Second Stage Recovery?

 

drug-addiction

 

Recovery is Discovery

Eight years ago, when I had just completed by first two years in recovery from Chronic Alcoholism, I was approached by an elderly, wise woman, who, on hearing of my having completed two years in recovery, suggested that I was now in position to “really start my recovery”!

I was a bit offended my this. I felt she was intimating that my first two years in recovery were not really recovery.

I reacted in an adverse way, stating I was more than happy with my recovery “thank you very much!” and would continue to simply do it the AA way, the 12 steps and traditions. I  had a spiritual awakening  by this stage and thought her rude to suggest I needed additional help.

But she was right, I do need more help, much more additional help.

I was not born a fully fledged alcoholic, I was born with a pre-disposition towards alcoholism.

The genetics I inherited from both parents contributed, but the fertile soil of all my later addictive behaviours, and there are a few (certainly more than I thought), was my traumatic upbringing in a dysfunctional family.

What the wise elderly woman was suggesting was that I  start attending Adult Children of Alcoholics and Dysfunctional Families meeting, knowing that not only was my father alcoholic (sober but not recovered, “dry drunk”) and my mother was dependent of Valium but that, evident from my AA “shares” over the past two years, that I have been reared in a very dysfunctional family.

Looking back now eight years later, it seems rather unfortunate that this elderly woman had not rephrased this suggestion somewhat. Perhaps if she had said there was a stage 2 recovery after initial recovery from alcoholism, which dealt with some of the primary reasons why we became alcoholics in the first place I might have listened more?

Perhaps not?

Perhaps what she was suggesting was too threatening and I wasn’t ready, perhaps my unconscious was revolting at such an idea?

As they say in AA, “it takes time to realise it takes time”.

For me this means it has taken a further eight years to realise, via 6 years of academic research into affective neuroscience, to realise I suffer from a primary disease of arrested development which has impacted on both my ability to grow emotionally and cognitively and has severely impacted on my ability to have relationships with other human beings.

I have quite simply not learnt the majority of the survival mechanisms one is supposed to learn in childhood.

These, according to the book Co-Dependence:Healing he Human Condition  by Charles Whitfield, include the “arrested identity development” and “failure to achieve psychological autonomy” of not learning fully to connect, love, trust, explore, initiate, be autonomous, think, cooperate, master, create, develop values as well as regenerate (heal) evolve, and grow…

Due to the trauma of childhood “we are in survival mode, focusing outside of ourselves, and neglecting our inner lives…in our relationships with self and others we often have difficulty with achieving development in areas such as connecting, trusting, mastering and loving.

Recovery gives this dysfunctional Adult Child a second chance to work through these developmental stages in a health way. But even in early recovery we can feel as though we are starting over – even from a kind of infancy…”

I can really relate to feeling of being like an infant in early recovery.

In fact, I felt like a baby at times, I was so challenged by life and survival. Getting to the “terrible twos” was actually progress!

I had to be helped intensively by my wife and my sponsor.

I have blogged before about my shock also at not being able to sit with and identify emotions. All of this lack of emotion processing ability and chronic lack of survival skills was obviously worsened by the chronic neuro toxic effects of alcohol on the brain, but the alcohol was only worsening an already existing impaired ability to deal with life on life’s terms.

The simple truth is that the wide range of survival skills needed were not taught to me and as such internalised by me.

When I was in early recovery this was so apparent. It was frighteningly apparent but I never knew why I was so poorly prepared for life when i got sober.

It is in reading about co-dependency that I have learned much about my primary disorder, that of co-dependency.

My alcoholism grew out of this fertile soil of co-dependency.

For example, I have often talked about emotional processing deficits in alcoholics and these may have been the consequence of living in dysfunctional  families.

Not only were emotion regulations skills not taught and not learnt but it seems that if a child is constantly repressing their feelings and emotions as a way of simply coping with quite threatening emotions then we may lose the ability to feel our feelings and distinguish one emotion state from another.

This then has a negative effect on our decision making as emotions are used to guide decisions and the consequences of our impaired decision making.

If we can’t differentiate our emotions from each other then they are distressing and we are destined to make haphazard  and distress based decisions – we act impulsively and then, in time, compulsively.

Our sister blog looks at the link between repressing coping style and emotion processing deficits (alexithymia).

I have a brain that needs to “know” about a disorder on multiple levels. The books on co-dependency appear to tally with very recent neuroscience research – they seem also to help bridge the link between insecure attachment and later emotional disorders in addicted individuals. Co-dependency offers insight into a mechanism that turns parental neglect into emotion regulation via external addictive means.

We appear to have an emotional disease as I have stressed before.  This effects us internally in our relationship with ourselves and externally in our relationships with others.

Emotions make the world go around not money.

Thus the emotion processing deficits , negative self schema, shamed based psychic reactions to the world and so on, that I have demonstrated to my own mind, and to my own satisfaction as been part of the pathomechanism of addictive behaviours, are all probably the consequence of my dysfunctional upbringing.

Perhaps I have needed to recover these 10 years to deal with these issues, this new awareness about this multi-faceted chronic disorder I suffer from.

Regardless of all the contributory factors to my later addictive behaviours, they all ultimately represent a constant threat to relapse back to addictive behaviours, including some addictive behaviours I never thought I had before!

It seems that if I do not start dealing with this primary dysfunction of which I call a co-dependence disorder, my addictive behaviours will squirt out here, there and everywhere, in some form, whether it is excessive shopping, eating, obsessing, etc.

I regulate  emotions externally unless I share them with someone else – from obsessing about my noisy neighbours to food binges. I am always attempting to fix my emotion in the most maladaptive way possible, by making my distress states more distressful.

There are many reasons for this co-dependence disorder which I will be blogging on regularly from now on.

Reading books about co-dependency has been a bit like reading an autobiography written strangely by someone else.

The last time I so identified with what is effectively a description of me was when I first read the Big Book of Alcoholics Anonymous.

Recent revelations have been that startling.

Now is what to do done about these?

I still intend to do EMDR therapy when the opportunity exists but I will also attend a local Co-dependents Anonymous meeting  in my home town too and continue to read around this area to increase my awareness about this primary condition.

Hopefully you will join me in this new journey through this so-called second stage of recovery.

There are also more recent books on co-dependency which I will look at in the following weeks too.

It is exciting in a way, all this new insight.

Most people in recovery have to employ the skills of a scientist, experimenting in themselves with this or that to try and get more healthy. I can see now I have been doing that not only in recovery but since I was a teenager. Long may it continue too.

Recovery  is Discovery after all!

 

 

I Am What I Have Been Looking For.

  1. Do you find yourself needing approval from others to feel good about yourself? Yes_____ No_____
  2. Do you agree to do more for others than you can comfortably accomplish? Yes_____ No_____
  3. Are you perfectionistic? Yes_____ No_____
  4. Or do you tend to avoid or ignore responsibilities? Yes_____ No_____
  5. Do you find it difficult to identify what you’re feeling? Yes_____ No_____
  6. Do you find it difficult to express feelings? Yes_____ No_____
  7. Do you tend to think in all-or-nothing terms? Yes_____ No_____
  8. Do you often feel lonely even in the presence of others? Yes_____ No_____
  9. Is it difficult for you to ask for what you need from others? Yes_____ No_____
  10. Is it difficult for you to maintain intimate relationships? Yes_____ No_____
  11. Do you find it difficult to trust others? Yes_____ No_____
  12. Do you tend to hang on to hurtful or destructive relationships? Yes_____ No_____
  13. Are you more aware of others’ needs and feelings than your own? Yes_____ No_____
  14. Do you find it particularly difficult to deal with anger or criticism? Yes_____ No_____
  15. Is it hard for you to relax and enjoy yourself? Yes_____ No_____
  16. Do you find yourself feeling like a “fake” in your academic or professional life? Yes_____ No_____
  17. Do you find yourself waiting for disaster to strike even when things are going well in your life?  Yes_____ No_____
  18. Do you find yourself having difficulty with authority figures? Yes_____ No_____

http://www.k-state.edu/counseling/topics/relationships/dysfunc.html

Answering “Yes” to these may indicate some effects from family dysfunction. Most people could likely identify with some of them. If you find yourself answering “Yes” to over half of them, you likely have some long-term effects of living in a dysfunctional family. If you find yourself answering “Yes” to the majority of them you might consider seeking some additional help.

child_pic3

While  I have been waiting to start EMDR therapy (don’t ask!?) I have been exploring my childhood with my wife.

As opposed to simply talking about the past, I have been allowing the sometimes painful emotions to come up from past episodes in my life. Instead of intellectually distancing myself from these mainly traumatic or abusive events from the past, I have been simply allowing myself to feel these emotions however painful. And boy have some of them been painful!

It was my father’s anniversary of this very premature death last week, 28 years since he left this mortal coil. He died at a pivotal point in my life. I had just left home and started University, the future promised so much.

A lot of my future problems were not helped by not having a father figure to “guide” me in some ways or to square some parts of the past perhaps?

Who knows?

I can’t believe how much I grieved his anniversary this year. In fact, I cried on and off for two full days which is something I could never do before.

I wasn’t crying for him nor myself but for our shared loss. I just sat there and cried when I needed too, for the bottom of my heart. It didn’t kill me. Didn’t make me want to run away.

This is all a function of a decade in recovery, the ability to do something I couldn’t do before.  To sit with very painful emotions and just allow them to come and go.

I was told in early recovery that I would properly grieve the loss of loved ones, particularly my parents, as my recovery went on (they both passed on while I was drinking) but this was more than that.

I was not only grieving my father’s passing but also grieving my dysfunctional childhood.

According to a rather excellent book I have been reading recently  Healing the Child Within by Charles L. Whitfield, M.D.    we need to grieve our pasts in order to heal the past and move form a False Self to a more integrated True Self.

The false self may also be called the co-dependent self, unauthentic self or public self.

To quote and para phrase from this book ” Our false self is a cover up.  It is inhibited, contracting and fearful…It is envious, critical, idealized, blaming, shaming and perfectionistic.”

“Alienated for the True Self, our false self is other-orientated, i.e., focuses on what it thinks others want it to be…doesn’t know how it feels or does know and has censured these feelings as “wrong” or “bad”.

Our false self tends to be the “critical parent”…It pretends to be “strong” or even “powerful”. Yet its power is only minimal…it is in reality usually fearful, distrusting and destructive.”

“…our co-dependent self tends to repeatedly act our unconscious,  often painful patterns…it feels separate…we feel numb, empty or in a contrived state. We do not feel real, complete, whole or sane.  At one level or another, we sense that something is wrong, something is missing.

Paradoxically, we often feel like this false self is our natural state, the way we “should be”….”

In the next blog I will look at how this False Self is formed in our childhood interaction with our parents.

So how do we become the True Self?

Via a process of grieving according to this insightful book.

“A trauma is a loss…we experience a loss when we are deprived of or have to go without something that we have had and valued, something that we needed… or expected.

Minor losses or traumas are so common and subtle that we often do not recognize them as being a loss. Yet all of our losses produce pain or unhappiness: we call this train of feelings grief.

When we allow ourselves to feel  these  painful feelings, and when we share the grief with safe and supportive others, we are able to complete  our grief work and thus be free of it.”

I will blog on the actual grieving process in later blogs.

The purpose ultimately of this grieving process is to return one to the True Self. What does he mean by this? Again we can see by quoting and para-phrasing some extracts from this book.

“Our Real Self is spontaneous, expansive, loving, giving and communicating. Our True Self accepts ourselves and others. It feels, whether the feelings may be joyful or painful.  And it expresses those feelings. Our Real Self accepts our feelings without judgement and fear…

Our Child Within is expressive, assertive, and creative. It can be childlike in the highest, most mature, and evolved sense of the word…taking pleasure in receiving and being nurtured…

By being real, it is free to grow…

…when we are our True Self, we feel alive. We may feel pain in the form of hurt, sadness, guilt or anger, but we nonetheless feel alive.

Or we may feel joy, in the form of contentment, happiness, inspiration or even ecstasy.

…we tend to feel current, complete, real, whole and sane.”

I have had increasing flickers of these real emotions  on a daily basis the longer my recovery has gone on. It is great to see these as the real me.

It is certainly the me I want to be and will continue to strive to be.

The light at the end of the destination is me.

I am what I have been looking for.

 

This book is well worth reading if you also believe you were reared in a dysfunctional family and have suffered the shame-based trauma ever since.

This and other similar books were written in the 1980s and it is kinda strange there seems to have been a lot less in recent years as they describe shame-based family trauma so well.

It may be that these books need to be explored via neuroscience and neuro-psychology to update the effects family trauma has on the developing brain and how this maps onto later addictive behaviours, especially as my false self sounds kinda like my alcoholic and addicted self.

It is a real message of hope. When reading this book,  parts of my psyche that I have always labelled alcoholic could equally be reappraised as being this false self created for me via a co-dependency fostered in my own dysfunctional family.

It was suggested to me 8 years ago that I check out this Adult Child stuff but I resisted it.

It is only via researching neuroscience and seeing the demonstrable effects of child mistreatment that this stuff all kinda makes sense now. Certainly in a way I never understood before.

Perhaps I was not ready to understand. Perhaps the time is now to fully get to grips with my past.

When I say my past, this is not completely accurate as the past lives on in this false self. This false self is a negative, mal-adaptive self schema which I inherited from my parents and they probably inherited something similar from their own parents?

 

Healing The Child Within Discovery and Recovery For Adult Children of Dysfunctional Families by Charles L. Whitfield, M.D.

“The Smartest Guy in the Room”

Checked this out again last night and well worth another listen.  In the first half hour, in particular, I explain  why I think addictive behaviours of all sorts are emotional disorders – how the “spiritual malady” of 12 step recovery  can also be seen as an emotional disease.
Trying to get to the heart of what constitutes this pathology of addiction and the pathomechanism that drives it is still the burning issue.
For us emotion processing deficits are the most likely candidate that explains all the important aspects of addiction demonstrated in research, it explains impulsive behaviour, distress based thinking and decision making, it explains heightened reward systems, obsessive compulsive behaviour, intolerance of uncertainty etc and it also explains why most people relapse.
We have to help people in recovery learn how to cope with negative emotions and distress as well as negative self schemas which wrongly say we are not good enough have a successful recovery.

 The recovery brain is different to the addicted brain.  Recovery alters the brain’s functions.  The brain does recover.

Click image to listen or download on SoundCloud

Here is Paul Henry  being interviewed at length by Chris Aguirre on his excellent Since Right Now podcast about his theories of addiction, and other research, his experience of addiction and recovery and how academic and so-called anecdotal or “experiential”  evidence have been combined to shape his world view regarding what he believes is at the heart, the pathomechansim, of addictive behaviour and also what recovers in recovery and why?

 

Prevention – Is addiction inevitable?

Just added another page…called “Prevention”

This blogsite suggests that addiction is the consequence, most often, of maltreatment in childhood.

The “hole in the soul” is often the result of poor attachment to caregivers in early childhood, or the effect of abuse or trauma in childhood.

 

it should not hurt to be a child 362015_f260

This reduces a brain chemical called oxytocin”the love chemical” which moderates stress levels in the brain and the effect stress has on dopamine, two of the most important brain chemicals in addiction.

We suggest in many articles on this blog that this “hole in the soul” is not only a brain chemical deficit but that this creates a problem with processing emotion, something akin to alexithymia – the reduced ability to identify, label and describe/verbalize emotions.

This emotion processing deficit is very common to all addictive behaviours, not only substance addiction but sex, gambling and eating disorders etc.

Thus this emotion processing means some children are vulnerable to later addiction may not use emotion to guide behaviour.

If you cannot differentiate emotion or what you are feeling then it is like a distress like state which prompts “fight or flight” responding rather than recruiting the prefrontal cortex in reasonable, rational decision making. If you constantly make poor decisions you constantly resort to maladaptive behaviours like substance abuse to eternally regulate your emotions, you fix your feelings via activities which help escape, avoid, or cope with negative emotions.

How can we prevent this in vulnerable children, often children of alcoholic and addicts etc? We teach emotion processing and regulation skills from childhood, in nursery, kintergarten and primary/junior schools.

I believe if we start doing this and also do this with their parents we can perhaps alter the seemingly inevitable course of addiction. Alcoholics and addicts use substances and behaviours to cope, we can instead teach coping strategies and emotion regulation strategies so that we do not need to run away from our emotions and our selves.

Please if you need any more help or directing to suitable article then please contact me again. I am very happy and encouraged that some people are considering this approach in their jobs with children, in their schools, recovery communities or other communities.

At the very least it would not hurt children to have the opportunity to express more articulately how they feel and to help them with these often distressing feelings.

Growing up in a family where there is addition is heart breaking and causes untold hurt and distress. Children in these families often need the wider support of communities, whether educational or other.

Addiction is a combination of genetic inheritance and environment. If we change the environmental influence of genetic coding we can then change behaviour, there is a possibility we can help very young people not become addicts in later life.

We are the environment, all of us.

This is my belief.

Paul

Shame is a Soul Eating Emotion?

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Post traumatic shame has been described as “soul-death,” “soulmurder,” loss of ego identity, and a sense of self as “empty.” which also seems to be close to the “hole in the soul” often talked about by recovering people in recovery groups.

Is addiction brutalizing and traumatically shaming, this may be a pertinent research question moving forward?

I will be discussing how post traumatic shame effects me in future blogs.

 

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.

 

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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. Psychology2014.

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

 

Powerless over Thinking!

When I first came into recovery I would be plagued by intrusive thoughts about drinking, I would have thoughts about drinking, at certain times of the day in particular, on sunny days etc.

These thoughts used to greatly distress me and I would end fighting with these thoughts which only seemed to make things worse, the thoughts seem to increase rather than decrease and I got increasingly distressed.

I had no control over these thoughts and would get into a terrible emotional state over this. All before I decided it was now a good time to ring my sponsor. I always waited until I was in as much emotional pain as possible before ringing my sponsor!

I thought I could go it alone – that I did not need any help. I was in control of this.

Geez, surely I could control my own thoughts for flips sake!

Hmmm…afraid not!?

In early recovery I was as powerless over thinking as well as my drinking.

It was obvious I had lost control of my thinking like my drinking – it took a lot longer (and I still forget this even today!) to realise I have no  control over my thinking.

It chatters away regardless of my will, my wishes. It I have found is not usually a friend.

So like everything else in recovery I decided to research this! To find out why my thinking seemed out to get me, to negatively affect my recovery. To find out why my thinking did not seem to help me in recovery.

I found out that the idea that abstinence will automatically also decrease alcohol-related intrusive thoughts had been dismissed by research and vast anecdotal evidence.

Practically all therapies for alcoholism e.g  AA, SMART and so on suggest that urges create automatic thoughts about drinking.

This has been demonstrated in research that distress automatically gives rise to intrusive thoughts about alcohol. (1) This reflects emotional dysregulation as these intrusive thoughts are correlated to emotional dysregulation (2).

These thoughts to the recovering/abstinent individual can be seen as egodystonic which is a psychological term referring to behaviors, values, feelings that are not in harmony with or acceptable to the needs and goals of the ego, or consistent with one’s self image.

Other conditions, such as OCD, have these egodystonic thoughts creating the distress that drives a compulsive need to act on them, rather than letting them pass.

In other words, these thoughts are seen as distressing and threatening and compel one to act to reduce this escalating sense of distress. A similar process can happen to those in early recovery.

Thoughts about drinking or using when you now wish to remain in recovery are egodystonic, they are contrary to the view of oneself as a person in recovery.  The main problem occurs when we think we can control these thoughts are that these thoughts mean we want to drink or are going to relapse!

Early recovery is a period marked by heightened emotional dysregulation and the proliferation of intrusive thoughts about alcohol .

In fact,  research demonstrates that alcohol-related thoughts can resemble obsessive-compulsive thinking (3,4).

In fact, one way to measure “craving” in alcoholics is by scale called the Obsessive Compulsive Drinking Scale (5) , thus highlighting certain similarities between alcoholism and OCD.

This finding is also supported by clinical observation and leads to the expectation that among abstinent alcohol abusers, alcohol-related thoughts and intrusions are the rule rather than the exception (6)

Relatively little is known about how alcohol abusers appraise their alcohol-related thoughts. Are they aware that alcohol-related thoughts occur naturally and are highly likely during abstinence?

Or do they interpret these thoughts in a negative way, for example, as unexpected, shameful, and bothersome? Misinterpretations of naturally occurring thoughts or emotional reaction to them  may be detrimental for abstinence (7).

 

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A number of papers and  studies have shown that individuals’ appraisal of their intrusive thoughts as detrimental and potentially out of their control may lead them to dysfunctional and counterproductive efforts to control their thinking.

Alcohol-related thoughts cause an individual to experience strong emotional reactions; however, alcohol abusers will increase their efforts to control their thinking only when they have negative beliefs about these thoughts.

For instance, spontaneous positive memories about alcohol (‘‘It was so nice to hang out at parties and to drink with my buddies’’) may be appraised—and misinterpreted—as ‘‘the first steps toward a relapse’’.

Such an appraisal of one’s thoughts about alcohol as problematic may instigate thought suppression and other efforts to control the thoughts.

These efforts must be assumed to be counterproductive and  will increase rather than prevent negative feelings and thoughts, and they may even demoralize alcohol abusers who are trying to remain abstinent

On the other hand if positive alcohol-related thoughts are not appraised as problematic but as a normal part of abstinence, the awareness of these thoughts might even lead to the selection of more adaptive coping responses, which could help to reduce the risk of relapse, such as talking to someone about them or just simply letting these thoughts go.

 

In one study (8), participants who reported on their thoughts about alcohol in the previous 24 hours, 92% reported experiencing at least some thoughts about drinking that ‘‘just pop in and vanish’’ without an attempt to eliminate them. This suggests that if both suppression and elaboration can be avoided, many intrusive thoughts will be relatively transient.

An “accept and move on’’ strategy provides an opportunity for the intrusion to remain a fleeting thought.

In other words, just let go.

This means the thoughts go, and the distress which activates them, too.

This is recovery a lo of the time.  Getting embroiled in thinking and then letting go, repeat…

That is why helping others is important  -it takes us out of our crazy heads

References

1. Zack, M., Toneatto, T., & MacLeod, C. M. (1999). Implicit activation of alcohol concepts by negative affective cues distinguishes between problem drinkers with high and low psychiatric distress. Journal of Abnormal Psychology108(3), 518.

2. Ingjaldsson, J. T., Laberg, J. C., & Thayer, J. F. (2003). Reduced heart rate variability in chronic alcohol abuse: relationship with negative mood, chronic thought suppression, and compulsive drinking. Biological Psychiatry54(12), 1427-1436.

3. Caetano, R. (1985). Alcohol dependence and the need to drink: A compulsion? Psychological Medicine, 15(3), 463–469

4. Modell, J. G., Glaser, F. B., Mountz, J. M., Schmaltz, S., & Cyr, L. (1992). Obsessive and compulsive characteristics of alcohol abuse and dependence: Quantification by a newly developed questionnaire. Alcoholism: Clinical and Experimental Research, 16(2), 266–271.

5. Anton, R. F., Moak, D. H., & Latham, P. (1995). The Obsessive Compulsive Drinking Scale: A self-rated
instrument for the quantification of thoughts about alcohol and drinking behavior. Alcoholism:
Clinical and Experimental Research, 19, 92–99.

6. Hoyer, J., Hacker, J., & Lindenmeyer, J. (2007). Metacognition in alcohol abusers: How are alcohol-related intrusions appraised?. Cognitive Therapy and Research31(6), 817-831.

7. Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the
treatment of addictive behaviors. New York: Guilford Press

8. Kavanagh, D. J., Andrade, J., & May, J. (2005). Imaginary relish and exquisite torture: the elaborated intrusion theory of desire. Psychological review112(2), 446.

 

An Addicted Brain but a Recovering Mind

This blog used excerpts from

Do I still have an “Alcoholic Mind”!?

 

When I first came into recovery I used to get frightened by other abstinent  alcoholics proclaim that they were so glad they did not get the “wet tongue” when they saw alcohol or people drinking alcohol.

I used to feel ashamed as I did have an instantaneous “wet tongue” or mild salivation (Pavlovian response) and still do  years later when I see people drinking alcohol. Is this a “craving” for alcohol, do I still want to drink? Do I still have an “alcoholic mind?“. Did I do my steps properly?

It used to churn me up, these so-called alcoholics who had no physiological response to alcohol-related “cues”. By “cues” I mean the sight, sound and smell of alcohol and alcohol  related  stimuli, like wine gulping , glasses clinking, people having a good time, etc.

Part me also thought it was linked to addiction severity, how bad or chronic one’s alcoholism become, how far down the line or how low your rock bottom was? There may some validity in that observation.

It was partly because of mixed messages from alcoholics that I decided to take matters into my own hands and do some research into my alcoholic brain.

What I have discovered is that I have an “alcoholic brain” and not a “alcoholic mind” and there is a huge difference.

I found there is a difference between by addicted brain that has been altered by chronic abuse of alcohol and drugs and my recovering alcoholic mind, that  essence of me that is dedicated to recovery from alcoholism and addiction. These are very distinct – let me explain – on a daily basis I use my mind to help my brain recover.

For example, I meditate, I ignore the incessant chattering of my “illness”.

Both these are the function of my mind affecting the neuroplasticity of my brain.

In other words my mind is in control of my brain, the brain’s functions and structure can be shaped by my mind.    This is in effect, recovery.

For example, meditation can strengthen my control over emotional states, especially negative emotional states, by building yo the neural “muscles” of brain regions which regulate emotion.

Hence my mind and brain are distinct from each other, one effects the other.

So if there are people out there relatively new to recovery, listen up.

For chronic alcoholics there is an automatic physiological response when we see cues such as other people drinking. Mild salivation, quickening heart rate etc.

These are automatic, habitual, these responses happens to us rather than us wanting or willing it to happen. It happens unconsciously without our say so!

If you get a “wet tongue” i.e. you mildly salivate, then this is what happens when you have crossed the line into chronic alcoholism.

Loads of studies have shown there is this automatic response and have also shown there is also an attentional bias to alcohol cues. We notice alcohol cues in the environment before anything else. They have a heightened “noticeableness”.

Have you ever been in a new town and counted the number of drinking establishments automatically or had a heightened awareness of half drunken bottles of alcohol lying in the street? This is an attentional bias, we notice alcohol related stuff before anything else.

Some researchers in science call this a craving. I disagree.

I call this a physiological urge, distinct from craving.

I think a craving is more akin to a “mental obsession” about alcohol.

Alcohol has only had ‘luring’ effect on me while very emotional distressed or in the early days of recovery I was very scared that  I would drink but, looking back, I never had any desire to.

It is hugely important for recovering persons that we distinguish between urges and craving, in a clear manner that science seems to have been unable to do!

Lives can depend on this.

We are so vulnerable in early recover that we need sound direction on what is happening to us automatically and what we are encouraging to happen, consciously.

An urge for me is a physiological response to cues, external and internal (e.g. stress). A craving is different but interlinked.

Let me explain.

If I have an urge and it becomes accompanied by automatic intrusive thoughts such as a drink would be nice, and maybe a suggestion on where to get this drink, this does not mean I want a drink.

It is simply automatically prompted intrusive thoughts, the type of thought I used to get all the time and so became habitual, stored away in an automatized addiction schema or addiction action plan.

If I realize this and simply let these thoughts go, i.e. do not react to them, then they lessen and dissipate altogether.

This is not a craving. I have not consciously and emotionally engaged with these intrusive thoughts (although we often do in early recovery when they scare the life out of us!).

If I consciously engage, emotionally react, to these thoughts either because I want a drink (elaboration of these thoughts as in embellishing a desire state) or the thought scares the life out of me (averse reaction) I can end up in a mental obsession.

If in recovery, we try to suppress these thoughts then they will come back stronger than before which will raise  already high stress levels and recruit a whole host of memories of why I should drink, with who, where, and how much I will enjoy it.

They will also activate an Alcoholic Self Schema (different to the recovery self schema still being formed in early recovery).

Then I have a memory Hydra effect where attempting to suppress this terrible flowering of desire based memories or to cut off the heads of these thoughts and memories leads to them increasing and increasing.

 

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Then there are lots of these memories driving you crazy and scaring the life out of you.  And this is in someone who does not want to drink but wants to remain in recovery!!?

The other guy who is embellishing these thoughts is kinda thinking about drinking or toying with the possibility, so but again he is reacting cognitively and consciously to these intrusive thoughts. He is elaborating on them. He is using a different more cognitive part of the brain and a different memory system to those activated when he was simply having unconscious, habitual, automatic intrusive thoughts. He is now involved in this process rather than it simply happening to him.

So what I am saying is that there is no simple urge state that automatically leads to drink. We have to cognitively and emotionally react to it.

In my time in recovery, I have rarely heard of or witnessed  someone lured siren-like by a cue to a drink and when I have it is because he wanted to drink really, was testing their alcoholism, or he was in huge emotional distress and went “to hell with it!”

As we will see in later blogs,  there has to be a  cognitive-emotional reaction which mediates between an urge and a relapse!

If you have urges of a “wet tongue” accept this fact, that it is because you are an alcoholic. Non alcoholics are bedeviled with these things, only alcoholics are.

Thank the heavens you have had this reminder of your alcoholism. I used to replace this urge states with gratitude, and thank God for giving me another insight into my condition.

 

A Final Word and a New Page?

A Final Word – before I get all close up and personal next week  with our new format on Alcoholics Gide to Alcoholism which will now be blogs, 600 words or less, based on my own experience of addiction and recovery. Written specifically for those thinking of coming into or actually coming into recovery and their families.

I want to help explain in more simply terms this most profound of conditions – this strange illness of mind, body and spirit.

I will still blog on the latest neuroscientific,  neuropsychological and neurotheological insights into addiction and recovery on my other blog insidethealcoholicbrain.com – it was always intended that I was personal on one blog and a researcher on the other.

Now I am clearly letting you, my readers, know of my intentions.

I have to say I can’t wait to get my teeth into the new format.

I can’t tell you how much effort it has been over the last year, continuously writing research blogs?

I now believe most of what you need to know about addiction from a neurobiological, emotion and cognitive perspective can be found on these blogs if you look around them. We have covered much ground.

 

But there is more to this strange illness which can only be fully explained via sharing my story and hopefully you sharing your stories.

12 step groups primarily work via story sharing and fellowship/support, which allows newcomers to identify with the progression of an illness in others while identifying this progression in themselves.

Listening to these stories usually shows the newcomer what the solution is also.

The power of identification is why I am here, sober and in recovery since 2005.

I identified with what a bunch of strangers in a room in a parish chapel said about their illness, their struggles to live life on life’s terms, their descent in alcoholism and addiction, their rock bottoms and their turning points to eventually finding their solution to their problems.

The necessary psychic change happened in my first meeting – I suddenly realised what my problem was and where I could get the solution.

I found through their stories that I identified with these strangers, that I belonged for the first time, in this club. I had found my tribe for the first time ever in my life.

These people could help me. The first glimmers of hope.

Hopefully  identifying with what I write about will set you on your journey to recovery  or help you on the journey you have already started.

I want to hear from you!!

But I wanted to set out my comprehensive view of addiction so that one can find a whole view as regards addiction and recovery in one blog. I believe my theory of addiction and recovery stands up to the highest scrutiny and certainly reflects my own experience and the experience of hundreds and hundreds of alcoholics, addicts and those suffering other addictive behaviours.

There is so much more to addiction than the substance or behaviour used! Hopefully science will grasp that idea fully in time.

Neurobiology affects emotion which affects thinking. Go figure?

Maladaptive neurobiology and endocrinology affects impaired emotion regulation which distorts thinking in those suffering addictive behaviours.

 

Before that however, notification of another new Page! 

This page will be dedicated to addressing the co-occurrence of  other psychiatric conditions with addiction and addictive behaviours.

For example, conditions such as post traumatic stress disorder and generalized anxiety disorder and major depression are said to frequently co-occur with addictive disorders.

This page will be addressing how frequently these disorders actually co-occur with addiction, or whether their influence has been overstated.

How they should be treated, whether treatment for addiction can help with these disorders too or whether they should be treated separately and importantly whether these so-called co-morbid conditions are tributaries which feed into the overall disorder of addiction?

In other words, when we receive treatment specifically for addictive behaviours are we also treating the conditions which have canalized into addiction.

 

 

If so does medication help or hinder sobriety and recovery, especially if prescribed based on a misdiagnosis of addictive disorder showing as an affective disorder?

When considering relapse prevention, are we addressing behaviours and responses to negative emotions and stress reactivity which are common to all affective disorders?

Do these conditions all contribute to addiction severity?

Do they contribute to similar hyper amgydaloid reactivity, to the same cognitive distortions, to similar “fight of flight” responding, to common recruitment of more motoric parts of the brain when making decisions, to similar rumination, in effect to a similar profile of emotion dysregulation?

Do they all have common neurotransmitter deficits, similar dysregulated stress systems and reward networks?

Is addiction a unitary disorder whereby negative affect leads to an impulsive, urgent desire to regulate these emotions by external means such as substances and behaviours, whereas other affective disorders do not have this behavioural manifestation?

Is negative urgency a trait that distinguishes between addictive behaviour and other affective or psychiatric disorders?

These questions seem very pertinent in trying to understand if addiction is in fact a unitary disorder in it’s own right or whether it is a unitary disorder also affected by co-morbidity?

Are so-called co-morbidities really co-morbidities or are they substance induced disorders which dissipate in the early weeks of recovery?

Do they manifest as anxiety and depression in active addiction but disappear when a neuro-toxic substance is eliminated from one’s nervous system?

Or perhaps we continue to have anxiety type issues in recovery but do not appreciate this because we are managing these issues with 12 step recovery?

One way or the other, surely addiction is more than use of substance of behaviour despite negative consequences. Surely it is more than simply reducible to use of substance or behaviour alone?

If addiction is a unitary disorder how come we appear to share common distorted thinking and maladaptive behaviours as a range of other affective disorders?

Do the vast majority of us have various affective disorders which lead to chronic reliance on substances or behaviours?

Or is addiction a unitary disorder in it’s own right? A disorder neuro science and psychology knows little about – so little they relegate all it’s emotion dysfunction to that of co-morbidity?

The answers to these questions seem more urgent now than ever before?

In this page we will attempt to answer some of these questions.

We will address the reality that addiction shares a  multitude of cognitive distortions and maladaptive responses and behaviours with other affective disorders.

Why is this? Are these disorders different and how so?

Are there similar underlying neuro-mechanisms with all these disorders?

What it is about addiction that sets it out as a disorder separate from all other disorders?

For example, we believe addiction has a distress based impulsivity at its core which is based on a lack of emotion clarity and differentiation which results in risky (impulsive) maladaptive decision making. This appears to differentiate addiction from other affective disorders?

This makes addiction a disorder of “just one more…that’s all I need” – it is an affective disorder which results in a motivation to alter feelings via external means.

One may also be able to use certain scales such the Difficulties in Emotion Regulation DERS scale which appears to be able to differentiate between different disorders.

Ultimately, are all these disorders similar in their emotion dysregulation but not in the manifestation of this emotion dysregulation in terms of manifest behaviour?

Have we been diagnosing some affective disorders for years when they are often addictive disorders in disguise?