Reversing Addiction’s Damage—Recovery and the Brain
Recovery and the brain can often be a tricky subject. Many people who are overcoming addictions worry about any damage their brains might have suffered as a result of drinking or using substances. The brain has to heal from active addiction, and this involves reversing the damage of prolonged toxicity. Substance use toxifies the brain with every intoxication, altering brain functioning and also brain structure. In recovery, the brain resumes normal functioning in most cases, although some damage can be permanent. The brain heals because it is ‘plastic’ or malleable, and can regrow damaged neurons. Just as it changes in active addiction, it can change in recovery.
Brain Changes and Neuroplasticity
The human brain changes throughout our lifetimes. And, does so in response to the things we are exposed to in our environments, both good and bad. As we grow, learn and develop, the brain changes. If we are traumatized or become addicted, it changes as well, and there are countless other influences. The changeable nature of the brain helps us adapt to our worlds and our lives. Without it, we wouldn’t develop and mature.
Neuroplasticity is the means through which the brain organizes and reorganizes itself by forming new neural connections, or connections between nerve cells. A very simplified explanation of neuroplasticity is that the brain continues to learn throughout life, and as it learns, new connections are formed, leaving older ones less utilized or not used at all. This happens in learning healthy ways of life, and in learning unhealthy patterns, as well as in compensating for illness and injury. Essentially, our neurons adjust to changes in our internal and external environments.
If we were able to see neuroplasticity occurring inside the brain, we would see our nerve cells, or neurons, sprout new nerve endings and connect with other nerve cells. Connections would continue until new entire pathways have been developed, or the brain has ‘rewired’ to perform new types of functioning. Sprouting neurons work for us and against us. For example, if part of the brain is injured in an accident or stroke, the rest of the brain can form new pathways to compensate for the injury. This is the way people learn to walk and talk again after a brain injury. Similarly, if one becomes addicted, new neural pathways are made that perpetuate the addiction. Reversing addiction’s damage then requires us to create new neural pathways that support our health and recovery.
Addiction–A Disease of Neuroplasticity
Addiction can very well be called a disease of neuroplasticity. Throughout the process of becoming addicted, our brains learn the finer nuances of addiction, steadily building new neural connections related to compulsive drug taking. In short, the brain evolves into a different brain when we use substances long enough and heavy enough. Addiction literally creates a new brain for us. Reversing addiction’s damage requires that we once again reinvent our brains.
At the most basic stage of addictive patterns is becoming intoxicated and incorporating intoxication more and more into our lives. As we grow more used to intoxication and seek it out more, we are using mind and mood-altering drugs to essentially alter our brains and their neural connections. When we reach for an addictive substance, we want brain changes (intoxication), or we wouldn’t reach for them in the first place. As that behavior becomes more of who we are and how we live, it is reflected in our brain wiring and functioning. In addiction treatment and recovery, we can use the same underlying principles of neuroplasticity to work in our favor. We can train the brain to seek and enjoy sobriety.
Reversing Addiction’s Damage
Our brains not only learn to be addicted, but they also remember how to continue to be addicted. Our neural connections in addiction lay down what amounts to brain memories, leading to the characteristic symptoms of addiction such as:
- Compulsive use—continuing to use despite a desire to cut down or stop use; having unsuccessful attempts to cut down or stop; recurrent use despite continuing social or interpersonal problems related to use; continuing to use despite awareness of physical or psychological harm done by using, and spending a great deal of time obtaining, using, and recovering from use.
- Cravings—having strong desires and urges to use; being triggered by both external and internal experiences to use (people, places, things, feelings, thoughts).
- Tolerance—needing more of the substance over time to achieve the desired effects of intoxication.
- Withdrawal—have physical and psychological symptoms of distress and discomfort when using is abruptly stopped or the usual dose of a substance is lowered.
- Other behavioral changes—Behavioral changes also occur across a range of life experience such as withdrawing from usual activities because of use; participating less in social or family interactions; reducing work or school performance; and failing to meet responsibilities, obligations, and commitments.
Forming Memory Traces in Addiction and Recovery
We can think of neural pathways as new avenues through the brain that course through new territory, pulling us along with them. As we go along our new brain avenues during addition, we establish new memory traces or new pathways. Once these new avenues open and we have traveled them a bit, we can retrace them in the future with greater and greater ease. The more we trace new pathways, the greater our chances of traveling them without much conscious awareness. To understand this better, think of the first time you drove a new and complicated route. You were very focused on just finding your way and may even have taken wrong turns or missed a turn. Now, compare that to how much easier you get to that destination after driving it daily for a few months. Your memory of how to get there becomes so entrenched that you don’t even have to think about your drive as you travel.
These sorts of things very much illustrate the addictive process as well as what happens when reversing addiction’s damage to the brain. Addiction treatment and recovery efforts make new neural pathways, detouring us from the addictive neurological avenues. We set out to learn a new way to travel to a new destination. Initially, we feel awkward navigating unknown territory, just like we did when learning to be addicted. With practice and sustained effort, however, we can forge new and healthier brain connections that we frequent. Eventually, we learn to be in recovery, and to travel recovery neural pathways more easily, remembering the memory traces of recovery, and avoiding those of addictive behavior.
Reversing Addiction’s Damage Requires More Than Abstinence
Reversing addiction’s damage requires healing the brain on many levels. First, we must detoxify and stop the harm we do to the brain by ingesting toxic substances, or mood or mind-altering drugs that have caused damage to the brain, or what are known as brain insults, assaults, or injuries. Withdrawal and detox stop the toxic dumping we have been exposing our brains to and sets the stage for healing at the level of brain circuitry. A detoxified system provides fertile ground for reversing addiction’s damage through health-giving neuroplasticity.
Therapy and other recovery-related activities make use of the brain’s malleability and little by little establish new brain circuitry. This happens in many complex and significant ways. For example, we learn to employ healthy coping strategies when craving so we don’t relapse. We learn that a bad feeling doesn’t have to end in intoxication. Or, we learn to do activities sober that we’ve always done intoxicated like dating or having sex.
Learning in addiction recovery is more than gathering intellectual knowledge. Addictive dynamics happen at deep and unconscious levels (brain circuitry), as well as on those levels we can better capture and work with. For example, brain imaging research demonstrates how unconsciously and rapidly we can respond to drug-related triggers. Blood flow to the brain’s reward and pleasure pathways rapidly increases when people abstinent for 30 days are exposed to drug using triggers. Some of those exposures were so brief that subjects were not even consciously aware of them, but they still responded with cravings. This is strong evidence that what the brain learned in addiction lingers into abstinence. Such basic addiction circuitry needs time to be rewired. Therapy, insight, emotional processing and practicing new behaviors are needed for those healing brain changes to occur.
The Underlying Causes of Addiction
Reversing addiction’s damage always involves correcting ‘underlying causes’ such as altered brain functioning and structure as we’ve already discussed. However, there are other types of underlying causes from which addiction arises that we think of in psychological terms. Unresolved trauma, for example, is strongly correlated to the problematic use of substances, as are other unresolved psychiatric issues such as anxiety and depression. However, such conditions also have their roots in brain circuitry and the psychological symptoms are observable reflections of those.
Medications such as anti-depressants change brain functioning and support an individual from the inside out in very basic neurochemical ways. The same could be said of addiction-specific medications like methadone, buprenorphine, and naltrexone which are used to reduce cravings and alleviate other issues in addiction. All such medications have their own working mechanisms and are not appropriate for everyone. An addiction medicine practitioner can best determine which may be indicated for use in treatment. However, best medical practice and research tell us definitively that medications alone are not enough to cause deep change that is lasting and sustainable. Therapy and rehearsing new coping strategies are also needed.