“Celebrate your uniqueness. You are unique, just like everyone else.”
If you think that I have found the answers through science, I did not. If you think that the solution to the addiction crisis should be simple, you are wrong. People are complex. They confuse me, that is why my degrees are in geology and oceanography. Since my last post, the theme that seems to keep hitting me from all directions is variability. Variability in the teenage brain, variability in our personal experiences with addiction, and variability in how we deal with addiction.
I am afraid that I am giving the impression that there is a single model for addiction that we can use to solve the problem. While addiction does cause changes to occur in an individual’s brain that are more or less universal, the brains that are being altered are not. We can map the changes and we can interpret those changes to explain some of the confounding behavior of people with substance use disorders, but they are people, not machines. We are destined to be stymied in our attempts to solve the addiction crisis if we do not account for the impacts of the thousands of other factors that shape human behavior. So please join me in a discussion of some of the variability.
The Adolescent Brain
I started my discussion of the science of addiction with the place that addiction typically starts and that is the adolescent brain. I asked a psychiatrist and college professor to review some of my writings and give me his thoughts. He works with adolescents and given the limited time that he has, that was a good place to start. If I can summarize the main theme of his comments, it is that what I said does not apply to everyone.
The development of prefrontal cortex of the adolescent brain makes adolescents tend to make poor decisions because they rely more on emotion than logic. That statement is true, but we all know (or knew) adolescents that made excellent decisions. They were good at predicting the possible future risks and outcomes of their decisions. Likewise, lower baseline dopamine levels and greater dopamine response tends to make some adolescents crave new experiences and take greater risks. For some this means new experiences that help them mature while for others it may mean taking serious risks for fun. To illustrate this variability, my son was the voice of reason among his friends in high school while he was considered the wild one in college..his behavior had not changed, his group of friends did.
The truth is that all of the physical and developmental issues that I discussed with regard to the adolescent brain are true and they make adolescents more prone to addiction. BUT not everyone suffers from these issues and certainly they are not impacted to the same degree. In fact, I think that it is safe to call this collection of issues risk factors. Just as a reminder, these issues include:
- The prefrontal cortex, responsible for executive functions (logic, self-control, risk evaluation, empathy, etc.), lags behind the development of the rest of you brain and does not catch up until your mid-twenties.
- Adolescents are very socially-driven which makes the opinions of their peers, who suffer from the same underdeveloped pre-frontal cortex very important.
- The adolescent brain appears to have a lower baseline of dopamine while at the same time it has an increased dopamine response to stimuli. This helps in the transition to adulthood by seeking new experiences, but it may lead to greater risk taking and may also make the response to addictive substances more pronounced in adolescents.
- During adolescence, the brain is going through a period of re-wiring. Since the brain is already re-wiring itself in many areas, it may be easier for the changes to occur that support addiction as a result of substance abuse.
Behavior of People with Substance Use Disorder (SUD)
An author contacted me about a book that she had recently published, The Weight of a Feather by Lynda Hacker Araoz and I was excited to read someone else’s journey with a loved one suffering from SUD. What I noticed was that her experiences, while occurring in a similar home life situation were very different from my own. Her son caused a great deal of chaos in her house beyond just the fear and panic that accompanies the knowledge that your child is abusing deadly substances. Her son’s actions were all too familiar; no consistent job, troubles with the law, disregard for other family members, coming home loaded, and failure to take rehab/recovery seriously. Our experiences had none of that. I refer to Nate as flying under the radar; good job, paid his bills, and worked hard at recovery but periodically relapsed.
Was our situation an exception? In my experience, exceptions are rarely the case and that applies here. I spoke with my psychiatrist friend and he said that our situation is very common. I spoke with a woman that I met in a training class to become a Certified Family Recovery Specialist in Pennsylvania. Her experiences were eerily similar to our own, even to the age at which our respective sons overdosed and died.
What does all of this mean? The fact is that there is a broad spectrum over which families are affected by a loved-one’s addiction. There is no typical and you cannot judge a family based on what they are going through. There are mistakes that we make, see my post on Enabling/Accommodating, but the uniqueness of people and situations means that there really is no uniform basis from which to judge or fix the impacts of someone with SUD on themselves or their family. Each plan must be individualized. Each family must find their own way, hopefully with help and support from others that have been there.
What We Do
As is discussed in my previous post much is said about enabling. So much so that families suffering through a loved-one’s addiction feel that they are being blamed, that they are somehow making the addiction continue. Lynda Hacker Araoz discussed in her book how she felt that the family was being left out of the discussion of addiction and how to attack the problem. She does not put a definite timeframe on her experiences, so I am not sure when she encountered this. Certainly, in the past there was an attitude that could best be summed up as “We are the professionals, we will tell you how it is and you just do what we ask of you.” We did not encounter this attitude. We did, however encounter some of the guilt for enabling, the pressure to use tough love, and the need to hit rock bottom.
My wife and I are like-minded and fiercely independent. We listened carefully to what the experts said and made our own decisions. Decisions that I am still comfortable with to this day, despite the outcome.
Fortunately, the concepts of leaving the family in the dark, of tough love and rock bottom are being tempered. Not everyone must hit rock bottom to seek recovery and tough love is being replaced with the more complex but more useful self-evaluation of when you are accommodating the addiction.
One last thought. I have heard numerous alternatives to 12-step programs and even some disparaging comments about AA and other 12-step programs. I love the idea of alternative approaches, as I said we must account for the fact that we are dealing with humans in all their glorious uniqueness. But AA and other 12-step programs have worked and continue to work for many people. Let’s not throw out the baby with the bathwater.
Do you have thoughts or experiences to share? Do you think I am full of s**t? Please comment, let’s work together and help each other.