Recovery Tools

 

Aspects of Treatment:

Making Choices in Recovery

Choices

Choices in Recovery

Choice is our purest expression of free will, and with choice comes sacrifice-through choosing one thing we forsake the rest.   In active addiction and alcoholism, we are robbed of this because our brain has been hijacked by the substance, making us believe we are nothing without the substance.  Addiction and alcoholism take the choice to be free away from us.

In active addiction and alcoholism, the things we say and do are evidence of this:  parents who put their children in jeopardy by driving drunk, stealing valuables from our loved ones, irrational and angry tirades to others, missed appointments, work, school.  Things we would never choose to do if we were in a sober mind set, free from the substance.  

Recovery means taking back our free will, our ability to choose, and learning that we are everything  without the substance.  It also means sacrificing the drug or alcohol, facing our physical, emotional and legal consequences, in order to live.

In early recovery, our choices are fairly basic-use or don’t use, isolate or go to meetings.  But life is begging us to rejoin as a fully functioning person, and the way we choose is the first part of ourselves we need to address to build our recovery foundation.  

Is Your Brain Hijacked by Drugs or Alcohol?

Alcohol and drug use disorders change our brain stability.  ASAM describes: “Addiction and alcoholism impacts brain chemistry and circuitry and results in compulsive drug-seeking and drug-using behaviors that interfere with daily functioning. A high level of drug dependency, co-occurring medical or mental health disorders, polydrug abuse, family history of addiction, high levels of stress, experience of trauma, and low level of support at home can all contribute to the onset of addiction” 

Drugs and Alcohol Change the Brain, Changes Everything

The brain regulates temperature, emotions, decision-making, breathing, and coordination. This major organ in the body also impacts physical sensations in the body, emotions, cravings, compulsions, and habits. Under the influence of a powerful, but harmful chemical, individuals abusing substances can alter the function of their brain.

Drugs interact with the limbic system in the brain to release strong feel-good emotions, affecting the individual’s body and mind. Our brains reward us when we do something that brings us pleasure. To illustrate, individuals continue taking drugs to support the intense feel-good emotions the brain releases, thus creating a cycle of drug use and intense highs. Eventually, they take the drug just to feel normal.

Your Brain on Drugs

Different drugs have very different effects. For example, the brain’s response to marijuana is much different than its response to cocaine or heroin.   Pleasure or euphoria—the high from drugs, involves surges of chemical signaling compounds including the body’s natural opioids (endorphins) and other neurotransmitters in parts of the basal ganglia (the reward circuit). When some drugs are taken, they can cause surges of these neurotransmitters much greater than the smaller bursts naturally produced in association with healthy rewards like eating, hearing or playing music, creative pursuits, or social interaction.

Your Brain on Drugs-continued

The feeling of pleasure is how a healthy brain identifies and reinforces beneficial behaviors, such as eating, socializing, and sex. Our brains are wired to increase the odds that we will repeat pleasurable activities. The neurotransmitter dopamine is central to this. Whenever the reward circuit is activated by a healthy, pleasurable experience, a burst of dopamine signals that something important is happening that needs to be remembered. This dopamine signal causes changes in neural connectivity that make it easier to repeat the activity again and again without thinking about it, leading to the formation of habits.

Just as drugs produce intense euphoria, they also produce much larger surges of dopamine, powerfully reinforcing the connection between consumption of the drug, the resulting pleasure, and all the external cues linked to the experience. Large surges of dopamine “teach” the brain to seek drugs at the expense of other, healthier goals and activities.

Why is Quitting So Hard

Addiction is a brain disease.  Alcohol and drug affect the chemical stability in our brain; change the chemical signals in our brain, making stopping use difficult and often painful.  Neurotransmitters play a crucial role in normal functioning of the brain and body, including: mood regulation, movement and coordination, appetite, autonomic functions of the central nervous system, the ability to think clearly and make sound decisions, stress levels, memory and learning, sexual desire, sensory perception, motivation, concentration levels, cognition, feelings of pleasure, and processing rewards.

Many neurotransmitters in the brain are affected by drug use, here is a breakdown of some of the major neurotransmitters affected:
• Dopamine— pleasure, rewards
• Serotonin— mood stabilizer, impacts mood, sexual desire, sleep, appetite levels
• Glutamate— increases neuron activity, involved in learning, memory, and cognitive function
• Gamma-aminobutyric acid— lowers stress and anxiety by slowing down heart rate, blood pressure, and body temperature; acts like a natural tranquilizer
• Norepinephrine— similar to adrenaline (activates the fight-or-flight stress response), speeds up heart rate, blood pressure, and respiration; increases body temperature while impacting movement, anxiety levels, sleep, moods, appetite levels, memory functions, and sensory processing abilities
• Endorphins and endogenous opioid peptide system— naturally activate opioid receptors in the brain to slow central nervous system functions, impact mood, and have a sedative and analgesic (painkilling) effect
• Endogenous cannabinoids— natural system in the brain that impacts memory, cognitive functions, and movement
(American Addiction Centers).

 

 

Why Is Quitting So Hard continued

Psychotropic drugs affect the brain’s “reward” circuit. Normally, the reward circuit responds to healthy, pleasurable activities by releasing the neurotransmitter dopamine, which teaches other parts of the brain to repeat those activities. Drugs take control of this system, releasing large amounts of dopamine—first in response to the drug but later mainly in response to other cues associated with the drug—like being with people you used drugs with, or being in places where you used drugs. The brain remembers this feeling and sends out an intense motivation to seek and use the drug again. So dopamine does not cause the rush of feelings; instead it reinforces the desire to use drugs.

The brain of an addict or alcoholic adjusts by producing fewer neurotransmitters in the reward circuit, or by reducing the number of receptors that can receive signals.  As a result, the person’s ability to experience pleasure from naturally rewarding (i.e., reinforcing) activities is also reduced.  Without the drugs or alcohol, we feel physical and emotional pain, depression, and sadness.

Combined with these adverse feelings, we are also aware of what we have done, said, how we acted while under the influence or to get the drugs or alcohol.  Compound layers or guilt, shame and remorse, where all we want to do is forget or have a ‘do-over’ of our life, you have a difficult and seemingly insurmountable obstacle to overcome.

Neurotransmitters Affected by Drugs and Alcohol

Serotoninan inhibitory neurotransmitter:   works as a mood stabilizer and impacts mood, sexual desire, sleep, and appetite levels

  • Ecstasy (MDMA or Molly), Cocaine, PCP (phencyclidine)

Glutamatethe principle excitatory neurotransmitter:  increases neuron activity and is involved in learning, memory, and cognitive functions

  • Alcohol, Ketamine, PCP

Gamma-aminobutyric acid (GABA)an inhibitory neurotransmitter:   lowers stress and anxiety by slowing down heart rate, blood pressure, and body temperature; acts as a natural tranquilizer

  • Benzodiazepines (Valium, Ativan, Xanax, etc.), Alcohol, Sedatives and tranquilizer
  • Barbiturates (Phenobarbital, Secobarbital, Amobarbital, etc.  Also known as Pink Ladies, Yellow Jackets, Amytal, and Nembies)

Neurotransmitters Affected by Drugs and Alcohol continued

Norepinephrinean excitatory neurotransmitter:  similar to adrenaline, activates the “fight-or-flight” stress response in the body; speeds up heart rate, blood pressure, and respiration, and increases body temperature while impacting movement,anxiety levels, sleep, moods, appetite levels, memory functions, and sensory processing abilities

  • Methamphetamine, Amphetamine, ADHD medications (Ritalin, Adderall, Concerta), Cocaine

Endorphins and endogenous opioidspeptides:   activates opioid receptors in the brain to slow central nervous system functions (including breathing rates), impact mood, and have a sedative and analgesic (painkilling) effect

  • Prescription opioid pain relievers (OxyContin, Vicodin, morphine, fentanyl, etc.), Heroin

Endogenous cannabinoidsnon-standard neurotransmitter:   interacts with CB1 cannabinoid receptors in the brain, impacting memory, cognitive functions, and movement

  • Marijuana, Spice (synthetic cannabinoids)

Dopamine-The Enforcer

Dopamine in our brains are wired to make sure we will repeat survival activities, like eating, by connecting those activities with feeling good. Whenever this reward circuit is kick-started, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it. Because drugs come in and “hijack” the same circuit, people learn to use drugs in the same way.

After repeated drug use, the brain starts to adjust to the surges of dopamine. Neurons may begin to reduce the number of dopamine receptors or simply make less dopamine. The result is less dopamine signaling in the brain—like turning down the volume on the dopamine signal. Because some drugs are toxic, some neurons also may die.

 

What is Anhedonia

As a result, the ability to feel pleasure is reduced. The person feels flat, lifeless, and depressed, and is unable to enjoy things that once brought pleasure. This is called Anhedonia.  Anhedonia is a disinterest in social contact and a lack of pleasure in social situations. Physical anhedonia is an inability to feel tactile pleasures such as eating, touching, or sex.

The symptoms of anhedonia include:

  • social withdrawal and difficulty adjusting to social situations
  • withdrawal from relationships
  • negative feelings toward yourself and others
  • reduced emotional abilities, including having less verbal or nonverbal expressions
  • a tendency toward showing fake emotions, such as pretending you’re happy at a wedding
  • a loss of libido or a lack of interest in physical intimacy
  • persistent physical problems, such as being sick often

Anhedonia is an often unspoken about and difficult to treat symptom in recovery, most commonly associated with methamphetamine, cocaine and opioids.

Impulse or Choice?

Alcohol and drug use disorders change our brain stability.  ASAM describes: “Addiction and alcoholism impacts brain chemistry and circuitry and results in compulsive drug-seeking and drug-using behaviors that interfere with daily functioning. A high level of drug dependency, co-occurring medical or mental health disorders, polydrug abuse, family history of addiction, high levels of stress, experience of trauma, and low level of support at home can all contribute to the onset of addiction” 

But however it begins, no matter how long it has existed, recovery is possible.  We are told, “The only thing you have to change is everything”, but how do we start making changes to keep us in recovery?  Just stopping the use is only the first step; through stopping use, we begin the process of claiming our lives and our control over our actions.  We finally begin to think clearly and make healthy choices for ourselves and our loved ones.  

Before recovery, while we were active in our addictions, all of our choices, regardless of how high or how low we functioned, revolved around our next use.  Our ‘choices’ were made,  transmitted and based  on the malfunctioning portions of our brain that were affected from the continuous use of alcohol or drugs.  Our minimizing or denial of our use, hiding the extent of our use, and planning and preparing for our next use impacted and encompassed all aspects of our lives.  

Our ‘choices’ determined our daily patterns of life, and these patterns became our habits.  Sometimes they are more subtle, sometimes more identifiable.  These habits evolved, developed, and were created from the necessity to use.  We set our alarms earlier to give us more morning time to recover from the effects of the night before.  Our recreational activities were specific, with time slotted before, during and after for use.  

There was a man once who did not drink alcohol all year; he worked very hard at his job, and planned for his vacation over the Christmas holidays.  He made elaborate plans for these two weeks off from work-he fully stocked his liquor cabinet and his mixers; completed all of his holiday shopping, wrapping and mailings ahead of most of us as he planned for his vacation.  But his vacation was a two week drinking binge.  He began on the night of his last day of work, and drank throughout each day and night of his two weeks, ending on New Years Day.  This was his ‘recovery day’.  And then he would start the planning and process for the next Christmas holiday.  His entire year was dedicated to these two weeks and being drunk.  

Our vacation destinations were influenced to ensure access to, or the ability to bring, alcohol or drugs.  Most of us were very detail oriented, with alternative plans carefully identified in the case of unforeseen obstacles.  Our choices for shopping, driving, and eating reflected this.  We develop a pattern in the grocery store if we buy our alcohol there.  Even how we dispose of the evidence of our use becomes a pattern.  

A friend of mine would hold a bonfire burn several times per year.  He would begin making the new pile for later burning right after the first one was completed.  His burn pile contained all burnable trash on his property, including plastics, roofing materials, anything.  Throughout his active alcoholism, the containers for his secret, or extra, alcohol had to be made of plastic.  On the eve of his big burn, he gathered his hidden empty stash bottles and hid them within his burn pile.  The next day, he would burn his pile.  It smelled awful, but he dissuaded questions because it contained the visible trash he kept just for this occasion.  

Every decision we make in active addiction or alcoholism is skewed by our need to protect our use-in recovery, we need to change, create new patterns and build new habits to protect our recovery.  In active addiction or alcoholism, our ability to choose is controlled and defined by our addiction.  Our choices were determined by our internal motivation to use them.  In recovery, our ability to choose becomes ours again, but we are training our ‘new’ brain, and we must create a new internal motivation to not use them.

Question Everything

Remember the story of the gal who kept dating the ‘wrong’ type of guy?  As she lamented over the break-up of yet another terrible relationship, she was told; “You’re not a bad person-your choices are.  She had to first learn to know herself, and then she could recognize a good choice.  

One of the first steps in learning to make healthy choices in recovery is getting to know you.  

Consider these questions and ask yourself:

  1.  What are my values?
  2. What matters to me in life?
  3. What are my goals? 

 

Learning to Make Healthy Choices

Identify Your Core Values

The first step in making healthy choices and decisions is understanding what your core values are.

Through identifying and understanding your values you begin to understand the central part of who you are – and who you want to be. By becoming more aware of these important factors in your life, you can use them as a guide to make the best choice in any situation.

Some of life’s decisions are really about determining what you value most. When many options seem reasonable, it’s helpful and comforting to rely on your values – and use them as a strong guiding force to point you in the right direction.

Follow the link to a worksheet!

What Matters to You Most In Life?

What matters to you?  In recovery, the number one thing that matters most is usually our recovery, because without that, we have nothing.  Not love, not family, not friends.

Recovery offers an infinite variety of choices and challenges; with those challenges come opportunities that we may succeed in or not.  Either way, what is important is that we have the ability now to try.  

We identify our core values, but do we really know what is important to us?  And, when we can identify these, are we able to prioritize them?  

What is the Goal, or the Outcome You Seek?

Goals-Outcomes-Results

Choice making, or Decision making, is a skill to be learned over time, and this is based upon: 

  • Experience
  • Knowledge, and 
  • Trials

Sometimes, choices must be made in the moment and they are not always the best, but may be the best choice for that individual instance.  Many times, we get bogged down with regret about the decision we made, but try to remember these choices are what we made with the knowledge and the experience we had at the time!  Hindsight, looking back and reflecting, and ask ourselves, “Why or why not was my decision a good one?”

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