The Physiology of Addiction

This is an excerpt from an article that appeared in Wired magazine on Alcoholics Anonymous, which we freely acknowledge as the inspiration for CMA.
Even though it discusses alcohol, the resemblance to the addictive experience of meth is so striking that I thought it would be helpful for anyone who wants to understand how intoxicants work on the brain of an addict.

To understand the prefrontal cortex’s role in both addiction and recovery, you first need to understand how alcohol affects the brain. Booze works its magic in an area called the mesolimbic pathway—the reward system. When we experience something pleasurable, like a fine meal or good sex, this pathway squirts out dopamine, a neurotransmitter that creates a feeling of bliss. This is how we learn to pursue behaviors that benefit us, our families, and our species.

When alcohol hits the mesolimbic pathway, it triggers the rapid release of dopamine, thereby creating a pleasurable high. For most people, that buzz simply isn’t momentous enough to become the focal point of their lives. Or if it is, they are able to control their desire to chase it with reckless abandon. But others aren’t so fortunate: Whether by virtue of genes that make them unusually sensitive to dopamine’s effects, or circumstances that lead them to seek chemical solace, they cannot resist the siren call of booze.

Once an alcoholic starts drinking heavily, the mesolimbic pathway responds by cutting down its production of dopamine. Alcohol also messes with the balance between two other neurotransmitters: GABA and glutamate. Alcohol spurs the release of more GABA, which inhibits neural activity, and clamps down on glutamate, which stimulates the brain. Combined with a shortage of dopamine, this makes the reward system increasingly lethargic, so it becomes harder and harder to rouse into action. That’s why long-term boozers must knock back seven or eight whiskeys just to feel “normal.” And why little else in life brings hardcore alcoholics pleasure of any kind.

As dependence grows, alcoholics also lose the ability to properly regulate their behavior. This regulation is the responsibility of the prefrontal cortex, which is charged with keeping the rest of the brain apprised of the consequences of harmful actions. But mind-altering substances slowly rob the cortex of so-called synaptic plasticity, which makes it harder for neurons to communicate with one another. When this happens, alcoholics become less likely to stop drinking, since their prefrontal cortex cannot effectively warn of the dangers of bad habits.

This is why even though some people may be fully cognizant of the problems that result from drinking, they don’t do anything to avoid them. “They’ll say, ‘Oh, my family is falling apart, I’ve been arrested twice,’” says Peter Kalivas, a neuroscientist at the Medical University of South Carolina in Charleston. “They can list all of these negative consequences, but they can’t take that information and manhandle their habits.”

The loss of synaptic plasticity is thought to be a major reason why more than 90 percent of recovering alcoholics relapse at some point. The newly sober are constantly bombarded with sensory cues that their brain associates with their pleasurable habit. Because the synapses in their prefrontal cortex are still damaged, they have a tough time resisting the urges created by these triggers. Any small reminder of their former life—the scent of stale beer, the clink of toasting glasses—is enough to knock them off the wagon.

AA, it seems, helps neutralize the power of these sensory cues by whipping the prefrontal cortex back into shape. Publicly revealing one’s deepest flaws and hearing others do likewise forces a person to confront the terrible consequences of their alcoholism—something that is very difficult to do all alone. This, in turn, prods the impaired prefrontal cortex into resuming its regulatory mission. “The brain is designed to respond to experiences,” says Steven Grant, chief of the clinical neuroscience branch of the National Institute on Drug Abuse. “I have no doubt that these therapeutic processes change the brain.” And the more that critical part of the brain is compelled to operate as designed, the more it springs back to its pre-addiction state. While it’s on the mend, AA functions as a temporary replacement—a prefrontal cortex made up of a cast of fellow drunks in a church basement, rather than neurons and synapses.

Finally, the 12 steps address another major risk factor for relapse: stress. Recovering alcoholics are often burdened by memories of the nasty things they did while wasted. When they bump into old acquaintances they mistreated, the guilt can become overwhelming. The resulting stress causes their brains to secrete a hormone that releases corticotropin, which has been shown to cause relapse in alcohol-dependent lab rats.

AA addresses this risk with the eighth and ninth steps, which require alcoholics to make amends to people they’ve wronged. This can alleviate feelings of guilt and in turn limit the stress that may undermine a person’s fragile sobriety.

Bill W., as Wilson is known today, didn’t know the first thing about corticotropin-releasing hormone or the prefrontal cortex, of course. His only aim was to harness spirituality in the hopes of giving fellow alcoholics the strength to overcome their disease. But in developing a system to lead drunks to God, he accidentally created something that deeply affects the brain—a system that has now lasted for three-quarters of a century and shows no signs of disappearing.

The article can be read in its entirety here. This is not an endorsement of its content--we are neutral in such matters. (My personal opinion is that is gives short shrift to the spiritual aspects of 12-step programs.)

There is one informational tidbit that it very interesting should you not have the time or inclination to read the entire article. It would seem--to the degree they have been able to study this--that one of the best indicators of long-term sobriety is how many meetings are attended in the first year. The recommendation to go to 90 meetings in 90 days, and then one a day if you can swing it, would appear to be a smart one indeed.


Editor

Submission for CMA Manuscript

Please be aware that it is still possible to submit pieces to the CMA Manuscript, collection of essays and personal stories about our recovery.

You can sumbit pieces here:

http://www.crystalmeth.org/general-services/literature-contributions.html

GSR Report

Hello CMAer’s,
I would like to start by thanking Victor D. for all his love and service with our H&I panels. He has been the chairperson for H&I since the first district meeting in August 2007 and he was instrumental at what is now a rich and successful committee. The time has come to pass the torch. Welcome to the new chairs: Donald L and Bob S.
I am proud to see so many of us in service work. Thanks to all of you. Let’s now get the word out.

* Love and Service: June 19th 2010 starting at 1:00 pm is the annual GSO conference. This is a 1 day event which will feature 3 workshops, a desert social ($15.00) and a speaker meeting. This event will be taking place at the Hilton Gardens Inn LAX/El Segundo 2100 East Mariposa El Segundo Ca. 90245.

The district is growing and now it’s time for its members to step up and get into service. Currently we have a solid GSR base and we have committee leaders. What we need are members to serve on these committees. The following is a list of upcoming meetings that any member can attend and be of service.

* Meetings that need support are:
Monday: Steering Clear 12:00 pm 5715 Broadway Los Angeles.
Tuesday: Spinning into the Solution 7:30 pm @ 2530 Hyperion Ave. in Silver Lake.
Wednesday: Stick to the Solution 7:00 pm @ Weho D&A Center 626 N. Robertson Blvd.
Wednesday: Sex and Relationships 8:00 pm @1773 Griffith Park Blvd. Los Angeles.
Thursday: CMA book (Unspun Stories of Hope) reading meeting 8:15 pm @ 1773 Griffith Park Blvd. Los Angeles.
Saturday: Stayin’ Alive 7:00 pm @ 2530 Hyperion Ave. in Silver Lake.
Saturday: 8:00 pm Crystal Clear Methage @ Unit A 10641 Burbank Blvd. in North Hollywood.
Sunday: The Internet: Sobriety's Dirty Little Secret 2:00 pm @1773 Griffith Park Blvd. Los Angeles.
Sunday: Stepping Forward 4:30 pm @ 1403 4th Street Long Beach.
Sunday: A Method to our Madness 7:30 pm 3025 North Lincoln Ave. Altadena.
New Meeting: Wednesday 8:00 pm Candlelight @ The Wall Las Memorias 111 North Ave. 56 in Los Angeles.
New Meeting: Thursday 7:00 pm Joyous, Grateful and Free 9436 Slauson in Los Angeles.

Public outreach and information: Join Roger D. and be part of a team spreading the word of CMA throughout the community. The next Info/outreach meeting is to be announced. 750 post cards were distributed at the Gay Pride event in West Hollywood with thanks to the help of The Tweakers Project. A special thanks to all at The Tweakers Project.

Helpline: Join Chuck C. and take a 4 hour shift answering the helpline. The next meeting is on Monday June 28 at 1010 N. Hammond Street #305 WeHo 90069.

Events planning: Join Dale G. and the team to plan these upcoming events! The Los Angeles Vs Long Beach softball game and BBQ is on 7/10/10 in Pan Pacific Park from 12-4pm. If people want to play they can email Dale through the website.

Our first annual spiritual retreat - “Conscious Contact- a Spiritual Awakening” focusing on prayer, meditation and yoga- October 8th, 9th &10th 2010. The cost is $175/person. There is a link on CMAinLA.com for registering. Dixon P. is registration chairperson.

The Blog: If you would like to submit your view on a CMA related topic, please write to Mark O. at editorcmainla@gmail.com. The blog itself can be read at cmainla.blogspot.com.

Registration/Directory: Marvin M. - The summer 2010 directory is available. Fresh copies can be picked up at the monthly district meeting or you can go to CMAINLA.COM to download it.

H&I: Donald L. & Bob S. - There are 2 new panels – Phoenix House and McIntyre House. Coming soon: Long Beach H&I

We are looking for speakers to visit recovery houses to share their experiences. Invite your sponsees to join as well. To sign up, please attend the next meeting
Thank you.
Being of service,
Freddie

Meetings&Me

(Ed. Note: This is abot twice as long as the usual entry, but well worth it.)

After 9 months as a “meeting maker,” the incomprehensible weirdness I first felt is wearing off so fast I wanted to write about it before it totally slipped away. The contrast between then and now is stark: from baffled, bewildered, and terrified, I have become a sort of meeting junkie. As with drug addiction, my experience illustrates a simple lesson: the weirdest behavior can come to seem totally normal after enough repetition.
About 6 months after quitting crystal meth, I slunk into a meeting for “educational purposes.” After deciding it would be interesting to learn “the party line” about drug and alcohol counseling, I quickly realized that 12-step programs were so integral to recovery that I ought to understand what they were all about. Having gone to a couple of CMA meetings in the midst of my addiction, to support a friend who was trying to stop, I actually thought I did not deserve to be there. I believed they were for people who had really suffered during their addiction and who were struggling to stay clean. By contrast, I considered myself unscathed, and I felt cocksure about my recently-acquired, but firm, repugnance for the drug and the culture that surrounded it.
So 9 months ago, after an entire month of tortuous hesitancy, I finally got myself to a CMA meeting one Saturday afternoon. I felt relieved that I had arrived after people had introduced themselves, and glad that the only empty chairs were in the last row: the “observer” position. My major response was “What the hell is going on here?!” Why does everyone have to call themselves an addict, tweaker, or dope fiend every time they say their name? Why does everyone have to say their name every time they speak? [Short term memory deficit?] How come some participants say such devastatingly painful things and nobody speaks up to comfort them? Why does someone with vision problems or a speech deficit have to read the 12 steps and someone else who sounds like he's still tweaking have to read the 12 traditions? After all, they're on the wall for everyone to read during the entire meeting. When the time came to get in a circle, hold hands, and say the serenity prayer, I wanted to crawl out of my skin. I couldn't get the word “God” out without gagging, so I skipped it and self-consciously mumbled the rest. I made a beeline for the door and fled.
Although the final admonition to “keep coming back – it works if you work it” fell on skeptical ears, I felt dutiful about my “fieldwork” and recognized that a sample of one was inadequate. The next time I strategically positioned myself behind a column that blocked me from the leader's line of sight so I would not be called upon other than to mumble my name and “addict” identifier. Little sunk in during the next couple of meetings because I was by then completely preoccupied by desperately trying to figure out the principles of a “good share.” I was relieved to learn that it was acceptable to say “I pass.” But by my third or fourth meeting, a leader must have seen my extreme discomfort, looked my way, and called on the “guy in the white t-shirt.” After desperately looking around in the hope that someone else was similarly attired, I knew I had to bite the bullet. I thought he was hot, so I didn't want to be a wimp and pass. I mumbled something as unmemorable to me as to the other people in the meeting.
After less than a handful of meetings I was starting to wonder why every meeting began with such long and drawn out readings, sometimes by such inept readers. By then, some of what people were saying got through the anxious mental chatter inside my own skull, and I was starting to feel uneasy about all the “God-talk,” since I still was on the verge of gagging every time I had to say the G-word – at least twice per meeting. It wasn't long before I found myself in a meeting where the Lord's Prayer was substituted for the serenity prayer, and that made me think “this isn't just a cult, it's a Christian cult.”
But by then, the enthusiastically-chanted phrase “honesty, open-mindedness, and willingness” had begun to sink in. I like to fancy myself having those attributes – despite ample evidence to the contrary – so I stuck around. And as the volume of internal chatter subsided slightly, I also noticed something. Almost everyone else in the meeting seemed to be having a great time. I heard people talking about changes that sounded nothing short of astonishing and found myself thinking “What sort of Kool-Aid are these people drinking? They must be on Prozac, in very high doses.” Despite differences in the specifics, almost everyone seemed to be reading off the same script. Life on crystal meth was wretched or worse. One way or another they made their way into the Program, and – even in tough times – life is better than ever now. Brainwashing? Groupthink? Cult? No matter how much I turned up the sensitivity of my b.s. detector, I thought not.
I continued to go to a few meetings a week for a little over a month, when an acquaintance in another fellowship suggested that I read the Narcotics Anonymous basic text. Days later, wandering into a used book store, a copy all but fell off the shelf into my hands. That began a parallel process of reading both NA and AA literature and other material that convinced me I wanted to get a sponsor and start working the steps. But that's another, parallel, story. The essence of that story is that I came to understand the spiritual malady that both predated and perhaps preordained active drug addiction, and to recognize that a spiritual malady requires a spiritual remedy.
Talking with prospective sponsors, one challenged me to go to 90 meetings in 90 days. I balked, whined, felt overwhelmed, and – fortunately – got a grip on myself and recognized the truth of what he said: that it was a minor effort in comparison to the rigmarole necessary to assure an uninterrupted drug supply. He also told me – my naivete and literal-mindedness seems ridiculous in retrospect – that, yes, it was OK for me to go to Cocaine Anonymous meetings even though I hadn't been a cocaine or crack user, and that even though methamphetamine is not, strictly speaking, a narcotic, I would not be ejected from Narcotics Anonymous meetings.
I learned that every morning at 7 am there's a Cocaine Anonymous meeting a mere 10 blocks from home. Although by then I had established a sobriety date, I marked that first meeting in my mental calendar as my “recovery date,” because – more than at any other meeting – I actually felt, as much as I heard, recovery. And I began to believe – not just in the Program but in the power of faith in God. In a loud, rowdy, raucous room of 30 – 70 people, where side-conversations are the norm not the exception, every meeting includes a handful of newcomers as well as members with 20 and more years' clean time who continue to show up every morning, day after day, week after week, month after month. Many of them share at least a few times a week and, every time they do, it's just as passionate. And every share reveals a different facet of how to live a life in recovery long term. More than once a week I'm moved to tears by something I hear there. Over the months, I've seen people change before my very eyes, from angry to temperate, from disheveled to well-groomed, from pained to happy. Other than when I've been out of town or had a conflict with school, I haven't missed a meeting in 6 months: my days would feel somehow misshapen if they didn't begin there.
From that experience, I learned a lesson that has proven correct again and again, but one that I seem to have to re-learn again and again: the advice I least want to take is the advice I most need.
Gradually my self-absorption dissipated enough so that I didn't spend entire meetings figuring out a perfectly-organized speech when I shared. I learned that the less premeditated, the more “real” and spontaneous, the better. And with that slight diminution in trying to “sound good” I was able to listen better and watch more closely what was happening around me. I saw how the people with more clean time attached themselves to newcomers. I saw how meeting secretaries and leaders asked newcomers or other people who seemed more withdrawn or tentative to read, so that even if they didn't feel comfortable sharing they had a place and a voice in meetings. If nothing else, that made me a lot more tolerant of hearing the same readings at every meeting, even when the reader stumbled over every second or third word. In those subtle ways, I realized, the fellowships reach out and take care of their own.
As I became accustomed to prefacing every interjection with “Michael … addict” or “Michael … tweaker,” I felt much more grateful than puzzled or irritated: my memory for names is so atrocious that the only way I was going to learn them was by hearing them repeated over and over and over again. By the time meeting commitments expired and were to be reshuffled, I had come to consider them a gift – an opportunity to become more involved in the fellowship and more committed to and engaged in my own recovery process. I felt grateful that, as a newcomer, I was invited to accept commitments at four meetings a week. Beginning every day with a meeting, plus commitments at four evening and afternoon meetings, plus a couple of other meetings I liked going to regularly, meant that by day 90 my attendance tally was probably twice that number. More important, I felt no urge to slacken the pace.
In my drug using days, travel meant assembling a list of bars, bathhouses, cruisy parks and beaches, and smoke shops likely to sell drug paraphernalia. Nowadays, I download 12-step meeting schedules. I arrange mealtimes and visits with friends or relatives around meeting times. I hear people in the fellowship talk about people in meetings getting on their nerves so much they stop going to particular meetings. I try to use those responses for self-diagnosis, for I believe that whatever is bothering me is probably some reflection of myself that I'd rather not look at. Sometimes I find myself feeling less than enthusiastic about going. I think about the “old timers” at my morning meeting who “suit up and show up” every day, day after day – some of whom struggle painfully up and down a flight of stairs to that basement – and laziness becomes repugnant. I remind myself that if it weren't for the other fellowship members who keep coming back so someone's there for the newcomers, the rooms would have been empty when I first sought them out. Most of the time, no matter how I felt about going to a meeting beforehand, I'm happy when I'm there: more so all the time as I see more and more familiar faces of people I am beginning to think of as friends. And when I leave feeling ill at ease, I know enough to recognize that it spotlights something I need to look at: maybe I felt rejected, neglected, criticized, preoccupied, tongue-tied. Those very symptoms tell me I must keep coming back.

Michael G.