Michael Groat 2013-10-02 03:21:11
A look at addiction, a neurobiological illness and stress regulatory disorder. CONTEMPORARY VIEWS OF ADDICTION: PSYCHOLOGICAL AND NEUROBIOLOGICAL PERSPECTIVES The field of addictions has come a long way in eradicating some of the misconceptions and myths about addiction. Although people once considered addiction a moral failure, we now know that individuals do not become addicted because they lack integrity. The object of their addiction can be a substance (alcohol, amphetamine, etc.) or a behavior (gambling, the Internet, etc.). And they become addicted as a habitual way to cope with pain and suffering and to regulate stress (Schore, 2003). In fact, stress is one of the most important predictors of substance abuse. Many in the legal profession suffer extraordinary levels of stress, including an exceedingly high number of work hours, unpredictable legal cases, pressure to win cases, and heavy workloads (Cory, 1992). Some individuals are more susceptible to addiction due to genetic factors, family environment, and poor coping skills, as well as other co-occurring forms of emotional distress, such as bipolar disorder, schizophrenia, post-traumatic stress disorder, depression, or anxiety (Khantzian & Albanese, 2008). Advances in the understanding and treatment of addictions make recovery, and healing, possible. Addictive substances and behaviors activate the human neuronal reward system. Thus, individuals use substances because they serve a rewarding function. This function might include easing anxiety in a social situation, numbing physical pain, ridding boredom, increasing energy, or relieving feelings of emptiness. Achieving the hoped-for result leaves individuals prone to want to use the substance again under similar circumstances, or to repeat the behavior that evoked the desired emotion (Khantzian & Albanese, 2008). With continued use, individuals’ brains and minds start adapting to the substance or behavior, and it becomes habitual. The amygdala, a structure in the brain involved in memory and emotions, reminds individuals that they can feel better or escape pain through cravings and urges. The problem is that uncontrollable desires for a substance or behavior override rational thought and activate the amygdala. Individuals are then likely to act in out-of-control ways—the kinds of ways that often lead to suffering for themselves, their families, and their colleagues (Erickson, 2007). Many attorneys enter into treatment after suffering severe relationship problems, depression, anxiety, driving under the influence charges, poor health (such as liver damage), or threats to their career. The negative consequences of use have led them or those around them to recognize a need for help (Beck, Sales & Benjamin, 1996). Many professionals, including attorneys, struggle with acknowledging the need for assistance. Keen analytic abilities contribute to professional success, but addiction cannot be solved simply through reasoning. Many find that the power of the addicted brain can quickly overwhelm all rational arguments in favor of stopping the addiction, which can generate profound feelings of helplessness, shame, and failure (Volkow & Li, 2005). RECOVERY OCCURS BEST WHEN SECURELY ATTACHED TO OTHERS Left to themselves, most are not able to counter the incredible forces of cravings and urges, or escape the ravages of serious depression. The reward system of the human brain reinforces behavior that our brain considers essential for survival—and for the individual with an addiction, using a substance or engaging in an addictive behavior can feel like a life-and-death matter (Volkow & Li, 2005). An individual’s best hope for recovery lies in learning to make use of others (Coan, 2010). Learning to turn to someone who offers an empathic, attuned, and supportive response—instead of turning to a substance to cope with pain and suffering—sets in motion a new pattern, and a new reward, but without many of the negative and devastating consequences of substance use. Consequently, the distress will become more bearable, the individual will feel more secure, and an optimal foundation for healing and recovery will be established (Allen, 2013). Experimental research strongly supports that individuals regulate stress best when connected to others who provide emotional support (Coan, 2008). Going it alone when ill is going it the hard way. Psychologist Jim Coan, while conducting neuroimaging research at the University of Virginia, found that merely holding a partner’s hand during a stressful laboratory situation significantly diminished brain activity associated with distress, as well as brain activity associated with effortful regulation of distress (e.g., deep breathing or positive self-talk). Moreover, the mere contact with a partner was especially effective in decreasing the load on the brain when the relationship felt highly supportive and trusting (Coan, Schaefer, & Davidson, 2006). To begin reversing the habits of addiction, individuals must gradually replace their deep attachments to a substance or a behavior with a secure attachment to others (Coan, 2011; Karen, 1998). MANY IN THE LEGAL PROFESSION DISCOVER HOPE OF RECOVERY Twelve-step recovery groups, like AA and NA, work not only because of the steps of change that are introduced, but also because they offer individuals a routine place to feel accepted, known, and understood (Moos & Timko, 2008). Peers can relate to the pain of addiction, offer solace, and provide hope, inspiration, and encouragement. The experience of responsive emotional support lies at the heart of the relief provided and is a resource for the individual with an addiction to turn to time and time again. Engaging in recovery helps the brain to begin forming new neural pathways, and recent evidence points to a 90- day period for this process to begin taking hold (Erickson, 2007). In addition to modifying some of the neural networks involving addictions to a substance or a behavior, individuals can change their brains by forming deep attachments to people—instead of to substances or behavior. The possibility of forming secure, healthy attachments and learning to turn to others for support and help in managing moments of distress can help individuals stay on the road to recovery (Coan, 2010). Many legal professionals have taken the daring step of allowing their brain to heal from addiction, as well as replacing their attachment to an addictive substance or behavior with caring, responsive human connection. Twelve-step recovery, family counseling, new coping skills, medication, and addictions counseling can all serve to alter attorneys’ brains—for good. NOTES 1. Allen, J.G. (2013). Restoring mentalizing in attachment relationships: Treating trauma with plain old therapy. Arlington, VA: American Psychiatric Publishing, Inc. 2. Beck, C.J.A., Sales, B.D., Benjamin, G.A.H. (1996). Lawyer distress: Alcoholrelated problems and other psychological concerns among a sample of practicing lawyers. Journal of Law and Health, 10, 1-60. 3. Coan, J.A., Schaefer, H.S., Davidson, R.J. Lending a hand: Social regulation of the neural response to threat. Psychological Science. 2006; 17:1032-1039. 4. Coan, J.A. The social regulation of emotion. In: Decety, J., Cacioppo, J.T., eds. Handbook of social neuroscience. New York: Oxford University Press; 2011:614-623. 5. Coan, J.A. Adult attachment and the brain. Journal of Social and Personal Relationships. 2010; 27:210-217. 6. Coan, J.A. Toward a neuroscience of attachment. In: Cassidy, J., Shaver, P.R., eds. Handbook of attachment: Theory, research, and clinical applications (Second Edition). New York: Guilford; 2008:241-265. 7. Cory, T.L. (1992). How not to snap under pressure. Trial, 28, 28-31. 8. Erickson, C.K. (2007). The science of addiction. New York, New York: W.W. Norton and Company, Inc. 9. Karen, R. (1998). Becoming attached: First relationships and how they shape our capacity to love. New York: Oxford University Press. 10. Khantzian, E.J. & Albanese, M.J. (2008). Understanding addiction as self-medication: Finding hope behind the pain. Lanham, Maryland: Rowman and Littlefield Publishing Group, Inc. 11. Moos, R., & Timko, C. (2008). Outcome research on twelve-step and other selfhelp programs. In M. Galanter, & H.O. Kleber (eds.), Textbook of substance abuse treatment (4th ed. pp. 511-521). Washington, D.C.: American Psychiatric Press. 12. Schore, A.N. (2003). Affect regulation and the repair of self. New York, New York: W.W. Norton and Company, Inc. 13. Volkow, N.D. & Li, T. (2005). The neuroscience of addiction. Nature Neuroscience, 8, 1429-1430. MICHAEL GROAT is the director of the Division of Adult Services at the Menninger Clinic in Houston. He is an assistant professor of psychiatry and behavioral sciences at Baylor College of Medicine and specializes in the application of attachment research to the treatment of mental illnesses and addiction.
Published by State Bar of Texas. View All Articles.
This page can be found at http://mydigimag.rrd.com/article/This+Is+Your+Brain+on/1523379/177679/article.html.