Recovery

One of the more common questions around treatment centers and the recovery fellowships goes something like,”I’m addicted to prescription drugs, not alcohol, so why can’t I have a drink?  What’s this cross-addiction I’ve heard about?”

That’s really not an unreasonable question. Why do addicts who don’t seem to have problems with alcohol need to stay away from it anyway? Why can’t a prescription drug addict have a few drinks?

There are really two reasons:

• Alcohol reduces our inhibitions and increases the likelihood that we will make bad choices; and
• Just as they say in the rooms, “A drug is a drug is a drug.”

Number one is pretty much self-explanatory, and can be attested to by anyone who has regretted something he or she did while they were drinking. The parts of our brains that are responsible for taking in information and allowing us to make reasoned decisions are among the first functions to be depressed by alcohol, along with some motor skills. (See any relationship to drunk driving problems there?)

We make poor decisions about driving, about kissing the boss’s wife at the Christmas party, about arguing with large men who carry guns and handcuffs, and all sorts of other things, including whether or not to drink more or use other drugs. “It seemed like a good idea at the time” can become a major problem when we’ve had a couple of drinks. Essentially, booze makes us dumber while convincing us that we’re smarter.

The second reason, known as cross-addiction, is a bit more complicated but makes perfect sense when you understand a few things. Cross-addiction refers to how we addicts, once addicted, are far more likely to get hooked on other drugs or behavior in addition to our drugs of choice.

Why do we drink or use drugs? We may say we like the taste of whiskey, but the fact is that we like it because we associate it with the way alcohol makes us feel. We use alcohol and other drugs because they change the way we feel. They make us feel “good,” or they “relax” us, or they (insert own reason here). Sometimes we use because we’re happy and we want to feel happier, but most of us use drugs and mood-altering behavior because they distract us from reality. Trouble is, the drugs always wear off, and we’re always there, wishing we still felt good. It doesn’t take us long to figure out how to make that happen.

Certain activities stimulate the production of chemicals in the brain that make us feel pleasure. Generally, these relate to things that are mostly beneficial: seeing a loved one or good friend, eating, exercising, playing games — especially if we win — fun, daydreaming, getting a good grade in school, a compliment, sex and so forth. They are quite literally our bodies’ way of insuring that we keep on doing things that are good for us. We refer to the portion of the brain that is stimulated as the reward center.

Alcohol and other drugs also stimulate the reward center, and they do it extremely well to begin with. When we start drinking and using drugs, the feelings are phenomenal. They are much stronger than the normal sorts of feelings, because the drug causes the production of extra quantities of feel-good neurotransmitters or, in some cases, stimulates the receptor sites in the reward center directly. Now that’s a reward, we think (sort of) — a powerful reward for using the drugs instead of our natural system of feeling good. Doing it again seems like a very good idea indeed.

But the goodness doesn’t last. As our reward centers become accustomed to the higher levels of stimulation, they become pretty much immune to the natural reward chemistry. We begin to need chemicals in order to get any sense of pleasure, and eventually just to feel normal. As we increase the levels of drugs, our brain attempts to compensate for the high levels of stimulation in two general ways: first by reducing the production of the natural feel-good chemicals, and also by building new receptor sites to deal with the excess chemicals floating around. It does this in an attempt to keep things to something like normal, but it’s doomed to lose the contest. Eventually, we have to have the drugs in order to function at all. We’re — guess what — addicted.

Now some of you are going to think, “Man, they oversimplified that big time!”, and you’ll be right. Others are going to think, “What crap! I drink…use drugs…whatever…because I want to!” Well, if you only have have a couple of whatevers a week you may be right, but if you’re reading this because you think you might have a problem, you’re wrong and you’d best pay attention.

So what does all this have to do with a prescription addict having a drink? Everything. At the end of the day all drugs, including alcohol, act on the reward center. We get our good feelings from the reward center, and the reward center doesn’t know the difference between one drug and another. We can tell the difference in our conscious mind, because we feel the physical changes in other parts of our brains — stimulation, depression, whatever those effects may be — but the reason we enjoy them is because of the effects on our reward center, which operates mostly below the conscious level. Really now, who would want to get all jittery…or dumb and sleepy…or stupid and hungry if it didn’t feel good?

So, when we take a drink, our reward center is like, “Hello? This feels good, and we know how to make it feel even better, don’t we?” If we’re in early recovery — the first two years or so, say — our brain hasn’t even gotten back to normal yet. It has to deactivate all those extra receptor sites that it created to handle the extra stimulation, and it also has to have time to reactivate the systems that make the natural neurotransmitters. During that time we’re sitting ducks for relapse. Even after the repairs, the receptors are still there waiting to be reactivated by the presence of the drugs. We’re talking repairs here, not new brains.

Any mood-altering drug or activity can affect the reward center, and so any of them can become addictions. Cross-addiction normally refers to substances, but it can also apply to behavior.
People often replace alcohol and other drugs with mood-altering activities like gambling, which is especially dangerous because of all the booze and drugs around (they know it makes people stupid). Other behaviors include relationships, porn, other sexual acting out, exercise, thrill-seeking and other activities that heavily stimulate the reward center. The fact is, you can get addicted to almost anything, if it causes pleasure or distraction from life issues.

That means that the name of the game in recovery is avoidance of all mood-altering substances — okay, not caffeine (in reasonable quantities) — and excess in other areas of our lives. Fun is fine. Pleasure is fine. But when the feelings become the reason for what we’re doing, to the exclusion of the activity itself and the people involved, we are headed for trouble.

The aim of recovery is not eliminating fun, it’s moderating our behavior and learning to live without mood-altering in unnatural ways. Four generations of alcoholics and addicts have demonstrated millions of time that it’s the most reliable way to remain clean. Until someone comes up with something better (and our bet is that it will be a long time) abstinence and a good program of recovery are the best, if not the only, way to go.