Author: neuroscientistinrecovery

I’ve been away for a bit

Some of you may have noticed that I haven’t posted a blog entry for the last few months. Perhaps people may have thought I relapsed, but I’m happy to say that I haven’t. I have been completely alcohol free now for over 15 months.

The last time I did post was about my disappointment at not getting a job I’d applied for. One of the reasons I was applying for this new job and was so desperate to get it is because I am having a very difficult time with my current boss. Only recently I have come to realise that my issue with him is not simply that he is annoying or bad-tempered, he is abusive. And working for him has made me feel like I am an enabler – a concept that I’m possibly extra sensitive to given my history of addiction.

So why don’t I just get another job? Well I am still looking, but my field is highly specialised and there aren’t a huge number of jobs going in my field at any one time. Moreover, the application process is very intense (each application is usually more than 10 pages long), and it usually takes 6 months to a year for a person in my field to move between jobs. So whilst I am waiting to find another job, I have faced an unfortunate choice: either put up with my boss’ behaviour without doing anything about it, and feel like an enabler at the same time, or do something about it. I have tried the first option for a long time but it has just made me miserable, so today I took the first steps towards option 2: doing something about it. The first steps in a long road, but first steps nevertheless.

*Sciencey bit* People are Obedient

The Milgram experiments were famous psychology experiments carried out in the 1960s that tested how obedient people are. Participants were not told that this was the intent of the experiments, rather they were told that they were taking part in an experiment about learning in which they had to administer electric shocks to another participant that they could hear but couldn’t see. In reality, there was no other participant, it was a person who was ‘in’ on the experiment who kept answering questions wrong. Each time they got a question wrong, the real participant was required to continually administer ever-increasing  electric shocks. A range of different conditions produced variations on the result, but one thing was consistent: an unexpectedly large proportion of individuals (29-90%) were found to keep turning up the level of shock until finally, they’d administer a shock to the other participant that they believed was fatal. That is, they believed they had killed the other person, who’s screams they could hear, just because they were told to.

These experiments would be unlikely to get ethics approval nowadays, but the information they provide about people’s propensity to be obedient is important. In fact, these experiments were devised in order to test the hypothesis that the guards in the SS had carried out the holocaust during WWII because they were following orders; a hypothesis that seems to be supported by the results. I remember a Professor of Jewish studies referring to these experiments, and suggesting that the people we should really be studying is that small percentage that refused to give the fatal shock, even under the conditions that enticed 90% of other participants to give it. The disobedient few. They are the ones, he said, that we should be looking at emulating and aspiring to be like. Those who in the face of injustice, stand up and refuse to simply follow orders. It seems a relevant lesson for current political times, but that’s not the story I’m telling today.

Ever since learning about these studies and their relationship to atrocities that have happened in our history, I have liked to think that, if faced with a situation in which I come across a situation in which I think an injustice is being carried out, I will be a part of that 10% that stands up and refuses to participate. I will stand up to that person or people perpetrating the injustices and I will not, under any circumstances, contribute to or enable them to continue abusing people.

*End Sciencey bit*

Coercive Control in the Workplace

I have been in abusive relationships before, which is perhaps why I have been faster than others to recognise the patterns of abuse in my boss. In domestically abusive relationships there is often (but not always) physical violence, but what really defines the abuse is coercive control. My boss has never done anything so obvious as physical violence, but from the very beginning, the signs of coercive control were there. The attempts to cut me off from my network, my colleagues, and my collaborators began almost immediately. It was classic attempts to isolate me; just as an abusive man (and yes some women) might try and isolate their partner from their friends and family, my boss was trying to cut me off from my professional network so that I relied on him completely.

There was also gaslighting. Promising me certain things and then acting like they had never been promised. Making statements and then denying that he ever made them. Twisting and turning reality to suit his own purpose, all the while skirting the edges of what, if you take each incident in isolation, seems pretty reasonable. But when you add together the bulk of the actions you can see that there is a concerted and systematic attempt to get me under his control. I remember having a moment before I signed my contract when ‘Bossman’ said to me half-jokingly that he favours the hire of females. Part of me did wonder if that was because he considered females easier to get under his control. Now I know that that is indeed why. Well oopsie for him, I guess he made a mistake with me.

No More Enabling

Once I had a boyfriend who I thought was going to kill me. He drank too much too, and smoked weed every day. But he was a typically entitled white man who tried to isolate me from my friends, control what I wore, control where I went, and control what I did. The abuse escalated gradually, but it wasn’t until I had finally left him for good that he’d come around to my apartment drunk to talk about the ‘break up’ and we got into an argument. He threw my phone out of the window (I lived on the 6th floor), hit me and kicked me several times. I ran into the bathroom to try and lock myself in and get away from him but I wasn’t fast enough, so he wedged his way in. Motivated by alcohol, misogyny, and entitlement, he held me up against the wall by my throat and started to strangle me. I saw my life flash before my eyes at that moment, I seriously thought I was going to die. This was it, I thought, at the age of 22 I was going to be murdered by my drunk boyfriend. Somehow I found the strength to kick him in the balls as hard as I possibly could and he let me go. He started crying then ran and got an iron and started smashing it against his head until blood was pissing out. By some grace of something, my flatmates came home at that exact moment, and I screamed at them to call the police. Before they could call however my boyfriend ran outside the apartment off into the street, and my female flatmate came in and showered me to wash off all the blood and tears, dressed me like I was a little baby, and put me to bed whilst stroking my hair. Bless her.

That was over 15 years ago, and it is just one of many incidents that I have been through that make me so determined now that I will not enable the behavior of a narcissistic, paranoid person believes that they are entitled to subjugation and recognition that they didn’t earn, even if its unlikely that my life will ever be directly in danger as a result. Further, unluckily for him, but luckily for me, I’m sober now.

So I have taken action. I don’t want to give too many details about that in the name of anonymity, but formal proceedings are beginning. Most importantly for my peace of mind, for me to feel like one of the 10% of Milgram’s subjects, not of the 90%, no more enabling. No more agreeing to ridiculous requests because its easier than arguing, no more trying to placate situations by going along with things I don’t agree with. No more putting this man on my grants and publications and giving him success that will enable him to treat other people the same way he has treated me.

For today, this journey has only just begun. I’m not sure where it will end up. Maybe I’ll lose my job, maybe I’ll ruin my career. I sincerely hope not because I love what I do, and it would be such a shame to lose all that I have worked for. But that’s the risk I’m currently willing to take, because I toed the line for so long and I know how miserable it made me. Even though I know what I am risking, I feel so much happier knowing that I am finally standing up to this man.

Wish me luck…

NB: I feel like I should put some links in for people suffering from domestic abuse, but it really depends on what part of the world you are in. Here are some excellent books that contain information about where to get help. If this applies to you, please do get help. You don’t have to suffer alone.

See what you made me do by Jess Hill

It Ends with Us by Colleen Hoover

 It is New Year’s day today, and instead of nursing a hangover as I have in so many New Year days of past, I have been up and about for ages, just taken my daughter to the movies, gone out for lunch, and now I’m writing this blog.

A memory about NYE came back to me yesterday: about 10 years ago (give or take) I missed midnight on NYE because I was passed out. Naked. In the bath of a person’s house that I didn’t really know that well. I guess I had been trying to take a bath (either that or I just want to get naked when I’m blackout drunk?). And because the toilet was located in said bathroom, many people (apparently) saw me lying naked in the bath, one of whom was kind enough to tell my (now) husband, who picked me up and put me in one of the beds at whatever house I was at. I then woke up at around 1am with no idea where I was, and no-one around to tell me because they’d gone to watch the fireworks. That was scary, confusing, and took me a long time to recover from. Yeah, a sober NYE is certainly preferable!

*Warning Sciencey bit*

Neurogenesis

That aside, one topic I thought would be particularly well suited to a post on New Year’s day is that of neurogenesis – the process by which (two very specific parts of) the brain produces new brain cells. It is something I have touched on in previous blog posts, but have never really explored in detail before.

The discovery of neurogenesis a couple of decades ago was, at the time, contrary to the long-held belief that the number of brain cells we have is fixed for life. Since then, there has been an explosion of research into what the purpose/consequence of these new neurons is, how to increase neurogenesis, and what processes decrease neurogenesis. It is a fascinating field. I should also mention that it is a somewhat controversial field – some research groups have cast doubt on whether neurogenesis even occurs in humans, whereas others strongly suggest that it does. My personal view is that it more likely occurs than doesn’t, but can be difficult to detect in certain studies for particular reasons. I could be wrong of course. It has happened once before (but let us never talk of that dark time). In any case, neurogenesis is certainly robust in other mammalian species, with a lot of what we know about it coming from rodent studies.

*End Sciencey bit*

Alcohol and Neurogenesis

There’s so much I could say about neurogenesis, but to stay on topic for today I will stick to two aspects of it: how it is affected by alcohol, and what that might mean for the individual with alcohol use disorder in recovery (i.e. me).

*Warning Sciencey bit*

New neurons arise from neural stem cells, a kind of embryonic cell that, under the right circumstances, can become a neuron. Fetal alcohol syndrome occurs when alcohol consumed by a pregnant woman affects the neural stem cells in the developing foetus. Likewise, in adults, consumption of alcohol interferes with this process via multiple mechanisms. In the adult human, it is difficult to say what exactly the consequences of this is, but certainly neurogenesis has been shown to be critical for learning, memory, regulation of mood, and decision-making. All of these things are also, of course, affected in alcohol use disorder. This does not necessarily mean that alcohol’s effect on neurogenesis alone is what underlies impairments in learning, memory, mood, and so on in AUD, but it likely plays a role.

*End Sciencey bit*

New Year’s Neurogenesis

But I’m not here to bring you gloomy news on this New Year’s day. This is a day about new beginnings. No doubt, some people will be making resolutions today; perhaps to give up alcohol for a month, a year, or for life, and other people will be resolving to eat more healthily or do more exercise. Well the great news for your brain is that ALL of these things are likely to lead to an increase in neurogenesis. Aerobic exercise, in particular, sports (pun intended) a wealth of evidence across a number of species (including humans) that it enhances the birth of new neurons in our brains. This is often cited as the reason why exercise improves mood, as well as learning and memory. Interestingly, neurogenesis has also been linked to forgetting. Although this seems contradictory to its role in learning and memory at first, forgetting is in fact a crucial function of the brain, allowing for the constant turnover and categorising of information; prioritising what it is we need to remember, and letting go of what we don’t. Moreover, my suspicion is that the role of new neurons in our brains in forgetting is what also helps to elevate mood, by encouraging forgetting of negative events and emotions, thus decreasing rumination over these events (which is heavily linked to depression) and allowing us to move on.

2019 and Beyond

So I hope that this information can provide a little extra motivation for those of you aiming to drink less, quit drinking, start eating healthily, and/or do more exercise. As for myself, I have already quit drinking and I already do a lot of exercise, but I certainly could do with eating a little more healthily. However, I have talked about the fact that I have had an eating disorder in the past, and have a tendency to become a little obsessive if I try to eat healthily. Therefore, my new year’s resolution this year is simply to try and be more mindful about what I eat, thinking about the taste and texture of each bite, and being guided by my hunger rather than just eating out of habit. Not sure if I’ll succeed, but if I don’t I won’t beat myself up. After all, each day is a new day, not just New Year’s day :).

I have seen a lot of recovery-themed blog posts around about the particular challenges facing us addicts at this time of year and have thought about writing something, however I have hesitated so far because there’s already a lot of excellent posts about how to cope etc, and I’m not sure I have much to add. So I’ll just tell you about my experience. Personally, this is my second sober Christmas (although I did briefly relapse since then, in March). If this is your first sober Christmas/holiday period and you are struggling, then please hang in there because the second one is soooooooooo much easier than the first. This is because, in addition to having been sober for longer and reaping all the benefits that come with that, I have been through the festive season sober once before and have already extinguished some of the associations between Christmas stimuli and drinking, as I will explain in more detail at the end of this post. First I will share my experience.

Like most addicts for whom alcohol was their drug of choice, Christmas has been inextricably linked with drinking for me for around 20 years, and especially so for the last 10. This is the time of year that suddenly people turn a little more of a blind eye if you start drinking at lunchtime (or earlier ) – hurray! – and it’s a bit more socially acceptable to be stumbling around drunk at any time. “Tis the season to be merry/smashed” after all. As much as I could get away with at this time of year, I would often start drinking around midday, continuing on late into the night, punctuated by periods of eating and snacking. Then I would start off the New Year feeling bloated, unhealthy, and miserable.

Last year – my first sober Christmas – honestly wasn’t that much fun. It was just so hard. As soon as the tinsel started to appear and the Christmas parties began, it took a ridiculous amount of willpower to resist drinking at every social event. And because I’m a stubborn bitch, I decided I wasn’t going to miss out on Christmas parties just because I was sober. So I went to almost everything, sat and watched everyone drinking whilst sipping on my soda and lime whilst feeling bitter and resentful. By the time it got to Christmas day, I was so angry with the world and everyone around me that seemingly everyone else could drink except me, that I spent the day in an agitated stupor.

This year has been VERY different. As a general rule, I love Christmas. I’m not religious in the slightest (as you know from my posts) and have never been a Christian, but I love Christmas nevertheless. I love the carols, the cheesy Christmas movies, the decorations, the dressing up, and the festive mood. I have been so glad to realise this year that I can still enjoy all that without alcohol. Indeed I enjoy it more, and remember it, and still make it to the gym in the morning so I don’t feel like a bloated mess. I am far more organised and get more done.

I have also learned to prioritise: I don’t have to go to every social activity. No idea why this didn’t occur to me last year, but hey, you learn right? So I still might go to a lunch, dinner, or a special Christmas workout at the gym, but if the point of the outing is simply to go to the pub and drink, then I’d rather be at home watching “the Christmas chronicles” on Netflix (how good is that scene when Santa gets everyone in jail to sing with him? Love it!).

This year, I bought Christmas presents early so I didn’t have to go at 11pm on December 23rd with all the other stressed out parents, and wrap them at the last minute whilst being annoyed with my husband because yet again, I had to do all the shopping (to be fair to him, he always does a lot of work on the house at this time of year that I don’t help with either). Also this year I don’t have to worry too much about cooking for Christmas Day because we’re going out for Christmas lunch! Not cheap, but then again I won’t be spending any money on alcohol this year, so overall I will still come out on top. I’ve also embraced the parts of Christmas that are fun and don’t require booze: I have done Christmas themed arts and crafts with my daughter, and made Christmas jellies and other Christmas snacks. I have a santa dress, two different pairs of elf leggings, and some bejewelled raindeer antlers that I’ve been wearing which has been a lot of fun. It is very hard for someone not to smile when they look at you while you are wearing a pair of elf leggings.

So to the brain. Just a little bit of fun neuroscience for you today. Did you know that there has been a study that has identified a part of the brain that represents the ‘Christmas spirit’. No way? Way! People who don’t celebrate Christmas didn’t have the same level of excitation in the primary motor cortex, the parietal lobule, and sensory motor cortex when exposed to Christmas-themed images. Of course, this network didn’t evolve solely for the purpose of Christmas spirit, but rather these parts of the brain are activated by the associations of Christmas-related stimuli with positive emotions, recognition of emotions in others, and spirituality (among other things). Back when I was drinking, and on my first sober Christmas last year when I still thought a lot about booze, these associations would have also included relations between Christmas stimuli and booze. However, having been through one painful Christmas without drinking would have meant that the expected outcome (i.e. an expectation of sparkling wine) did not match the actual outcome (i.e. soda and lime), which would have weakened the neural pathways underlying that association between Christmas images and sparkling wine. As a result, Christmas images this year are not making me think so much about sparkling wine, so I don’t have to fight so hard against that craving, and I can just relax and enjoy myself with less effort.

Finally, I should mention (as I have in other posts) that although these associations become weaker or replaced by other things, there is also a ton of evidence that they never go away completely. I certainly have had my moments of looking at a colourful cocktail for example, and imagining just one sip… but then I never did manage to ‘just have one sip’, so I have to also imagine the inevitable sips after that, and the obnoxious behaviour that would inevitably fall close behind, and the terrible hangover the next day, the drinking to get over the hangover, and… anyway, you get the point. Instead, this year I’ll just stick to my lime and soda (preferably with some fresh mint – no reason not to fancy up the soft drinks and make them feel special).

MERRY SOBER CHRISTMAS EVERYONE!!!

I quit drinking a year and 3 months ago, but since then had 4-5 relapses. However, I have been completely free of mind-altering substances now for a full 6 months (exactly 6 months today, Huzzah!). The thought of having a drink seems foreign to me now, and despite having some heavy stress at work, I haven’t once thought of drinking to get through it. Rather it surprises me that I ever used this as a coping tool. I have been in some incredibly awkward and difficult situations, but ones that came about because I confronted issues that were necessary to work through, and it occurred to me that if I were still drinking I would have taken a lot longer to confront them. Rather I would have hidden behind my drinking, escaping into my world where memories are lost instead of made, and thought I was ‘coping’ because at least I have a few hours each night where I didn’t think about the stress. This way is so much better. Having said that, I have randomly had the thought of drinking pop into my head a few times out of the blue – all the terrible things it brings with it are forgotten for a brief moment in which the urge just comes on strong and fast. But I either distract myself or talk myself out of it, and then it is gone almost as fast as it comes on, and I am left wondering how it could have ever entered my mind.

Another strange thing has been happening lately. My senses have seemed to be heightened. In particular, I will be walking along the street and seem more acutely aware of the sounds around me, things happening in my peripheral vision, smells seem stronger, and the ‘atmosphere’ appears to be more present. Then at home I noticed that I keep telling my husband and daughter to turn things down, and that I don’t ask people to repeat themselves as much when I am talking to them. It occurred to me… does drinking affect your hearing? Your sight? Since alcohol is a GABA-A agonist, and GABA-A receptors are found throughout the entire brain (rather than being localised to more specific areas such as, say, dopamine neurons and receptors are) we could assume that alcohol does indeed affect the visual and auditory cortices, as much as any other brain region I have talked about on this blog. So I did some digging.

Alcohol affects hearing and vision and olfaction (smell)

Lo and behold, alcohol DOES affect your hearing, vision and olfaction! Whhhaaaaat???

I mean, it is fairly obvious that your senses are impaired when you are drunk (especially if the room is spinning, or you can’t keep your balance – something that relies heavily on hearing), and scientific studies back this up. In one study, cats were given different doses of ethanol, and the amplitude of electrical activity in the auditory cortex in responses to sound were measured. After consumption of the 10% solution amplitudes increased, but after 20 and 30% solutions they decreased. Similar results were recorded in humans (10 white males) who were measured using EEGs. But these are acute effects. In other words, these are the effects of one-off consumptions of alcohol, not long-term effects resulting from its long-term consumption.

It is important to know that how the brain co-ordinates vision and audition is a much more complex process than often realise, because we take so many of the underlying processes for granted. For example, our brains are constantly working out whether what we observe matches our experiences, whether to pay attention to something and what to pay attention to, and what information is irrelevant and should be filtered out. In order to achieve these processes and stitch them together to form the unified, uninterrupted representation of our environment that we experience as consciousness, various underlying cognitive processes are also necessary. Indeed, to determine if current experiences matches things we have observed in the past or are novel, we must retrieve past experiences from memory. Memory is therefore involved in perception. Moreover, to determine what is important and should be attended to, emotions are often relied upon. Therefore, emotions must be integrated with sensory information to determine attention, and attention, in turn, of course informs what is sensed and what is ignored (i.e. you can’t see something if you’re not looking at it). When these processes come naturally we barely notice the array of complex computations that underlie them, but when they go awry, they can result in a number of different neuropsychological deficits, with schizophrenia known as one of the most common.

Prefrontal cortex (mild sciencey bit)

It turns out that the prefrontal cortex (among others), which is a region of the brain heavily affected in alcoholics, is also heavily implicated in many of the cognitive processes underlying sensory integration, and as a result, over-consumption of alcohol over a long period of time can affect these underlying processes. The result of this is a dulled experience of perception that can last for several months into early recovery. However, they do seem to abate after several months (although perhaps not as drastically if you have drunk so much as to have caused Korsakoff’s syndrome, a type of dementia caused by over-consumption of alcohol and under-consumption of thiamine), which I believe is the reason why the world seems to be a brighter, smellier, and noisier place to me now. It isn’t a huge shift, but it is noticeable, and it is wonderful, and it is something I don’t want to lose again. I should also note that alcohol can damage the sense organs themselves, such as the retina, damage which may also not be reversible.

Emerging from the fog

I have heard many people describe early recovery as ‘emerging from the fog of addiction’ and it certainly felt that way to me. However, I have been pleasantly surprised to find out that this emergence only gets better and more intense over time – months even. I know, of course, that some of this fog was caused by dulling of cognitive capacities that had nothing to do with perception, but I am surprised to find out that some of it did. I hope it keeps getting better.

Perfectionism Fucks You Up

I’ve been fucked up in various ways throughout my life, and most of these ways have been linked to my perfect storm of perfectionism, extreme discipline, and low self-esteem. I had an eating disorder for many years when I was younger, because I just couldn’t lose weight fast enough so I almost stopped eating altogether. Ignoring the growling stomach and the obsessional thoughts about food, I saw the weight drop off, listened to the compliments I received, and felt validated in my choices. Although this was many years ago, the after-effects lasted a long, long time, and it was only when I got pregnant that I decided to eat normally, because I didn’t want to starve my baby. At that point I realised that actually eating when you are hungry makes life soooooooo much more enjoyable, and leaves cognitive capacity free to think about things other than food. How on earth I earned a PhD whilst being so damn hungry I’ll never know, but then I was also a burgeoning alcoholic back then, so I guess it simply speaks to my other kind of ‘addictive’ behaviour: working too hard.

I have had plenty of opportunities to work myself ragged, starting in school during adolescence, and lasting right up until the present moment. I have studied away, getting great grades, qualifications, and more recently, publications in great journals. The phasic burst of dopamine that no-doubt accompanied each accolade (as well as each compliment when I was losing weight back in the day) did more than just make me feel good, it motivated me to work harder/eat less, and so forth. Only when those things didn’t come so easily anymore – when suddenly everyone I’m competing with had a PhD and was super-smart, or when I had a baby to look after and don’t want to starve myself – that phasic burst was harder to come by. This was when I really doubled-down on my drinking.

As I’ve mentioned previously, drinking is primarily a GABA-A agonist, which means it increases the actions of the major inhibitory neurotransmitter in the brain which can quiet all those pesky thoughts of not being good enough. However, it also increases dopamine (as I have also written about before). So when ‘life’ stopped producing those phasic bursts of dopamine, and reinforcing those adaptive and not-quite-so-adaptive actions of starving and working hard, I replaced them with a quick, easy, and artificial way in which to produce that same dopamine burst. This time, however, because the effects of alcohol are more complex than simply increasing dopamine in the brain, and because when the alcohol wears off the brain is trying to reach equilibrium again and dopamine levels are low, over the long term the drinking just made me extremely unmotivated.

There were hungover days when I didn’t get out of bed, and many, many more day when I did get out of bed, but not because I wanted to. Rather, what got me out of bed was because a sense of duty to my job, my husband, and my daughter. I remember the first time I took my daughter to the park after I stopped drinking, and I remember feeling bloody marvellous but also deeply ashamed that this was the first time in years I had taken her to the park without a hangover. I also remember when I first got into recovery, that feeling of having energy again. Suddenly it wasn’t too hard to do my laundry, clean the house, and sort out my clothes I don’t wear anymore and put them in the clothing bin. Suddenly I had the energy to do all the things I couldn’t be bothered doing before.

When Perfectionism Takes Over in Recovery

For all the wisdom and fabulous advice I have heard people give in recovery groups and have read in books, there is one piece of advice I think has been fundamentally missing. That is, you MUST find a balance in life. It can feel so great when you get into recovery and you suddenly have energy again, you feel motivated again, and you participate in life again. However, I do worry that some people take this too far.

Time and time again I have heard of people in recovery and their behaviour seems just as extreme as it was when they were still drinking/drugging, only it is being channelled into what is seen as ‘healthy’ behaviours and therefore is encouraged rather than discouraged. For example, people become vegan, or give up all sugar, or exercise three hours a day, or work themselves to the bone. I’m not saying that just because people do any of these things that they have a problem, they might not! But they might. And look – there are times (during grant applications for example) when I also don’t eat a lot and work pretty much 24/7. But the important thing that I have learned over the years, is that I can only do this temporarily if I want to stay sane. I am generally only writing grants for a certain part of the year, and I know that in that time, I will be working like crazy. But I also know that when those couple of months end, I’m gonna watch some real good Netflix, have some great picnics with my family, and have some loooooong baths. Even in those months I am writing grants I try very hard to take at least one whole day off a week.

It is common wisdom throughout the recovery community that ex-addicts make fantastic workers, at least once they have been sober long enough to become stable. I wholeheartedly agree with this, and no doubt our ability to work hard and do what it takes to get the job done feeds into this, not to mention the motivation and desire to be successful (once levels of dopamine are more or less restored and working as evolution intended – not induced artificially by a drug). These are all great things. However, I can’t help wondering sometimes whether the ex-addict who is running ultra-marathons and refusing to eat all sugar, dairy, and meat, is really doing so from a healthy mind-space (and all power to them if so), or is doing so in a desperate ‘addict’ kind of a way.

One of the men in one of my recovery groups died of his addiction recently after many years sober. In recovery, this man dieted and exercised to the extreme, worked hard, wrote a book, and so on. And who knows? Maybe those things had nothing to do with his death. I know he had other personal things going on. But I can’t help but wonder – when your mindset is so ‘All or nothing”, if you let go of the ”all” for a moment and let yourself eat a sausage, or sit on the couch instead of going for a run one morning, maybe it’s easier to lapse into the ‘nothing’ and get on that train straight back to addiction. I know that it would be for me.

So for that reason, I really try and watch myself, and all facets of my addict behaviour. I actually don’t diet at all anymore, although I do try and eat healthily (minus the two brioche buns I ate whilst writing this, but shhhhh). As I mentioned before I love to exercise – but to be strong and fit, not to win competitions or to be skinny. At work I also try to have a balance, although it works better at some times than others. But I have learned to say no a little bit more than I used to, and it feels good.

There isn’t much science out there that speaks to this that I know of, although please send some my way if you do. I do know, however, that addicts tend to be less sensitive to punishment, and I wonder if that applies to all of these other kinds of ‘addict’ behaviours as well as drinking/drugging. For example, if a ‘normal’ person stops eating sugar, but finds it really hard to the point of being aversive to refrain from eating cake, they will probably just crack and eat the cake. An addict, on the other hand, might just handle that aversion and manage to not eat the cake. This really is just speculation on my part, but it would be quite interesting if I were right. Indeed, it would imply that addicts actually have increased will-power relative to ‘normies’, contrary to common wisdom, and as counter-intuitive as that may sound.

In any case, I guess that is a question for future research. But for now, my suggestion to those in recovery is try and kerb all aspects of your ‘addict’ self, even those unrelated to your drug of choice. Because if you don’t, your ‘all or nothing’ attitude could lead you back down the path of addiction, and you KNOW that is not a place you want to be.

Yes. Now we can all stop reading. Thanks very much, please read again.

OK fine I will go into more detail, but seriously? Why is this even a question?

The definition of a disease according to Wikipedia: “A disease is a particular abnormal condition that negatively affects the structure or function of part or all of an organism, and that is not due to any external injury” well yep, I’d say that covers addiction wouldn’t you? Wikipedia goes on “In humans, disease is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in contact with the person”, wow it’s almost as if the person who wrote this broader definition did so with addiction in mind!

Still doubtful? OK what does the National Institute of Health say? “Recent scientific advances have revolutionised our understanding of addiction as a chronic, relapsing disease and not a moral failure”. That really gets to the crux of it, don’t you think? Because what people are really saying, when they say that addiction is not a disease, is that it is a choice, a moral failing. They see it as the individual’s choice to pick up a drug or a drink, that they could stop at any time if they wanted to. OK so let’s unpack that a little. Is addiction really a choice? Luckily, my research speaks directly to this question.

It is well established, and without dispute, that addiction is accompanied by particular chances in the brain. Some of these I have talked about on this blog already: the alteration in phasic dopaminergic firing from responding to the drug itself to the stimuli that predict it, and the long-term plastic changes in glutamatergic receptors in the nucleus accumbens to name but two examples. There are many more.

However, it is also true that all learning and memory changes the brain, and some have used this as their reasoning to say that addiction is not a disease after all. In particular, that other ‘neuroscientist in recovery’ Marc Lewis is a strong proponent of the idea that addiction is a memory disorder that is formed by repeated experience. I don’t dispute this, but I would argue that it does not mean that it is not a disease.

*Sciencey bit*

In addition to the changes I have already described on this blog, there are alterations in the striatal “action-selection” centres of the brain during addiction. To be specific, there are two parts of our dorsal striatum that control action selection the middle ‘caudate’ and the more lateral ‘putamen’. When we are in control of our actions, or our actions are voluntary and conscious, there’s a lot of evidence from animal studies, neuroimaging studies in humans, and more, that it is the caudate that regulates action selection.

On the other hand, when actions are repeated over and over, in the presence of the same stimuli, they no longer become consciously controlled, but are instead involuntary, automatic, and habitual. At this point action control is transferred to the putamen.

*End science bit*

There are a number of consequences of this switch in control from what we call ‘goal-directed’ to ‘habitual’ processes. One of the main ones is that actions will be elicited in the presence of particular stimuli much faster than they would if they were voluntary, and under normal circumstances this is efficient. For example, right now I am touch-typing this blog post without any thought as to where the letter ‘A’ actually is, and if I start to try and think about where the letters are, it slows me down. This habit is adaptive.

However, in the case of addiction, habits can be maladaptive. This is because another consequence of action selection becoming habitual is the fact that, once habitual, the ‘goal’ or the ‘outcome’ of the action itself becomes somewhat irrelevant to whether the action will be produced or not. So when you hear someone say that they went to X place and ended up drinking/drugging, without even really knowing why or how they ended up there, chances are that it was a simple reflex, a habitual response elicited in the presence of particular stimuli without any thought for the consequences. This often happens outside of addiction too: when we automatically take a wrong turn because we are so used to turning left at a particular intersection, for example. At these moments, it is our putamen and not our caudate that is in control.

There is lots and lots of evidence that, in addiction, goal-directed control is impaired. What this means is that addicts have less voluntary control over their actions, and are more reliant on habits. When those habits are tuned towards drinking and taking drugs, well you can imagine the consequences: more drinking/drug-taking. So no, sorry, addiction is not a choice. Absolutely not.

The other thing I’d like to point out, is there are plenty of brain disorders that involve an interaction between a genetic predisposition to a particular disorder and environmental circumstances, that no-one would question the nature of whether they are legitimately a ‘disease’ or ‘disorder’. Individuals with a genetic predisposition to schizophrenia, for example, who smoke a lot of weed in adolescence, might end up schizophrenic. If either of those components had been missing: the predisposition OR the smoking weed, the individual might not develop schizophrenia. Does that mean schizophrenia is not a disease? Of course not! To take a different disease: there is evidence that individuals who do not look after their health generally, do not exercise, and do not perform cognitively demanding tasks are at more risk of Alzheimer’s. So again, there is often an interaction between a genetic predisposition and environment for an individual to end up with Alzheimer’s. Do we then say it’s not a disease because there’s often (although not always) an environmental component? Of course not.

The truth is, addiction is just like these disorders in the sense that individuals who have a genetic predisposition to addiction who are exposed to alcohol or drugs will often become addicts. Again, if either of these elements are missing: the exposure or the predisposition, an individual will not become addicted. Indeed, most people who drink alcohol do not have a genetic predisposition, and therefore do not become problem drinkers. Yet they still make the same choices addicts do initially: to have a couple of drinks. No-one sets out to become an addict. Therefore, to characterise addiction as a disorder of low will-power is simply ludicrous.

To those who prefer not call addiction a disease because they find it empowering and believe that it gives them a choice not to drink in recovery, that’s fine by me. Do whatever you need to do for your recovery. But I choose to exercise a lot, partly because I know it is neuroprotective against Alzheimer’s -that’s my choice, but it doesn’t mean Alzheimer’s is not a disease.

Having said all of that however, whether you call addiction a disease or not, the really, really important thing to remember is that addiction is not a moral failing, it is not a choice, and most importantly of all: you can make choices every day that will help you recover.