“We believe, and so suggested a few years ago, that the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit and found they cannot break it…their problems pile up on them and become astonishingly difficult to solve.”
— William D. Silkworth, MD, from the Alcoholics Anonymous “Big Book,” 4th Edition
In our last post, we took a look at the brain chemistry of addiction and how it relates to the “pleasure principle.” To summarize, addictive substances hijack the natural chemical processes in our brains so that, eventually, using these substances is the only way a person can feel pleasure.
There is growing scientific evidence that some people are more prone to becoming addicted due to abnormalities in the way their brains process the neurotransmitter dopamine. Dr. Quinn T. Chipley, Counseling Coordinator at the University of Louisville Health Sciences Center and a psychologist with years of experience treating addiction, explains:
“The average [substance] user or drinker…has this integration of a network which provides not only pleasure feedback, but they have this other network that provides a sense of distaste, and they all work together to actually modulate the motivation network. What we see with people who are becoming addicted…they get to a point in life where they are experiencing the fact that this is not working for them anymore, but they still can’t stop doing it. Which means that somehow or another, those systems of motivation—the system of internal punisher and the system of internal reward—have uncoupled. They are no longer working together well enough to be able to auto-regulate.”
For substance users suffering from this extreme level of addiction, abstinence-based recovery may be the best option to return to a healthy, fulfilling life.
Benefits of the Abstinence-Based Approach
As the name implies, abstinence-based recovery is defined by complete abstinence from any and all mind-altering substances. Dr. Chipley is a strong believer in abstinence-based recovery because of the potentially harmful consequences of using “replacement” drugs known as agonist-antagonists during treatment.
In fact, Dr. Chipley and his colleagues from the University of Kentucky recently found that among multiple substance users who were taking the drug buprenorphine-nalaxone as part of their treatment, 75% reported the drug had either no effect or a negative effect on their drug problems.
Why was this the case? Possibly because agonist-antagonists can “remind” the brain about the experience of using the original substance, triggering intense cravings in people with the dopamine abnormalities explained above.
According to Dr. Chipley, “When they finally stop what they’re doing—through methods of abstinence recovery, peer-support community, things of that nature—they are easily triggered again…The least amount of contact with anything that creates that pleasure reward or euphoria reminds them of what it used to be like a long time ago when they first started, and then they go back to thinking, ‘I can achieve that feeling again.’ “
In the video above, Dr. Chipley explains the importance of matching a substance user’s unique needs to the correct type of treatment.
The Role of Community in the Recovery Process
The road to recovery for someone with a substance addiction does not end once they’ve completed treatment, however. It can take the brain as much as 14 months or longer to return to normal functioning after long-term substance use, and recovering substance users need continued support during this time to guard against relapse.
“One of the things that’s so important is to have people be in really long-term, ‘arms around’ community along the way,” Dr. Chipley says. “The hand-off from any kind of residential treatment into community life is crucial.”
Joining a transitional sober living facility is an excellent way for recovering substance users to ease back into independent living and build supportive relationships with peers. Attending support groups can also provide a sense of community and help former substance users remember why they decided to get clean in the first place.
Addiction recovery professionals have the responsibility of helping recovering substance users find the community they need to heal and thrive. In the words of Dr. Chipley:
“The big thing is we need to think about the “long game”—the long game towards quality of life, not necessarily the long game only towards harm reduction.”
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