The Head Center

I work as an addiction treatment specialist. The information in this post is material from a lecture I often give to my patients on the disease concept of addiction.

Why can't I quit? Cocaine, alcohol, and as it turns out, gambling, have a similar effect on the dopamine system in the brain. I'm going to explain, in terms anyone can understand, why an addict is addicted and why that is such a powerful and inexplicable thing.

Dopamine is a neurotransmitter which is active in certain key parts of the brain. To understand addiction, you have to understand something about how the brain developed and look at the part of the brain where this dopamine does it thing. When I say developed I mean how the human brain evolved. At the base of your brain, the part just above the spinal cord at the center of your head, is an ancient part of the brain, sometimes referred to as the neomammalian brain. (It is also referred to as the meso-limbic system, for you techies.) The word neomammalian comes from the roots new + mammal. All mammals, even mice and chipmunks have some form of this brain region. While dopamine exists in various places in the brain, this is where the dopamine which we are interested in lives. This area of the brain is also called the pleasure center and the dopamine itself is active in the process of feeling pleasure.

Bookmark that while we look at another part of the brain. The frontal cortex is the part of the brain that is just behind your forehead, above your eyes. This part of the brain, evolutionarily speaking, is much younger. It almost certainly developed along with the ability or phenomenon we call consciousness which exists in the higher mammals such as the so-called great apes of which humans are one species. It is where the part of us we call "I" or "me" resides. This is the manager. The executive. When we think, plan, make decisions, or play the piano, the frontal cortex is involved.

Now, back in the ancient part of the brain we were talking about earlier -- that part has responsibilities too. The neomammalian part of the brain contains the hypothalamus and other areas where we know that functions such as sleep, hunger, thirst, and the sex drive are located. The neomammalian brain also contains a structure called the amygdala, which is a key area where processing emotions are involved.

Now, you can use your frontal cortex, your executive function, to decide to stay up late tonight and watch a movie. You could probably even stay up all night. But could you stay up for two days? How about 5? Eventually, no matter how grand your plan (planning is a frontal cortex function) you will succumb to the commands of the ancient part of the brain which asserts itself when you need sleep in order to survive.

Likewise, we can control our appetites. We can control them to the point where we almost starve ourselves. We do this by using our management part, the decision making part of our brains, again, the frontal cortex. But eventually, you'll be so hungry you'd eat anything, if you starved yourself long enough. The part of the brain that makes you ravenous and unable to overcome the desire to not eat is that ancient part.

In addicts, the ancient part of the brain is the part that is addicted.

When you abuse alcohol, or cocaine, or gamble to excess, the addictive substance or addictive behavior causes an abnormal increase in the amount of dopamine present in the pleasure center of your brain. This has two nasty side effects. One side effect is that the brain decides to produce less dompamine. The second side effect is that the brain, over time, becomes less responsive to dopamine. This phenomenon is why we become addicted and why addiction is a disease process.

Just like in the examples with eating and sleeping, you can decide not to use drugs or drink or gamble. The question is how long can you go without? That ancient part of the brain, modified by historical abuse, needs for you to do drugs, or drink, or gamble. That ancient part of the brain asserts itself behaviorally. It makes you crave. Sometimes subtly, but it asserts itself because there is an imbalance of dopamine. A shortage. Of course, addiction is not exactly like sleep and hunger. While the mechanisms of assertion are different in hunger, sleep and craving phenomena, the routes between the meso-limbic system and the frontal cortex are the same for all of them and dopamine is active in those regions of the meso-limbic system where the signals originate.

I like to say that ... We can't choose not to use.

Before I leave this topic, I want to address the issue of the nasty side effects I mentioned. The result of the brain being out of balance with dopamine means that the pleasure center is not working properly. So if before you got loaded a bazillion times you enjoyed going to concerts and watching you child in a school play and having a milkshake, now your booze-addled brain doesn't respond to those things the same way. They don't give you as much pleasure. Abstinence is the only thing that makes this go back to normal. These processes are reversible. A long period of abstinence will in most cases restore the majority of dopamine system functioning.

Long-term abuse creates an addicted brain. Sustained abstinence slowly reverses some of the damage."

Abstinence heals. That's why we call it recovery. Since recovery can take a long time, we are quite likely to relapse before our brains are sufficiently restored. So what do we do? We can't choose not to use, but we can choose to recover. We can choose meetings, and service, and sponsorship, and the steps.

Arranging my head
on the stairs. Rose petals
cling to my clothes and
skin like those little bits
of plastic bag. I want
more out of life
than clingy plastic or
even rose petals. But
as I sit on the stairs
gathering my head
I wonder what it was
that was so important.

Why did I get all
worked up over nothing, when
peace was all I ever sought
in the first place. I
need to let you know
that you are in my heart
and I didn't know that until
I sat on the stairs after
we argued. I'm sorry for
what I said. I know
it was awful.

You had put together
such a grand plan. The place
all decorated and filled with
love. I was blind to it --
I only saw the mess
of you and me. Now without
even knowing why I do things
I can say I'm sorry and I
love you. It's something I
learned somewhere along
the way. Thanks
to you.

I sit here with my age and all my years of hard living hanging on every muscle and impinging on every joint. My insides don't forgive me for the missed check-ups and maintenance visits. My spiritual connection to AA has subsided; I have taken up the mantle of atheism. My physical connection to meetings, though I have gone to two in two days, is slight.

I heard an old coot share tonight. A good old boy I appreciate very much. He had been spared death on numerous occasions, having flown over the handlebars of a motorcycle at high speed and then his liver went sour decades later from the hepatitis he received along with the blood transfusion. I also reconnected with an old coworker and friday beer bash drinking buddy who was at the meeting. The coot's topic was gratitude and though it seemed redundant that a lot of folks were grateful to be sober and such, tonight it struck me and I found myself grateful for precisely that.

I forget sometimes that sobriety and the work of recovery provides for sobriety. I expect and want a whole lot more. If I can settle in and go to AA in order to simply not drink, I might get a lot more out of it.

I heard a woman share the other night. The woman who shared spoke beautifully, with many graceful, sober years in her voice. I hadn't been to a speaker meeting in a pregnant stretch of time. Lately, I've been immersed in my work. I work in a treatment program, helping people overcome their addictions professionally. My clients, when they open their mouths, tie themselves in a knot. Perhaps they are tanged up in their lies; or perhaps, ensnared in their emotions.

As the woman shared, the contrast between what she was saying and what I've been listening to my clients say was stark. The woman's wreckage, her personal problems, her struggles, her fears ... these were yielded unabashedly, as matters-of-fact. She held the HOW. She demonstrated the honesty, open-mindedness, and willingness which we know as the essentials. She utterly got it done.

The word that popped into my mind was courage.

As the woman carried on, I was transfixed by her gaze. It pierced. The word that popped into my mind was courage. I heard a great definition of courage later in the same meeting, delivered in the negative. A friend of mine shared, "I once asked my sponsor, 'How shall I walk through the fear?' and he told me 'You shall walk through the fear afraid.'" This was what the woman had done to stay sober. It was what she had done a few minutes ago as she shared her story. She demonstrated the HOW.

"We beg of you to be fearless and thorough from the very start."

'nuf said -- iz

Man Alive!

There's this feeling that is indescribably wonderful. It comes upon me only when I am spiritually connected and when my mind is laid open. Of late it happens but once in a great while, but when I was earlier in sobriety, say with two or three years, it would happen with regularity because I was more spiritually productive in my program. When it swells up in me, it defeats anything negative I am feeling. It's the presence of God's grace ... it is a lightness of being combined with a depth of feeling. It commands my attention. I can think of nothing else. It's in my stomach more than my head. I can only be happy; worry is defeated. It imbues me with a sense of permanence and invulnerability. It is neither like a hallucination nor is it mysterious. It is not in the future nor the past. It is right now!. When I have it I can only be in the moment.

It convinces me that life is good.

Now I'm sure you can imagine ... and I am feel rather silly making such an obvious statement ... but I should tell you that I quite enjoy it! Hahahahaha. Now I'm laughing out loud. Man Alive! Hahahahahaha. It feels GREAT to be alive! It feels GREAT to be sober! I want us to share this feeling. Please come with me on my journey! I can't go it alone! I need you! I need you to come feel this wonder with me! This is sobriety and it is for everyone who wants it! It's for everyone who needs it. And it's for anyone who does it. Goddamit, now I need kleenex!

Today the problems I have don't include anything that God-awful. There are none of the self-imposed crises of yesteryear, such as forgetting to file taxes or brush my teeth for two years. I don't hate myself, nor do I hate much of anyone or anything. Mosquitoes can be annoying, but Deet(tm) is a good product, and generally available.

You see, I have what you call Cadillac problems. For the two people out there in blogland who are unfamiliar with that term, a Cadillac problem is a problem that is a high-class problem, such as the problems people have with their Cadillac cars. (Though today we might ought to call them Range Rover problems, or Beemer problems, or something that makes sense to someone under 40.)

Having a job you love and a great job offer for a new and better job at the same time is a Cadillac problem. Having an early dinner date with the a-little-too-serious-but-cute brunette and a date with the ravishing-but-a-little-too-wild redhead for late-night dancing ... wait a second, tha'ts not a Cadillac problem, that's a fantasy, sorry, wrong blog entry.

But anyway, you get the idea ...

Interestingly, When I'm complaining about Cadillac problems, I'm complaining as if I was going to have my big toe surgically removed after lunch, just as if it were one of the standard problems. But then I will realize, or usually, someone will point out, "hey, that's a Cadillac problem," and I'll go, "oh, yeah," and I am grateful to have it, unlike the time my car was impounded for the registration being three years out of date.

"Uhhh, yeah, officer, I've been meaning to get around to that ..."

A sponsee of mine who has been sober for five years called me yesterday. He announced something that he had said to me before on a number of occasions. He said, "I feel like I want to hurt myself." There was a tone in his voice decidedly unlike any prior call he had made of this nature. He was distressed more than usual. He then added something new; he said, "I'm at the hospital. I'm standing in front of the emergency room entrance."

I swallowed hard. I told him to go on in and tell the nurse how he was feeling. He doesn't always do what I say, except when he's in a lot of pain -- then he becomes an extremely good listener and exceedingly obedient, to boot.

Long story short ... he's having a rest now and a few days off of work. He's not in a good head space, he needs to work on a number of issues. He asked me for a pad and he's going to do another fourth step, which he had been putting off. He also said he was really furious with God right now, and that God had failed him utterly on a number of fronts. I told him to make two lists and to define a new higher power. I told him to make a list of traits he wanted his HP to have and traits he did not want his HP to have. I think in the end, he'll end up with the same HP he had before and hopefully he will have a spiritual experience along the way.

I may also. When I saw him hurting this badly, and so scared, and nearly falling apart, and needing so much help, it touched a vulnerability inside me. It scared me because this guy has kept me sober for five years. It also touched the compassionate place inside me that working the steps gave to me. He is not just a sponsee, he is a friend. No, he is a loved one. I felt profoundly sad that this was happening to him.

I'm sure everything will work out. It usually does. My sponsor told me when I had five years, that "you go crazy in your fifth year." I said, "what?!?!?!" He said, don't worry about it, just keep coming back. I don't know what else to say at this point except that the wisdom of the elders is certainly to be respected. That is a spiritual way unto itself and part of my spiritual experience.

"relieve me of the bondage of self, that I may better do Thy will ..."

-- 3rd step prayer

Step 3 was, is, and almost certainly always will be the hardest step for me to understand ... and to undertake. If you talk to a lot of folks in recovery, each might give you a different answer about how they approach their relationship with their higher power and what it is that power is guiding them towards. So I suppose one answer lies in the old adage to each his own.

Early on in my sobriety, I went along, searching and asking and questioning and guessing at what God's will was for me, without much satisfaction and with irregular results.

Finally I realized that I could borrow a simple idea from the big book, and it would apply in almost every situation.

God's will for me became this: to be of maximum service to God and to my fellows ...

This orientation keeps me on course. In this mindset, I can be a human being following a spiritual path. That keeps me right-sized and on target.

God bless you, izzy

As I progressed in AA, as I took the steps, as I grew spiritually, I frequently felt as if I still was not doing enough. I often compared myself to others and it always seemed the people who I looked up to had a better program than I. More sponsees. More 12 Step calls. More prayer. Better meetings. A heartier laugh.

I was certainly afraid of drinking. That's something to be respectful of if you are still on unsure spiritual footing, which I was at the time.

Then it hit me. I'm not sure of the exact way the idea got into my head, but, I think we all realize at some point that we don't just come up with brilliance -- we hear it at meetings while we're daydreaming and then make it our own. But the brilliance that landed on me that day, the gem that I plucked from the ether, was a simple and clear idea.

Never try to do more than is humanly possible.

As soon as I think I can do more than I am able to do, I exalt myself to the level of God. As soon as I think I can handle my affairs, I don't need God to handle them any longer. As soon as I think I can be a good brother, a capable sponsor, a smart engineer, or a decent friend, I don't need God to help me be those things any more.

Surrender let's God in. Don't edge him out by expecting of yourself a level of performance that creates undue stress in your life.

-- izzy

"It has to stop. This has to stop. This madness must end."
- me on March 7, 2000, the day I took my last drink

Welcome. I won't say that you're in the right place. I hope you have a home 12-step group that you visit in person. I hope you have a sponsor that you meet with in the flesh. This blog is for a number of things that are merely related to sobriety and nothing I've found online is a decent substitute for brick-and-mortar 12-step meetings. That having been said, you are welcome here under any circumstances. And if you don't have a face meeting you attend yet, believe me, I understand.

The things I will try to accomplish in this blog are to inform, entertain, and hopefully, occasionally inspire you. So I welcome you and I'm glad you decided to drop by. Please come by any time and make yourself comfortable.

- The Izman

"Help is possible. Oh my god, help is possible.
I can do this. I can let these people help me."
- March 8, 2000