Addiction seems at varying times to be a four letter word, the elephant in the room that no one wants to talk about ,or a buzzword for any behavioral problem. So what IS an addiction?
Wikipedia says that it is a 'neuropsychological disorder characterized by a persistent and intense urge to engage in certain behaviors, despite substantial harm and other negative consequences'. Psychology today says that "A person with an addiction uses a substance, or engages in a behavior, for which the rewarding effects provide a compelling incentive to repeat the activity, despite detrimental consequences" The key here in these definitions and in other accurate descriptions is continued or repeated behavior despite negative consequences. What we will talk about today, is how behaviors can become addictions, what types of processes or substances people misuse or become addicted to, and possible ways to overcome addictive behaviors - how we can help ourselves or a friend or loved one who may be looking for help.
HOW WE FEEL PLEASURE
Our brains have been wired for more than 200,000 years to help us survive. The midpart of our brain contains an area known as the ventral tegmental area (VTA) whose main function is to release dopamine to the rest of the brain, particularly to an area called the nucleus accumbens (NA). That's super important because the nucleus accumbens is considered the neural interface between motivation and action, playing a key role in eating, sex, drug use, etc. Simply put, you do a behavior that makes your critter brain happy and the VTA sends dopamine to the nucleus accumbens so that it creates an association with that behavior and getting a reward for doing the behavior. The biological purpose for this mechanism is to encourage life-sustaining behaviors (such as eating when hungry) by producing a pleasurable sensation when the necessary behavior happens.
The problem with that system is that when we use it for pleasure, rather than to ensure our survival the way it was intended, we hijack our dopamine production and throw the system off. First, non-survival related substances or behaviors (processes) like drugs, alcohol or gambling, cause much higher levels of dopamine than we can get naturally from food or healthy behaviors (which also release things like oxytocin and endorphins). These new ways of creating good feelings artificially cause our brains to produce that dopamine and do so more efficiently and intensely than the natural behaviors that give rewards.
The other part of the problem is that nature knew that once we had a habit it wouldn’t need to keep us going back by giving us dopamine, so the amount of dopamine released when we repeat a behavior gets smaller each time we repeat the behavior, until it reaches a modest, minimum amount. So repeated behavior doesn’t give us the same 'high' that it did the first time we experienced that rush. Finally, we also become used to having more dopamine in our systems from artificially cuing it up more often than nature intended, so we end up with a new baseline of feeling 'normal' with higher amounts of dopamine in our systems - so when that level drops down to the previous normal, we don’t feel so good any more. The graph below from Brain Connections references gambling, but could really be applied to any addictive process or substance. Using the smiley faces on the graph, lets call the bottom one a 1, and the top one a 5. That graph shows how our natural setpoint is a '3'. But when someone initially gambles and wins, even a little) or uses a drug, or shops for the thrill of buying something, etc etc, their mood goes way up to a '5'.
The next time they gamble, use, smoke, shop… The spike doesn’t quite get up the top smiley face any more, and each time they repeat that behavior, it pushes the natural setpoint down a little towards the unhappy faces, and then they have to repeat the behavior to get a spike just to feel normal and reach the natural set point again. And that, in a nutshell, is how someone, almost anyone, can get addicted to something, or almost anything. That's why there are 40-50 twelve step groups available to help with everything from Anorexia to Workaholics.
SO WHY KEEP DOING IT WHEN IT'S CAUSING PROBLEMS ?
To answer that, we need to mention the habit loop briefly: Cue, behavior and reward. Cue is anything that reminds us of the behavior that will give us a reward. For example, for many people having a sweet snack in the evening is a habit. Maybe somone routinely watches TV after dinner, and then something in their routine reminds them that they want a treat, so they go get a small bowl of ice cream, which is delicious in and of itself and ALSO give them a little dopamine. Boom. Habit starting to form. But next time, that small bowl of ice cream won't cause quite as much dopamine to be released, so maybe the time after that, it gets a little chocolate sauce on it…
So what is the reward of doing something that is potentially bad for us or will have negative consequences? First, it's surviving: We are wired to survive, to eat high calorie foods so that we have enough energy for the day and for the next day, to have sex so that the species will survive and to do things that make us feel safe and comfortable. Each of those behaviors is wired to give us dopamine and, as mentioned earlier, the VTA and NA work together to lock that behavior into the deepest recesses of our memories as a good thing that we should go back and repeat.
And that's the tricky part - tricky as in what kind of tricks the brain has up its sleeve.
While we are wired to get less dopamine when we repeat behaviors, our brain really wants to make sure we do, in fact, repeat those behaviors, so it now gives us a little of that dopamine for planning the behavior. That's right, just planning the behavior will give us a little dopamine in anticipation of doing the behavior and getting the full dose.
In other words, as soon as our TV watcher decides that he is going to have his ice cream, and stands up to go get them his brain rewards him for the decision and behavior by giving him a small shot of dopamine. The rest will come when he actually does the behavior (in this case eats the ice cream), but the rest of the dopamine is still a fairly small dose. This is why many people with addictions become very ritualized with their habits - always going to the same places, buying the same brands, sitting at a certain spot at the blackjack table, or setting things up a certain way before they actually do the behavior that will give them the reward. The ritual itself creates a reward and reinforces the behavior.
Emotions Behind Alcohol or Substance Abuse
So let’s think about someone who is starting to see some negative consequences from their habits or addictions. It could be as little as some weight gain, a little less spare cash, or a few more disagreements with friends or family - or as big as a diagnosis of diabetes, arrests for driving under the influence, loss of loss of a job or relationship, or wiping out a savings account - or worse than any of those. People continue to engage in these self-destructive patterns despite the negative consequences: not because they don’t think about it and it’s not painful to them, but because it has become a habit and their brain just kind of defaults to the behavior. Our brains are wired to think this will get rid of the problem, when in fact it just allows the brain to forget about it for a bit, while it enjoys the dopamine that it got. Later, the more conscious part of the brain may recognize the problem is just getting bigger and there may be new problems being added. As the problems continue to mount, these people are usually struggling and in a lot of emotional pain. They are probably angry, self-critical, and down on themselves. Not only that, they probably think about quitting throughout the entire day. Meaning they probably think about it up to the moment they’re about to repeat the behavior again , whether it is drinking, gambling, overeating or any one of the other dozens of addictions available for humankind to abuse. Why is this? Because it is now a habit and the brain is wired to seek the pleasure, usually without even thinking about it. Remember the habit loop? It can be used to for good, like walking the dog every day as soon as we get home; or for not so good, like stopping for a coffee and donut every time we pass the coffee shop on the corner.
THERE IS A WAY TO BREAK THE CYCLE
But, there is good news. The dopamine levels that we hijacked at the beginning of this article with drug, alcohol, food, gambling or shopping addiction CAN be brought back to normal. Brain chemistry can return to pre-addiction level and the short circuits that we created will go away. But it will take a lot of effort and, in some cases, possibly even professional help. For someone who has a physical addiction to alcohol, withdrawals can literally kill them due to strokes and seizures from stopping suddenly. Withdrawal from opioids will reportedly make someone wish they were dead. With any process addiction such as gambling, surfing the web, shopping, or whatever the unwanted behavior is, the cravings can feel just as real and physical as they are for people with substance addictions - including having physical symptoms.
For the person suffering the addiction there are numerous methods, all proven to work, but sometimes it takes multiple attempts at any one method, or trying several methods until the one that works best for the individual is found. These include mindfulness training, including cognitive behavioral therapy (CBT), RAIN technique (Recognize, Allow, Investigate, Nurture) 12 step programs and spin-offs of 12 step programs. For people who prefer a more agnostic or atheistic approach there is SMART Recovery and some similar programs. Those who want a MORE theistic approach find like-minded people and support in groups like Celebrate Recovery. Whichever method is used it is imperative that the person trying put as much effort into their recovery as they did their addiction in order to see the most benefit.
HOW CAN I BE SUPPORTIVE?
While we need to be supportive with someone struggling with some kind of addiction, we also need to be direct. It is human nature to try to avoid difficult conversations. No one really wants to tell a spouse or loved one, that their gambling, drugs, drinking, or internet addiction has become a problem. We suspect they already know and try to use that as an excuse to avoid the conversation. We especially don’t want to tell them their issue is a problem for us or other people and assume it is just going to be argumentative. But a conversation like that will be difficult no matter when you have it. So you have to ask yourself - 'will it be more difficult before or after the next bad thing happens because of it?' Just remember to approach a conversation like that from a place of support, because most likely, their immediate reaction is going to be defensive. ‘I don’t have a problem, I can handle this'. You’re making this bigger than it needs to be.’ Or, they might even be angry at being called out on their behavior - which is just another defense, by trying to direct blame away from themselves.
BE DIRECT
Try approaching it along the lines of: "I care about you, I care about me, and I care about us. I’m just being honest with you. Whether you see it or not, I’m letting you know I see it, and this is how it’s impacting us. So, what I’m doing is being direct. I’m having a conversation upfront."
You can ask them "Do you want to have this conversation now? Or do you want to have it when things start getting worse? Because my concern is that when things get worse, it may be too late." "I cant continue to participate in this dysfunction and madness that is creating a problem.
SET EXPECTATIONS
Clearly identify what the expectations are. This is where you have to lean in to the conversation, and not start backpedaling. You have to have thought this out ahead of time, but approach the conversation from a place of love, support and understanding and have an open conversation but no backpedaling on what YOU need to happen.
It’s one thing to tell people, hey this is an issue. It’s another thing to say to them, look, this is my expectation. You would have to decide, for you, what those expectations are. But, they need to be significant enough that they create a change.
COME UP WITH A PLAN FOR SUCCESS
Finally - come up with a plan or a goal, and remember that when setting goals, they should always be SMART goals (Specific, measurable, achievable, realistic and time based). So, come up with a long term plan - not just a plan to get through the day. Not drinking, gambling, surfing, etc, for today, tomorrow, or next week is not the long term goal. That’s not the issue that needs to be addressed, although it can be part of the SMART goal. The issue that needs to be addressed is, what is our plan for long term success. It could be professional help, attending some type of meeting like was discussed earlier in this blog, taking some classes on CBT, meditation or mindfulness. The idea is to get to the root of the problem AND help break the habit loop because doing one without the other will most likely not work. This is where the supportive person and the person with the addiction, or the whole family, could work together. Every member can assume some responsibility as they all have their roles in the family. Think along the lines of "Let’s get professional help" rather than YOU need to get professional help. Or meetings, therapy, etc. Work together and talk about things like what the future is going to look like - Not just today or tomorrow, but next week. What’s it going to look like two years from now? How do we create healthy relationships? How do we manage emotional distress when it comes up? Because it's life and it's going to come up.
WHAT'S NEXT?
It has been proven time and again that our brains default to habits we have formed. We can break habits and we can replace habits with new ones - but given the right cues and potentially the right stressors, we will default back to old habits. We are wired to and that's how we've survived for tens of thousands of years. So what do we do? Replace the old or bad habits with new ones that we like, and then keep reinforcing the newer, better habits, every day. Every day. People who frequent 12 step meetings are known to say that they drank, drugged, gambled etc, every day, so they have to go to meetings every day. THAT may or may not be the case for each individual, but it is imperative that the person doing the recovering do SOMETHING every day to keep the new habits in place, and the old behavior at bay. One of the pieces of the puzzle looked at in mindfulness, CBT and RAIN is to help the addicted person see that their behavior is just that - behavior. Not WHO they are; it is just a set of habits based on past cues, behaviors and rewards. Once a person can learn to separate themselves from the addictive behavior and not identify as it, it is easier to find ways to break the patterns and behavior.
Life and Health coaches are experts in habit change. Follow the links to our booking page to set up a free consultation to talk about whether working with a coach could help you create some healthy habits.
Photo credits:
"http://www.freepik.com">Designed by macrovector / Freepik</a>
References"