Is breaking the cycle of drug addiction possible?
How can we stop the cycle of addiction? Why is it that people who develop a substance use disorder enter an addictive cycle, where they return to their addictive behavior over and over again?
When someone develops an alcohol addiction, prescription drug addiction, or an addiction to illegal substance use, they find themselves unable to stop. They feel shame, as they obsess over their drug of choice, struggling with maintaining sobriety, and often giving in to relapse.
People who have not experienced a drug addiction or alcohol addiction may not be able to related to the difficulty in overcoming active addiction. Why would someone who has suffered through the pain of withdrawal symptoms from opioids or alcohol ever want to go back to alcohol abuse or drug abuse?
It seems as if someone who enters addiction recovery, for example with opioid addiction treatment or alcohol addiction treatment, would want to continue with a drug-free life of sobriety. Feeling healthy and waking up clear-headed every morning in recovery feels great.
Why do alcoholics and drug addicts relapse?
Why would anyone who has overcome alcohol abuse, pain pill abuse, or even heroin, fentanyl, meth, cocaine, or crack use, ever consider going back and relapsing? Why do they hold reservations, allowing for the possibility of using drugs or alcohol again in the future?
Yet, the substance abuse cycle continues for many people, even after substance abuse treatment in an inpatient or outpatient treatment program. Sometimes, even days after leaving the treatment facility, drug or alcohol relapse can occur.
Even people who have attended the best rehab treatment programs and received the best professional help available have had great difficulty in breaking the cycle of addiction.
In order to understand the addiction cycle, we must understand what a habit is, and how habits form. Habits are your brain’s way of developing shortcuts to get through the highly complex processes involved in surviving a typical day.
How are addictions different from bad habits?
Imagine all of the things you must do to simply drive to work. Unlock the car, adjust your seat, pull your seatbelt around and click it in. Start the car, put it in gear, check your surroundings, follow all of the rules of the road.
Learning to drive is difficult, but once you master it, you may find yourself walking into your workplace, not remembering the drive from home to work at all. How did you get there, navigating through traffic?
As you can see habits are a unique and highly useful part of our powerful human brains. Yet, the brain does not really know the difference between a healthy habit or an unhealthy habit.
Driving to the store to buy cigarettes, opening the pack, lighting a match or lighter, and inhaling the nicotine-filled smoke is also a complex process, yet it provides no benefits to the smoker, other than a bit of stress relief. Nicotine is known to be the most addictive substance on Earth, and smoking cigarettes is a major cause of disease and death.
How is it that we know better, that certain actions are not good for us, but we engage in unhealthy activities regardless of our better judgement? In order to better understand healthy habits, or even unhealthy bad habits, versus an addiction, it is helpful to use an analogy.
Addictions involve reinforcing reward pathways, using highly addictive substances.
Imagine that you dig a shallow, wide hole in the sand, on the beach, right near the water. As the water washes up on the beach, the hole fills with water.
At first, the water stays, not moving, until you use your hand, making a small channel to allow the water to flow out of the hole. As the water hole fills up again, it immediately flows down your new, handmade channel.
Now, if you dig a deeper channel, next to your original channel. The water, of course, chooses the deeper channel, preferring to take the path where you have made it easier for more water to flow.
Think of each of these channels that you dig in the sand as habits. Digging the channel deeper, or wider, allows water to flow more easily.
When you repeat an action over time, something similar happens in your brain. Pathways are formed to help you repeat the action again in the future with less awareness and less thought.
Of course, forming habits is a much more complex process than digging holes in the sand. Your brain has a reward center, which is made up of various structures in the central nervous system.
How do addictions differ from good, healthy habits?
Do you remember the first time you were able to ride a bicycle successfully? Many people remember the first time they were able to balance and ride forward, without falling.
With your first successful bicycle ride, your brain put together the complex actions that your body used to propel the bicycle forward, keep the wheels straight, and maintain balance. Your brain rewarded itself with pleasurable neurotransmitters, and new pathways of reward and memory.
But, drug abuse is harmful to the body, and riding a bicycle is healthy. How is it that a person can develop a habit of using an illicit drug?
Unfortunately, addictive drugs are able to hijack the reward system, providing rewarding feedback, and strong new connections of reinforcement in a very short time. Imagine, back on the beach, as you dig new channels in the sand with your hand to allow water to escape from the water-filled hole, someone hands you a large shovel.
With the shovel, you can quickly dig a deeper channel with little effort. Or, to take it to an extreme, you are giving a powerful hydraulic excavator. Climbing into the driver’s seat of the excavator, you are able, within seconds, to dig a channel in the sand that is so deep, the small hand-made channels are barely visible, by comparison.
Who is at the greatest risk for developing an addiction?
Now, you are able to visualize the power of an addiction forming to a highly addictive substance. When a person smokes crack cocaine, or injects heroin or street fentanyl, they feel at first a high that is outside of normal human experience.
Imagine the habit forming machinery in the brain that normally creates new pathways that are gradually reinforced over time. It takes weeks, months, or even years to develop a healthy habit, such as daily exercise, or eating healthy.
A malignant habit, such as drug use or alcohol use, can develop quickly, and is a more powerful habit than habits that form naturally. The refined drug goes to work quickly, digging deep channels in the mind, drawing all thoughts to focus on that one drug.
Of course, not everyone develops an addiction after experimenting with addictive drugs. We all know people that dabbled in drugs and then gave them up. Developing an addiction cycle requires a perfect storm of circumstances.
Are drug addictions always a response to trauma?
If a drug is highly pleasurable for a person who is normally unable to feel pleasure or happiness in life, for example a person who struggles with depression or anxiety, they will receive more reward from using certain drugs. People who feel that they are bored with life and normal life experiences are at high risk for developing addiction.
What types of people are at the highest risk? In my experience, I have noted that people who are highly intelligent, creative, and driven to succeed, are at very high risk for developing an addiction.
Who is likely to be bored with normal life activities? Who will have a tendency to become depressed, and develop anxiety related to attempting to engage in social activities?
In addition to geniuses, artists, and entrepreneurs, other people who are at high risk include those with mental illness, and serious mental disorders. Additionally, people who have suffered serious trauma, physical or emotional, will also be at higher risk for entering the substance abuse cycle.
Do you know how to break an addiction?
Going back to our beach sand analogy again, imagine our hand-made lake in the sand, with the various channels we have dug out, allowing for water to flow back to the ocean. What happens during low tide, when there is no water to fill the water hole or flow through the channels?
Think of this low-tide state as being similar to a person who has stopped using drugs or alcohol after being in active addiction. There is no water flowing through the channels, yet, they are still there. Just because a person does not give in to the urges of a habit or addiction does not mean that it has gone away.
What happens when the water returns to fill our water hole on the beach? The process starts all over again, water flows out, preferring the deepest, widest channels to escape.
Drug users who have undergone addiction treatment may feel as if they have been cured, yet they are still at high risk for environmental triggers that can lead them back to active addiction. While treatment and social support are helpful, they do not always prevent relapse, because the drive to return to active alcohol or drug use is powerful.
Why do people who go to rehab still relapse?
A great example is the alcohol deprivation syndrome, which often occurs after a person has left treatment in rehab. After detox and entering into a recovery program, a previously heavy drinker re-enters society and normal life, and may feel as if they have beat the alcohol addiction.
Yet, for many people who have given up alcohol suddenly by going through inpatient detox and rehab, the alcohol cravings may return after a few months of sobriety. This is known as the alcohol deprivation syndrome.
Some people are able to stick with the program, using intense social support, meetings, therapy, and whatever other tools are available, including modern prescription digital therapeutics, which are support apps that help to reinforce sobriety. However, many people eventually succumb, and find themselves drinking again.
Imagine the guilt and shame of drinking alcohol after spending tens of thousands of dollars on a fancy rehab. To make matters worse, family members, coworkers, and friends also pile on, pointing a judgmental finger.
Relapse is not a sign of weakness.
People who relapse are seen as weak and irresponsible. How could they not work their program hard enough? How could they not see how good their life is and what they have to lose?
Judging people who struggle with addiction is similar to judging someone with a broken leg because they can’t walk faster or climb the stairs. Why is a mental health issue not taken as seriously as a physical health issue?
The misunderstanding of mental health problems, such as addiction, reminds me of an issue I once had with a kitten who kept urinating around the house instead of using the litter box. I thought the kitten had a behavior problem.
Was I supposed to scold her? Would it help to hold her near a puddle of pee on the floor and say, “bad cat!” I called the vet to ask what to do.
After bringing her in for an evaluation, it turned out that she had a urinary tract infection and required medical care. All the scolding and shaming in the world would not have treated her medical condition.
Yet, providing her with medication to treat the problem worked very well! Within a short time, she was back to her normal playful self. It turned out that her behavior was a cry for help, and no amount of yelling, scolding, or “therapy” was going to help. The behavior was not the problem, it was a symptom of the problem.
Do you know how to stop an addiction with medical treatment?
Throughout history, the medical field has been in the difficult situation of knowing about various illnesses, but not having any effective treatment. For thousands of years, physicians have studied the human body and human behavior, identifying and categorizing disease, and learning how to make a diagnosis.
However, without effective treatment, doctors were forced to do their best, often providing treatments that were completely unhelpful, and often harmful. For example, draining a person’s “bad blood” will not get rid of an infection. More likely, it will lead to more serious illness, or even death.
Addiction is a serious health condition that is difficult to treat. Until recently, effective medical treatment did not exist for alcohol or drug addiction. For some drug addictions, we still do not have effective, long-term treatments.
What do we do when we have no medical treatment? We put people in residential rehabs to get massages, play with horses, paint paintings, and sit in group circles to talk about their mothers and past traumas.
Yet, there are now effective medical treatments for addictions such as alcohol addiction and opiate addiction. When people are struggling with these addictions, the appropriate course of action is to see a doctor for medical treatment.
Do rehabs provide proven therapies to treat addiction?
An example of an “evidence-based” therapy that is provided in rehab is 12-step facilitation. This process involves counselors in rehabs introducing 12-step programs to their clients, such as Alcoholics Anonymous and Narcotics Anonymous.
They teach them about the steps and drive them in a bus to AA and NA meetings around town throughout the week. What is the “evidence” that 12-step facilitation works?
It turns out that the evidence, based on studies, shows that rehab residents are more likely to go to 12-step meetings after engaging in 12-step facilitation. The proven success of the process has nothing to do with remaining drug or alcohol free long-term.
Do doctors know how to break an addiction with medical treatment?
If a person has an opioid addiction, they should see a provider offering, Suboxone treatment in Fort Lauderdale, or possibly even a methadone treatment provider. Or, if the person has already gone through opioid detox and they are opioid free in rehab, they should be offered naltrexone injections, known by the brand name, Vivitrol.
Medication-assisted treatment for opioid addiction works, and it works well. When a person takes Suboxone long-term, for a year or more, the brain heals.
The deep pathways formed by addiction become more shallow over time. The scars left by addiction, in the form of unhealthy reward center neuronal pathways, start to heal.
In our beach sand analogy, we know that over time, the channels that we have dug in the sand will eventually dissolve away, smoothing over. The secret is to stop digging them over and over again.
The deep channels will take more time, yet they will also go away with time. Medications, such as naltrexone, buprenorphine, or methadone, provide a temporary filling for the channels of addiction formed in the brain.
How can medication help to treat an addiction?
These medications can help to reduce, or prevent drug cravings and obsessions. When a person stops obsessing over drugs, they are able to think more clearly and function better with respect to activities of daily living, such as caring for a family or going to work.
In the case of alcohol addiction, there is a medical treatment known as The Sinclair Method, or TSM. This harm reduction treatment involves a doctor prescribing naltrexone tablets to be taken one hour before drinking alcohol.
The combination of naltrexone and alcohol work to gradually erase the pathways of alcohol addiction from the brain. It is as if we are filling in those channels dug in the sand with handfuls of sand. Each naltrexone use is like another handful of sand thrown in to make the addiction channel more shallow.
Over time, the result is an erasing of the addictive habit from the brain. The cravings subside, and the person is able to stop obsessing over alcohol use and abuse. They eventually reach a stage of pharmacological extinction of the alcohol habit.
Is it possible to break the cycle of addiction in families?
When a person with an addiction learns how to stop using drugs, with the help of effective medical therapies, they are also helping to put a stop to intergenerational addiction. Addiction does tend to run in families, partly to a genetic component, but also greatly due to behavioral influences.
Breaking the cycle of addiction in families involves being aware of the addiction disorder and learning how to educate family members about how they can avoid it, or treat it early if needed. For example, TSM is effective for full-blown alcoholics, but it is also effective for gray area drinkers as well.
While it is better that a college student avoid alcohol altogether, if they do choose to drink, they may want to see a doctor and ask about naltrexone tablets. Taking naltrexone before going out to drink with friends can help to keep drinking under control and to prevent an alcohol habit from taking hold in the brain.
We must also educate children and young adults about the dangers of gateway drugs, such as cannabis, which can intoxicate and lead to people making poor decisions. Many first experiences with drugs such as cocaine, meth, or heroine start with being intoxicated with marijuana and willing to try something new.
Please consider this article to be a a breaking the cycle of addiction worksheet, which may help you, or a loved-one to better understand the process of addiction and how dangerous habits are formed. By being aware and mindful, we can avoid developing addictions, and we can work towards overcoming existing addictions.
With time, if we give our brains a chance, they do heal from the trauma of addiction. Social support and therapy are important, and medical treatment, when available, is also important, to allow for the healing process to take place.