Narratives and the brain: A Drunk Story

 

pexels-photo-374809.jpegFunny shit

Like most drunks, I have done some fucking dumb shit when I have been drunk. I’ve also done some fucking funny shit. There was the time, during a blackout at a work conference, I was sleeping in the same room as two colleagues (both female) and at some point in the night got up out of the trundle bed in which I was sleeping naked (presumably out of habit as I really don’t know why I was naked!), went to the bathroom, and when I came back tried to get into bed with one of my colleagues. Naked. I have no memory of this of course, but apparently I was very difficult to persuade to go back to my own bed.  So much so that the current occupier of the bed gave up trying to persuade me to, and went and slept in it themselves. The first I knew of any of this was when I woke up in the morning in the wrong bed, naked and totally confused.

Was I mortified? Not really! Slightly. Luckily my colleagues are good friends and forgiving. Did this stop me from doing the same thing a few months later? HELL NO!! In fact, I must have subconsciously decided that I wanted to dial it up a notch, because I couple of months later I did the same thing… TO MY PARENTS!!! It was the night of a Prince concert (R.I.P) and my daughter was about 2 so my parents were staying over to babysit. I drank loads, I remember sweet talking the bar man into selling me more drinks after the bar had closed, then later entered a black out and kicked the side of a bus for no reason whatsoever. Apparently. My poor, ever-suffering husband had to CATCH MY VOMIT IN HIS HANDS in the taxi on the way home so I didn’t get in trouble, and helped me all the way up the stairs. I went to sleep for a couple of hours, and then as some of you might know, your blood alcohol level can actually rise a couple of hours after you stop drinking as your liver can only metabolise a certain amount, and I can only assume this is what happened to me.

The rest I only know from what my husband told me. Apparently, first he woke up to me crouching down in the corner as if I was about to wee. He yelled at me what the hell am I doing? And sent me to the toilet down the hall. Next thing he knows, my mother is screaming for my husband, and he walks in to the room they are sleeping in and there I am, naked again, trying to get into bed with my mother and Step-Dad. Wow. Mortified doesn’t even begin to describe it. Mort. Dead. Deadified.

So let’s get serious

So they are probably the funniest things I did drunk. They certainly weren’t the stupidest, or the meanest, or the most dangerous, but they are pretty funny. The reality behind these stories however, is not that funny. It was still a number of years before I admitted that I had to do anything about my drinking problem, although I had no problem admitting that I was an alcoholic. Step 1: Admit that you are powerless over alcohol. Done and dusted years before entering recovery. Why? Mine was a special kind of denial.

I will never forget visiting a friend’s place about 3 years before quitting drinking. She was also a rather large drinker and quite functional, and I said to her that I had been taking online quizzes to determine whether I was an alcoholic. The answer kept coming up as ‘yes’. She then said “Oh yeah I’m totally a functional alcoholic”, just shrugging it off like it was nothing. And I thought that if she can admit that she’s a functional alcoholic and not be bothered about it, then I can too. I am certainly functional, I have a good job, a family, friends etc. It was as if by admitting that I was an alcoholic, but brushing it aside as if it weren’t a problem, I gave myself permission to carry on doing what I was doing. Who cares? My life is fine! Until it wasn’t.

Fast forward about 3 years, and as many people say, the alcohol just stopped working. I was going through some very stressful times at work (unsurprisingly, being a neuroscientist is highly competitive and stressful, as well as full of rejection so not great for the ol’ self esteem), was severely hungover every weekend so that I was being a shitty mother and wife, and I was bloated and not getting any fitter. Whereas years beforehand I would have drank only on weekends and special occasions, and only when all my responsibilities were taken care of, as my tolerance was increasing I was increasingly able to do everything (even Crossfit) after drinking large amounts the night before. The time that I did spend sober increasingly lost its colour, and I felt like I was always counting down time until I could drink again.

Quitting

I am ashamed to say that originally, the reason I quit drinking for a month was because I was sick of being fat. That month was by far and away the hardest month in my whole sobriety journey and I spent every second counting to the end of the month when I could drink again. I didn’t go out at all, I wasn’t around alcohol, but through sheer force of will, I made it to the end of the month. Then I went out and got wasted, drank so incredibly much I injured my leg, I have no idea how, but I still have a scar from it today. I then spent the next month drinking again, not every day but most, and life was shitty. So I took another month off and life was better. I could concentrate at work again, I had so much more motivation not just at work but at life in general, and I stopped instigating stupid fights with my husband every Friday night so he was happier. I wasn’t hungover every weekend so I could actually spend quality time with my daughter so she was happier. And I lost a few kilos. Hurrah!

But because I never intended to quit drinking forever back then, I always went back. And every time I went back it sucked more than the last. The time I finally decided to quit for good was after going to a work conference, getting absolutely wasted, sleeping through most of the talks and then drinking through my hangover during the next day’s talks when I finally did make it. When I got home I hadn’t seen my family for 3 days, but I was so sick that all I could do was lie in bed even though my daughter had really missed me and wanted me to hang out. My husband just looked at me, sighed and shook his head in disappointment.

Drinking and Recovery

Yet of course, I still drank two days later. Friends came over for lunch, they were going to the movies after. I decided to have a wine because if they were leaving, then I would stop drinking when they left. They didn’t leave, we ended up drinking until late in the night, I ignored my daughter all day again on a Sunday which is often my only day off from work, and drove to work the next morning hungover as fuck. Again. THAT was when I decided no more.

That week I started living and breathing recovery. I decided not to be put off by all the talk of a God and Higher power, to just ignore that stuff and pay attention to the stuff I found relevant. As a scientist it was not easy to ignore the irrationality, but soon the payoffs started to come. It had been so long since I had actually put some thought into life, instead of just bumbling along doing whatever and drinking to numb out the thoughts and emotions. The epiphanies came thick and fast. And here we still are.

The podcasts/memoirs/literature I found most useful were not the self-help podcasts and books, but were the ones that told a story (special shout out to http://theshairpodcast.com/). Listening and reading about the stories of addicts who had gotten sober I found myself identifying with them over and over again, even ones that I expected to have little in common with. This powered me on and gave me new hope that I could get sober, and although I have had a couple of relapses since then, I have been mostly sober for around 9 months. The times I have drunk again I have been able to stop again relatively quickly. The gifts of sobriety just outweigh the gifts of drinking by a million miles, it just seemed crazy to leave that all behind.

Stories and the brain

The epiphanies of sobriety have not just informed my personal understanding of the world and of myself, but of my work. My work had already been part of a movement within the basic behavioural neuroscience world that is increasingly beginning to recognise that even rodents form ‘states’ or contextualise information into ‘situations’ and it is largely the orbitofrontal cortices that carry out this function. This is part of the prefrontal cortex, that sits behind your eyes, hence the name “orbital”. Although it does receive some filtered visual information, however, it does not directly regulate vision. Rather this part of the brain, in conjunction with some subcortical regions such as cholinergic interneurons in the striatum, and centromedian/parafascicular thalamic nuclei, is the part that infers your current location within a task space. In fact this was described elegantly by a close personal friend of mine in a recent article as if your brain has created a kind of ‘google map’ of a task (e.g. to make a cup of tea: if I walk into the kitchen and put the kettle on, then hear the kettle boil so pour out the water… etc) the orbitofrontal cortex provides the ‘pin’ that tells you which part of that map of the task you are currently in.

In other words, the brain constantly constructs a narrative, it is how we are wired. It is my assumption, although untested, that in addicts this narrative gets pushed aside as automated actions take over without much thought. Thus it feels good in sobriety when we start to take control of our narrative once again. Indeed, the OFC has strong reciprocal links with the amygdala, a part of the brain that has been heavily implicated in regulating emotions. Emotions drive, and form part of our narrative.

In short, stories are important to us. In addiction research it is often said that the neural “reward” circuitry gets hijacked by drugs. In normal, non-addicted brains, neurotransmitter responses that are supposed to tell us about intrinsically rewarding outcomes so that we repeat certain actions. When we take drugs/drink, we artificially activate this circuitry so that value becomes attached to the wrong stimuli and destructive actions. Furthermore, dips in this reward circuit are supposed to tell us when expected rewards are omitted or removed, motivating us to seek out how to reinstate them. Therefore, when negative things happen (e.g. we fight with our partner/lose a job etc), our reward circuit can detect this negative outcome and motivate us to do something about it. If, however, we have hijacked this pathway by taking drugs, then we do not experience the same dip in neurotransmitters and are therefore less motivated to do something about it. It is theorised that this is why addicts will continue to drink/use in the face of so many negative consequences.

But encoding reward is not all those neurotransmitters do. Dopamine, for example, is commonly cited as the neurotransmitter that is activated by reward, but it does so much more than that. I would argue that it forms part of our narrative, our story that we tell ourselves. It helps us contextualise events. If, by taking drugs we strengthen the wrong circuit and attach value to the wrong items, this means that our internal narrative also gets skewed. Only in sobriety can we begin to take back control of our narratives. And that is a great feeling, undoubtedly underpinned by the strengthening of new synaptic connections in the brain.

13 thoughts on “Narratives and the brain: A Drunk Story

  1. Hi – I love this article and would be very interested to hear your take as a neuroscientist going through addiction recovery. I’ve been in 12 step recovery for about 3 years, from an eating disorder (and then lots of other behavioural issues I realised were driving my crazy patterns!) and I love it… but the doubting part of my brain keeps pushing against the ‘science’ in the Big Book – The Doctor’s Opinion, allergy of the mind and body, etc. I am able to take what I want and leave the rest, and the support and connection I get from 12 steps is amazing. But I’d love to know more about cutting edge science around the brain and addiction.

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    1. Hi Kenicke, thanks for your interest! I’m just doing some edits on my next post where I touch on these issues directly! I won’t answer here because my answer is too long, so will save it for the post in a few days time. In short I, like you, see both positives and negatives, but connection is key to recovery, I do agree on that. 😊

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  2. As someone who spent way to much time drinking in school, and not enough to show for it, because of said actions. I did admittedly enjoy many a night with doctoral students from the U of Iowa neurology department and have always thought you neuroscientists were a hoot. Looking forward to some more stories and some insights from a neurological perspective!

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      1. Well to start with you[neuroscientists] tend to be both intelligent and curious, and that in itself can lead to over consumption. I remember my therapist told me(this was before I quite drinking) I should try and find some lighter reading material and try not to think so much…lol. I mean really not bad advice for a depressed drinker, but somethings are just hardwired in I guess. I definitely needed a reboot. Anywho, congrats on your sobriety!!:)

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      2. Well rumination is linked to depression, and alcohol is a GABAA agonist, meaning that it increases activity at the main inhibitory receptor in the brain, so can be used to ‘quiet’ a lot of that rumination. I think that’s possibly why alcohol is used to self-medicate depression in so many. I have a theory that SSRI’s do a similar thing, as some studies have shown that increasing the actions of serotonin can slow neural transmission in some parts of the brain. In fact, maybe I should write a blog post on this…

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      3. Very interesting stuff. I would love to read more about it. When I was trying to quite drinking 3 years ago I was on the SSRI venlafaxine and it made my need to drink insatiable. It was really crazy, as soon as I got off of it I had my last drink(except for one relapse) 3 weeks later. I’m not the only one whose had this experience either. I wouldn’t have even thought about getting off it unless my general practitioner(who knew I was trying to quite drinking) hadn’t had mentioned to my wife that venlafaxine had greatly increased her desire to drink from almost not drinking to 1-2 drinks a night. As soon as she got off of it she said those desires went away again. I find this at least qualitatively interesting, don’t know if this would apply to your theory, but I ABSOLUTELY don’t think I could have quite drinking while on it.

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      4. Quick look on wikipedia and venlafaxine is a an NSRI not an SSRI. This means it affects the reuptake of both serotonin AND norepinephrine (noradrenaline if you’re in the US). However, it seems that many antidepressants including SSRIs can have the effect of increasing alcohol cravings. Although this is obviously bad news for alcoholics in recovery, it is quite interesting from the point of view of what neural mechanisms are driving this in some people and not others. Ponder it I will

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      5. Yes I’ll be interested to hear your take on it at some point. It really worked for my depression but man I could not resist the drink on it and venlafaxine and booze are NOT friends. It could be that most types of antidepressants would have this affect on me and I just noticed it because I was trying to quit. No surprise that what does work for me is bupropion, which is an NDRI and sometimes used for cessation smoking programs.

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      6. Well I’m glad you found something that works at least, and that is interesting to know. There’s still so much research to be done on the actions of these medications within the brain at various levels (i.e. circuit-level, cellular-level, receptor-level, etc)

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