“Never forget where you have been. Never lose sight of where you are going and never take for granted the people who travel the journey with you.”
Are you tired of thinking? Tired of my long-winded discussions of addiction? Take heart, because for today’s blog I am going to cheat and write several short segments. I am going to revisit some of the analogies and thought experiments that I have presented before. Some of these are my own and some I have borrowed from other people. They will range from the relatively simple to more complex.
I learned a great deal before I started writing this blog and I have learned more since. One of the things that I have learned is that analogies are one of the most effective ways to explain the difficult and counter-intuitive concepts of addiction.
No Brakes – “Telling an addict to just stop is like telling someone driving a car with no brakes to just stop. They want to, they just don’t have what they need.” – paraphrased from Dr. Nora Volkow, NIDA. This is a wonderful analogy that is summed up with the statement that they want to, but they do not have what they need. Don’t make the mistake of thinking that this statement implies a lack of willpower as many people suffering from addiction, our son included, have tremendous willpower. This is explained with our next analogy.
One Hand Tied Behind Your Back – Individuals battling addiction are fighting their own brain with one hand tied behind their back. Whatever willpower they have to fight the addiction, they also have to continue the addiction. Furthermore, the part of the brain fighting to continue the addiction has access to both the conscious and subconscious while the part of their brain that is fighting against the addiction only has access to the conscious brain. You are in a fight with one hand tied behind your back. Remember someone attempting to conquer addiction is not battling the drug, it is just a chemical, it has no fight. They are battling their own, altered brain.
Why Addiction Typically Starts in Adolescence – This is more of a thought experiment than an analogy that I used to illustrate adolescent decision-making flaws that result from an incompletely developed pre-frontal cortex.
Suppose you met someone in their mid-20s who did not have a lot of experience with substance abuse and you told them; “I will give you this powder and a straw so that you can snort it. When you do, it will give you the best feeling you have ever had and ever will have. It will last about 15 or 20 minutes, followed by a couple of hours of feeling very relaxed and peaceful. There is just one catch, if you do this you may become addicted to this substance. If that happens, obtaining more will become the only thing that matters in your life. You will lose interest in everything else. You will destroy your relationships. You will destroy your health. You will destroy your career. Even if you manage to free yourself from the hold of this substance, you will never be completely free, the addiction will lie in wait for you to make a mistake. Do you want to try it?”.
The answer you will most likely get will be something like; “Why would I throw away everything that I have achieved and everything that I might achieve for this temporary feeling. Get the Hell away from me.”
If, however, you made the same offer to an adolescent, you may get an answer something like, “Best feeling ever? Hell yeah, bring it on. I won’t get addicted. That happens to other people, not to me.”
Cucumbers – Some analogies are quite simple but they paint a very clear picture. I met a woman who is in recovery and she told me this analogy to show how addiction never completely leaves you once it has taken hold. She said, “I used to be a cucumber but now I am a pickle. I can never go back to being a cucumber.” She is fine with who she is, she is a wonderful person, but she knows that if she tries alcohol again (tries to return to being a cucumber), she will fail.
Off-Switches – Similarly, a friend of mine explained the difference between my binge drinking in college then stopping when I hit the real world with his becoming an alcoholic. He said to me, “You have an off-switch, I don’t.”
Dopamine and Pavlov’s Dog – Every time that Dr. Pavlov fed his dog, he rang a bell. Soon, by merely ringing the bell the dog would act like he was fed. He would salivate. This is classical condition, very much like the dopamine system in your brain that gives you a little boost of the feel-good compound, dopamine, when you do certain things that are beneficial or were beneficial to the survival of the human race. This is a brilliant design, we are prodded along to do things that help our species survive and we don’t even know it. Just like Pavlov’s dog was not aware that the sound of the bell was making him salivate.
When we use addictive substances, we cause a veritable flood of dopamine in our brain. This is what feeling high is and it is something on the order of 10 to 20 times the amount of dopamine released during good sex. Wow, that is a whole lot of feeling good. This hijacks that brilliant system designed to help us survive and it drives us very rapidly toward addiction.
Drowning in Dog Spit – So using the Pavlov’s dog analogy, how do we stop that flood of dog spit that is the rapid spiral to addiction driven by the hijacking of our brilliant internal design? Pavlov couldn’t nag his dog to stop salivating, nor could be threaten it or beat it into stopping. He had to stop ringing the bell. When you remove the stimulus, the conditioning slowly begins to degrade. Unlike Pavlov’s dog, we have an opposable thumb..we can ring our own bell. We can go buy our drug of choice. To begin recovery, we need help staying away from the bell. We need inpatient rehab, we need a supportive community around us.
Roadways and the Neural Network – Neural pathways in our brain are the elaborate system of cells designed to pass messages through our brain. It is most closely akin to a massive network of wires but also can be visualized as a system of roadways. As our brain descends further toward addiction, a process called Neuroplasticity (See Part III of the science of addiction) literally begins building new neural pathways and interconnections to support the addictive areas of the brain. Our brain is building highways to support our addiction and letting the roadways of our former self that would interfere with addiction, like morals and ethics, fall into disrepair.
Recovery consists of getting off of the highways of addiction so that they can fall into disrepair and focusing on the roadways of the old, ethical you. By doing this you are using neuroplasticity to undo the damage that was done. Unfortunately, because the addictive behavior caused such an overwhelming response in your brain, your descent toward addiction was rapid but your climb out of it will be a long and arduous journey. No matter how long you remain in recovery, the paths to addiction will still be present and it won’t take much of a slip to send you back down that road.
You NEED Air – The statement “Imagine trying to live without air. Now imagine something worse.” by Amy Reed is a wonderfully profound analogy to describe the driving force of addiction. It describes how it feels when a part of your brain is certain that you need your drug of choice to survive and it is doing everything it can to drive you to get what you need. It is my understanding that when you have truly become addicted, your brain has begun to believe that you must have your drug of choice to survive. You intellectually know that you don’t need it, but powerful, primitive parts of your brain believe that you do need it to survive. Survival is our most basic drive so your brain pulls out all the stops to make you use; vicious cravings, panic attacks, triggers, drug dreams, etc.
Finally, Narcan – If you were dying of thirst, literally DYING of thirst and you found some water would you drink it? Suppose you almost died because it was contaminated but you survived. Now you are even closer to death. If you found more water but there was a possibility it too was contaminated, would you drink it? Of course you would, you are about to die anyway.
Suppose your brain was certain that you had to have heroin to survive because you were suffering from addiction. Suppose you overdosed and died but you were revived with Narcan. Narcan flushes the opiates off the receptors in your brain, so your brain is now even more desperate to get the heroin that it KNOWS you need to survive. Do you think that you would use again?
Now you know why someone who was just revived from an overdose, will go back and use again if they don’t have the help and support that they need.
Do you have analogies to add to this list? Do you have ideas to share or a disagreement with something I have posted? Please comment, let’s work together and help each other.