By Lisa Martinovic
In battling addiction, neuroscience offers a complementary and alternative approach to twelve-step programs.
Cutting-edge 21st century neuroscience and a certain Depression era, Christian-based self-help fellowship might make strange bedfellows, but they have one thing in common: when it comes to the treatment of addiction, both rely on the brain’s innate capacity for transformation.
This may come as a surprise to those who think that Alcoholics Anonymous and other twelve-step programs are all about ‘turning your will and your life over to the care of God.’ Countless people do precisely that, but sobriety doesn’t happen in the absence of a tremendous amount of real-world footwork. And footwork, be it psychotherapy or working the steps, is what changes your brain and paves the way from addiction to freedom. I know this because I lived for eighteen years as a dedicated twelve-stepper, followed by fifteen years of self-directed sobriety. Understanding the science behind how we make monumental changes in our lives will help anyone who wants to clean up — with or without God.
Back in 1982 I needed monumental change and I needed it badly. I was living in San Francisco’s Mission District. It was decades before the tech boom, and the Mission was still gritty and low-rent. I’d been an alcoholic from my first drink some ten years earlier, and went on to get strung out on meth, opiates and, most devastatingly, crack. Toward the end, I was under no delusions about the fact that I was a raging, out-of-control addict, headed for an early death. Though the prospect of sobriety struck me as a life too boring to be worth living, I decided to give it a whirl. I had nothing to lose.
The apartment where I hit bottom was right on top of a Valencia Street storefront that housed the longest-running AA meeting in the city. Known as The Divine Dump, it was home to a rough assortment of last-chance drunks, many of whom lived at the nearby Salvation Army. I was a young woman, middle class reared and university educated, but I had fallen so far so fast that I fit right in.
Since every AA group is autonomous, each has its own culture. What I especially loved about ours was that we were all invited to interpret “God as we understood Him” quite liberally. Members deified doorknobs, light bulbs, pet Chihuahuas. Some were dyed-in-the wool atheists like me. Others had lost the God of childhood somewhere on the road to their own personal hell. To be sure, there was a preponderance of members who spoke of God as depicted in traditional Judeo-Christian teachings. I never felt any pressure to adopt their “understanding,” though I did try it on for size. Eventually I settled on something comfortably vague that I called the Creative Life Force.
But secretly? Secretly I always felt that I cleaned up because I made a decision and stuck to it.
However we made peace with “the God thing,” many of us got sober and stayed sober while many more did not. I went to twelve-step meetings on a near-daily basis for some ten years: AA, NA, OA, CA, WA, DA, SLAA, CODA and Al-Anon. Now, after a decade and a half of charting my own course, I’m still happily sober — and more emotionally sober than I have ever been. Still, my years first as a hard-core addict and then as a born-again twelve-stepper were formative, so I’ve never stopped wondering: by what mechanism do we get sober? Neuroplasticity offers some answers.
Whether or not you believe in God — indeed, whether or not God exists — we all have the capacity to change our behavior, our thinking, and the very structure of our brains. Applying the principles of neuroplasticity can help you get sober and stay sober. If you feel the presence of God in your life, or choose to invoke a God you don’t know in hopes that he or she will come to your aid, more Higher Power to you! But to augment your chances for success, or for an altogether different approach to sobriety, consider directing your brain.
How it works — neurologically
Simply put, neuroplasticity is the phenomenon by which the brain changes itself through experience. It does so by strengthening the neural connections (synapses) associated with a particular course of action every time we take that course. Visualize your brain as an untamed continent and you are the first person to forge your way across it. You’re probably going to look for the path of least resistance, skirting the highest mountain peaks and roughest river crossings. As you trample through the brush you’ll leave the beginnings of a trail in your wake. Should you ever make this trek again, for the sake of minimizing your ordeal, you will likely follow the same path. The more often you do so, the better defined it becomes, and the less likely you will be to brave unknown territory or take unnecessary risks. Why would you? You’ve navigated terra incognita and made it to the promised land. You won!
The brain is similarly biased towards efficiency. Say you’re a shy, insecure teenager at your first party with the cool kids. You feel awkward, tongue-tied, and extremely uncool. Someone offers you a drink. Before long you are relaxed, then giddy. By the end of the night you’re making out with the hottest boy in class. You judge the adventure a huge success — and your brain sets up a powerfully reinforced neural pathway through the wilderness of your teens. Why would you choose to be timid and vulnerable when a few drinks unleash your confident, sexy beast? So you go to party after party, imbibing drink after drink, and with every episode the neural pathway that tells you this is the way to deal with your psycho-social limitations becomes more entrenched. What started as a shortcut becomes your default, then your habit, then your addiction. The more often you walk this path, the harder it becomes to walk any other.
Years later your life is in shambles. You’ve tried and failed repeatedly to get it together. In desperation you turn to AA. Though its founders considered it a spiritual program, the twelve-steps are also a master class — a practicum — in neuroplastic change.
Neuroscience tells us “neurons that fire together wire together.” Activities we perform habitually and simultaneously, such as unwinding with Ben and Jerry’s at the end of the workday, become neurologically linked by association in our brains. Do that ritual often enough and you will be very uncomfortable when one day you arrive home to an empty freezer. But here’s the key: for good and for ill, neuroplasticity cuts both ways. It reinforces self-destructive habits if you keep doing harmful things and it builds healthy habits when you start turning your life around. Your choice.
Just to begin weakening the neural connections that paved your road to ruin demands multiple lifestyle changes. Addicts who sank as low as I did can’t just eliminate drink or drugs. We have to avoid the people, places, and situations associated with our addiction. (Don’t trigger those neurons!) Then we have to replace them with alternatives, which is where twelve-step programs come in. Going to meetings becomes something to do instead of getting loaded. Meetings also keep our focus on the habits we want to build until they become as automatic as drinking or using once was.
Or is it brainwashing?
There is much grumbling on anti-twelve-step listserves about the interminable amount of time spent reading, reciting, and discussing AA’s official text (known as The Big Book), its steps, and traditions, as if it’s brainwashing. Well, in a sense it is. But so are Sunday school, Fox news, and boot camp. Everything that we do or think, see, say, or hear — everything — changes our brains, either strengthening existing connections or forging new ones. Sober or addicted, we train our brains 24/7. The question is: are we doing so consciously?
If you drank every day for ten years, that’s 3,650 times you reinforced the neural pathway that associates alcohol with relaxation or fun or sex or whatever else you used it for. Drinking releases feel-good neurochemicals. So do vigorous exercise and creative challenges — too much work if there’s an easier, softer way. When it comes to triggering the release of yummy endorphins and dopamine, your brain became a one-trick pony. It’s going to take a while before sobriety feels comfortable, let alone pleasurable. Which is why most people need support trading their neural superhighway for what is initially a mere footpath to recovery. It could be inpatient treatment, therapy, an exceptional network of family and friends, or a twelve-step program.
Perhaps the most prevalent alternative to twelve-step programs is Cognitive Behavioral Therapy (CBT), a form of psychotherapy used first to prevent relapse when treating problem drinking, then adapted for every other addiction you can name, and administered by everyone from big-name rehabs to your neighborhood therapist. CBT does not concern itself with moral turpitude or God’s will; instead, it narrowly focuses on teaching the addict coping skills such as avoiding high-risk situations, handling cravings, and self-monitoring. Learning and practicing new skills engenders neuroplastic change, regardless of whether you achieve it with a therapist, a sponsor, or through sheer force of will.
There is no consensus as to which approach is more effective, twelve-step or CBT. Success rates in twelve-step programs are extremely difficult to quantify precisely because they comprise anonymous amateurs. But they do have one huge advantage over any form of professional therapy: they cost nothing. No money, doctor’s referral, insurance approval, or intake appointment is required. You just show up and get started. Of course, many people feel the need for a clinical setting, or enforced accountability. If they can afford it, therapy or rehab may be better options. Even at that, CBT practitioners often suggest their clients also attend twelve-step meetings to reinforce the often overlapping skills they’re learning in therapy and increase their chances for lasting recovery.
As with any new practice, consistent participation in twelve-step programs gradually and methodically builds new neural networks. Every sober foray into a situation you used to get high for — first date, party, being alone and lonely — strengthens your capacity to do so again. Thanks to your malleable brain, the more you do something sober the easier it becomes. But, using my earlier example, you may need to muddle through a thousand situations sober before it comes as naturally as it did when you were drunk. It’s hard for most of us to stick to our resolve that many times. But with the support of others it is possible.
AA contends that because our willpower has “failed utterly” to get us sober, we have no recourse but God. Really? Well, what does every participant at every meeting find every time? What is the common denominator? Not God, but other people getting sober. We find community. The generous support of other human beings carries us when we cannot carry ourselves. A strong case can be made that it would be easier for an alcoholic with AA but no God to get sober than for an alcoholic who has God but no recovery community.
At its best, twelve-step offers:
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a physical and psychic container within which addicts are supported to change;
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living proof, in the form of sober members, that recovery is possible. This provides a neural imprint, a model for the brain to latch onto;
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coping strategies and practical techniques to get through rough patches;
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friendship, solidarity, and hope — as transmitted by dopamine and oxytocin. These chemicals strengthen neural pathways to reinforce new behaviors;
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the constant repetition of twelve-step language that systematically replaces the thought patterns that got us into so much trouble (“stinking thinking”) with thoughts that support us to be our most honorable and mature selves. It’s true this language is steeped in the Christian ideology that rankles so many. Nonbelievers find solace in the unofficial AA adage: Take what you like and leave the rest. (You won’t find that workaround in The Big Book, but you will hear it in meetings, to the consternation of some AA fundamentalists.)