Filling the Empty Self

In the first part of this two part blog – we looked at how addicts in recovery move from a more negative (perhaps chronically negative) self schema to a more positive recovering self schema and how this now sense of self and the new interrelatedness with others which develops in recovery drives recovery and an increased self empowerment.

The self, via schema, is increasingly positive in outlook, attitude and action. In other words recovery does for the self schema, sense of self, what we could not do for our own selves, our own self schemas. The self and the self schema becomes a vehicle for increasing well being and not further disease and disorder.

It is a vehicle by which we recover.  For me it helped recover the person who I was meant to be, the person who had become so lost to alcoholism for so long. It in some ways introduced me to a person I did not really know and in many ways am still getting to know.

The fascinating thing also is that negative self perception, as we know from previous blogs, generates a brain frequency very similar to thinking about drinking and not similar to drinking itself. We presume a positive self perception does not and this not only does not lead one back to drinking but very much in the opposite direction.

We again cite from the same article as before (1) to demonstrate perhaps how self schema, especially, the recovering self schema, is so vital to recovery for alcoholism.

“….From this perspective, specific disturbances in the underlying structure of the self-concept are considered intermediary factors that serve as important mechanisms that link more distal factors (e.g., genetic factors, family history of alcohol problems) to alcohol
use. A person with a self-concept composed of few positive and many negative and highly interrelated self-schemas would not have the internal motivation necessary to facilitate adaptive behavior. The negative affect stemming from such a self-concept configuration
would be likely to motivate maladaptive
behavior in an attempt to escape the negative self views
(Baumeister, 1990) and “fill up” the empty self (Cushman, 1990).

Persons with a family history of alcohol problems or other risk factors for alcohol problems would be likely to turn to alcohol (versus other types of maladaptive behavior) as a means to escape the negative emotions. A core belief about the self in relation
to alcohol (drinker self-schema) would be likely to form as drinking experience accumulates and similarities across drinking-related incidents are abstracted. Such a drinking-related self-schema
would serve to motivate schema-consistent (drinking)
behavior.
According to the hypothesized model, a person in sustained recovery (long-term abstinence) would have a more well-developed self-concept—one that consists of newly developed positive self-schemas and a recoveryrelated
self-schema. The recovery self-schema is conceptualized
as central to the recovery process as it would serve to motivate schema-consistent (recovery) behaviors.

During the process of recovery, new positive self-schemas are likely to form as a result of new relationships, activities, and involvements. The development of new positive self-schemas would diminish the proportion of negative self-schemas and the overall level of interrelatedness among the self-schemas.

 

How-To-Fill-The-Inner-Emptiness-Of-Addiction-PhysicianHealthProgram

 

TESTING THE THEORETICAL MODEL

… findings provide empirical evidence that (a) young adults with early-onset alcohol dependence have impaired self-concepts that are characterized by many negative self-schemas, a tendency toward few positive self-schemas, and an elaborated self-schema related to alcohol; and (b) young adults in recovery have healthier self-concepts characterized by few negative self-schemas, a tendency toward many positive self-schemas, and an elaborated recovery related self-schema.

If further longitudinal research studies demonstrate that the self-concept configuration that we found in persons with early-onset alcohol dependence contributes to the development of the disorder,
then prevention strategies aimed at children and adolescents
could be beneficial, particularly for those children who are at risk for alcohol problems based on the presence of other risk factors (e.g., familial alcohol problems, conduct problems). More specifically, interventions designed to build a healthy self-concept (by
fostering the development of a diverse collection of positive self-schemas, thereby decreasing the relative proportion of negative self-schemas) may serve as a protective factor that buffers the effects of the more distal risk factors.

 

At the other end of the spectrum, the data from our study suggest that interventions may also profitably focus on fostering the development of a recovery self schema in persons with alcohol dependence. 

…the nature of any recovery related intervention would depend on how ready the person is to change. For a person who does not yet recognize that alcohol is a problem, the goal would not be
to foster the development of a recovery schema but to help him or her identify that drinking is a problem.

One possible way to do this is to assist the person to make associative links across the multitude of negative alcohol-related outcomes so that rather than a series of unrelated incidents, the individual begins to see a pattern of repeated, enduring, and pervasive alcohol-related problems.

when the individual is able to pull unpleasant alcohol related episodic memories together to identify that he or she indeed has a problem with alcohol. So whereas
assisting the person to increase his or her awareness
of problems with alcohol is consistent with the basic
tenets of motivational interviewing (Miller & Rollnick,
2002), fostering the development of a recovery self schema
is not.

For people who recognize that they have a problem with alcohol or people who are seeking treatment for alcohol problems, one strategy may be to foster the idea that they can be recovering persons— that is, that recovery is possible for them. Fostering communication with other recovering persons and encouraging involvement in recovery-related activities may help to form a recovery-related “possible self”—a future-oriented conception of the self one “hopes to be,” that is, a recovering person.

Imagining the self in the future by developing detailed images of what one would be like in recovery is an important part of this process. Participation in 12-step recovery programs such as Alcoholics Anonymous that explicitly foster the development of a recovery related identity may also be helpful…

In fact, one plausible explanation…for an emerging recovery related self-schema is that the alcohol dependent participants were in a treatment  facility based on such a 12-step recovery program.

 

 

Reference

1. Corte, C. (2007). Schema model of the self-concept to examine the role of the self-concept in alcohol dependence and recovery.Journal of the American Psychiatric Nurses Association, 13(1), 31-41.

Euphoria Re-experienced not Recalled?

I never, never want to drink again, I would rather kill myself.

This does not mean I will not drink again however.

A possible relapse is thus not down to desire for a drink, it is because something in my brain and in my heart goes awry.

I remember being in early recovery and thinking the following line from the Big Book of Alcoholics Anonymous was very strange  “Remember that we deal with  alcoholcunningbafflingpowerful! Without help it is too much for us”

What did they mean, alcohol was cunning, baffling, powerful? Surely they meant, alcoholism was cunning, baffling, powerful? Right?

Alcohol itself has not got magical powers? It isn’t a ghost or a spirit that can come and get you lured you back into drinking? Why be wary of a substance?

I suffer from alcoholism not alcohol, don’t I? ISM – I, self, me, the internal spiritual malady treated formerly by alcohol. Right? Alcohol was symptomatic?  “Bottles were only a symbol”

Now what is it to be?

In AA, I used to think alcohol got off light, considering the damage it causes to the brain. I always felt alcohol and it’s comprehensive deleterious neuro-toxic effects on my brain have greatly contributed to my difficulties with emotions and thinking and memory and perception etc. The list does go on and on.

One only has to look at a brain image from a fMRI scan to realise  that the damage to the brain wrought by alcohol is extensive and some of it irreversible although there is extensive repair in certain regions of the brain in recovery. I have felt for some time that alcohol gradually help change, over years,  how I felt and thought and perceived this world.

Alcohol literally moulded my brain. If I emotionally reacted or  thought in the same distorted way as I did while drinking or perceived this world in the same jaundiced way I did while drinking ,but while in recovery, then the same behaviours would soon follow.

I would drink.

Like a lot of alcoholics, I had a terrible sense of self, a very negative self perception in other words. I thought I was the lowest of the low, that I had screwed up my life and squandered my talents, that I didn’t even deserve recovery or to recover. I was not even worth that. It was this shame and guilt-fuelled lack of self esteem, this devalued sense of self that helped drive my drinking and which threatened to ruin any chances of recovery.

But what does this have to do with alcohol being cunning, baffling, powerful I hear you ask? Lots, is the answer. This negative self perception, I have had since early childhood,  well since I could reflect on my self and the product of emotional and mental abuse and traumatic parenting is ingrained in my brain.

Even now when I reflect on myself I have a tendency to think negatively or poorly about myself and my achievements, I have a negative bias in my thinking about me. It could depress me even, if I indulged in thinking about me for too long.

Again what does this have to do with alcohol? Well these negative perceptions, ingrained in neural structures in my brain have had more than a helping hand by alcohol. Alcohol has helped reinforced this faulty image of my self.

Alcohol had helped colour this jaundiced view of my self and this can has serious repercussions in recovery. This distorted view was partly the result of staring at my refection on the warped  glass of a wine bottle or on a glass of beer.  It cemented this view or “concretized” it in my self perception neural networks. Every drink helped dig the grave of my self worth.

I have seen many people in recovery relapse after a period of negative self reflection, after not thinking they are good enough to recover. It is immensely sad, tragic but nonetheless true. That is why they need love more than anything when they come into recovery. Not orders or dictats but love, plain and simple, make them feel part of, that they belong, that they have found their place, their surrogate home.

I have seen countless people who were so severely abused that they could not face the self disclosure at the heart of the 12 step program of recovery. I have seem than unconsciously “choose” to drink rather than take the steps. Part of this is something deep inside whispers a barely audible solution. To drink again.

Why is it barely audible? Because it is. It doesn’t actually have a voice. It is the whisper of a neural ghost (1). It is ghost that lives in the machinery of the brain. As alive as you are. It will probably remain to haunt you as an alcoholic  in some form  and at some time of weakness. Never think otherwise!

It is like a euphoria recalled but also it isn’t!? It may be worse than that; it is actually to a very great extent re-experienced.

Euphoria re-experienced not simply recalled.

Euphoria wasn’t just the pleasure you received but also relief from…negative emotions surrounding the self. Negative self perception, emotional distress and so on. It appears that negative affect (emotions, mood, anxiety) can automatically prompt thoughts of alcohol or drugs (2) and that the neural circuitries of affect, reward, memory and attention are taken over or ‘hijacked’ in the addiction cycle and often prompted into activation by emotional distress so that attention is directed to alcohol to relieve distress, with the resultant ‘craving’ coloured by numerous memory associations ingrained in the brain linked to habitually drinking to relieve negative emotional states.

Also, pertinent to this blog, negative self perception may also prompt relapse. I partly reconcile alcohol being cunning, baffling, powerful and alcoholism by reference to an article I read a while back by Rex Cannon(3).

His observations about a possible role for negative self perception in relapse was based on a study conducted  on recovering alcoholics. It found that by measuring their brain frequencies, when thinking about drinking and when thinking about self perception that there was a change in the frequency of their brain waves. In both cases, thinking about drinking and negative self perception, Cannon et al observed that widespread alpha power increases in the cortex, commonly seen by use of certain chemicals, were also present and in the same areas of a common neural circuitry for his study group during their reports of ‘using’ and ‘drinking’ thought patterns as well as in negative self perception.

These reports of ‘using’ and ‘drinking’ thought patterns as well as in negative self perception which appeared to bring the brain into synchrony, if only for a brief period of time, suggesting this to be the euphoria addicted individuals speak so fondly of and one possible reason for difficulty in treating these disorders.

In relation to using thoughts they suggested that “if the brain communicates and orchestrates the affective state of the individual in response to contents and images relating to self and self-in-experience – it is plausible that a large scale feedback loop is formed involving not only perceptual processes but relative automatic functioning.

This process reinforces the addicted person to become habituated to an aroused cortical state (i.e. increased alpha/beta activity) and when there is a shift to ‘normalcy’ (or recovery/sobriety) it is errantly perceived as abnormal thereby increasing the desire or need for a substance to return to the aroused (perceived as normal (or desired)) state”.

This would surely have a profound impact on addicts attempting to contain normal negative emotions when there is an automatic desire state suggesting, unconsciously, an alternative to wrestling with these torturous sober realities.

I have seen a similar process but over a much longer time frame in some alcoholics in recovery who relapse. They seem to disappear into themselves, right in front of you, like they were being lured by some internal, inaudible siren, into a self drowning.

Letting go of the life boat trying to keep them afloat. I have seen it many times, the dimming of the eye’s light, the turning inwards to the alcoholic darkness. A submerging into this illness.

It may be that indulging in one’s negative self perception recreates a neural based virtual reality. One is almost bodily transported back in time. Back to a drinking period. In a neural sense, back in the drink and not fully in sobriety, however fleetingly.

It does leave a neural taste for it, a torturous transient desire.

I remember it, particularly in early recovery, when the ‘recovery’ script was not written yet and I did not have a habitual recovery self schema to automatically activate, to pull me out of this neural reverie, this most bio-chemical vicarious pleasure.

The problem is that it happens to you without you asking it! You can be invoking a negative self schema automatically without wanting to reawaken this  ghost.

But that is alcoholsim in a nutshell. It happens to you without your express permission. It takes over the brain step by step, while impairing ones’ ability to observe this progression.

That is why we are are the last to know. It is not just denial, it is brain impairment and limited ability to reflect on what has happened to one’s self.

The self has been ‘hijacked’ so it is nigh impossible to figure this out without the help of others.

It is others that lead you out of the fog, as one has become lost to oneself. If nothing else, in early recovery especially, before the steps are done, it is a dangerous place to visit, the self and it is safer to spend as much time as possible outside of it and working with others!

It is a horrible, frightening experience, the limbo between addicted self and recovery self schemas. It is fraught with danger! I remember bumping into people places and things from the past and experiencing the most excruciating cognitive dissonance of literally being caught in between two worlds and not knowing if I was a drinking or a recovering alcoholic; the sense of self as a drinking alcoholic was much stronger than the recovering self. I would hurry to my sponsor or wife to help pull my sense of self as a recovering alcoholic to the surface, out of the neural swamp of my drinking alcoholism.

But it felt alien as Cannon observes, this sober self.  All new, awkward, pained, exposed and frightened.  A constant vacillation between two worlds, that of active use and that of recovery. Recovery had not become “concretized” in my neural networks!

This left an oscillating experiential schism, with one caught in two realities almost simultaneously.

I see people relapse because they have no emotional sobriety and they seem to be emotionally drunk before they are actually drunk. Emotionally drunk seems to be like a virtual drunk, brings up the similar feelings or neurochemical reactions as actual drinking.

The best way to stay sober is to act sober and develop this habitual schema so that it can be retrieved instantaneously, automatically, without thinking. We achieve this schema through our actions, so in a sense is also an action schema. Tiffany (4) states that alcoholics and addicts are prompted to relapse by automatized schemata surrounding drug and alcohol use rituals, so we must have automatized schemata surrounding recovery rituals. Such as ringing a sponsor, mentor, friend, doing a  step ten, praying, meditating, working with others, letting go and letting God, re-appraising distress, regulating emotions, putting thoughts of others before thoughts of ourselves, living outside self.  There are so many automatic schemas in AA and other therapeutic regimes.

Either way, whatever path you choose, make your recovery  tools automatic, so that they come to hand without yourself having to think about them.

 

 

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.  Cannon, R., Lubar, J., & Baldwin, D. (2008). Self-perception and experiential schemata in the addicted brain. Applied psychophysiology and biofeedback,33(4), 223-238.

3.  Tiffany, S. T. (1990). A cognitive model of drug urges and drug-use behavior: role of automatic and nonautomatic processes. Psychological review97(2), 147.

4.  Adinoff, B. (2004). Neurobiologic processes in drug reward and addiction.Harvard review of psychiatry12(6), 305-320.