Relapse Part 2: When reality doesn’t meet expectation

Heartbreak          

When I gave in and drank, surprise surprise, it was not as good as I had imagined. It didn’t taste as good, it didn’t make all my problems magically disappear, even for a little while (duh) and it just made me feel a bit fuzzy in my brain! After 6 or so months of being relatively clear-headed, I really did not like this feeling at all. I experienced what, in behavioural neuroscience, is known as ‘prediction error’ – the ‘error’ between predicted and actual outcomes. In other words, the reality of the alcohol I drank did not match up to the romanticised representation of drinking alcohol I had been imagining in my mind.

Of course like a trouper I didn’t stop drinking there and then, but instead I drank for a few more days, then stopped again, then repeated the whole pattern again a couple of weeks later. Unbelievably, it STILL didn’t match my expectations, and still didn’t cure all of my problems! I know, shocking right?

*Warning Sciencey bit*

In science, the common wisdom is that when there is an ‘error’ between predicted and actual outcomes, learning occurs. In fact, this is the process that has been shown to be most closely aligned to phasic (i.e. ‘quick’) dopamine firing. In my case, I experienced negative prediction error, meaning that the outcome (alcohol) I predicted was more valuable than the alcohol I actually experienced. When there is negative prediction error, we start to unlearn associations between stimuli/contexts/internal stimuli and alcohol, and I’m pretty sure this is what happened with me. I realised that the outcome was not as valuable as I had expected, so when I saw things/thought things that had previously triggered me to drink, that triggering was now vastly reduced. So much so that my last relapse honestly ended with me leaving half of the bottle of wine I was drinking halfway through because I just wasn’t into it. Something that NEVER would have happened a year ago.

*End Sciencey Bit*

So I think this process worked, because since then I have not craved alcohol. Glasses of wine have stopped jumping out at me when I am around them. I have been to several dinners with people drinking and haven’t even paid attention to their drinks. This is progress!

However, although I can be pretty arrogant, I am not so arrogant to believe that I will never experience a craving ever again, or begin to romanticise alcohol in a way that is not realistic. In fact, science also supports the notion that these associations between cues and alcohol are still there lurking underneath (it makes sense for the brain to retain information about things that predict reward, as I’ve talked about previously). Also of course there’s the possibility that the craving will incubate again, or that times of very high stress will cause cravings again. But I am hoping that I have learned enough to remember that alcohol doesn’t really provide an escape, or taste like heaven, or solve world hunger. It just makes me feel fuzzy in the head.

*Warning Sciencey bit*

As mentioned, it is this process (prediction error) that is linked to dopamine firing, although more recent research suggests that this function is confined to a subset of dopamine neurons. However, I have also mentioned that dopamine doesn’t straightforwardly represent a ‘reward’ pathway as many people believe. This is because if outcomes are perfectly predicted, there is no (phasic) dopamine response. You can see this below (from Schultz, 1998, J Neurophysiol), where the dopamine response is strongest (i.e. where the dots are closest together on the rasta plot) for the ‘CS’, i.e. ‘conditioned stimulus – in addiction this could be the pub, sight of glass of wine etc. When the reward is actually delivered, where it is labelled ‘R’, there is no phasic dopamine responses (i.e. the dots are the same as before and after reward delivery).

In real life terms, this means that if you are an alcoholic and you walk past a pub, then your dopamine will fire to the pub, and other cues (e.g. beer label/taps etc) that predict alcohol. When you drink the alcohol itself, however, because it is perfectly predicted by these cues, there is no dopamine firing. If dopamine was a straightforward ‘reward’ circuitry, it should spike whether alcohol was predicted or not. Rather, it is thought that dopamine in fact ‘teaches’ other parts of the brain about what stimuli to associate with reward, and therefore provides motivation or incentive to seek out those stimuli in future to maximise reward.

 

Screen Shot 2018-05-28 at 1.26.45 pm

*End Sciencey Bit*

So as you can see, the neural circuitry of addiction is far, far more complicated than simply having a ‘reward’ circuitry or a ‘pleasure’ circuit. We still have so much to learn about addiction even in rats or mice, whose brains are far less complex than humans.

Having said all that, I really don’t recommend relapsing just so that you can learn to like drugs/alcohol less! It is not a good idea. There were a couple of times in my relapses I really felt out of control and had to email friends/my recovery coach/others and beg for help. Luckily I was able to get it back under control and get sober again, this time. Perhaps next time I won’t be so lucky and perhaps the consequences will be severe. So why play with fire? I have seen relapse lead to so many bad consequences for so many people. It just isn’t worth it.

 

 

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