Getting Personal in a Time when #timesup

woman hiking
Photo by Alex Tim on Pexels.com

 

I watched ‘Nanette’ by Hannah Gadbsy on Netflix last night, and WOW WOW WOW! What a show (if you haven’t seen it I have tried to keep spoilers out of this post). I have to be honest, I was a little apprehensive about watching it beforehand, based on a couple of reviews I had read. I mean, I like to think I’m pretty ‘woke’ an all, but sometimes I’m just… tired (ironically so it turns out, so is Hannah). I had heard that Nanette was bang on message for many current ‘woke’ issues, and sometimes I just get a bit of fatigue with it all (‘woke fatigue’?). I know that it is part of my privilege that I am able to get fatigue about these issues, and as a middle class white woman I’ve certainly had my fair share of privilege. Nevertheless, I just wasn’t sure if that’s how I wanted to entertain myself after a long, hard day at work then being a mum etc. But damnnnnn, Nanette was worth it.

One area in which the odds have been stacked against me somewhat, and I can relate to being an underrepresented minority, is in my career. Neuroscience, and behavioural neuroscience in particular, is very top heavy with white men. That is, although most of the graduate students and people in the early phases of their career are female (I’m not sure of the exact numbers, but I’d estimate at around 70-80% female), the further you get up the career ladder, the more those numbers switch around completely. By the time you reach Professor level, the numbers are approximately 80%+ male. Representation of other minority groups is even worse, and those of us working in science have a lot to do to make things fairer and more equal.

What does this all have to do with drinking or addiction I hear you ask? Well a number of things. Before we go on, I would like to say that I know these are first world problems, but they are still problems, and did feed into my addiction nevertheless. One of the reasons I drank was because I think that as a female striving to make it in this field, I felt highly visible in the sense that each time I go to give a talk, I feel the weight of various expectations on me based on how I look (i.e. that I won’t be that smart). I have also experienced things like giving a talk and having all questions about my research being directed to my (white male) supervisor. I have been overlooked a number of times in favour of males when trying to ask questions at conferences, something I see happen to other females all the time. I have been told that people think I don’t understand my own research. I have had grant reviewers pull me up on ‘gaps’ in my track record, that they extended to 3 x as long as they actually were and having completely overlooked the fact that I had given birth to a WHOLE FRIGGING HUMAN BEING the year before and had been on maternity leave. I have had other grant reviewers question the contributions I made to my first author publications relative to my (white male) senior author. I have been told that I need to have a thicker skin and get over all of this. Put the pressure of dealing with all of this on top of all the other immense pressures brought on by such an intensely competitive career choice and it’s a potent mix, ripe for self-esteem issues and you guessed it… drinking.

As I said, I know these are first world problems. They are far from the worst problems I have ever had to deal with in my life, but that doesn’t mean that they don’t matter and that they are not important. They do and they are.

Well I am emboldened by Hannah Gadbsy, and I am sober now, and I’m not gonna take this shit any more.  Because I have advanced in my career somewhat now, I don’t tend to get overlooked when trying to ask questions at conferences so much anymore, and I don’t get people making as many inaccurate comments on my grant reviews. But that doesn’t mean the unfairness isn’t there any more for other, younger females. I also really hope that I can help the young female scientists navigate their way through it the way that some of the badass female neuroscientists I know have helped me. I know there are also some fantastic men in my field who are also well aware of these issues and are fighting to make things fairer and more equal, and I totally support that too. And if someone tells me to grow a thicker skin then they might be told which improvements society could make to be more supportive of female scientists.

I am so glad I sobered up at this point in my career. I think I had a lot of shame, I certainly had low self-esteem, and I took these negative things people said and did personally or thought that I had done something wrong. But my head is clear now, and I can see clearly.

I can see clearly now

What does this have to do with Nanette? Well the reason I found this show to be SO incredible, was not anything to do with it being so zeitgeisty, but rather because it was so raw and honest and vulnerable. Damn Hannah, your emotions were real and you made me feel. I didn’t agree with everything she said, but that’s OK. We’re adults and we can still be friends (can we Hannah? Please?).

It also made me think about this blog and what I am doing here. I wanted to start this blog so that I could start a dialogue with the recovery community, and I sat back and thought for a moment about how well I have been doing at that. I start thinking about whether I was really connecting. Have I been my most vulnerable and honest self? I certainly haven’t been dishonest, and the topics that I have covered have been interesting and important to me, but something was niggling at me.

Then I came across a podcast interview with Prof. Alan Jasanoff, author of the “The Biological Mind: How Brain, Body, and Environment Collaborate to Make Us Who We Are”. Very interesting interview, give it a listen if you have time. Again I didn’t agree with everything he said (I guess I can be quite disagreeable sometimes!) but one point that he did make got to the core of something that was niggling at me. It was this concept of ‘cerebral mystique’. This is the idea that the brain is not some distinct, unknowable entity, but although complex, is essentially a part of the body it is attached to as well as the environment it experiences.

It was exactly this mystique that I wanted to tackle in my blog. I wanted people to realise that the brain can be knowable and although it is unimaginably complex, we also do know a lot about how it works. I wanted people to know that it is not just drugs that change the brain, but our experiences, learning and memories all change the brain as well. I wanted people to know that even though the names of particular parts of the brain sound big and scary, in the end they are just names – names like ‘arm’ or ‘leg’ or any other part of the body. When you know the names of the brain parts this mystique recedes a little bit. And if we realise that experiences can change the brain, just as drugs can, then I think this can feel very empowering.

Other than that, I also want to figure out how to be vulnerable and how to put the ‘real me’ on the page. I really struggle with this, as I know many other people do, but, as the famous Australian saying goes “I ain’t here to fuck spiders”. In other words, I’m not writing this to half-ass it, I want to be vulnerable and I want to give you all of me. But I need to figure out how to do that, so after this post I’m gonna take a little break and re-assess. Thank you all for reading so far.

Should I Smoke Marijuana in Recovery?

 

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Using Marijuana in Recovery

I don’t really like smoking weed. Those who know me might be surprised to hear that, because I have given it a really good nudge in the past. I think sometimes I would smoke it just to feel something other than sober, or because I was hungover, but I never really like the high. I certainly never liked it as much as alcohol.

In my younger days I would smoke weed in cars or parks and stuff, and I would always have to be the last person out of my friends to smoke because as soon as I did I was immediately convinced the police were going to come and arrest us – much to the amusement of my friends. As I got older my paranoia would move on to believing that people were talking about me, or laughing at me, or other paranoid thoughts. One time I may or may not have even been a little bit scared that aliens were coming to get me from outer space (sadly not even joking). I have smoked weed a couple of times since I quit drinking, just to make sure that I reeeeaaalllly don’t like it. However, I finally admitted to myself that I don’t like it several months ago and stopped for good.

But other people do like it. It doesn’t make them feel paranoid, it makes them feel relaxed. Some people believe that it is not as addictive as alcohol and other drugs, and not as damaging, so some people substitute it for their drug of choice. Well I have no judgement on people who choose to do that – I can’t tell you what’s right for you. But I can tell you the facts, and they do seem to suggest that it isn’t quite as harmless as many would like to believe.

Cannabis and the Brain

*Warning sciencey bit*
There’s actually still a lot we don’t know about the effects of cannabis on the brain. This is one of the reasons I tend to be sceptical when I hear claims that it is ‘harmless’ and not linked to mental health disorders etc. The latter claim in particular, is demonstrably untrue, because cannabis use is strongly linked to schizophrenia, as well as several other mental health disorders, particularly amongst those who smoke heavily during adolescence. However, it’s not entirely clear if the evidence is causal or correlational (in other words, does smoking weed cause schizophrenia, or does schizophrenia cause smoking weed? Perhaps those affected are more likely to smoke to get relief from their symptoms. I don’t think science has answered this – but happy to hear about it if I am wrong). One thing that is pretty clear, however, is that smoking weed is not good for the developing/adolescent brain. So if you’re a teenager, then you probably just shouldn’t smoke weed.

Brain_Marijuana-1500x630

As for what we do know about marijuana’s effects on the brain; well the active ingredient in cannabis is THC, and it is this that binds to cannabinoid receptors (specifically CB1 receptors). This has been linked to increasing ‘magical thinking’ and ‘imagination’, but I think at a fundamental level it really just magnifies your thoughts. So whatever the basis is there for already gets exaggerated. It also releases dopamine and norepinephrine, which can lead make you feel good or anxious, depending on several factors.

At a circuit level, marijuana can affect CB1 receptors in your hypothalamus, messing with satiety signals and hence giving you the munchies. It can affect your amygdala that regulates emotions and basal ganglia linked to decision-making. We’re not really sure why it has different effects on different people, but my assumption is that it builds upon the foundation that is already there. For me, because I am already quite prone to anxiety, smoking weed can amplify these thoughts and feelings and lead to paranoid thoughts. Of course it also affects your cerebellum which regulates movement and coordination.

Smoking marijuana also affects the hippocampus, although this possibly occurs primarily through neurotransmitters other than cannabinoids. This brain region is central to learning and memory. In particular, it is important for those memories of the things that you experience, rather than memories that have to do with learning facts about the world or learning skills. This is why if you smoke weed often, your memory can tend to be quite hazy (alcohol also affects this part of the brain, so if you drink and smoke, you might be particularly forgetful!).
*End Sciencey bit*

Should I Stay Away from Marijuana in Recovery?

I just don’t think that there is a ‘one fits all’ answer to that question. If you smoking weed sparingly (not every day), whereas you used to shoot dope every day, and your life is all the better for smoking, then I don’t think I should be the one to tell you to stop. Especially if you do stop and your life goes to shit again, that’s not going to do anyone any good.

I should also make it clear that I am not referring to medicinal marijuana for anything other than addiction here. The science is really very preliminary with regards to medicinal marijuana, despite what a few loud voices over the internet might have you believe. Therefore it is totally possible that smoking weed might be helpful in overcoming nausea for cancer patients undergoing chemotherapy, for example. There’s also cannabidiol that does not contain THC, which might be particularly helpful in treating a range of conditions. I am not speaking to those uses of marijuana here, I believe with regards to those we should go with what the science says. I am only speaking to the addict in recovery who is thinking about substituting their drug of choice for marijuana.

In these instances, my worry is that the person who substitutes one drug for another will not adequately address the underlying issues that led to their addiction in the first place, and then end up addicted to a whole new drug all over again. I have heard of this happening to a number of people in recovery. And yes I do think marijuana is addictive, psychologically at least. It might not induce tolerance and physical dependence in the same way as alcohol and heroin etc, but it certainly contains perceived value that can be imbued in its use and everything associated with it. That alone can produce a physical reaction in the brain and, over many learning episodes, a psychological need for the drug. It’s also a little worrying that if you are smoking weed you are still partaking in a mind-altering drug that could lead back to your drug of choice. Also if we take what we know about marijuana’s effects on the brain into account, then it just doesn’t seem to be as harmless as advocates would have you believe. Several lines of evidence now suggest that the damage from smoking heavilly over a long period of time can be long term.

So in short, my answer is that you probably shouldn’t smoke weed whilst recovering from other addictions. But as I said, I never liked it much anyway so the decision may have been easier to make for me than for others.

I’m sure there are bound to be those who disagree with me on this one, so feel free to let me know what you think. I am here as much to learn as I am to impart the knowledge that I have.

Big Pharma, Industry, and the Study of Alcohol: A Scientist’s Perspective

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Oh Frigging hell.

A $100 million study titled “The Moderate Alcohol and Cardiovascular Health Trial” was recently pulled because of corruption and credibility issues, resulting from collusion between Alcohol industry executives, scientists, and government officials.

Frigging hell.

But before I get to that…

Big Pharma Tangent and Sticking up for Scientists

I started this blog for many reasons, one of which was to try and give a different perspective to the way that scientists and scientific research is portrayed on social media and certain other circles on the internet. What I mean is that there is a general distrust of big corporations, of ‘Big Pharma’ and so on and so forth, and sometimes scientists get lumped in with that. We can be seen as pawns working for pharmaceutical companies, exploiting people for profit, or altering findings in order to earn money for shareholders.

I get it! I really do. I look upon the role of drug companies in the US in the current opiate crisis with as much horror and disgust as anyone else. It is awful that people are dying and lives are being ruined every day, all because of greed.

But to speak for myself for a second, and for my colleagues, and for the vast, vast majority of scientists I know, I would like to say that most scientists I know are good people, who got into this biz because they want to help others. I know I did. Like myself, most of the scientists I know don’t work for pharmaceutical companies (although plenty of good scientists do), they work for Universities and Institutes. Most scientists I know work on their own ideas funded by competitive grants with no vested interest in particular outcomes. We are just trying to find out what the brain does, and we don’t argue with the data. Most scientists I know have never had anyone tell them what to study, ever, or had anyone put pressure on them to produce results in a certain direction. Most scientists I know have never knowingly been compromised or misrepresented data. I certainly haven’t.

A Lack of Trust

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Despite all of that, however, there is still a general distrust of the scientific community, and the recovery community is particularly vulnerable to this. Although this makes me a little sad, it makes sense. Those in recovery are those who have lost so much because of drugs and alcohol, and their addictions may have started with a prescription, or succumbing to societal and advertising pressures to drink, and when these things are seen as being linked to scientists, it is understandable that we would be looked upon with distrust.

But scientists and industry/big Pharma are not one and the same, and they’re not all bad. There are so many of us out there, working hard to try and make things better for people.

A Setback (back to Frigging hell)

With all of that in mind then, it was more than disappointing to read about a recent $100 million study involving over 7,000 participants examining the possible health benefits of drinking alcohol being shut down because of corrupted interactions between individuals in the alcohol industry, scientists, and government officials. Disappointing on so many levels. It is events like this that make it difficult for the general public to trust scientists, and make it tempting for people to tarnish us all with the same brush.

I must be clear for a minute, however, that when it comes to science and the study of the effects of alcohol or drugs, scientists MUST approach that the data for what it is. As much as my life has unimaginably changed for the better since I have quit drinking, that doesn’t mean that this is the same for everyone, and it doesn’t mean that moderate drinking is bad. If the data shows that moderate drinking is healthy, then we have to go with what the data says, whatever our personal feelings are on the matter. We have to be unbiased.

Of course, as it turns out, there are plenty of studies showing that even moderate drinking can actually be bad for us, especially in terms of raising the risk of cancer (alcohol is a group 1 carcinogen), and more recently dementia for example. This information was produced from good studies conducted by good, uncorrupted scientists, in the aim of trying to help us become a healthier society.

Therefore, I am as disgusted and as horrified as anyone else that this large study has been corrupted, that people’s trust has been betrayed, and so many people’s time and money has been wasted. I can’t imagine how it must feel for the scientists involved with the study who were innocent – and there were many because they were the ones who worked diligently to expose those that were colluding with industry. I would also like to note was scientists at the National Institute of Health and the National Institute of Alcohol Abuse and Alcoholism that shut down enrolments into the study and eventually investigated and exposed the corruption.

So we’re clearly not all bad.

But we have to do better.

Scientists Have to do Better

As scientists we are privy to a certain way of thinking. For example, if we see reports in the media of a study showing that ‘drinking red wine is as good as going to the gym’, for example, we would usually know to take this with a large grain of salt. Specifically, because of our extensive years of training in how to critically evaluate information, we know that things like a) the findings of the study are likely to be much more nuanced and complicated than have been reported (in the linked study, for example, participants were fed resveratol, an ingredient in red wine, not red wine itself), b) one study alone generally doesn’t prove very much, rather what is important is the convergence of evidence from many studies, and c) we can make informed assessments about the likely quality of the study based on the journal it is in, and how likely it was to have involved conflicts of interest (such as industry funding from a partner that has an interest in seeing certain results). We can know all this information quite quickly upon reading an article. But the general public don’t study science for around a decade like we do, and then go on to live and breathe science every day in their jobs like we to. So we have to do better.

As scientists, we need to ensure our results are being reported accurately, and to ensure that hyped up results are put into their correct context in a way that is jargon free, and easily accessible. Hopefully this way, we can start to install trust in our profession again. We also need to talk to people, to start a dialogue. Not to sit in our labs and talk to other scientists all day, but talk to the real people that are living the issues (e.g. addiction, dementia, mental health disorders) that we are studying. I should note that there are plenty of scientists already doing this – the conversation is a good example. But there’s always room for improvement, and in the words of the great Michael Jackson “I’m starting with the (wo)man in the mirror“, starting with this blog. Even in the short time I have been writing here I have learned so much about the opinions of non-scientists, how to communicate my ideas more effectively, and so on. But I still have much to learn.

Progress not perfection eh?

Sunsets in Recovery: Something I can’t explain with science

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Photo by Pixabay on Pexels.com

It has been a massive week. HUGE! Usually I would have written this post a few days ago and then spent a couple of days editing it. This week I am late and there will be no time for editing. Straight from my brain to the page.

It has been a massive week because of work, but also because we went away for the weekend. One thing I appreciate very much since getting sober, and something that seems to be pretty common among those in recovery, is an appreciation of nature. So I was really looking forward to going away for the weekend, getting away from the traffic and busyness of the city, and spending some time in nature. Unfortunately it rained pretty much the whole weekend.

Today was sunny though, and as I was hanging out the washing I turned around to see the most beautiful sunset, and took a few moments to appreciate it. This is something I don’t remember ever doing when I was drinking – back then it was as if I just didn’t notice the world around me. Possibly I simply wouldn’t have been out hanging washing at that time because I would have been inside drinking, so I just didn’t have the same opportunities to appreciate nature. Now if I’m angry, or frustrated, or just feeling waaaaay too many emotions (y’all in recovery know what I’m talking about!), taking a walk and getting among nature is right up there as one of the best things I can do to work out those stresses, along with exercise and writing about it.

Going for a walk has saved me from drinking a number of times. I remember the first BBQ I went to after I got sober, and I found myself getting really agitated. Everyone was fine (my friends actually accept the fact that I don’t drink anymore – they are far more grown up than I ever used to be) but I was getting antsy. Then I thought, why not just go for a walk? So I did. I walked and walked and walked until I stopped on a bridge, and saw the most spectacular sunset I had ever seen. It was mesmerising. It even made me understand for a second why people could feel that there was a higher power guiding them, sending them messages and so on.

When I saw that spectacular sunset in early recovery, I certainly felt a sense of connection with nature, but for me this was not necessarily spiritual. I am sure there is a scientific reason out there for this feeling, and that it is discoverable, but I haven’t come across it myself. Indeed at the time, I tried to think of scientific ways I could make sense of this connection. For example, I reasoned that everything in nature is connected in a sense, as everything living shares a certain amount of DNA. But the sun doesn’t have DNA. And even for things that do, what is the mechanism by which shared DNA might make us feel connected?

At the end of the day though (see what I did there? The end of the day! That is when we see the sunset!!! Ah ha ha ha ha ha ha. Just me? OK just me), it doesn’t matter why. It doesn’t matter what the mechanism is, the most important thing is that we feel that awe of nature, or some type of connection when we need to. And that we don’t pick up, of course.

So that’s it for this week. No ‘sciencey bits’ as I really have no knowledge of any science that speaks to the fact that we didn’t notice nature in addiction but do in recovery, and I haven’t had time to research any. Happy to hear about it if anyone knows of any studies? Or your personal theories! I’m super busy so I can’t promise extremely detailed responses, but I will read I promise.

Have a great week 😀

 

Overthinking and Drinking

 

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If you’re anything like me, then there are times when you start thinking about something…. then something else… then that same thing you first started thinking about again… around and around in circles without getting anywhere and you wish your brain would just shut the hell up! Especially at night when I’m done with work and chores for the day, and all I can think about is what I have to do at work over the next few weeks, all the chores I haven’t gotten around to yet, that bill I haven’t paid, and the fact that it’s library day at my daughter’s school tomorrow so I must remember to put her library book in her school bag. Fun.

Then there’s the longer-term and more serious kind of rumination (basically a fancy term for overthinking) that my brain appears to involuntarily indulge in. I am definitely a ruminator. I can have conversations with people and still be thinking about something stupid I’ve said hours later and what I should have said instead. I also ruminate about work. A scientific career is one ripe for rumination: about how I’m not good enough, how I should have X many publications and grants by now, how people are going to rip me apart next time I give a talk, how people don’t take me seriously because I’m female in a still relatively male dominated field, how if they do take me seriously then they end up finding me pushy or arrogant or resting bitch facey.

If you like being happy (because so many people love being sad), then rumination is a problem. In fact, it can lead to quite serious anxiety and depression. Or maybe it’s caused by anxiety or depression, or maybe its both caused by it and causes it. Regardless, it is highly correlated with anxiety and depression.

This is why alcohol can be so appealing for people who like to overthink. Just a few sips of alcohol and suddenly, all those unnecessary extra thoughts go away. You get to be present in the moment and stop worrying about tomorrow, as put so elegantly by Sia in her song Chandelier: “IIIIIII’m gonnna swing from the chandelier…. I’m gonna live like tomorrow doesn’t exist”. A kind of alcohol-induced mindfulness.

*Warning sciencey bit*

Like most things (everything) in life, there’s good reason why alcohol helps us quiet our thoughts. This is because it is a GABA A receptor agonist, meaning that it activates GABA receptors, and GABA is the primary inhibitory neurotransmitter in the brain. Activation of these receptors therefore causes hyperpolarisation of the neuron. In lay terms, it means that alcohol makes the neuron less likely to fire and therefore slows or reduces its communication with other neurons. This is similar to what anxiety medications such as Xanax or valium (or other benzodiazepines) do. (As an aside – some neurons that release GABA are known as “chandelier cells”. I wonder if Sia knew this when she wrote her song?)

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These effects of alcohol on GABA are further compounded by the fact that it seems to suppress glutamate, the main excitatory neurotransmitter of the brain. This is another way in which alcohol depresses neural transmission. Thus when people say that alcohol is a depressant, and they don’t mean that it makes you feel depressed, they actually mean is that it slows neural transmission. In fact, because it can cause your brain to shut the hell up for a second, it can make you feel happier, especially for those prone to rumination.
*End sciencey bit*

It is this reduction of neuronal excitability that makes alcohol particularly appealing for overthinkers like me. All those thoughts, worries about what you said yesterday, about what you have to do tomorrow etc, get dampened down and all that neural noise just shuts down for a little while. Want to sleep? Just lay your head down on the pillow…. And voila. Sleep. Aaaaaah bliss.

But there’s one more piece of this puzzle that I haven’t explained yet, but that is really key. Alcohol only shuts your brain up for a little while.

What happens when the drunk feeling goes away? The overthinking and anxiety and depression come back stronger than before. The thing is, the body and brain don’t like being artificially ‘thrown out’ of their normal state of equilibrium by alcohol or any other drug, and it will fight to get back to where it was when the alcohol wears off. This means that although when you are drinking all that neural noise shuts up for a minute, the next day it comes back harder, stronger, and more forceful. Not only that, but you are now possibly also dealing with a hangover so you are overthinking whilst your body feels like shit. Not only that but you also have to deal with the very possibly stupid things you did last night that you regret, or have the vague feeling that you might have done something stupid but you can’t remember. I certainly spent many ‘next days’ trying to piece together what I said to whom, or did the night before (getting in bed with my parents naked anyone? Nope just me).
Of course, because alcohol can make your brain shut up for a little while, many people who suffer rumination in anxiety and depression are drawn to drinking it. But then when the effects of it wear off the next day, you feel more anxious, and if you’re like me, you drink again to get over it. Before you know it BOOM you have both anxiety and a drinking problem. FUN FUN FUN!!

When I got into recovery, I was very pleasantly surprised to find that many of my anxieties just went away by themselves. At social events I stopped forgetting what I said to people, and was more sure of what I did say because it was under my control. Therefore I didn’t need to ruminate over it later. I also just learnt to put the thought out of my mind before giving into rumination. If I start thinking about the stupid thing I said to someone, I just immediately counteract that thought with “that person will not still be thinking about it, so you don’t need to”. Sometimes this works better than others of course, but ya know. Progress not perfection. At work too, I’ve found that I believe in myself a lot more. I also work harder and my thoughts are clearer, so that helps a lot. Plus I have been more successful at work in sobriety (who knew right?) so I have received positive reinforcement from my successes.
The one final thing I will say with regards to overthinking is that, in sobriety, I do think it is very important to find some kind of mindfulness in life so that you have a certain amount of time each day when you are completely absorbed in a task and not thinking about what you have to do tomorrow or what you did yesterday. Science has shown that we are happiest when we are totally absorbed in a task. I have never been particularly good at meditation or tried particularly hard to get good at it, but that’s one avenue that a lot of people swear by. The science about meditation in particular is overall a little mixed but certainly there’s some positive studies and plenty of anecdotal evidence out there suggesting it works. What works best for me, however, is exercise, particularly vigorous exercise at the gym with other people. When I am working out, my mind is completely focused on how many reps I’m doing/what weight I’m doing/how gassed I am etc. Working out with other people also provides a social aspect, and lots of people who aren’t that into drinking go to the gym. Exercise is also amazingly good for your brain and general fitness etc. I really couldn’t have gotten sober without it.

So whatever you do in sobriety, my advice is find something to do that helps you shut your brain up for a second in a healthy way. Exercise, meditation, singing at the top of your lungs, or even watching a scary movie. All great things to do with the added bonus of not producing a hangover tomorrow.

Relapse Part 1: Romanticising alcohol

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How long does it take your brain to return to normal in sobriety?

One question I see asked a lot within the recovery community is, “How long does it take for your brain to return to normal when you quit drinking/drugging?”. The answer I see given most often is one year, but like anything to do with the brain, the answer isn’t that simple. The truth of the matter is, some recovery of normal function will occur within 24 hours, whereas some synaptic pathways laid down during addiction may never change within a lifetime. This isn’t reason to despair – remember that every time we learn something/make a memory, there are changes in the brain that accompany that. So all the learning that occurs in addiction, such as all the associations between relaxing and drinking for example, or even between the label on your favourite brand of beer and getting drunk, those associations might potentially last for a lifetime. This is why you might hear old-timers 20 years into recovery suddenly reporting a craving after catching sight of a beer they used to drink, or the thought or drinking seeming to randomly pop into their head when celebrating an occasion or milestone.

I say this isn’t reason to despair, because we do a lot of learning in recovery too. We form new associations, new coping mechanisms, and new habits that counteract the old ones. All of these changes are also associated with plastic changes in the brain, such as new synaptic pathways, and the increased/decreased likelihood of an existing pathway firing. So what I’m saying is, we can and do change our brains for the better as we go through sobriety. Unfortunately, however, this learning isn’t always enough to prevent a relapse, although I do believe that through relapse we also learn, as I will explain.

As I mentioned in my first blog post, I have had a few relapses since I made the decision to quit drinking for good, perhaps 4 or 5. Perhaps 2 of these relapses have involved drinking over a few days, whereas the others were only a single day. In the recovery community it is often stated that relapsing is part of the journey, and I think that this is one area in which the science and recovery wisdom match up. Before I explain why, I want to say that I really don’t want anyone reading this to use this information as an excuse to relapse. I can’t have that on my conscience!! I am JUST talking about what I have learned from the relapses I have already had. I DO NOT intend on relapsing again ever.

In fact, whilst I was writing the first draft of this blog, something happened that really drove home to me how dangerous relapse can be. One of the lovely men in one of my online recovery groups relapsed after many, many years of sobriety, and he died. It actually makes me really sad to write that sentence, because although there are around 5,000 people in this particular group so it’s hard to know everyone, I had had some really lovely chats with this man. A lot of us had, and he had written a book as well as given an interview for a podcast, so a lot of us felt like we knew him. So of us did actually know him.

So PLEASE don’t read this and relapse! Don’t do it. OK? OK good thanks for that.

What does it mean to say relapse is a part of your journey?

When it is said that relapse is a part of your journey, it’s hard to know exactly what is meant. Like anything in recovery, it probably means different things to different people. I think part of it is probably intended to take the shame out of relapse. I see in the groups that people seem to suffer great shame when they relapse, and are very hard on themselves. If they can turn around and take the positives out of the experience, then it removes some of the shame. Also the identification of the fact that relapse is something most of us experience helps remove some of the shame. Personally I have never felt shame about my relapses, because I focus on how much sobriety I have had over the last year. A hell of a lot more than I had the year before that, that’s for sure! But I’ve also learned a lot from each and every incidence of relapse.

Incubation of craving – otherwise known as ‘romanticising of drinking/drugging’

My first relapse was a glass of wine I drank at a wedding, and it was because I was hungry. I was also angry, or “hangry” more accurately, and “Hungry, Angry, Lonely, Tired” are the common signs to watch out for in relapse. I was suffering two of them. OK, don’t to to weddings hungry. Lesson learned. My second relapse was at a 40th birthday. I didn’t start drinking until 10pm. I was stressed, and anxious, and lonely and wanted to hang out with my friends. Next time go home, post online, write. Wait until the morning and give my husband and daughter cuddles. Lesson learned.

The third time was different. I was stressed and working far too much, but that wasn’t the reason for the relapse. I had started romanticising drinking in my mind. I would see a glass of wine and I could almost taste it on my tongue, and it tasted like heaven, like nothing I’d ever had before. I started imagining this ‘old’ world in which I could drink and escape from all my problems for a few hours (never mind that alcohol was the thing causing a lot of these problems, and never mind that for the last few years it didn’t offer much of an escape anyway).

*Warning sciencey bit*
In the behavioural neuroscience literature this romanticising of drinking/drugging is known as ‘incubation of craving’. We can model this in rats. Of course we don’t know what the rats are actually thinking or feeling, but if a rat or mouse are trained to press a lever for ethanol (alcohol) or cocaine for example, and when the animal receives the drug, a light in the box will also turn on. If you then don’t give the animal the drug for 24 hours, then allow them to press the lever for the light they will press less than if it had been 3 weeks since they last had the drug. Similar effects have been shown when animals are tested 6 months later, which is a quarter of the lifetime of a rat or mouse, so these are long-lasting associations.

From this work we know that within the nucleus accumbens, there are changes in the way that neurons communicate with each other via synapses, and even the way in which particular neurons receive messages from other neurons, after long periods of withdrawal from drug. These are long-term plastic changes in the nucleus accumbens; specifically the way in which various types of glutamate receptors respond to neuronal inputs (see diagram of gluatamatergic synapse below). In this way it has been shown that addiction involves more than just dopamine as is commonly thought, but also involves changes in glutamate transmission, glutamate being main excitatory neurotransmitter of the brain.
glutamatergic synapse

What is especially exciting about this research is the possibility of developing medication that could specifically target these (metabotropic) receptors that have specific effects in incubation of craving weeks and weeks after withdrawal to prevent relapse. But that is still a way off into the future.
*End Sciencey bit*

Similarly, in my personal experience I found that after getting over the initially strong cravings, I honestly didn’t think about drinking that much. I thought I was cured! Yet at around the 4 month mark suddenly I would walk along the street and see someone in a café drinking a glass of wine out of the corner of my eye and it was like everything else in my vision went dark and I could only see the wine. I could almost taste it in my mouth and it tasted like heaven. I could feel the warmth as the wine trickled down my throat into my stomach, and I missed it. A lot.

I resisted these cravings for a long time, but then came a particularly stressful time at work and I couldn’t resist any longer. I needed a mental escape from my life. So I drank.

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.