The Epiphany, a Watershed Event, The “Aha” Moment

Did you ever have a moment when something clicked in your mind, when you finally knew the reason for something that had affected you life for a very long time? Did it change the basic way that you approached an important relationship or perhaps change a major habit? This has happened to all of us, but what actions followed this? Did anything change on your life?

I firmly believe that many substance abuse patients get to the point where they are “done”, when they realize that they must change in order to survive socially and even physically. Another term for this is “hitting bottom”. Where this is, is different for each person. When this happens things can change rapidly. Getting off drugs becomes “easy”. Acceptance of reality actually brings a freedom that they never realized existed when they were always afraid that it would bring restrictions and outside control.

I have had the wonderful experience of witnessing the “aha” moment with several patients. They are ready to solve their problems and will do what it takes to do it. They need guidance, support, and education to make the most of their lives. It is amazing that patients who would not taper their drugs or suffer the slightest discomfort, taper and stop on their own or with minimal urging. I often set out a taper schedule and when they come for follow up; I find that they have far exceeded my suggested dosage cuts. I tell them. “ It’s easy to get someplace once you know where you are going.”

I have had the wonderful experience of witnessing the “aha” moment with several patients.

I believe that there is a physical change that takes place in the brain after an “aha” experience. This is probably centered in the limbic system where feelings arise and are modulated. The limbic system is also drastically altered in substance dependence. The nucleus accumbins is the pleasure center. The main neurotransmitter in this area is dopamine. Drugs of abuse stimulate this area with high amounts of dopamine, bringing euphoria and a sense of well-being. Unfortunately, the brain becomes used to having these high levels of dopamine, which resets the mechanism that maintains proper levels, resulting in too little dopamine without the outside stimulation. In addition, the naturally occurring substances that increase dopamine are suppressed and the dopamine receptors become less sensitive. This results in “dysphoria” (the opposite of euphoria), depression, increased pain sensitivity, fatigue, and many other negative feelings. The usual things that give pleasure, such as a hug or playing with your children no longer make you happy. Nothing but using drugs or alcohol helps. Once this point is reached, the physically dependent person has to use to just avoid 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. This means dealing with a person as they are, whatever that may be. If someone does not think that they have a drug problem, then telling him or her that they do and forcing them to attend groups or meetings, in which they are told about “their” problem accomplishes nothing. The task is to help that person see the problem himself or herself. This can be a very slow and frustrating task. The basic method, called motivational interviewing, is outlined in my book, A New Prescription for Addiction. We also use the Readiness to Change evaluation to help the patient and the therapist see the problem as it really is.

Reaching “bottom” is another time where a major change can take place. This may be after losing a job or a marriage. It may be in the hospital ICU. During these times, empathetic treatment can make a big difference.

Another way of finding the “aha” is called “Focusing”. In the 1960’s Eugene Gendlin, PhD, a psychology professor and researcher at the University of Chicago, did a series of studies looking at which patients made changes and why. This was not only in the substance abuse arena. He analyzed thousands of hours of therapy session tapes. He made a startling conclusion: in many cases, the patient made the difference, not the therapist or even the type of therapy. Those that looked at the real reasons behind their problems made the most progress and changes. He then devised a method to help people find the “aha”.

He called this method Focusing. It involves a type of directed meditation, which allows one to concentrate on one problem at a time and then delve into this in a specific and reproducible way. The information can then be used to help change. This can be done alone or with the help of a therapist. There are many books available and Dr. Gendlin’s book, Focusing, is still in print and available on Amazon.

A third way of “getting inside” is experimental and is not widely available at this time. The amygdala is an area of the midbrain where emotions are regulated. When there is a stressful event circuits that cause a flight or fight adrenalin rush may become reinforced so that any thought of the event, even years later, causes a large reaction with sweating, racing heart, anxiety, and fear. Most of the time, the patient does not even make the connection between the event and reaction. This is the cause of post traumatic stress disorder (PTSD), a major coexisting problem with substance abuse. A major cause of drug abuse is anxiety and anger. If these reactions can be tamed, stopping drug use becomes much easier. Often realizing that this is the problem makes a huge difference. (The “aha”)

There are several ways under study to help cut these abnormal reactions. One is EMDR, eye movement desensitization and reprocessing. ( This is a process in which the patient is asked to make eye movements while the therapist directs them in experiencing a stressful memory. The combination seems to unlink 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 these 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 treatment 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 can help with any difficult journey. There is a physical, as well as a psychological, basis for many of these problems, but there are many ways of looking for that major experience and feeling. Once one finds it, change 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 the blood are called homeostatic mechanisms. A shift resulting in a new set point is called allostasis.


By Richard I. Gracer, M.D.