Here we’ll cover:
- Hi-jack of the rewards system - the why!
- Impaired decision-making
- Readiness to change
- Brain repair takes time
- Noticing changes
1. Hi-jack of the rewards system - the why!
People addicted to substances experience an overall reduction in the sensitivity of the brain’s reward system (especially the brain circuits involving dopamine), both to addictive substances and also to natural reinforcers, such as food and sex.
(Surgeon General Report)
To put it simply, when we engage in certain activities, like eating or having sex, chemicals in the brain’s basal ganglia generate feelings of pleasure. This is a reward that motivates us to continue engaging in these activities, and is a built-in way to make sure our species survive.
Similarly, in the face of danger, the brain’s stress systems in the extended amygdala get activated and motivate “fight or flight”; responses. These responses are also critical for survival.
Here’s the trouble:
These and other survival systems are “hijacked” by addictive substances.
2. Impaired decision-making
What all of this means is that brain functioning is actually impaired.
We no longer have to wonder why people who develop a substance use disorder tend to not get the same level of satisfaction or pleasure from once-pleasurable activities. The changes in the brain make it impossible to (for now).
This general loss of reward sensitivity may also be the reason people compulsively increase their substance use.
They are simply trying to regain feelings of pleasure that the rewards system in the brain used to provide, but doesn’t anymore.
On top of the rewards system being hijacked the area responsible for reasoning and decision-making is impaired, which makes even more sense as to why decisions which lead to negative consequences continue to be made.
3. Readiness to change
Given what we know now about the brain, when substances are in use an individual may not want to stop or change their use. Still, motivations do change over time and people will be at different stages of motivation to change at any time.
Research names six stages on the continuum of change. Our desire to change can change daily or more frequently, another way of thinking about it is that we can shift along the continuum.
It’s helpful to consider where our loved ones are at with their desire to change in any of our interactions with them. Understanding the stages, and which one our loved one is at, allows us know when certain conversations will be most effective.
Another way to learn about the stages of change is to think about this as if it were a change we were going to make for ourselves, like go to the gym more, or get to bed earlier. It’s similar for our loved one and changes in substance use.
Let’s take a look at the stages.
First, there is precontemplation.
This is the part in the process where we have no intention of taking action anytime soon (defined as in the next 6 months). We’re often oblivious that our behavior is a problem or that it brings negative consequences.
When we’re in this stage, we tend to underestimate the benefits of changing our behavior. Instead we are more aware of the ways we’d suffer from changing. Conversations about change at this stage may cause more conflict than benefit.
Second is contemplation.
Here’s the spot where we intend to start a healthy behavior sometime soon (defined as in the next 6 months). We can see that our behavior might be a problem, or that there’s a good reason to make a change, and we’re more thoughtful about the cons and pros of changing our behavior, with almost equal emphasis on both. Even seeing this, though, we still may feel conflicted and hesitant about changing behavior.
Third, we have preparation, also seen as determination.
Now!! We’re ready to take action … within the next 30 days. We begin taking little steps in the direction of behavior change, and we actually believe that changing our behavior can lead to a healthier life. Conversations at this point can be about making plans and setting the groundwork for change.
Next up, we’ve got action.
In the action stage, we are taking action. Conversations at this point should be about taking action. We may have recently, (within the last 6 months), changed our behavior in some way AND we plan to keep moving forward in the change direction. The change we’ve made may be a modification of our problem (or no longer desired) behavior or the action may be focused on creating all new healthy behaviors.
The fifth stage is maintenance.
Here, we have maintained our behavior change for a while - more than 6 months - and we fully intend to sustain this change. When we’re in this stage, we purposefully work to prevent relapse back to earlier stages. Conversations now are best focused on reinforcing the positive changes that have taken place.
The last stage in the process of change is termination.
Hallelujah. We have no desire to circle back to unhealthy or undesired behaviors and we are certain that we won’t.
Since this is a tough stage to identify because none of us can see or be certain about the future, we tend to be happy hanging out in the maintenance stage. The termination stage is not the main focus of this stages of change model, and it’s important to note this because our knee jerk reaction can be to focus on recovery as a final destination. We now know there’s a lot more to it!
What’s important to know here is that your loved one may be at a different stage of the continuum depending on the day or the hour, just like ourselves, so it’s important to check in on where they’re at regularly to have a better chance at communicating.
4. Brain repairs - takes time
Change takes time - so take it slow and practice patience!
It’s been shown in research that it takes time for the brain to heal. A good rule of thumb is that abstinence for 6 months will be represented in the brain repair to the order of magnitude of 50%. Knowing this fact can help us empathize with the recovery journey our loved ones are on and shape how to support them as they build new habits in place of the old.
Things to keep in mind:
Removing a habitually used substance removes the rewards the brain is used to so for a while after substance use is stopped things won’t feel that good
Healing doesn’t mean going back to the way things were, cast your eyes forward, as new habits are formed it’s best to create new norms together.
Keep in mind healing can take years, relapse is part of the process, and you can help by not moving goalposts too far ahead or forgetting about goalposts that have been met. Celebrate the progress.
5. Noting Change
Note that a change that has taken place!
Because we now understand a bit about the complexities involved in the changing and healing process, we’re better equipped to notice subtle changes…
Changes that may not have seemed “enough”; before you stopped to really think about it.
So the action to take today is positively acknowledging any change you can identify, however small, because in doing so, you’re building one more bridge for connection with your loved one who needs your positive reinforcement.
Cast your mind back to 6 and then 3 months and 3 weeks ago (exercise), what was a change then you were hoping for at each of these times? Can you think of one for each time stamp?