Where Addiction Meets Your Brain

The Neurobiology of Addiction

Deconstructing Your Triggers

It takes tools and practice to deconstruct fear and anxiety.

One of the things that patients talk with me about when they are sober is the euphoric recall associated with the use of drugs or alcohol. When the stress, anxiety and fears are high, there is a longing for the times when a drink or a pill or gambling or pornography could be used to get rid of the bad feelings. It was an automatic move to go from an uncomfortable state to something that would alter the bad or uncomfortable feeling back to manageability. The problem with the mood alteration is that it doesn’t solve the problem. It just buys some time until the next stress, fear, craving or symptom occurs.

The reason to have a sponsor if you are in 12-step recovery, a sober friend, a therapist or a coping mechanism of whatever kind is to get past the automatic stereotypical moves towards drugs and alcohol toward a deconstruction of the problem. I was talking with a patient yesterday who wanted to take a pill because she wanted to relieve the pain she was feeling at that moment. She had been sober for about 3 years, but the idea of taking an addictive substance was strong.

We began to talk through the crisis and the cravings. It turns out that she had verbally accepted a job but between the time the job was accepted and the final contract was given to her, the job description was altered. She was under financial pressure to take the job, but she had not agreed to the “new” job as it was presented. This created a lot of stress on many different levels and her previous coping mechanisms had been to catastrophize and then use substances to relieve the stress which, in fact, did not change the situation and postponed the resolution of her problems.

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This is a simple example. We talked through the situation and after some problem-solving, she put a plan together to resolve the issues and all was well after she made a couple of phone calls to the prospective employer.

Life with addiction, however, is some variation of this example. Objectivity is quickly out the window when the limbic system of your brain goes into fight or flight mode. The “auto-pilot” of the addicted brain defaults to relapse. As a psychologist colleague of mine describes, our job as therapists for people with addiction is to “buy them problem solving time” to put space between the patient and the problem and space between anxiety and relapse.

In AA, one always hears of avoiding “people, places and things.” It is a simple way of creating space and time. All the AA slogans such as “Think,” “One day at a time,” and “Just for today” are tools to create space and time. Therapy is a way to create space and time. If there is enough space and time, the anxiety and fear that predicates relapse can prevent the hard-wired responses from occurring. If one is able to create the time and space, new solutions are possible and objectivity can come into the crisis.

I think that hot air balloon rides and flying at high altitude, going to movies or working for a cause have similar effects of getting one out of him/herself and seeing a bigger picture. We, as humans, need connectedness and at the same time we need time and space.

It takes tools and practice to deconstruct fear and anxiety. Different things work for different people, and it doesn’t matter too much how you get your time and space as long as it keeps you out of your addictive behavior.  Be counterintuitive. Do the opposite of what you usually do under stress. Buy yourself some time and space however you can when the stress comes on. That is when you are moving forward and growth and serenity occur.

Joseph Troncale, M.D. FASAM, has been working in addiction medicine for 20 years. He is the Medical Director of the Retreat.
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