On treatment and “the wall”

As part of the sentence for my DUI (ok, physical control, but I’m just going to say DUI since it’s easier and everyone understands it, ok?) charge, I have to go through a year of mandated alcohol treatment. I’ll admit to being of two minds about this. First, it’s something I’m somewhat ashamed to admit. I’ll fess up; I don’t like sharing that I’m “in treatment”… I’m not sure why; maybe it conjures images of being “broken” and needing professional help?

But… it has been helpful, or at least interesting…

One of the things I appreciate about my current counsellor is that he made it clear right away that relapse is a normal part of recovery — he isn’t giving us permission to relapse, but knowing this reduces the shame of relapse and can help those who do relapse pull out of the cycle quicker, with less destruction before they do. Many people don’t want to emphasize this fact because they feel it predisposes addicts to relapse, but I disagree — addiction predisposes addicts to relapse. Sticking your head in the sand about just how hard this thing is to beat is not a particularly effective strategy.

You see, addiction is very much a medical condition — those who claim it’s a spiritual illness or sin or just a “failure of willpower” are flat-out wrong. It’s a complicated one because it interacts with basic components of human cognition and psychology, but it’s a medical condition. Because our brains are wired to seek pleasure and avoid pain, and drugs and alcohol bring tremendous (if fleeting) pleasure, and because addiction also damages our ability to truly grasp the destructive long-term consequences and control our impulses, we are predisposed to repeat the addictive cycle over and over. These mental side effects, these insane thoughts and cravings despite our own very clear understanding of the costs of relapse, are no more under our control than is our heart’s beating. However, just like with our heart, with some practice and life changes, we can influence it..

The brain’s “healing” from the damage done to it takes time, and goes through predictable stages, just like blood clotting and the eventual formation of scar tissue is a very predictable phase of physical wound healing. In addiction treatment circles, the symptoms of this healing are often called “post-acute withdrawal syndrome” (PAWS — cute, eh?) Essentially, after ceasing to abuse a substance, the physical and mental recovery takes a good deal longer than the initial detox. The brain needs a while to re-establish balance — to find the “new normal.” I’m long past alcohol detox at this point, but I’m deep in the throes of PAWS.

One of the known phases of recovery from alcohol abuse is in the 60-120 day range (it varies by person) where a period of low-grade depression can set in. The medical term for this is “anhedonia” but informally it’s often called “the wall.” This isn’t full-bore depression; life doesn’t seem pointless, and suicidal thoughts aren’t usually an issue. But everything can seem sort of grey, and muted. You don’t want to do much of anything, you don’t take much pleasure in things. Very often people relapse at this phase of recovery, asking “is this as good as it gets?” I should mention, this anhedonia comes and goes in waves — even while going through “the wall” phase, I have days where everything seems pretty blah, and days where things seem more hopeful, life seems more full of possibilities. This is good; if every day was a “blah” day, I’m not sure I could get through several months of this.

In the “wall” phase of PAWS, the immediate detox is past, the repeated assault of the brain’s executive (decision making) functions by addiction is halted, and the healing of the impulse control/healthy pleasure-seeking circuits has begun. The problem is that it’s not complete yet — we’ve stopped artificially dumping huge quantities of dopamine into our pleasure centers, but we don’t have anything to replace that with. More importantly, because we’d been “over-consuming” dopamine, our brain has “turned down the volume” on the existing dopamine receptors. Just like people learn to ignore loud and incessant talkers (like, say, me!) the brain learns to ignore (or at least dampen) the effects of massive dumps of neurotransmitters like dopamine. This is why it takes more and more of our drugs of choice to make us feel “high,” and this is why, when we stop using, everything seems sort of blah and grey.

This is a very dangerous time; I’ve taken away the “high” of drug use, and I don’t have other, healthy “highs” to substitute for it yet. Not only that, but my prefrontal cortex (the part that helps make healthy decisions) is damaged — either through genetics or through drug abuse, or both — so I have an impaired ability to say “no” to that insistent little voice in my mind that tells me that just drinking a beer will make “everything feel better.” It’s true — it will — I know it will, because I’ve done it before. But then I’m right back in the cycle of addiction.

The best thing that treatment has done for me so far is teaching me about this shit, and teaching me that if I can get through it, it won’t last forever. This “healing” process of our brain will ultimately lead to proper balance of dopamine and receptors, and doing “normal stuff” will eventually “feel good” again. It’s important that we not withdraw from life during this phase, not give up, and most important of all, not start using again. One of the best strategies of this period is just to wait it out… to find ways to distract myself or healthy, achievable goals to pursue. In short, to use my “logical brain” to run the show while my “emotional brain” is healing

Treatment has also been useful to remind me of the (perhaps obvious?) fact that I can’t expect to feel good all the time. That’s one of the problems that lead me into addiction (above and beyond a biological bias) — I didn’t really know how to deal with unpleasant feelings like boredom of loneliness or fear. For instance, I wasn’t aware that almost everyone feels uncomfortable at social gatherings where they don’t know anyone; all I knew was that it was very uncomfortable — so to make that feeling go away, I’d flee or worse… drink. I never learned the basic life skill of reaching out for help or admitting that I felt uncomfortable (and perhaps even making a connection with a stranger because he does, too!) or even just accepting my negative feelings when I feel this way. For “normal” people — people who had good models for this growing up, perhaps — this probably seems very adolescent. But that doesn’t mean it’s not a very real thing that addicts deal with, and treatment is useful in helping me see that I need to develop these fundamental life skills; that my lack of some of them is what predisposed me (along with a genetic bias) to addiction all along. And like anything worth having, learning these skills will take time, take practice, and take work.

So… while I’m still rather embarrassed to admit that I’m “in treatment” — if I’m forced to admit it, I play it off like it’s just a court-ordered thing; I’m just doing it to stay out of jail — I’m also getting some useful information and support from it. I’m determined to break my cycle of relapse, and it helps me to understand just how complicated addiction is — from its biological roots to its interaction with higher brain functioning like decision making, attention, and impulse control, all the way up to “philosophical” or family history stuff like life skills and healthier habits.

This shit is hard… but treatment helps.

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