Written by: Dr. Christopher Ashton, Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
I wholeheartedly commend a close friend of mine who asked me for my opinion about whether he was an alcoholic or not. Daily consumption of over 6 ounces of hard liquor each evening without fail, concurrent with some impacts physically on such matters as sleep cycle, basal metabolic index and sex drive, the answer would seem simple: yes. His inner circle of loves and friends were certainly supporting that notion and their calls for him abstaining were steadily mounting.
What I found absolutely remarkable was his courage to ask me to help sort out whether he had ‘alcoholism’ in a society that still has not been able to agree on what it is, or even if it truly exists as a disease, disorder or otherwise real. In a sense, ‘surrender’ to the knowledge one is an alcoholic or addict is akin to accepting one is afflicted with modern day leprosy. Social stigma, personal hardships experienced or witnessed and interests of public safety continue to marginalize those pronounced to have ‘the disease,’ with the assumption that relapse is always an imminent possibility and the person simply cannot be trusted. Considering that Narcotics Anonymous views the inevitable outcomes for those who do not follow their program as ‘jails, institutions or death,’ the comparison to ancient leprosy bears some consideration.
The global expert institutions in mental health all refer, in one language or another to alcoholism or addiction as ‘chronic’ and ‘relapsing.’ Making so-called ‘surrender’ even more terrifying is, in the midst of the beauty of solutions that do occasionally work, there is no gold standard to definitively treating this mysterious phenomenon. It is little wonder that the need to ‘hit bottom’ prior to seeking help has become a mantra. By observation, that seems to be what real alcoholics and addicts need to do.
Why forever give up the pleasures of a drink or the buzz of pills or powder and banish oneself to the land of the ‘abnormals’ and stigmatized. (AA and NA pride themselves on maintaining a unique fellowship, predicated on the shared understanding of its membership that they will never be normal societal members). Recent evidence of this being organic in nature with deleterious brain changes seems to only intensify the stigma; now the alcoholic in addition to the craziness of drinking also has a brain disorder. Could it get any worse?
To say the prognosis for a happy life, once the diagnosis is rendered, is grim is an understatement. Seeking help from the ‘treatment’ (after 24 years, I still don’t understand why that word is chosen) industry is prohibitively expensive, full of mysteries unto itself, especially in regard to pricing and offers uncertain outcomes (see The Business of Recovery). More than anecdotal evidence exists to support the negative impact of ‘failed’ treatment center experiences (first presented by Breese, G. et al., 2005).
In spite of this swirling societal drama regarding this mysterious phenomenon, my friend wanted to know. I also felt I could give him accurate answers based upon my personal life-saving research (everything else was failing as I desperately tried to stop drinking) and extraordinarily positive results and knowledge gained through helping others in an educational and supportive context. Additionally, the knowledge of the existence of this disorder, based on objective assessment, is powerful in the prevention of further development.
This article is exactly in the right magazine: alcoholism and substance addiction (they are one and the same) exist in the brain as a series of characteristic adaptations, all leading to an eventual self-destructive dependency on chemicals as the ‘only’ relief and potential pleasure based on the sufferer’s misinterpretation of life as inevitably, painfully futile. I acknowledge that likely audience's first impressions on the fact that addiction is a primary brain disorder (‘primary’ meaning that the disorder runs the show) adds to the daunting prospect of recovery, given our rudimentary understanding of how the brain works.
My findings, that there are nine discreet subregions (see 14. Limbic System - Bing video) with six potential neuroadaptations that all communicate with each other and the body through compromised electrical channels, which eventually results in the trap of addiction, further compromises utility of knowledge-based approaches. Furthermore, epigenetics play a crucial role in development of the neuroadaptations characteristic to all who suffer from this disorder. Without the genetic code, regardless of environmental stressors, one cannot possibly construct the myriad proteins and enzymes necessary for this disorder of near perfect destructiveness. Try as one might, if you’re not one of the estimated 8% of persons who carry the full genetic sequence, try as much as you like with excessive drinking, you can’t become an alcoholic. Photos such as the following (Source: Harvard Medical School, 2021) demonstrate that, yes, something terrible is going on in the brain, but what:
In the course (Understanding Addiction - Course Overview (harvard.edu)), the life context for the individual whose scan is shown was not given. He/she could still be functioning in society; the ‘slice’ of the brain imaged pertains mainly to areas involved in emotion and primitive decision-making. Higher order segments are not shown.
The bad news that I have imparted thus far is fortunately mitigated by the truth regarding addictions. At some point, most people do recover (The Broken Brain Podcast with Dr. John Kelly (dhrupurohit.com)). Superb approaches such as given in this magazine by Alicia Rios Wilkes (The Sobering Truth About Addiction ‒ It's Time We Stop Abusing The Abusers (brainzmagazine.com)), Tina Rane’ Ingram (Addiction (brainzmagazine.com)) and Emanuela Visone (Overcoming Addictions (brainzmagazine.com)) do work and happen to be fully aligned with this articles’ message.
My formative education years were spent studying engineering physics: if a concept could not be rigorously proven mathematically, it wasn’t real. Since that time, unless I see concrete proof of something, I cannot fully embrace it (hence the ‘higher power’ thing at AA resulted in multiple crashes on very rocky shores for me). Incredible advances in neuroscience over the past decade have illuminated my initial notion that there was some true switch inside my brain, beyond conscious influence, that had taken control of my life.
Merging thoughts, feelings, emotions and actions with emerging and robust scientific discoveries fully empowers self-awareness and enable conscious influence over what were previously involuntary dark aspects of personal sentience. The magnificence and impact of the voyage provide more than ample motivation to understand, precluding the need for a doctoral degree or anything close in nature. For some persons, such as myself, knowledge is the difference between life satisfaction and the ignominy of an alcoholic or addicted death.
True hope is instilled by the fact that addiction is a disorder that has developed to varying degrees over a lifetime and that the better part of the brain wants and can fully recover. The potential inherent in neuroplasticity gives the brain the ability, for the vast majority of persons, to largely ‘undo’ maladaptations in circuitry and processes that began to occur from the instant one met the world.
Given this understanding at last (to myself, the strangest aspect is that the knowledge has been beckoning for someone to connect all the dots and I seem to be first), supportive efforts can now be geared to what directly accelerates and sustains the brain ‘healing.’ There is little mystery in this. We’re proficient at giving advice regarding improving general health; the same applies to the limbic system. Stop promoting the myths which are holding people back: it’s a spiritual disease, the root cause needs to be dealt with, la, la, la and let the brain get better. ‘Neurotypical’ function occurs in the vast majority of persons, under the right conditions between 18 and 24 months. Clients and families often call it miraculous. I call it the application of sound science.
What does all this mean? It means the addiction in the brain is over and affected circuitry has returned to healthy function. While a hellish ordeal, addiction can accurately be framed as a life experience and not a life sentence.
Back to my friend with a predilection for whisky in the evenings. In my searches surrounding the science of recovery, I found a highly reliable neurocognitive assessment suite of tools through Online Cognitive Assessment Platform | Creyos (formerly Cambridge Brain Sciences). Having performed hundreds of these assessments with clients, friends and myself, I clearly see a results profile that is characteristic for persons with severe substance use disorder (Addiction), exclusive of intellect. He definitely did not have the characteristic brain changes. His Alcohol Use Disorders Inventory Test (AUDIT) indicated mild dependency on alcohol.
My impression: if he quit alcohol he would miss it although might be to his benefit. He agreed. No need to get advance booking at the leper colony; that was highly unlikely given his age.
Dr. Christopher Ashton, Executive Contributor Brainz Magazine
Christopher Ashton is a thought leader and truth seeker in all matters pertaining to improving health in individuals, organizations and populations. Educated in engineering physics, medicine and business finance, Christopher is able to connect the dots in multidisciplinary, complex scenarios in a manner few other persons can. Driven by the belief that answers always exist, he is currently making sense of previously incomprehensible human decisions from an organic, scientific basis. His personal goal, create something so creative and discover new truths worthy of consideration for a Nobel prize.