Am I really an alcoholic?

adult alcohol alcoholic beauty
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Dangerous Thinking

Soooo my last post about alcoholics anonymous created a bit of controversy, which was not altogether unexpected. A lot of people are very passionate about AA. What did surprise me, however, was that it raised an old question within my mind that I had previously struggled with for a long time: “Am I really an alcoholic? If all these people are so convinced that you need AA to get sober, but I didn’t need AA, then maybe it’s because they’re ‘true’ alcoholics and I’m not?”.

This kind of thinking is dangerous for me. It inevitably leads me down a path where I start making excuses and start justifying my drinking. Excuses include: that I never drank everyday, I tried to have one or two days off most weeks (it was a struggle, and many weeks I didn’t succeed), I still went to the gym, I still had a good job, I still had a loving family. Despite all that, however, I’m pretty sure my drinking was not normal.

I’m pretty sure

I’m pretty sure that most people’s husbands don’t end up having to drive home on their own birthday when you were the designated driver, and pull over half way for you to vomit by the side of the road. I’m pretty sure that most people don’t have regular blackouts and spend every weekend with crippling anxiety about what they said to whom and whether they did anything stupid. I’m pretty sure most people don’t start drinking more and more alone at home (well my husband was there, but usually asleep and never drinking with me) and less and less when out with other people, so that if I did do something stupid no-one was there to remember it. I’m pretty sure most people don’t become so obsessed with alcohol when they stop drinking that every time they drive past a liquor store, or a restaurant/cafe in which people are drinking, they feel like the whole street goes dark so that all they can see is the alcohol and it’s like nothing else on the street exists.

And around and around I go, on the same thought loop I have been on many times before. Sometimes this has ended with me drinking again, later realising that I definitely do have a problem and stopping again. More recently it tends to end with me skipping the drinking bit, realising that I definitely do have a problem, and just not picking up.

A Problem and a Solution?

I have a problem with alcohol. Whether you want to label it as being an ‘alcoholic’ or not, I have known for a long, long time that I don’t drink normally. I was also constantly reminded of this by my husband. Oh how frustrating I used to find it that he would refuse to get wasted with me on a Tuesday night! In sobriety of course I thank my lucky stars that he’s not a big drinker. In fact since I have stopped drinking he also barely drinks at all, and never at home. I really don’t think I would have been able to stop by myself if he was drinking in front of me all the time.

My life has also changed dramatically since I stopped drinking: I have achieved many work goals, I do SO much more with my family now, and I have hit many personal bests in terms of fitness and strength at the gym. I actually deal with my problems in a mature manner (well more mature than before at least!) instead of just drinking and ignoring them. Now when I have a problem I write a list of what I can control, and a list of what I can’t control about the situation, then make a concerted effort to ‘let go’ of what I can’t control. I then try and work out a productive way of dealing with what I can control. If I have a talk to prepare for example, I stop procrastinating because of what people are going to think of me etc (I can’t control that anyway) and work on the talk itself – that bit I can control. As a result, when I give the talk I am calmer, more practised, more comfortable, and less anxious. What a revelation! Everything I was looking for in the bottom of the bottle happened when I put the bottle down! So I guess what I’m saying is, would my life really have changed so much if I didn’t have a problem with alcohol in the first place?

A Continuum of Alcohol Use Disorder (*mildly sciencey bit*)

So what I have decided is that ruminating over and over about whether or not I am a ‘real alcoholic’ and comparing myself to others is counterproductive. If I just compare myself drinking to myself sober (small sample size so not very scientific I know) then I can see that pretty much every aspect of my life – relationships, work, happiness, motivation, fitness, health – is better when I am sober. With regards to science, one thing that helps me understand myself in this area is the knowledge that most scientists don’t see the line between ‘normal’ and ‘problem’ drinkers as a hard line anymore. Rather, there is a continuum of ‘alcohol use disorder’ (AUD), and you can place ‘mild’ ‘moderate’ or ‘severe’ on the continuum according to the most recent edition of the DSM-V: the diagnostic manual used by psychologists and psychiatrists. When I take the DSM-V questionaire (page 2) and apply it to my drinking days, I answer yes to around 6 of the questions, putting me at the bottom of the ‘severe’ category. Alcoholism, even more so even than other types of drug addiction, is progressive. It certainly took me many years before my drinking become problematic, but the more I drank the more problematic it became. When I first became sober I watched a documentary called ‘rain in my heart’ about end-stage alcoholics in hospital dying of liver disease, and it occurred to me that if I didn’t stop drinking, this is where I was going to end up. Better to stop now I think.

NIAAA spectrum of alcohol use disorders.jpg

*End mildly sciencey bit*

I think that’s about all the science I’m going to include in this post for today. Next week I will include more. However I also wanted to respond, particularly to some of the more passionate posts I received in response to my last blog about AA and say: I am just telling you what has and hasn’t worked for me. I am just presenting my opinion, as a neuroscientist, I am not presenting the opinion of the entire scientific community. If you attend AA and it works for you, please do not stop! I’m sure if I attended I would get a lot out of it. I wrote the last blog entry simply because I remember when I first got into recovery and I felt like AA was pushed onto me very hard. I know that others in recovery felt the same. Because of all the reasons I outlined in my last post however, I wasn’t sure that it was right for me, and the pushing just made me resist even more. The first time I heard someone’s story who got sober without AA was when I read “I swear I’ll make it up to you” by Mishka Shubaly and I actually cried a little bit from relief. It IS possible to get sober without AA. It IS possible to get sober without a higher power. Maybe it’s not possible for everyone, but I say each to their own! I would never tell someone else that there is a right or wrong way to get sober, or that there is only one way. There are many paths.

Lastly, to those who are questioning whether you are an alcoholic or not, I hear you, I get you. But if that question even enters your head, I would suggest that in all likelihood, you are probably at least on the continuum of AUD and  would probably benefit from quitting drinking. I can tell you that my life has gotten a 100000000+ times better since I did.

Alcoholics Anonymous: Part 2: The good, the bad, and why I didn’t join.

pexels-photo-924004.jpegA quick note before I begin: I have received feedback that the science can be a bit hard to follow in this blog. From now on I will signal the sciencey bits with *Warning Sciencey bit” and signal the end of it with *End Sciencey bit* and if you choose to skip these bits, the rest of it should still make sense. Hope that helps, but open to more feedback if anyone has better suggestsions.

The Scientific Perspective on AA
For the most part (although this is not a consensus by any means) scientists do not particularly rate AA. To them it is a program that was made up by a guy a long time ago (1935) without being based on any kind of scientific evidence, and due to its anonymous nature is difficult to study in a systematic manner. What this means is, that the studies that have been done are largely observational, and do not involve participants being randomly assigned to AA vs. other treatments and control groups to infer outcomes in a more causal manner. And then there’s the God thing. For those who don’t know, a large part of the AA program involves putting faith into a ‘higher power’ – defined as a ‘God of your choosing’ which doesn’t necessarily HAVE to be God Himself, but often is.

*Warning Sciencey bit*
The notion of a higher power is inherently non-scientific. This is because it is non-falsifiable. What this means is that, because it can never be proven wrong, it can never really be tested. In other words, the concept of a higher power can be altered to fit any situation. For example, if someone prays for something, and subsequently receives what they asked for, a believer will assume that their higher power has answered their prayers. On the other hand, if someone prays but doesn’t get what they ask for, this doesn’t change the beliefs of that individual. Instead, a believer will assume that their higher power has a different plan or destiny for them. In this way, a person’s faith can be used to justify any outcome, and therefore can never be proven wrong. And although things are never proven ‘right’ in science, if something is non-falsifiable then we also cannot provide solid scientific evidence suggesting its existence. So at least within the realm of our capabilities right now, the concept of a higher power can never be proven or disproven.
*End Sciencey bit*

What the Soberverse thinks of AA
It is worth mentioning that this view of AA and other anonymous programs by scientists is far from a consensus, and some do have a positive view on it. But the soberverse (my made up name for the online recovery world) has a different perspective altogether: anonymous programs are still by far and away the most popular treatments for addiction. They are the most accessible as there are many such meetings at convenient times, all over the world, and all you need to attend is to give a gold coin donation. Even without that, you will not be turned away. Furthermore, within the soberverse you will find many people who have gotten sober using these programs, who swear by their efficacy, and become very attached to the ’12-step program’.

As for my point of view, as a ‘Neuroscientist in recovery’, I suspect the truth lies somewhere in between these two points of view. Whilst it is not the panacea that some people believe it to be (although it can be for many individuals), it is not completely useless either.

The Positives
The biggest ‘pro’, in my opinion, is that AA provides a way for people in recovery to connect. Furthermore, it provides an opportunity to connect with active and ex-addicts, and other people who generally understand what an individual might be going through. It gets people out of the isolation they might have been suffering, which even in basic neuroscience we know to be important because of studies such as the famous ‘rat park’ experiment.

*Warning Sciencey bit*
In brief, rats who were kept in isolation without enrichment were easy to train to self-administer cocaine or opioids and to became ‘addicts’, whereas rats that were given access to other animals in an enriched environment (i.e. rat park) were not. The implication, of course, is that individuals with good social connections and opportunities are less likely to become drug addicts than isolated individuals with little opportunity. I should mention that this finding hasn’t always been well replicated since the original, something else I will touch on in future posts.
*End Sciencey bit*

I think most people in recovery will tell you, and from my personal experience I totally agree, that connections are vital to recovery. So in this respect, AA does a good job. It is often said within the soberverse that “connection is the opposite of addiction” and I agree, although most of my connection has been achieved online.

Another thing AA gets right is that it provides a program of positive reinforcement of ‘good’ or productive actions that are learned in sobriety, such as paying bills, cleaning your house, getting a job and generally getting your shit together. That is, when good things start happening to the addict in recovery (because they are sober, no longer isolated, have help etc), not only do they feel the intrinsic happiness of getting their shit together, but they have the added feeling of a spiritual guide, a ‘higher power’ that helps the addict feel like they are not alone, and that they are being guided on the right path. Moreover, addicts often feel like the higher power affords them a strength to get better that they didn’t have alone. Over the months I have spent in recovery, I have really begun to appreciate the positives people get out of having a higher power. Although my beliefs prevent me not only from believing in a higher power, but really in any type of spirituality, over time I have honestly come to see this as a bit of a shame, because I see how much contentment such beliefs can provide.

These are not the only benefits of AA by any means. It provides a program of accountability, allows a person to address the issues in their past or in their current life with a new perspective (in particular changing from seeing themselves as as a helpless victim), and eventually provides a way for addicts to help others. Therefore I believe the AA program provides many things that even a scientist or skeptically-minded individual can appreciate.

The Negatives
So, given all those positives, why haven’t I been back to AA? In all honesty, I’m not really sure. For a long time I told myself I’m too busy as my job can be very demanding. But I’m sitting here writing this blog when I could be at a meeting, so I guess I would have time right now! Also as I mentioned, as much as I can see the benefits of believing in a higher power, I just can’t. As far as I can tell, even the agnostic or atheist alternatives involve some kind of higher power or spirituality – just not one based on God. This is just a 100% no from me.

I think that another reason for not attending is that I don’t think I need to. Whilst I have no problem admitting that I am an alcoholic, my life is not ‘unmanageable’ and never really has been. I have a family, I have a good job, I have a lot of friends and happiness, and I am relatively fit and healthy. I also have expert knowledge of the neural circuitry of decision-making, and that helps a lot. Further, if I’m going to be totally honest, the idea of walking into a room of people I don’t know to talk about being an alcoholic is terrifying, even if I have done it once before. I know that this is a weak reason, but I’d be lying if I said it wasn’t a factor.

So there’s all my excuses. I recognise that they are all excuses. If I really needed a program like AA, none of these excuses would get in my way – just as they didn’t when I was in Bali. However, my last and most important reason for not attending, I feel is not just an excuse, and this reason is the rigidity/inflexibility of thinking I see it produce in people. Although of course it is possible that it is the addiction that produces such rigidity, not the program, but there does at least seem to be a correlation even if the link is not causal. And of course I should mention that this does not go for everyone who attends AA, there’s plenty of people with their own take on things

*Warning Sciencey bit*
There is evidence in the lab, that even in animals that have been trained to be alcoholics or drug addicts, then their ability to make decisions is impaired. Specifically, if rats learn to press a left lever for sugar water, and a right lever for pellets, when later given a choice between levers a normal rat will choose the one that earns whichever (pellets or sugar water) is most valuable to them at the time. An alcoholic/drug-addicted rat, on the other hand, will choose both levers equally. This demonstrates that on a fundamental level, drug addiction impairs the capacity to make decisions. This impairment appears to be accompanied by alterations in neural activation and other structural changes in the striatum, which is part of the brain’s hub of action selection. Similarly, human drug addicts show reduced activity in prefrontal cortices and striatal regions associated with decision-making (see the figure below for a highly simplified diagram of this pathway, taken from http://addictionpathology.wikia.com/wiki/The_Reward_Pathway). I know for me personally, when I was drinking, a lot of the time my decisions were impaired because I just didn’t really care. All I cared about was my next drink.

The_reward_pathway_3.png
*End Sciencey bit*

So it is possible that the rigidity of thinking was there prior to attending AA. Alternatively, it is possible that because of the alcoholic’s impairment in their ability to make good decisions, it makes sense for them to ‘surrender’ this process to others, and to ‘take the cotton out of their ears and put it in their mouth’ as a common saying goes. Suddenly, when the program works for them like nothing ever has before, they start to believe that this is the only way to get sober.

It is this rigid attachment to the ideas and traditions of AA is that keeps me away. I am sure there is wisdom in the twelve steps, and as mentioned the higher power provides an important service. But the rigidity is very difficult to accept for people like myself, whose entire world view is built around scepticism, questioning, and the necessity of empirical evidence. I have had an MD in recovery say to me that he had to suspend his scientific thinking in order to go through the program, but I just don’t think this is possible (or necessary) for me.

So if not AA then what?
There are a number of alternatives. If you are looking for face-to-face meetings, there’s SMART recovery which is a research-based program. I was quite drawn to the idea of SMART but I couldn’t find a convenient meeting. This is one area in which AA beats SMART hands down, there are far more AA meetings than SMART meetings. Other than that, there are also medications such as the Sinclair method (an opioid receptor antagonist [i.e. blocker] taken in pill form that blocks the pleasurable effects of alcohol). I haven’t had personal experience with these, but the science suggests they are relatively effective.

For me personally to stay sober, I haven’t tried medication, SMART recovery or AA (other than that one time in Bali). But that doesn’t mean I haven’t worked hard on recovery, and I am still working hard. Online connection has been a big part of it. Of course I should acknowledge that, being a functional alcoholic, I was not too isolated already a close family, a good job, and a pretty good social network which already included some sober people. Perhaps if I were missing just one of these factors I would have needed face-to-face meetings to get sober. Perhaps I still will need such meetings one day, I certainly wouldn’t rule it out. As mentioned previously, I have also read every sobriety memoir going, listened to recovery podcasts (especially the Shair podcast), and joined recovery groups on facebook and elsewhere. I also do regular sessions with a recovery coach.

This blog is the next step on my journey. Writing here will keep me accountable, will allow me a way to express my feelings and thoughts. I am not doing this alone by any means. “Connection is the opposite of addiction” indeed. So welcome on my journey, let’s see where it takes us.

Alcoholics Anonymous Part 1: Bali

Bali Cravings
About 4 months into sobriety, I visited Bali with my family (including my parents and mother-in-law). When I got there, a feeling came over me… a peace and tranquillity like I’d never before experienced. Then I got in touch with my spiritual side and found God. Next I saw unicorns flying through the sky whilst pooping rainbows…

NOT!

Yeah OK, that never happened. I mean, I did go to Bali but faaaark me. It was hard. I experienced something that in the lab we refer to as ‘context-induced reinstatement’. Basically, it has been known for sometime, that addictions can be context-specific – one well-known example from real life is when many heroin-addicted soldiers returned home to the United States from the Vietnam war. Surprisingly, once home about 90% of these soldiers were able to shed their addiction, and only 10% remained addicted. However, what this also means is that addictions and can be ‘reinstated’ (i.e. the addict can relapse) when they return to a ‘context’ (place) previously paired with alcohol/drugs, or even visit a new place that is similar to the one associated with alcohol drugs, like a new pub or restaurant etc.

Contextually-mediated relapse in the lab
Similar effects have been shown in rats and mice too. The typical experiment goes something like this: the rat or mouse is first trained to press a lever for alcohol, or cocaine, or amphetamine, or whatever the drug of interest is, in a particular context, usually a skinner box with stripey walls, a grid floor, and vanilla odour. That same rat is then put into a different box with spotty walls, a smooth floor, and a peppermint odour, but in this box, the lever doesn’t earn the drug. In fact, in this box, the lever doesn’t earn anything (known as ‘exinguishing’ the lever press-drug association). If you put that rat back into the ‘extinction’ (lever-no drug) box the next day, s/he will press the lever at a low rates. If, however, you put the rat back in the original box, however, responding will be high again.
In drug addiction, this effect is mediated in the brain by circuits that regulates decision-making generally; structures such as the nucleus accumbens (often reported to be the brain’s hedonic ‘hot spot’, although it does more than just detect pleasure) and its projections to the ventral pallidum and lateral hypothalamus. Further, such ‘relapse’ isn’t only bought on by contexts (places), but can be caused by cues such as the sight of a particular beer label or a wine glass. It makes evolutionary sense for a brain circuit to ‘hold on’ to the knowledge that an action previously earned a reward in a particular place, or to explore whether that action earns a reward in a new place, because if it didn’t the person/animal might miss out on a reward. Unfortunately, however, in drug addicts this effect provides another example of circuitry that evolved to optimise receiving useful rewards, like food or sexual pleasure, going awry and supporting drug-seeking when this is not adaptive.

Contextually mediated relapse in real life
If you are an addict like me, the likelihood is that you have experienced this. You might never experience cravings anymore in your normal surroundings, having ‘extinguished’ the association between walking to your local pub and buying a beer. But then you go on holiday, or into a new environment and see a different pub and the craving comes back to you with full force. Well that’s what happened to me in Bali.
Bali ticked a lot of boxes driving me to drink: 1) it was sunny which I always associate with drinking, 2) I was on holiday so I didn’t have work, 3) my parents were there to be responsible adults and help out with my daughter so I didn’t have to be as responsible, and 4) parents were there being parents (i.e. driving me slightly nuts – love you Mum!). It was very, very, very hard. So I posted in my lovely facebook group about my troubles and so many of them said what I often hear in the group: go to a meeting. And I thought, “actually yeah, why the hell not? So I found the nearest meeting that was on in one hour, started walking there before I lost my nerve, got lost on the way so was a little bit late, but I got there. And it was good.

AA
When I got to the meeting I mentioned straight away that I was a first-timer and I was welcomed with open arms. Then people started to share. To begin with, it was only the men that shared, and they talked about many things. Some talked about how they had ended up in jail, or mental institutions, or how they had lost custody of their children and so on. This was bad. I couldn’t identify with this at all. After several days in Bali with a little voice in my brain (which part of my brain? That I can’t tell you sorry!) telling me I am not really an alcoholic, this was not what I needed to hear. Suddenly that voice started getting louder. “I’ve never experienced consequences like those, so maybe I’m not really an alcoholic?” “Maybe I can get out of here and go drink! And party! Woooo Hoooooo”
But then another voice (in my head) chimed in and asked: “why the hell are you sitting here if you don’t have a problem?” “And if you really don’t have a problem, how come pretty much every area of your life (work, health, fitness, relationships, happiness, anxiety) has gotten so much better since you quit drinking?”. If it wasn’t a problem, that wouldn’t have happened, surely.
So I shared. Can’t remember exactly what I said, but I sat there with my fake tan, thinking that all these people just think I’m some dumb blonde with resting bitch face (oops there’s those self-esteem issues again) and here I am talking about the fact I have a good job, and a loving family, but that alcohol has caused a lot of problems for me, so am I really an alcoholic after all?
But after I spoke up the other women in the group started to speak up. It was at this point that I heard my own story reflected back to me, over and over and over. Being there for your kids but not really being present. Waiting until they go to bed so you can drink. Getting angry with their partners over nothing. Dragging their sorry butts to work hungover and giving a sub-optimal performance. I realise now what I didn’t at the time: that alcoholism seems to manifest differently in men and women. I’m not sure why this is (scientific studies in rodents have by far and away used mostly males, although this is now starting to change). I know that in the human research there have been some differences found in how reactive men and women are to cues, but I’m not sure how that might translate to different manifestations of addiction.
In any case, that meeting saved me from a major relapse. I stayed and had coffee with some of the members afterwards, and they all were so welcoming and lovely and non-judgemental. Noone seemed to judge me for my resting bitch face, or blonde hair. No-one seemed to change their manner immediately and start acting a little self-consciously when I said that I was a behavioural neuroscientist, as often happens when meeting new people. Two of the women gave me their email addresses and numbers, and I messaged them a few times throughout the rest of the trip. And most importantly I didn’t drink.

Returning Home
So you would think that after I returned home after such a positive experience that I would continue to attend AA. Initially I did intend to, I looked up the beginners meeting and there was one nearby. I told my husband I was going to go that night. It was all sorted. Then I got to the evening and I just… didn’t. The cravings certainly dissipated when I returned home (i.e. as I returned to the extinction context), but I knew enough to be wary of this lack of craving, and that it could return at any time. However, I did think long and hard about it, and eventually decided instead to sign up to recovery coaching with the person who runs the podcast I had been listening to instead. In my next post I will elaborate on why.

Narratives and the brain: A Drunk Story

 

pexels-photo-374809.jpegFunny shit

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

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

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

So let’s get serious

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

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

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

Quitting

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

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

Drinking and Recovery

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

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

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

Stories and the brain

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

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

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

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

About me

pexels-photo-990819.jpegI am a behavioural neuroscientist, an alcoholic, a mother, a wife, a teacher, a student, and a mentor, among other things, not necessarily in that order. I have thought for a while about writing this blog, and now I have a little time, so here I am. Going through the process of recovery from addiction is often a deeply intense personal journey, and I am no exception. For the first time in so many years I have actually thought about why I feel the way I feel, or think the way I think etc, not just from the perspective of what the underlying neural substrates of those feelings and thoughts are, or how they are behaviourally expressed, as I had for so many years prior through my work.

Prior to entering recovery, I could tell you all about the reward circuit in the brain and how it is hijacked by the use of drugs (hint, it is extremely complicated, there’s still a lot we don’t know, and it doesn’t just involve dopamine and serotonin, although they are involved of course). I could have told you the same information when I was actively drinking, but it didn’t stop me. What I couldn’t have told you is what it felt like to go through the emotions of recovery, things that the recovery community have a pretty good handle on. The initial ‘pink cloud’ during which you come out of the fog of addiction and start to see clearly, then you feel like you can change the world! Then the inevitable wearing off of the pink cloud, and the way in which everything seems to be guiding you towards relapse. The way that social connection is so vital to recovery. This is something I could never have guessed, although I knew very well that taking naltrexone would partially block the pleasurable effect of opioids in the brain and was a relatively effective treatment for alcoholism.

Like most things in life, my discovery is that things are not black and white, but endlessly nuanced and individual. There are, however, so many things the two sides I have been exposed to could learn from each other. Behavioural neuroscience, in my experience, is primarily focused on finding medications that can treat addiction, without much thought to behavioural modifications or interventions, despite these being relatively straightforward to study in the lab. By contrast, the recovery community can be quite narrowly focused on alternatives to medication, particularly ideas derived from alcoholic’s anonymous (AA) and other anonymous programs, although I have noticed that this has started to change a little more recently. In any case, it is clear that the vast wealth of information we have gathered in basic neuroscience research has not made its way through to practise, and by the same token, there is a lot of wisdom in the recovery community that isn’t even considered in the scientific community. This blog is my attempt to bridge that gap.