Recent discoveries in neuroscience indicate what many have suspected all along. Barring a brain injury, the neuronal pathways in the brain that form habits are there forever. While one may suppress the behavior, the urge to perform the habit in the presence of the original gratification still remains. A habit is something we do without the gratification being present. It may have started out as a response to gratification, but it remains after the gratification has disappeared.
Sometimes we call these "personal idiosyncrasies, sometimes we call them "quirks," and sometimes we call them "little personality traits." Whatever the term, they are all habits. For the person who uses drugs, there was an initial gratification. Chasing that first high becomes a habit long after the original gratification has passed. The subsequent highs pale by comparison to the memory of the first high with the drug, yet the user continues the chase. The use, itself, is a habit. Yet, there is still some gratification, so the habit becomes reinforced. As one recovering cocaine addict stated, "I know this is wrong with everything I have been through and put my family through, but if you put a pile of cocaine on the desk, I would dive into it nose first."
The urge remains, and fighting that urge becomes a daily battle. The habit has been established. Those doing business in the drug trade bank on it. There is a significant difference between the words "explanation" and "excuse". Explanation merely presents the circumstances by which a particular event occurs. Excuse offers a reason and a pardon. The neuroscience behind habit offers an explanation for relapse but should not be considered an excuse. Once an individual has crossed the line between recreational use and habitual use, the habit has been formed. Relapse is the strongest proof that old habits remain. Just ask any smoker who lights up habitually and not necessarily because of any gratification, sometimes even in the presence of adverse circumstances.
Watching an individual with emphysema light up a cigarette while connected to an oxygen tank is a perfect example. We call that an addiction, a habit. Addictions come in many forms. Certainly physiological dependence and tolerance up the ante, but the neuronal pathways that have been created are just as much a part of the problem. Whether or not one agrees with the term "disease", there is now scientific evidence that the pattern of substance abuse and addiction is a brain issue. The labeling of the problem is subjective, but the results are scientifically objective. It is not only hard to break an addiction because of physiological dependence, but as importantly, and maybe more so, because the behavior has become a neuronal pathway.
Want a visual? Follow a raindrop down a window. Other droplets will follow the same path. Like little lemmings over a cliff, our behaviors tend to follow invisible pathways. Changing that behavior is extremely difficult, especially if the gratification is reintroduced. Many might argue that the initial use was a "choice" made by the individual. That certainly may be a true statement, but what follows is not as much under voluntary control as the "Just Say No" crowd would like to believe. It takes a lot of work to alter neuronal pathways, to override the urge to continue the behavior. Unfortunately, the urge will remain, but the behavior does not have to remain. It is only when the habits remain in the subconscious that the behaviors follow automatically.
The idea behind treatment is to bring the urges to a conscious level, to make one constantly aware of the threat. Relapse occurs when the individual relegates the habit back to the subconscious level, leaving it prey to the established neuronal pathways. As any self-respecting marketing expert will tell you, the subconscious is a powerful tool, one that can be easily manipulated. The millions of dollars paid to psychological experts by the advertising mavens to establish hidden messages is evidence of this fact. Once the idea has risen to a conscious level, it no longer has the same impact. Treatment centers and support groups, whether 12 step or otherwise, know this pattern well.
Fighting the urges, the habits, is a daily battle. It is not a battle that can be won. It is only one that can be neutralized. Letting down one's guard by demoting the habit to the subconscious results in a setback, sometime partially and sometimes fully. There is a reason that those in the know that have had problems with drugs label themselves "in recovery" because they intuitively know, even before the presence of the scientific evidence, the neuronal pathways of drug use have been established and will always remain. It is exceedingly important that both those in and out of the addiction community include this paradigm in their evaluation and treatment of those with addictions. There is a difference between "explanation" and "excuse," but there is no place for "blame."
If it were simply as easy as "Just Say No," the cure rate would be very high, and the relapse rate almost non-existent. So armed with this information, what now? Education and behavior modification become even more important weapons in the arsenal against drug addiction, substance abuse, or whatever term one wishes to use. This includes identifying the other factors that contributed to drug use in the first place. Dual diagnosis is not the exception; it is the rule. Physical abuse, learning and processing disabilities, and other psychopathologies only add to the toxic mix. Identifying the co-occurring conditions becomes even more important. With advances such as the fMRI, DESA, PET, and SPECT, more scientific and objective information is available to assist those treating the individual with the established neuronal pathways, the bad habits. Punishment does nothing to alter neuronal pathways. As any self-respecting therapist knows, positive reinforcement is the best shaper of behavior. Our societal policies, commonly called laws, should reflect this knowledge. Copyright 2009 Yellen & Associates All rights reserved.
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