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 by the name of Nora Volkow did some fascinating research using SPECT (single-photon emission computerized tomography) images of the brains of meth users to show how dopamine receptors are destroyed in meth use. The final slide in the presentation always elicited a powerful response in 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 fulfillment in life is damaged. Life can seem bleak and gray during this period. There are very little stimuli that will cause the middle picture above to glow red like the normal picture. However, because of the way 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 stimuli that will make the middle picture look like the normal picture on the left. The only thing that feels good during this period is thinking about meth. I then go on to explain that in about a year enough dopamine receptors grow back that the brain starts looking normal again.
Learning this was greatly comforting to me, and I have consistently seen similar reactions when I have given this talk. There is something about being able to see 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. This 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 that 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.
Over the course of my struggles with addiction, I achieved the one-year mark several times, and could no longer blame my relapses on meth-related brain damage. I believe that my relapses after longer periods of sobriety were driven by the toxic beliefs I held about myself. This is where I think harm reduction makes a difference.
Harm reduction benefits 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 rates of drug-related crime 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 benefiting the individual. All the above interventions are also extremely controversial. Opponents of harm reduction believe that giving needles and drugs to addicts or condoms to teenagers is condoning bad behavior. Harm reduction advocates accept that harmful behavior is going to occur whether we condone it or not, and that the damage can be mitigated. This radical acceptance of harmful 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 that 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 judgement regardless of what they were saying or doing). His ideas are still widely accepted today and have been adapted to different behavioral interventions that support 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.
#addiction #recovery #addictionrecovery #mentalhealth #rehab #methamphetamine #harmreduction #drugs #harmreductionsaveslives #harmreductionworks #humanism #humanist #dopamine #brain #neurotransmitters
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Next week: A Humanistic Approach to Addiction - Part 4 of 4 - Humane Treatment
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