Did you ever have a moment when something clicked in your mind, when you finally knew the reason forÂ something that had affected you life for a very long time? Did it change the basic way that you approachedÂ an important relationship or perhaps change a major habit? This has happened to all of us, but what actionsÂ followed this? Did anything change on your life?
I firmly believe that many substance abuse patients get to the point where they are â€œdoneâ€, when they realizeÂ that they must change in order to survive socially and even physically. Another term for this is â€œhitting bottomâ€.Â Where this is, is different for each person. When this happens things can change rapidly. Getting offÂ drugs becomes â€œeasyâ€. Acceptance of reality actually brings a freedom that they never realized existed whenÂ they were always afraid that it would bring restrictions and outside control.
I have had the wonderful experience of witnessing the â€œahaâ€ moment with several patients. They are ready toÂ solve their problems and will do what it takes to do it. They need guidance, support, and education to makeÂ the most of their lives. It is amazing that patients who would not taper their drugs or suffer the slightest discomfort,Â taper and stop on their own or with minimal urging. I often set out a taper schedule and when theyÂ come for follow up; I find that they have far exceeded my suggested dosage cuts. I tell them. â€œ Itâ€™s easy to getÂ someplace once you know where you are going.â€
I have had the wonderful experience of witnessing the â€œahaâ€ moment with several patients.
I believe that there is a physical change that takes place in the brain after an â€œahaâ€ experience. This is probablyÂ centered in the limbic system where feelings arise and are modulated. The limbic system is also drasticallyÂ altered in substance dependence. The nucleus accumbins is the pleasure center. The main neurotransmitterÂ in this area is dopamine. Drugs of abuse stimulate this area with high amounts of dopamine, bringingÂ euphoria and a sense of well-being. Unfortunately, the brain becomes used to having these high levels ofÂ dopamine, which resets the mechanism that maintains proper levels, resulting in too little dopamine withoutÂ the outside stimulation. In addition, the naturally occurring substances that increase dopamine areÂ suppressed and the dopamine receptors become less sensitive. This results in â€œdysphoriaâ€ (the opposite ofÂ euphoria), depression, increased pain sensitivity, fatigue, and many other negative feelings. The usual thingsÂ that give pleasure, such as a hug or playing with your children no longer make you happy. Nothing but usingÂ drugs or alcohol helps. Once this point is reached, the physically dependent person has to use to just avoidÂ the feeling awful.1
How do you get there?
How you get there is the challenge. Unfortunately, there is no easy path or formula.
At our clinic, as in many other modern centers we believe in using empathy as one of our major tools. ThisÂ means dealing with a person as they are, whatever that may be. If someone does not think that they have aÂ drug problem, then telling him or her that they do and forcing them to attend groups or meetings, in whichÂ they are told about â€œtheirâ€ problem accomplishes nothing. The task is to help that person see the problemÂ himself or herself. This can be a very slow and frustrating task. The basic method, called motivational interviewing,Â is outlined in my book, A New Prescription for Addiction. We also use the Readiness to ChangeÂ evaluation to help the patient and the therapist see the problem as it really is.
Reaching â€œbottomâ€ is another time where a major change can take place. This may be after losing a job or aÂ marriage. It may be in the hospital ICU. During these times, empathetic treatment can make a big difference.
Another way of finding the â€œahaâ€ is called â€œFocusingâ€. In the 1960â€™s Eugene Gendlin, PhD, a psychology professorÂ and researcher at the University of Chicago, did a series of studies looking at which patients madeÂ changes and why. This was not only in the substance abuse arena. He analyzed thousands of hours of therapyÂ session tapes. He made a startling conclusion: in many cases, the patient made the difference, not theÂ therapist or even the type of therapy. Those that looked at the real reasons behind their problems made theÂ most progress and changes. He then devised a method to help people find the â€œahaâ€.
He called this method Focusing. It involves a type of directed meditation, which allows one to concentrateÂ on one problem at a time and then delve into this in a specific and reproducible way. The information canÂ then be used to help change. This can be done alone or with the help of a therapist. There are many booksÂ available and Dr. Gendlinâ€™s book, Focusing, is still in print and available on Amazon.
A third way of â€œgetting insideâ€ is experimental and is not widely available at this time. The amygdala is anÂ area of the midbrain where emotions are regulated. When there is a stressful event circuits that cause a flightÂ or fight adrenalin rush may become reinforced so that any thought of the event, even years later, causesÂ a large reaction with sweating, racing heart, anxiety, and fear. Most of the time, the patient does not evenÂ make the connection between the event and reaction. This is the cause of post traumatic stress disorderÂ (PTSD), a major coexisting problem with substance abuse. A major cause of drug abuse is anxiety and anger.Â If these reactions can be tamed, stopping drug use becomes much easier. Often realizing that this is theÂ problem makes a huge difference. (The â€œahaâ€)
There are several ways under study to help cut these abnormal reactions. One is EMDR, eye movement desensitizationÂ and reprocessing. (emdr.com) This is a process in which the patient is asked to make eye movementsÂ while the therapist directs them in experiencing a stressful memory. The combination seems to unlinkÂ the reaction and can be a major factor in stopping the PTSD cycle.
The other area is the use of specific drugs, which help unlink the amygdala reaction. There are two of theseÂ under study. Both are commonly used very safe medications.
It is beyond the scope of this article to delve into these methods, but they hold great promise is the treatmentÂ of PTSD, as well as substance abuse.
Just knowing that an epiphany is possible and that finding it can make a huge difference in ones life canÂ help with any difficult journey. There is a physical, as well as a psychological, basis for many of these problems,Â but there are many ways of looking for that major experience and feeling. Once one finds it, changeÂ can follow. In future articles I will outline many of the above techiniques in greater detail.
1 The usual mechanisms that maintain everything from body temperature and heart rate, to the level of thyroid hormone in theÂ blood are called homeostatic mechanisms. A shift resulting in a new set point is called allostasis.
By Richard I. Gracer, M.D.