in the Winter 1999 edition of the AA News suggests that

“The principles of the programme of Alcoholics Anonymous are scientific and closely follow all the helping therapies which lead people to emotional well-being.

AA proposes living “ One Day at a Time”. It is emotionally healthy to live in the day … in the here and now. Professional therapists teach people to live in the present.  AA encourages members to share their experience, strength and hope with other members. It is emotionally healthy to accept our past experiences, however painful, as past events and move on to a richer, more fulfilling future.

Step 1 in the AA programme is “ We admitted we were powerless over alcohol – that our lives had become unmanageable”. It is emotionally healthy to surrender and accept things over which we have no control.
“God grant us the serenity to accept the things we cannot change, courage to change the things we can and the wisdom to know the difference” is the Serenity Prayer used at every AA meeting. It is emotionally healthy to prioritise problems. The Serenity Prayer is the greatest exercise in prioritisation.

It is emotionally healthy to accept that we cannot change a particular situation but we can change the way we react to it.

It is emotionally healthy to accept yourself as you are.
It is emotionally healthy to recognise your environment and interact with it as it is, not as you wish it would be.  It is emotionally healthy to associate or be in contact with other human beings.

It is emotionally healthy to be altruistic – to help others without question or expectation.
It is emotionally healthy to anticipate – to plan for future discomfort or crises. This is the function of the AA Step programme. ”

 

AA provides many ways of becoming more emotionally well, which ultimately means more emotionally mature.

 

 

 

Forgiving Others is the Number One Healer!?

“Resentment is the “number one” offender. It destroys more alcoholics than anything else… In dealing with resentments, we set them on paper. We listed people, institutions or principles with whom we were angry… The first thing apparent was that this world and its people were often quite wrong. To conclude that others were wrong was as far as most of us ever got. The usual outcome was that people continued to wrong us and we stayed sore. Sometimes it was remorse and then we were sore at ourselves. But the more we fought and tried to have our own way, the worse matters got…It is plain that a life which includes deep resentment leads only to futility and unhappiness…If we were to live, we had to be free of anger. The grouch and the brainstorm were not for us. They may be the dubious luxury of normal men, but for alcoholics these things are poison…We saw that these resentments must be mastered, but how?… (1)”

Later, p.77, it suggests  “a helpful and forgiving spirit.”

In the 12 Steps and 12  Traditions, p.78, in reference to step 8 it suggests “why shouldn’t we start out by forgiving them, one and all?

These truncated passages from the Big Book (1)  and the 12 and 12 (3) illustrates how resentments cause relapse and that they need to by treated with the antidote of forgiveness.

We suggest also that the myriad of resentments which swirl around our minds in early recovery are also negative emotions unprocessed and thus unregulated from the past. They continually haunt us because we have not put them “to bed” in long term memory.

We have not dealt with them, by clearly identifying, labelling, sharing via verbalising them with others and then by letting go of them via forgiveness. “Letting go” is another emotional regulatory strategy that healthy people use.

res images (42)

Instead of constantly holding on to memories and incidents from the past, endlessly ruminating on them we maturely face up to them and consign them to the past.

We were thus interested in a study which was not using 12 step recovery but which came to the same conclusion but via another route (2).

“Anger and related emotions have been identified as triggers in substance use. Forgiveness therapy (FT) targets anger, anxiety, and depression as foci of treatment. Fourteen patients with substance dependence from a local residential treatment facility were randomly assigned to and completed either 12 approximately twice-weekly sessions of individual FT or 12 approximately twice-weekly sessions of an alternative individual treatment based. Participants who completed FT had significantly more improvement in total and trait anger, depression, total and trait anxiety, self-esteem, forgiveness, and vulnerability to drug use than did the alternative treatment group. Most benefits of FT remained significant at 4-month follow-up.

The levels of anger and violence observed among alcohol and other substance abusers are far higher than the levels found in the general population.

Alcohol and other substance abusers administered the State-Trait Anger Expression Inventory typically have been shown to have higher state and trait anger, to be more likely to express anger to others, and to have less control of their anger.

Reducing levels of anger and its related emotions is now seen as an important feature of recovery programs. For example, according to the Project Match 12-step facilitation therapy manual, “Anger and resentment are pivotal emotions for most recovering alcoholics. Anger that evokes anxiety drives the alcoholic to drink in order to anesthetize it. Resentment, which comes from unexpressed (denied) anger, represents a constant threat to sobriety for the same reason” (Nowinski, Baker, & Carroll, 1999, p. 83).

Marlatt (1985) emphasized the importance of anger and frustration as triggers for relapse in both the intrapersonal and interpersonal domains. He noted that 29% of relapses are related to intrapersonal frustration and anger and that 16% are related to interpersonal conflict and associated anger and frustration.

Litt, Cooney, and Morse (2000) reported that those alcoholics who had urges to use after treatment had higher degrees of alcohol dependence, anxiety, and trait anger than those without such urges.

Forgiveness is an important way to resolve anger and restore hope (Enright & Fitzgibbons, 2000). In helping clients move toward forgiveness, it is essential to differentiate forgiving from condoning, pardoning, reconciling, or forgetting.

Forgiveness is a personal decision to give up resentment and to respond with beneficence toward the person responsible for a severe injustice that caused deep, lasting hurt. FT helps the wronged person examine the injustice, consider forgiveness as an option, make a decision to forgive or not, and learn the skills to forgive.

Findings – Our clients came to the program with trait anxiety and trait anger scores substantially above the published norms for adults; after treatment, however, FT participants exhibited scores comparable to the average.  In other words, the treatment did not lead simply to a change in anxiety and anger (particularly the reportedly more stable trait anxiety) but to a change toward normal profiles. In contrast, patients in the alternative treatment condition had anxiety scores well above average, especially in terms of trait anxiety, which showed little change at post test and only minimal improvement at follow-up.

FT did not focus on drug vulnerabilities, whereas the alternative treatment did. Urges to use substances are not necessary for relapse, they are important indicators.

FT  treatment is centered more on clients’ thoughts, feelings, and behaviors about someone other than themselves: an offender who hurt them deeply and unfairly. In FT, a potential reason for substance use is examined, that of avoiding painful memories of betrayal, violence, or abuse. When patients are allowed to heal, their motivation to abuse substances may be substantially reduced…(it) is worth considering as a way to address core issues of emotional pain.

resentment

 

This can lead to a reduction in negative emotions and increases in self-esteem and forgiveness… it moves to the heart of the matter for some clients. Deep hurts borne out of unfair treatment seem to play a part in substance use and abuse. Even when clients have many people to forgive…we find that they seem to know which person is most crucial to forgive first before moving to other offenders. Substance use, from this perspective, is a symptom of underlying resentments and related emotional disruptions.

If we fail to realize this, we may end up treating only symptoms rather than underlying causes. ”

 

This process seems practically the same as the inventory of Step 4 and the forgiveness implicit to steps 8 and 9. This study also highlights that we through forgiveness we actually tackle the underlying condition of emotional dysregulation. It is this emotion dysregulation (or spiritual disease) which appears to drive addiction so needs to be fundamentally addressed. By addressing these issues via the steps especially step 4 we begin to see how it works!

It was interesting that forgiveness led to higher self esteem, as if being tied to the past was akin to being tied to a former negative self schema, that people from our pained past did actually have the power to control us! Especially how we feel about ourselves. We change how we feel about ourselves and our past by simply forgiving, it is such a powerful tool in recovery.

Importantly by viewing studies like this (2)  we get beyond negative views of 12 step recovery to show that the recovery program’s effectiveness is clearly highlighted by the success of other psychological treatments getting the same positive results by using exactly the same strategies.

12 step groups provide a battery of the most profoundly effective psychological therapies for addiction ever contained within one treatment philosophy.

Don’t we all need to re-appraise how we see 12 step recovery?

Can’t we all benefit from stepping to one side and looking via a different angle to see why 12 step recovery is effective?

 

Reference

1. Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.

2. Lin, W. F., Mack, D., Enright, R. D., Krahn, D., & Baskin, T. W. (2004). Effects of forgiveness therapy on anger, mood, and vulnerability to substance use among inpatient substance-dependent clients. Journal of consulting and clinical psychology, 72(6), 1114.

3.   Twelve steps and twelve traditions. (1989). New York, NY: Alcoholics Anonymous World Services

Love is the Drug!

Science as we have shown in many blogs has given us unprecedented insight into brain mechanisms implicated in addiction. It has shown us how various neural networks governing reward/motivation, memory, attention and emotions seem to be usurped in the addiction cycle.

Important aspects of “the self” are taken over in other words. It has shown how those vulnerable to addiction seem to have decision making deficits, suffer impulsivity, choose now over later, do not tolerate distress or negative emotions etc. Over react to life!!

It shows how addicts have difficulties in  regulating stress, and that stress systems in the brain are altered to such an extent that they rely for brain function on allostasis not homeostasis.

They show us that various neurotransmitters are also reduced in the addict’s brain such as GABA, the inhibitors or brakes of the brain. We are deficient in natural opioids, dopamine, serotonin etc. Our brains are different to “normies” to “earthlings.

Science suggests the majority of addicts have had abuse or trauma, neglect or adverse experiences while in childhood and this too contributes to addiction vulnerability via stress and emotion dysregulation and a heightened sensitivity to the stimulating effects of drink, drugs and certain behaviors such as eating, sex, gambling, gaming, internet use  etc.

Science also offers suggestions on treatment. It offers the use of chemicals or antagonists to reduce “carving” and it suggest the effectiveness of CBT, Mindfulness and DBT but it seems to know little about how or why 12 step programs work.

Science can’t quite bring itself to believe that laypeople, fellow addicts, can help solve each others’ problems. It scratches it’s head about “spiritual maladies” and “spiritual solutions”; how the 12 steps could bring about such a cathartic change in personality to change someone from a hopeless addict to a person in recovery.

It wonders how helping others and taking fearless and honest inventory can bring about the psychic change sufficient to help some with addiction recover. To be restored to sanity.

 

love-pain1

In various blogs we have suggested the spiritual malady can also be viewed as a emotional disease and that the 12 steps also allow us to process emotions and regulate feelings in a way we could not before.

It helps us process the many negative emotions of the past via steps 4-9 and sets us free by consigning these emotions to long term memory instead of having them swirl around forever in explicit memory, forever tormenting us.

For us, 12 step programs offer a workable definition of the addict. The “spiritual malady” mentioned in the Big Book does however refer to all people, not just alcoholics/addicts, and is borrowed directly from the Oxford Group.  But reading around this, there are many examples of emotional and stress dysregulation in the BB, some 70 plus examples in the first 164 pages  of  how our emotions dominated us and how we were shot through with fear.

It is the description of alcoholics in the BB that highlights we have an emotional as well as spiritual  disease. What is a spiritual disease if not manifest in negative emotional states such as resentments, false pride, anger, jealousy, and so on. The need to control, to be better than, to know best, all also signs of emotional immaturity.  The BB clearly show us alcohol(ism) has made us very emotional irresponsible. We step on the toes of our fellows and they retaliate.

We have a spiritual malady but, from descriptions of ourselves, it seem more extreme than normal people. It is not only in terms of alcohol that “the delusion that we are like other people, or presently may be, has to be smashed.”

The definition is thus workable because it allows one to act in relation to it. For example, if I am aware of the nature of my defects of character I am in effect aware of what cuts me off from the “sunlight of the spirit”, aware of what keeps me spiritually and emotionally ill, what keeps me in a state of unprocessed emotions, of emotional dysregulation, of undealt with distress. Of what keeps me in resentment in a viscous circle of unprocessed negative emotions.

It shows me how this dysregualtion effects other people and gives me the tools to correct my mistakes, to make amends for the mistakes I have made. To relieve distress. It gives me a framework, a program of action which allows me to live with others, on life’s terms, although I might not immediately agree with those terms, which is often the case!

It gives me a choice that I never had before. It says to me you can live with unregulated negative emotions and cultivate your misery or you can choose to use the program to free yourself from these negative unregulated emotions and by processing them be restored to to sanity. It can help me get out of the past/future and into the now, the present.

The solution to my spiritual and emotional malady is this simple. Identify, label, verbalise either to God or to another human being the nature of these wrongs/sins/defects/shortcoming/negative emotions – those factors that trapped me in self propelled distress – and they are quite simply removed. That is my experience. Honesty, openness, willingness, the how of getting out of self. Repeatedly during the day. When I do not do this I suffer emotionally, and others suffer too.

The steps allow me to reduce my distress and this control of distress and stress via the cultivation of serenity, balance, selflessness deactivates my illness for a while allows me to be happy, joyous and free as this appears to be the state of freedom from self, in my experience, this seems to be a state of Grace in other words. The sunlight of the spirit that Bill W mentioned.

It is the solution. I drank to get away from myself. To exhale some air and go “phew!”  I do not not have to even consider that now because I can do that via the steps, by simply taking inventory and letting go. It is our emotions that hold on to negative thoughts, that grow them in the dark shadow of our souls like fungus. Honesty is a light that extinguishes them. By letting go, by allowing my emotions to lower in intensity, to label and identify them and thus allow via, God’ loving Grace, for them to be removed (and stored away where they belong in long term memory).

But there are so many more reasons why 12 step programs work! If the majority of us have had abusive upbringings then it suggests perhaps that there are attachment issues present in many of us. For me my insecure attachment to my primary care giver, my mother, may have caused an insecure attachment which has certainly kick started my later addictions. In fact some observers have gone so far as to view addiction as an attachment disorder.

I will blog on this in the next weeks or two. I will blog on this attachment disorder as perhaps causing that “hole in the soul” that many addicts talk about in meetings.

That not belonging, being separate from. That isolation – these may all stem from insecure attachment. Insecure attachment can shape the brain in a way that makes it difficult to regulate stress and emotion and thus contribute to later addiction. It may cause the differences in emotions mentioned above. It may also point to heart of the problem and why 12 steps groups work in treating addiction.

12 step groups seem to directly treat the “Hole in the soul” by instantly giving an addict a sense of belonging which is particularly powerful after many years in the desolation of addiction. I know that I stayed in AA because I have finally found the club, the tribe, that I belong too. This   like other families is a group of people I love, but sometimes have problems with, fall out with, return to and see in a new light. It is an organic relationship. It has never been wonderful at all times but that says as much about me and my distrust of others, my insecure attachment as it does AA.

I had grown up not even feeling part of my family. The required psychic change happened to me in my first meeting I believe.  Others have commented on how I walked into the meeting a different person from the person who left the meeting. I had a spiritual experience of some sort in my first meeting, purely through identifying with the other recovering alcoholics in the meeting. Not about their drinking, but by identifying with their spiritual malady. I identified with there emotional disease and I realised that if they could find a solution then there was a chance, however small, that I could too. The first flickers of hope happened in that very first meeting.

I knew in my heart I had somehow returned home in a strange way. I had found my surrogate family, those who would help love me back to health and recovery.
Perhaps this is what Science is generally not getting about 12 step groups, the powerful therapeutic tool of talking with someone who has been where you have, who shares your disease and who can help you recovery, as they have. Even now sitting in an AA meeting is the most spiritual thing I do. More so that attending Chapel, visiting monks in isolated monasteries.

Identification with those in the same boat as you is profound. It tells you are not alone. It tells you I need to help you to help me. We are in this together, not you and I. Us, together.

It accepts you as you are, at your lowest ebb, at your rock bottom, your most degraded self. It offers your affection when you are your most unlovable, most wretched.

This for me was the key, being accepted into a group I knew I belonged in. My new home. My new secure attachment. I believe this secure attachment and the love you have for fellowships, sponsees and the love you can now show yourself and your family and friends and people in your life is that solution. To Love and be loved.

I felt in my active addiction I was not deserving of love, that you shouldn’t give me your love. I didn’t know how to give you mine. Now I have so much love inside of me. It is this love that has filled up the hole in my soul.

Okay, it has also increased my natural opioids, raised my dopamine via belonging, raised the GABA brakes in my brain. It has also increase my serotoninergic well being and happiness, it has lower my excitatory glutamate. It has restored more neuro-chemical balance in my head. By prayer and mediation and helping others it restores sanity, fleeting periods of homeostasis, balance, serenity. It most importantly reduces stress/distress, silences my addiction, long enough for me to think of others, help others. And there is not greater buzz that helping others. Love is the drug that I have been thinking off. Love is the solution.

Trust someone enough so that you can begin to allow them and God to love you and you will eventually love them back. A whole new world, full of love and being whole awaits.

The journey is from the crazy head to the serene heart. 

It Works if you Work It!

Alcoholism takes away your life and then kills you.

We look at a study from 8 years ago to show the extent of premature deaths caused by alcoholism and how membership of Alcoholics Anonymous helps in reducing the risk of premature death from alcoholism.

This study (1) of women and men, over 16 years,  observed that those initiating help-seeking careers have better chances of long-term survival. Of the individuals for whom cause of death was known, of the 121 participants known to have died, 76 did so between the 8- and 16-year follow-ups.and 68% died of alcohol-related causes.

Men were more likely to die than were women. When gender was controlled, individuals who were older and unmarried and had more alcohol dependence
symptoms at baseline were more likely to die over the 16-year period.

“It is well documented that the course of alcohol use disorders (AUDs) may end in premature death (Rivara et al., 2004; Room et al., 2005) and …that remission may reduce the risk of premature mortality (Fillmore et al., 2003; Miller, 1999), there is little information about whether an initial course of
professional treatment, or participation in Alcoholics Anonymous (AA), can counteract the connection between AUDs and heightened mortality risk.

To address these issues, we examined mortality in a sample of individuals who had just initiated help-seeking for their AUDs at the start of the study and were followed for 16 years. Specifically, we ascertained the proportions of women and men who died and how these rates compared with matched general population rates…

It Works If You Work It

 

Data on mortality are much more extensive for treated than for untreated individuals with AUDs. Finney and Moos (1991) reviewed long-term studies of mortality among treated individuals. Overall mortality rates ranged from 15% to 42% and were higher when the duration of follow-up was longer (see also Nielsen et al., 2005).

…Among individuals treated for AUDs, mortality rates were higher for men than for women (Feurerlein et al., 1994; Hurt et al., 1996). In addition, in community samples, rates of mortality due to alcohol use were higher in
men than in women (John and Hanke, 2002; Zureik and Ducimetiere, 1996). Premature death due to alcohol abuse or dependence is particularly more likely among men than among women in young and middle-aged groups (Moller-Leimkuhler, 2003)…

…A more severe and longer duration of alcohol abuse predicts premature death (Liskow et al., 2000; Ojesjo, 1981)…. In an 11-year follow-up, Smith et al. (1983) found that women who developed their AUD early and engaged in binge drinking were more likely to die. Consistently, more alcohol consumption and having recognized at a younger age that drinking was a problem were related to more years of life lost to an AUD (Marshall et al., 1994).

…Mackenzie et al. (1986) found that men who were hospitalized for AUDs more frequently were more likely to die over an 8-year follow-up. Inpatient treatment occurring throughout the course of alcoholism may be a marker for a more severe and chronic disorder because such treatment is sought in response to a relapse (Timko et al., 2000). In a study of inpatients with AUDs, de Lint and Levinson (1975) found that death rates were lower in the first 2 years postdischarge than thereafter. They speculated  that intensive outpatient aftercare may delay or prevent the high rate of mortality that often occurs shortly after discharge.

Among individuals treated for AUDs, those who subsequently attended AA were less likely to have died by a 2-year follow-up than those who did not attend (Masudomi et al., 2004)…

… For inpatient care, longer duration appears to be an indicator of greater disorder severity and thus should be associated with higher mortality…However, for outpatient care and help from AA, a longer duration predicts better substance use disorder outcomes and so may  indicate continuing motivation to stop drinking (Moos and Moos, 2003a, 2004a). From this perspective, a longer duration of outpatient treatment or AA affiliation should be associated with lower mortality.

…Furthermore, those who relapsed after treatment were 3 to 5 times more likely to die as those who remained abstinent (Bullock et al., 1992; Feurerlein et al., 1994)…

(This study found)…individuals who are just beginning their help-seeking…have a better chance of long-term survival than do women and men with more chronic disorders.
That is, individuals entering an initial episode of help-seeking may be successful at preventing or reducing the harm associated with excessive drinking that is also potentially causal in death. In contrast, repeated episodes of AUD treatment are often a reflection of the chronic and severe alcoholism known to cause premature death. As other studies have found, men were more likely to die than were women (Feurerlein et al., 1994; Hurt et al., 1996; John and Hanke, 2002; Zureik and Ducimetiere, 1996). Of the individuals who died, over two-thirds died of causes related to alcohol use.

…individuals who were olderand had more alcohol dependence symptoms (Finney and Moos, 1992; Liskow et al., 2000) and were unmarried were
more likely to die over the 16-year observation period.
Alcohol-related mortality tends to be lower among married persons (Agren and Romelsjo, 1992; Lewis et al., 1995)…

keepcomingback

 

…continuous abstinence, had a positive effect on the survival of individuals with AUDs. Studies comparing stable abstinence with reduced frequency and
quantity of abusive drinking found that only stable abstinence prevented a higher mortality risk (Bullock et al., 1992; Gerdner and Berglund, 1997). Our results are consistent with those findings…

 

…Longer duration of AA attendance during the first follow-up year (specifically, attendance for more than 4 months) combined with better 1-year drinking outcomes was associated with a lower likelihood of death in the subsequent 15 years.

Alcoholics Anonymous participation may delay mortality not only by
reducing drinking and drinking-related, including medical,
problems, as outpatient treatment does, but also by increasing social resources and reducing…friendship stressors (Humphreys and Noke, 1997; Kaskutas et al., 2002; Masudomi et al., 2004).

 

References

Timko, C., DeBenedetti, A., Moos, B. S., & Moos, R. H. (2006). Predictors of 16‐year mortality among individuals initiating help‐seeking for an alcoholic use disorder. Alcoholism: Clinical and Experimental Research, 30(10), 1711-1720.

Why a spiritual solution?

The Alcoholics Guide to Alcoholism

In the first in a series of blogs we discuss the topic of why does the solution to one’s alcoholism and addiction require a spiritual recovery.

This is a much asked question within academic research, although the health benefits of meditation are well known and life styles incorporating religious affiliation are known to increase health and span of life.

I guess people are curious as to how the spirit changes matter or material being when it should perhaps be rephrased to how does application of the ephemral mind affect neuroplasticity of the brain. Or in other words how does behaviour linked to a particular faith/belief system alter the functions and structure of the brain. We have discussed these points in two blogs previously and will do so again in later blogs. Here I just want to highlight in a short summary why spiritual practice helps alcoholics and addicts with with…

View original post 2,028 more words

AA helps to reduce Impulsivity

 

One constant in studies on addiction and in alcoholism, in particular is the  fundamental role played by impulsivity in these disorders. It is seen to be present in early use but appears to be more distress based (i.e. more negative urgency based) as the addiction cycle becomes more chronic. This impulsivity has obvious consequences for propelling these disorders via impulsive behaviours and decision making difficulties.

Thus it then follows that any treatment of these addictive disorders must have treatment of impulsivity at the core as it appears to a fundamental pathomechanism.

 

Here, we review a study that on links  AA attendance and reduced impulsivity using a 16-year prospective study of men and women, who were initially untreated for their drinking problems. Across the study period, there were significant l decreases in impulsivity, and longer AA duration was associated with reductions in impulsivity.

Alcoholics Anonymous (AA) is linked to improved functioning across a number of domains [2,3]. As the evidence for the effectiveness of AA has accumulated, so too have efforts to identify the mechanisms of change associated with participation in this mutual-help group [4].

This study concluded that help-seeking and exposure to the “active ingredients” of various types of help (i.e., AA principles/practices, sponsors), which, in turn, leads to improvements in reduced impulsivity.

Impulsivity is typically higher among individuals in AUD treatment than among those in the general population [5] and, impulse control deficits tend to predate the onset of drinking problems [6-9].

Contemporary research has revealed that traits such as impulsivity can change over time [10]. Mutual-help groups like AA may promote such changes, given that they seek to bolster self-efficacy and coping skills aimed at controlling substance use, encourage members to be more structured in their daily lives, and target deficits in self-regulation [11].

 

impulse control.preview

 

Such “active ingredients” may curb the immediate self-gratification characteristic of disinhibition and provide the conceptual grounds to expect that AA participation can press for a reduction in impulsive inclinations. In turn, given the range of outcomes related to impulsivity (e.g., legal, alcohol-related, and psychosocial problems), decreases in impulsivity may account for part of the association between AA participation and improvements in these outcomes.

AA’s vision of recovery as a broad transformation of character [12], and  explores individual differences in emotional and behavioural functioning as potential mechanisms of change (13,14).

Such groups encourage members to be more structured and goal-directed, which may translate into greater efforts to delay gratification of one’s impulses and  to improve clients’ general coping skills (e.g., reduce avoidance coping).

Given that impulsivity is a risk factor for a host of problematic behaviors and outcomes beyond drinking-e.g., criminality [15], drug abuse [16], reckless driving and sexual practices [17],  lower quality of interpersonal relationships [18], and poor health [19] this reduced impulsivty is beneficial in other aspects too.

Notably, this effect was buffered by a higher quality of social support-a probable active ingredient of AA. Thus, the impact of reducing impulsivity may be widespread across a range of outcomes that are critical for long-term sobriety.

 

Our main caveat on this study is that it does not distinguish between different types of impulsivity and does not mention negative urgency (or distress-based impulsivity) which is more commonly seen is this sample group.

AA’s “active ingredients” may reduce distress, via a new found emotional regulation gained via the steps and use of a sponsor (acting as an external prefrontal cortex to help us inhibit our impulsive and distress based responses)  which in turns reduces our tendency to impulsive decision making and behaviour.

 

It would have been interesting in this study to have also measure how emotional dysregulation changed in the time span of 16 years (using the DERS scale) and to have used a different impulsivity scale i.e. used the UPPS-P scale which would both have helped more specificallylook  at the interaction of how emotional regulation and impulse control changed over the 16 year period.

 

References

 

1.  Blonigen, D. M., Timko, C., & Moos, R. H. (2013). Alcoholics anonymous and reduced impulsivity: a novel mechanism of change. Substance abuse, 34(1), 4-12.

2. Humphreys, K. Circles of recovery: Self-help organizations for addictions. Cambridge Univ Pr; 2004.

3.. Tonigan JS, Toscova R, Miller WR. Meta-analysis of the literature on Alcoholics Anonymous: Sample and study characteristics moderate findings. Journal of Studies on Alcohol. 1995

4. Kelly JF, Magill M, Stout RL. How do people recover from alcohol dependence? A systematic review of the research on mechanisms of behavior change in Alcoholics Anonymous. Addiction Research & Theory. 2009; 17(3):236–259.

5. Conway KP, et al. Personality, drug of choice, and comorbid psychopathology among substance abusers. Drug and alcohol dependence. 2002; 65(3):225–234. [PubMed: 11841894]

6. Caspi A, et al. Behavioral observations at age 3 years predict adult psychiatric disorders: Longitudinal evidence from a birth cohort. Archives of General Psychiatry. 1996; 53(11):1033. [PubMed: 8911226]

7. Cloninger CR, Sigvardsson S, Bohman M. Childhood personality predicts alcohol abuse in young adults. Alcoholism: Clinical and Experimental Research. 1988; 12(4):494–505.

8. Elkins IJ, et al. Personality traits and the development of nicotine, alcohol, and illicit drug disorders: Prospective links from adolescence to young adulthood. Journal of abnormal psychology. 2006; 115(1):26. [PubMed: 16492093]

9. Sher KJ, Bartholow BD, Wood MD. Personality and substance use disorders: A prospective study. Journal of Consulting and Clinical Psychology. 2000; 68(5):818. [PubMed: 11068968]

10. Caspi A, Roberts BW, Shiner RL. Personality development: Stability and change. Annual Review of Psychology. 2005; 56:453–484

11. Moos RH. Active ingredients of substance use focused self help groups. Addiction. 2008; 103(3):387–396. [PubMed: 18269361]

12. White WL. Commentary on Kelly et al. (2010): Alcoholics Anonymous, alcoholism recovery, global health and quality of life. Addiction. 2010; 205:637–638. [PubMed: 20403015]

13. Kelly JF, et al. Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms? Addiction. 105(4):626–636. [PubMed: 20102345]

14. KELLY JF, et al. Negative Affect, Relapse, and Alcoholics Anonymous (AA): Does AA Work by Reducing Anger? Journal of studies on alcohol and drugs.

15. Krueger RF, et al. Personality traits are linked to crime among men and women: Evidence from a birth cohort. Journal of abnormal psychology. 1994; 103(2):328. [PubMed: 8040502]

16. McGue M, Slutske W, Iacono WG. Personality and substance use disorders: II. Alcoholism versus drug use disorders. Journal of Consulting and Clinical Psychology. 1999; 67(3):394. [PubMed: 10369060]

17. Caspi A, et al. Personality differences predict health-risk behaviors in young adulthood: Evidence from a longitudinal study. Journal of Personality and Social Psychology. 1997; 73(5):1052. [PubMed: 9364760]

18. Ozer DJ, Benet-Martinez V. Personality and the prediction of consequential outcomes. Annu. Rev. Psychol. 2006; 57:401–421. [PubMed: 16318601]

19. Bogg T, Roberts BW. Conscientiousness and Health-Related Behaviors: A Meta-Analysis of the Leading Behavioral Contributors to Mortality. Psychological Bulletin. 2004; 130(6):887. [PubMed: 15535742]

 

 

 

 

 

 

 

 

Why erase addiction memories when they can help others?

According to one UK newspaper The Independent, dated the 9th July 2014 “Substance abusers could have their memories of drug addiction wiped in a bid to stop them using illegal narcotics, an award-winning neuroscientist has said.

According to new research by Cambridge University’s Professor Barry Everitt: disrupting the memory pathways of drug users could weaken powerful “compel” cravings, reduce “drug seeking behaviour” and open a new field of addiction therapy.

Professor Everitt  told this week’s Federation of European Neuroscience Societies (FENS) how his research in rodents had found that targeting “memory plasticity” in rats was able to reduce the impact of maladaptive drug memories.

He added that this knowledge could offer a radical new method of treatment of drug addiction in humans, where researchers have already established that the path to addiction operates by shifting behavioural control from one area of the brain to another. This process sees drug use go from a voluntary act to a goal directed one, before finally becoming an compulsive act.

It was this process that Professor Everitt’s research is trying to “prevent” by targeting “maladaptive drug-related memories” to “prevent them from triggering drug-taking and replaces”.

In humans this could potentially be done by blocking brain chemicals.

“It’s the emotional intrusiveness of drug and fear memoirs that can be diminished, rather than an individual’s episodic memory that they did in the past take drugs or had a traumatic experience,” he told The Independent. “Conscious remembering is intact after consolidation blockade, but the emotional arousal [that] leads to drug seeking or distressing feelings of fear that are diminished.”

His research group discovered that when drug memories are reactivated by retrieval in the brain, they enter a pliable and unstable state. By putting rats in this state Professor Everitt was able to prevent memory reconsolidation by blocking brain chemicals or inactivating key genes.

In one study, the team diminished drug seeking behaviours by obstructing a brain chemical receptor linked to learning and memory, thus erasing memories, while in another study it found they could weaken drug use memories by altering a particular gene in the amygdala, a brain area processing emotional memory.

“Of course, inactivating genes in the brain is not feasible in humans,” the professor told FENS. “So we’re directing our research to better identify the underlying brain mechanisms of memory reconsolidation.”

He added: “We specifically examined how we could target these maladaptive drug-related memories, and prevent them from triggering drug-taking and relapse.”

So to recap, this new treatment is based on altering genes in rats!

There is no need to actually wipe an alcoholics’ addiction memories.

In fact it may be very counter productive to recovery from alcoholism. One 80 year old and hyper ecologically valid experiment into the mnemonics of “treating addiction memories”  has shown that by honestly looking at the consequences of one’s actions as the result of one’s alcoholic drinking that the positive associations of previous drinking were reappraised in light of the damage done to oneself, one’s loved ones and family and society at large.

Addiction memories via this profound reappraisal were then more accurately processed in long term explicit memory. Implicit schematic memory was also altered fro a self schema in which one is a drinking alcoholic to one in which one is a recovering alcoholic.

So-called positive associations in long term episodic and explicit memory were,  when labile via recall, then challenged and replaced by more accurate negative associations in long term memory – no memories needed to be erased just reappraised more accurately.

 

mad scientist

 

This type of ongoing experiment is happening on a daily basis at an AA meeting near you.

AA groups have found that memories need not be erased, with possible deleterious knock on effects on fear processing and amgydaloid performance, but rather memories simply need to be faced up to, and via honesty appraisal reprocessed more adaptively in long term memory.

This also means alcoholics in recovery can use their addiction memories in not only clearing away the wreckage of the past, repairing broken relationships with loved ones and society as a whole by  making amends to those involved in this wreckage and also put the memories of the past to excellent therapeutic use by using it to help others with similar memory difficulties.

In fact even academic researchers have found and have demonstrated that abstinent, treatment seeking individuals also have a different cognitive or/and memory bias to active alcoholics. This has been illustrated in findings that the greater “accessibility” for positive vs. negative alcohol- associations in heavy vs. light drinkers was not found to be generalized to alcoholics in treatment vs. social drinkers (2). Rather, there was a trend for treated inpatients, motivated to attain abstinence, to show greater availability and accessibility for negative alcohol-related information.

This is how to use memories of addiction to the best possible use, instead of erasing them, wiping them our and hoping for the best, memories of our addiction can be used to great purpose in helping others. Also “addiction memory” is often activated by those who have not come to terms with their alcoholism and still want to drink. Unless some one has come to terms with their alcoholism little can be done, by erasing memories or otherwise. These are sticking plasters on a gaping wound. They will be replaced with other “addiction memory” as there an underlying condition to alcoholism ( we believe it to be emotional regulation and processing deficits) and it is this that drives this fear-based condition called alcoholism, memories are the result of this malady. Address the underlying conditions and the rest takes care of itself.

It is not brain regions which are the problem either such as activation of the amgydala, it is how this sometimes errant and overactive brain region in alcoholics is tamed via the serenity found in the AA program of recovery.

The compel parts of the brain, Everitt mentions,  are activated by emotional distress, so treat the distress not the symptom of it. He also confuses implicit, automatic memory, with explicit, conscious memory. Either way they are both activated by stress/distress, and are thus both emotional memories.  Again treat the emotional dysregulation, the primary problem not the secondary manifestation of the problem.

As I mentioned above, there has been an ongoing experiment into recovery from alcoholism going on for nearly 80 years now, there is a lab in most areas of town.

It would benefit the world and science, in particular, if neuroscientists would pop in for a coffee and check our our findings.

 

References

2. McCusker CG  Cognitive biases and addiction: an evolution in theory and method. Addiction 2001;96:47–56.

 

Spiritus contra spiritum.

Explaining the Spiritual Thirst

In this blog we copy from an article that we have come across recently in which very respective neuroscientists, in their introduction, give a good insight into the spirituality of recovery (1). One day we believe science will come to accept that these so-called spiritual practices are actually essential to recovery from addiction and alcoholism, and possibly a host of other psychiatric disorders  by helping to unite the fragmented self.

 

” One commenter Jerome Dollard says, “Spirituality is a lot like health. We all have health; we may have good health or poor health, but it‘s something we can’t avoid having. The same is true of spirituality: every human being is a spiritual being. The question is not whether we ‘have spirituality’ but whether the spirituality we have is a negative one that leads to isolation and self-destruction or one that is more positive and life-giving”

Addiction has been understood in terms of a spiritual craving for wholeness, freedom, and transformation. It is not by coincidence that the Latin root of “addict” connotes the idea of a willing slave, or one who has become enslaved by so many acts of willing devotion.

Once the pursuit of the special release from self, the self-transcendence, which comes with using a particular substance or activity, becomes the organizing principle of the person’s life, the hedonic habit takes on a life of its own. What initially promised freedom from the bondage of self or freedom to become someone else turns out to be a “rapacious creditor” bleeding the borrower of “all self-sufficiency and will to resist its demands” .

The “habit” becomes obsession and eventually fragments the person until his or her will to resist is rendered impotent, or powerless. The admission of this powerlessness is an intensely personal event, which functions as the first step toward actual freedom.

From this phenomenological interpretation of addiction, we can begin to see how it is linked to spirituality. This insight was captured well by the psychiatrist Carl Jung in his letter to Bill Wilson: “You see, Alcohol in Latin is ‘spiritus’ and you use the same word for the highest religious experience as well as for the most depraving poison. The helpful formula therefore is: spiritus contra spiritum.”

In other words, the highest form of religious experience counters the most depraving poison – high spirit against low spirit.

 

download (3)

 

In his Varieties of Religious Experiences, the philosopher William James related a similar insight about this interaction in the opposite direction: “The only radical remedy I know of for dipsomania (another name for alcoholism) is relgiomania.”

These insights have been validated more recently by neuroscientist Patrick McNamara. In his book, The Neuroscience of Religious Experience, McNamara makes the convincing argument that religion may have evolved in the first place to facilitate the process of unifying the fractured human person by means of a spiritual experience. The same spiritual craving for wholeness, self-integration, and freedom that motivates the use and abuse of a variety of substances and activities is also that which frequently motivates people’s involvement in religious and spiritual communities.

From this phenomenological interpretation of addiction, we can begin to see how it is linked to spirituality.

Evidence of McNamara’s insight can potentially be observed among the contemporary movement of mutual-help fellowships, such as AA and their Twelve Step Program. According to their preamble, “AA is a fellowship of men and women who share their experience, strength, and hope with each other to help other alcoholics achieve sobriety.” To be organized around the purpose of achieving recovery and helping others is certainly a crucial piece in transforming an individual’s purpose and meaning.

Another one of the reasons for the success of the AA fellowship in facilitating these transformative experiences is their emphasis on its members telling stories about “what they were like, what happened, and what they are like now.”

The continued practice of telling such stories not only serves to remind the storyteller of the despair and anguish associated with using alcohol, but also to remind them of how far they have come. It functions to facilitate a sort of deductive reasoning, where what exists today appears to have required what preceded it.

Therefore, gratitude is a frequent theme in these stories. Telling these stories also requires learning to look at oneself, and especially one’s relationship with alcohol, differently. It is a major piece in transforming that way of seeing oneself in the world that extends into a way of being.

The twelve steps are also about cultivating an expanded consciousness through a reinterpretation of one’s own actions and reactions towards the people, places, and things around him or her.

The morality emphasized in these steps encourages personal responsibility for one’s actions, consideration of other people’s cares and concerns, and thus, a kind of fitness in terms of the person’s conscience. They are a systematic method of actualizing the spiritual awakening that have consistently been exhorted by many of the world’s great religions.”

Well said.

References 

1. Blum, K., Thompson, B., Oscar-Berman, M., Giordano, J., & Braverman, E. (2013). Genospirituality: Our Beliefs, Our Genomes, and Addictions. J Addict Res Ther, 4(162), 2.

 

 

Why a spiritual solution?

In the first in a series of blogs we discuss the topic of why does the solution to one’s alcoholism and addiction require a spiritual recovery.

This is a much asked question within academic research, although the health benefits of meditation are well known and life styles incorporating religious affiliation are known to increase health and span of life.

I guess people are curious as to how the spirit changes matter or material being when it should perhaps be rephrased to how does application of the ephemral mind affect neuroplasticity of the brain. Or in other words how does behaviour linked to a particular faith/belief system alter the functions and structure of the brain. We have discussed these points in two blogs previously and will do so again in later blogs. Here I just want to highlight in a short summary why spiritual practice helps alcoholics and addicts with with regulating themselves especially when the areas of their brains which govern self regulation have been taken over by the action of drugs and alcohol, so that they have very limited control over their own selves and their own behaviour.

This seems to be at the heart of addiction and alcoholism, this increasingly limited self control over addictive behaviors. In addressing this need for a spiritual solution we also hope to address choice versus limited control arguments. As we will see, the addicted or alcoholic brain is usurped to such a profound extent by effects of drugs and alcohol and this brain acts so frequently without conscious awareness of the negative consequences of these actions that it is appears undoubtedly the case that addicts and alcoholics have profoundly diminished control over their choices of behaviour.

This is especially pertinent in chronic addicts and alcoholics were the thrill is long gone so why would they continue doing something which has little reward other than because they are compelled to.

In addiction, vital regions of the brain and processes essential to adaptive survival of the species become hijacked or usurped or “taken over” by the combination of the effects of alcohol or drugs or addictive compulsive behaviours (acting as pharmacological stressors)  on pre-existing impairment in certain parts and functions of the brain. The actions of drugs and alcohol lead to a hyperactive stress system which enhances the rewarding aspects of drugs and alcohol in initial use, especially in those with maladaptive stress response such as individuals who have altered stress systems in the brain due to abusive childhood experiences (1-3).

In the second abusing phase, stress interacts with various neurotransmitters especially dopamine to drive this abusive cycle. In this phase of the addiction cycle  stress heightens attention towards cues and creates an  heightened attentional bias towards drugs and alcohol (4,5). Stress chemicals also increase activation of “addiction memory” (6,7). Thus there is multi-network usurping of function in the brain as the addiction cycle progresses (8). Recruited of attention, reward and memory networks are enhanced by the effects of stress chemicals.

Stress also enhances the rewarding effects of alcohol and drugs so makes us want them more (9). Enjoy them more. These are the so-called “good times” some of us look back on, in our euphoric recall.

In the final endpoint phase of addiction, stress incorporates more compulsive parts of the brain, partly by the stimulus response of emotional distress which automatically activates a compulsive response to approach drug and alcohol use while in distress, which is a common reality for chronic addicts and alcoholics.

 

10350601_792571304116059_8113905016770358871_n

 

Thus stress chemicals acting on mainly dopamine  circuits in the brain and other neurotransmitters eventually take over control of the brain in terms of the control of behaviour (8).

In usurping  “survival” or self regulation networks in the brain, control over behaviour “implodes” or collapses inwards, from control over behaviour moving inwards from the action outcome, or goal directed, conscious prefrontal cortex to the unconscious automatic, motoric, subcortical  parts of the brain (10).

This greatly limits one’s conscious self control over one’s own behaviour  if one is addicted or chronically alcoholic. Control of behaviour appears to have becomes a function of hyperactive stress systems in the brain and their manifestation as emotional distress (11,12).

This emotional distress constantly activates a “flight or flight” response in the brain and this means behaviour is carried out without reflection or without explicit knowledge of consequences, usually negative in the case of addiction (13,14).

The alcoholic or addicted brain becomes a reactionary brain not a forward thinking, considering of all possible options type of brain. The addict or alcoholic becomes driven by his brain and to a great extent a passenger in his own reality. Automatic survival networks act or react continually as if the addicted brain is on a constant state of emergency, constantly under threat.

There is a profoundly reduced conscious cognitive control over behaviour. This heighted, excessive and chronic stress and distress cuts off explicit memory of previous negative consequences of our past drinking and drug use and recruits implicit memory systems which are mainly habitual and procedural, they are “do” or “act” without conscious deliberation systems of the brain (14) .

It is as if our alcoholic or addicted brains are doing the thinking for us. Or not as the case may be. Alcoholics are on automatic pilot, fuelled by distress.  This neuroscientific explanation fits almost perfectly with the description of alcoholism in the Big Book of Alcoholics Anonymous, “The  fact is that most alcoholics…have lost choice in drink. Our so-called will power becomes practically nonexistent. We are unable , at certain times,  to bring into our consciousness with sufficient force the memory of the suffering and humiliation of even a week or month ago. We are without defense against the first drink”

The” suffering and humiliation” are now called “negative consequences” in current definitions of addiction…”continued use despite negative consequences”. (15)

images (15)

 

We “cannot bring into our consciousness with sufficient force the memory” because this is an explicit memory cut off by the effects of excessive stress which “offlines” the prefrontal cortex and hippocampal memory in favour of unconscious habitual, implicit or procedural memory (14,16). The memory of drinking not the memory of the “ situations surrounding this drinking”. How is this not a disorder  that has placed us “ beyond human aid” and beyond our own human aid” ? 

The “unable at certain times” are possibly times of great distress or emotional dysregulation and they leave the alcoholic and addict vulnerable to  relapse.

“Once more: The alcoholic, at certain times, has no effective mental defence against the first drink.”

“His defence must come from a Higher Power”

In later blogs we will discuss, in terms of the brain, why we need to recruit parts of the brain, via selfless behaviours, which activate areas outside those implicated in self regulation.

The cited  power greater than ourselves in AA meetings, for example, often follows an experiential trajectory – first it is the first person an alcoholic asks for help whether a family member, loved one or a G.P. – this often leads to an AA meeting or a treatment centre – then they are presented with other alcoholics who suffer from the same disorder – in AA parlance this is the first, and for many alcoholics in recovery, their only experience or attempt to find G.O.D. – this Group. of. Drunks. is like all that preceded it, a power greater than ourselves, regardless on whether we attain a spiritual connection with God after that.

A sizable minority in AA remain agnostic or atheist. This does not mean they have not performed essentially “spiritual” acts such as asking for help, accepting powerless over their life at that present moment. These are all acts of humility of accepting one needs help from beyond oneself. They also attend meetings where no one is in charge apart from God as He may express Himself in our group conscience.

Our first sponsors (mentors) in AA are also a power beyond ourselves as are their sponsors and their sponsors and the people in all their lives who advise and support. From the moment one has wholeheartedly accepted the need for help, one has accepted that help will come from a power greater than themselves.  It is a humbling and I believe spiritual act. A new breath filling one’s life.

All these people are already doing something for us which we could not do ourselves, they are helping us recruit the prefrontal cortex and explicit memories of the disasters alcohol or drug addiction has wrought on our lives – they move, eventually, activity in the brain from the unthinking dorsal striatal to the reasoning prefrontal cortex, helped also by sharing our stories in meetings. They give us a new recovery alcoholic self schema to replace the former drinking alcoholic self schema and stores it in implicit memory.

These people helps us change positive memory association of alcohol with negative associations. They overturn old ideas about the good times with a deep awareness of how bad these so-called good times were. The attentional bias is avoided or is rarely activated as the distress and stress are greatly reduced so as not to activate it.

We find recovery rewarding in the way we formerly (but not latterly) found drinking. In fact we find recovery better than drinking even at it’s best. The worst day in recovery seems much better than the worst day in drinking. We learn how to regulate our emotions so as to avoid prolonged bouts of distress, we ring our sponsors when such moments arise, talk to a loved one.

Again an external prefrontal cortex helps us climb out of the sub-cortical “fear” areas of the dorsal striatum and the anxious amgydala. The solution  is in the prefrontal cortex, in it’s control over emotions, in it’s clear appraisal of our past, in it’s activation of negative, realistic  memories of the past and  in avoiding the people, places and things which remind us of drinking.

The prefrontal cortex becomes more in charge rather than our illness doing the thinking. The prefrontal also gets strengthened by us sharing our experience strength and hope at meetings, it uses a recovery narrative to reconcile the drinking self with the recovering self, making us whole,  it embeds in our mind the truth of the progressive nature of this illness. It helps us see what it was like, what happened and what it is today. It gives us the tools to help others.

In the follow up blog to this we will further explore how this works – this spiritual solution.

 

References

1. Cleck, J. N., & Blendy, J. A. (2008). Making a bad thing worse: adverse effects of stress on drug addiction. The Journal of clinical investigation, 118(2), 454.

2. Koob, G. F., & LeMoal, M. (2001). Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology, 24, 97–129.

3. Sinha, R. (2008). Chronic stress, drug abuse, and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141, 105–130

4. Peciña, S., Schulkin, J., & Berridge, K. C. (2006). Nucleus accumbens corticotropin-releasing factor increases cue-triggered motivation for sucrose reward: paradoxical positive incentive effects in stress?  BMC biology, 4(1), 8.

5. Ventura, R., Latagliata, E. C., Morrone, C., La Mela, I., & Puglisi-Allegra, S. (2008). Prefrontal norepinephrine determines attribution of “high” motivational salience. PLoS One, 3(8), e3044

6. Hyman, S. E. (2007). Addiction: a disease of learning and memory. Focus, 5 (2), 220.

7.  Adinoff , B. (2004) Neurobiologic processes in drug reward and addiction, Harvard Review of Psychiatry

8. Duncan E, Boshoven W, Harenski K, Fiallos A, Tracy H, Jovanovic T, et al  (2007) An fMRI study of the interaction of stress and cocaine cues on cocaine craving in cocaine-dependent men. The American Journal on Addictions, 16: 174–182

9. Berridge, K. C., Ho, C. Y., Richard, J. M., & DiFeliceantonio, A. G. (2010). The tempted brain eats: pleasure and desire circuits in obesity and eating disorders.Brain research, 1350, 43-64.

10. Everitt, B. J., & Robbins, T. W. (2005). Neural systems of reinforcement for drug addiction: From actions to habits to compulsion. Nature Neuroscience, 8, 1481–1489

11. Sinha, R., Lacadie, C., Sludlarski, P., Fulbright, R. K., Rounsaville, B. J., Kosten, T. R., & Wexler, B. E. (2005). Neural activity associated with stress-induced cocaine craving: A functional magnetic resonance imaging study. Psychopharmacology, 183, 171–180.

12. Goodman, J., Leong, K. C., & Packard, M. G. (2012). Emotional modulation of multiple memory systems: implications for the neurobiology of post-traumatic stress disorder.

13. Schwabe, L., Tegenthoff, M., Höffken, O., & Wolf, O. T. (2010). Concurrent glucocorticoid and noradrenergic activity shifts instrumental behavior from goal-directed to habitual control. Journal of Neuroscience, 20, 8190–8196.

14. Schwabe, L., Dickinson, A., & Wolf, O. T. (2011). Stress, habits, and drug addiction: a psychoneuroendocrinological perspective. Experimental and clinical psychopharmacology, 19(1), 53.

15. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 5–25.

16. Arnsten, A. F. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410-422.