Preventing Relapse

Drug addiction is a complex but treatable brain disease. It is characterized by compulsive drug craving, seeking, and use that persists even in the face of severe adverse consequences. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence. In fact, relapse to drug abuse occurs at rates similar to those for other well-characterized, chronic medical illnesses such as diabetes, hypertension, and asthma. As a chronic, recurring illness, addiction may require repeated treatments to increase the intervals between relapses and diminish their intensity, until abstinence is achieved. Through treatment tailored to individual needs, people with drug addiction can recover and lead productive lives.

The addict has a chronic, pervasive, progressive disease. In early recovery he/she CANNOT behave in the same way that other members of society do. In other words, the addict must identify and avoid those triggers that would lead to relapse. Although different people respond to different approaches, the research is clear on which approaches have the best success rates. The standard recommendations include:

1.    Recovery must be the number one priority in the recovering addict’s life.

2.    90 meetings in 90 days. The addict must substitute recovery for drug use and drug-seeking. Once addicted, the mere anticipation of getting high will trigger a marked dopamine response in the addict and/or alcoholic. Likewise early recovery from addictions is often hampered by the lack of dopamine d2 receptors that take many months to return to baseline functioning. The lack of sufficient d2 receptors is a primary reason that many drug addicts and alcoholics fail at abstinence during the first 90 days of their recovery.

Following the first three months of sobriety, the addict should attend no fewer than 3 meetings per week. After the first two years, the recovering addict can reduce this amount to one meeting per week if everything else is going well.

3.    Sponsorship. Daily calls and weekly meetings with a caring recovering addict are vital. Checking in with a caring person improves accountability.

4.    Step work. Homework assignments must be done and given to the sponsor on a weekly basis.

5.    Total and complete abstinence from ALL mind-altering drugs. This includes alcohol, even though it’s legal.

6.    A detailed and careful history to determine which triggers lead to relapse.

7.    Change of “playground, playmates and playthings.” The addict must avoid using friends, as well as places and activities that re-activate cravings.

8.    Abstinence from other addictions—cigarettes, pornography, etc.

9.    Relationships must be put on hold until the addict is on a firm footing with his or her sobriety. Although friendships are important, new relationships with the opposite sex should be avoided during the first two years of recovery.

10.    Study of inspirational literature. The people who have the greatest success rates are those who find a Higher Power and are able to “let go and let God.”

As I mentioned earlier, different people respond to different approaches. The above list has been standard for many years with minor variations for different people. With further research, even more variations are possible.  Those of us in the recovery field always hope for more research that can help the addict that still suffers.

Addiction–The Hijacked Brain

Addiction is a brain disease. Drug abuse is preventable behavior. Drug addiction is a treatable disease.  So many people think that it's a lack of willpower. But, it's not.  Addiction is a chronic, pervasive, progressive brain disease that worsens over time, devastating millions of families worldwide.

Some people are genetically more at risk than others. If you have a sibling, aunt, uncle, grandparent who is addicted (to anything) , then you're at higher risk of become an addict yourself. You're vulnerable to addiction. That doesn't mean that you're doomed.

It's all about dopamine

Dopamine is released in the brain in response to, and in anticipation of, a reward—be it alcohol, drugs, cigarettes, sex, food, or a shopping spree, to name a few rewards.  The reward center in the middle of the brain becomes overactive with usage of a substance or activity that stimulates that area.

The substance wreaks havoc with brain chemistry and structure, which can clearly be seen on brain scans. Over time with continued usage, the chronic flooding of dopamine results in the depletion and deregulation of dopamine as well as other neurotransmitters involved in stress and reward. Consequently, by the time an addiction is established, the drug brings little pleasure and only helps the user to feel temporarily ‘normal'.

The "Go System"

Deep in the brain, we all have a reward system, a pleasure center that evolved to help us to pursue rewards. This was necessary for our survival millions of years ago. When the reward system in the middle of the brain becomes active, it's as if it says, "Go! Go! Go!" Go for the drug! Go for that extra dessert! Go for the excessive alcohol! Go looking for porn on the internet! Go! Go! Go!

The "Stop System"

Another part of the brain, the prefrontal cortex or higher brain, evolved over time to help us to weigh the consequences of our decisions. It helps us to put a lid on impulsive behavior. It says, "Stop!"

The signals to the prefrontal cortex, however, tend to be a bit slower. So, we need to stop and think things out before forging ahead with an impulsive decision. To make things even more frustrating for parents, the brain isn't finished growing until we're about twenty-five or thirty years old. So we tend to have an undeveloped stop system before those ages.

The stop system in our brain says, "This is not smart to drive so fast, eat so much, or yell at a stranger." So, why doesn't it work so well with substance abuse?

The "Hijack"

Putting it in the simplest terms, the "go system" hijacks the "stop system" in the course of this brain disease called addiction. This is why addicts often lose everything before life smacks them in the face hard enough to get their attention that there is a problem--a BIG problem that they have been in denial about for quite some time.

The Twelve Steps of Alcoholics Anonymous begins with admitting powerlessness. From my point of view, the hijacked brain contributes to powerlessness. When addicts/alcoholics say that they can control their usage despite evidence to the contrary (that friends and family can clearly see), they are not understanding the first step.

Sobriety

In order to get better, the addict needs several things. One of them is a period of sobriety in which they are not activating the reward system of the brain through ANY addictive substances or behaviors. Since dopamine and other neurotransmitters have been affected, most addicts that I've seen over the years need another chemical source of help--antidepressants--in order to feel good enough to make it through that critical first year of sobriety.

Sobering Thoughts

I recently attended a substance abuse conference in which Dr. Michael Dennis, senior research psychologist and director of Chestnut Health Systems in Bloomington IL, spoke about the realities of drug dependency. Dr. Dennis was the coordinating center principal investigator of the largest adolescent treatment experiment to date in the United States, the Cannabis Youth Treatment (CYT) study. He has many more very impressive credentials. Some of the sobering thoughts that he said include:

• The younger a person is when they begin using drugs, the longer the person uses drugs in their lifetime. Early use is highly correlated with dependency.
• On average, most substance abusing teenagers are in treatment for two months. This is not enough for the vast majority of teens who are classified as having a substance abuse or substance dependent disorder.
• The average adult substance abuser takes three or four treatment episodes over a period of nine years to achieve one consecutive year of sobriety.

Knowing that, parents of teenagers ought to get a thorough drug and alcohol evaluation (including a SASSI-A2 assessment) with a licensed substance abuse specialist and FOLLOW the treatment recommendations made by that specialist. So much heartache could be avoided if parents would take the recommendations seriously.