There is a scientific explanation for why drug addicts relapse so much. Understanding it may help addicts stay in recovery.
Once I got sober, I began working with other addicts. One of the more rewarding things I would do would be to give a talk I developed about how methamphetamine hijacks the brain's motivation and reward pathways to create the perception that methamphetamine (meth) use is vital to survival. A neuroscientist named Nora Volkow did some fascinating research using SPECT (single-photon emission computerized tomography) images of the brains of meth users to show how meth use destroys dopamine receptors. The final slide in the presentation always elicited a robust response from patients in early recovery from meth abuse.
The slide depicts a healthy brain showing red areas of high dopamine activity in the limbic system (which governs motivation, reward, pleasure, fulfillment, etc.). Early recovery from methamphetamine abuse is difficult because the part of the brain that produces satisfaction in life is damaged. Life can seem bleak and gray during this period. There are minimal stimuli that will cause the middle picture above to glow red like the typical picture. However, because of how the motivation/reward circuit gets rewired in meth use, thinking about meth use and eliciting craving causes an unnaturally massive dopamine release and is the only stimulus that will make the middle picture look like the typical picture on the left. The only thing that feels good during this period is thinking about meth. I then explain that in about a year, enough dopamine receptors grow back that the brain starts looking normal again.
Learning this was enormously comforting to me, and I have consistently seen similar reactions when I have given this talk. There is something about seeing the difference in brain chemistry in these images that dispels the deeply ingrained belief that addicts relapse because they are losers. Here is evidence that addicts relapse because they have rewired their brains to do so. The research also illustrates that the dull gray period is temporary.
It is worth noting that I presented this in residential treatment programs where patients had already received education on the disease model of addiction. It is one thing to tell an addict they have a disease and quite another to show them proof of it. So pervasive is the self-loathing inherent in so many addicts that telling them they are sick does little to penetrate the toxic beliefs they hold about themselves.
Throughout my struggles with addiction, I achieved the one-year mark several times. I could no longer blame my relapses on meth-related brain damage. My relapses after more extended periods of sobriety came from my toxic beliefs about myself. I think harm reduction makes a difference at this point.
Harm reduction can benefit both the individual struggling with harmful behaviors and society. The many benefits are easy to quantify. Needle exchanges result in lower rates of HIV and hepatitis C, which are diseases that are very costly to treat. Methadone and Suboxone (drugs used to treat opioid use disorder) clinics lower drug-related crime rates and allow opiate addicts to become working, productive members of society. Providing condoms to teenagers reduces rates of STDs (sexually transmitted diseases) and unwanted pregnancy. There is plenty of data to demonstrate that these interventions reduce societal costs as well as benefit the individual. All the above interventions are also highly controversial. Opponents of harm reduction believe giving needles and drugs to addicts or condoms to teenagers is condoning bad behavior. Harm reduction advocates accept that harmful behavior will occur whether we condone it or not and that we can mitigate the damage. This radical acceptance of destructive behavior has its roots in humanism.
Carl Rogers was a pioneering psychologist of the 1940s and 1950s who developed "humanistic" or "person-centered" therapy. He believed people grow in an environment of authenticity, acceptance, and empathy. He would talk about the importance of having unconditional positive regard for his patients (meaning that he would accept them without judgment regardless of what they were saying or doing). This is a different approach to addiction than the punitive approaches typically used. His ideas are still widely accepted today and adapted to behavioral interventions supporting personal change, such as motivational interviewing and harm reduction.
In the next installment, I will share my encounter with the healthcare provider who showed me unconditional positive regard and planted a seed in my mind that may have saved my life.
References (section 3):
Volkow, N. D., et al. (2001). "Loss of dopamine transporters in methamphetamine abusers recovers with protracted abstinence." The Journal of neuroscience : the official journal of the Society for Neuroscience 21(23): 9414-9418.
This story was originally published on September 16, 2021.
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