A lesson in brain science for the family

“Why can't they just stop?” is the exasperated plea exhaled by family members sitting in front of me and looking at their addicted loved one in the chair next to them. The loved one is looking at the floor and glances at me, wondering the same thing. Failed attempts and unmet expectations have led to what the Big Book so aptly calls “incomprehensible demoralization“ in the addict, and hopeless exasperation in the family.

Really, though, “Why can't they stop?” is the wrong question to ask. Mark Twain said, “It’s easy to quit drinking, I’ve done it a thousand times.” This statement better mirrors what is happening. Most addicts and alcoholics quickly relate to the large number of times they have pronounced “I quit!” and meant it with every fiber of their being. There have been occasions where they did actually stop—for a while. Well-known recovery speaker Sandy Beach proclaims, “Stopping is not the hard part, it's the darn starting that is killing us!”

This describes the automatic pathways that addiction carves into one's brain circuits. These pathways are the result of co-opted normal brain physiology and its resulting drives. The disease of addiction is not the inability to stop using or drinking. It is the behavioral and chemical processes that make it seemingly impossible to stay stopped.

From birth, the brain is learning and reacting to the myriad of stimuli being processed during every second of life, and all of this information is attended to in a hierarchy of importance. This order of importance is determined by the relationship to staying alive and reproducing. The more important the information is to biological life, the more automatic it becomes in our brain. Foremost in this lineup are automatic items such as blood flowing or breathing, which sustain us.

Once these needs are met, other “less important” needs can be addressed. Things such as safety, food, water, reproduction and temperature are biologically less important than breathing, for example. Though some of these are extremely important to life, we have to learn them. They are not part of our initial automatic programming. Our brain has the ability to take the things we learn that are of utmost importance to survival and place them in an automatic place to make sure they happen. For example, we remember that water relieves thirst or sunshine warms us in automatic places in our brain because they are vital to survival. We do not rely on conscious thinking to have a compulsion for water when we are dehydrated because we have learned about water, and it is automatically desired.

Other more conscious behaviors may be less critical for survival, but they too can become automatic. Learned activities such as walking, bouncing a ball or making chords on a guitar can become automatic. This frees up the consciousness to think about other things while they are being done. We can drive a car and make three turns while adjusting the radio because of this ability.

The importance to survival also determines how long the behavior is stored in memory. We will never forget that thirst means we need something to drink. We can “forget” how to make chords on a guitar that were once automatic because they are not important for survival. We cannot forget how to swim because swimming is keeping our head above water in order to breathe. This is a learned skill, but once it is learned it is not forgotten. If it has been 50 years since you went swimming and someone throws you into a pool, you still will know how to swim without consciously recalling certain strokes or movements that were once learned. It is important to staying alive, so it is truly automatic and permanent.

All addictive substances have a certain property in common. Methamphetamine may have actions very different from alcohol, but they both may be interpreted by our brain as vital to survival, taking a place alongside water and food in the hierarchy of things we learn. We can stop using them, but only for a while. Then chemical processes signaling “I need this or I will die” produce motivations we are compelled to satisfy. The reason exasperated family members cannot comprehend their loved one’s addiction may be because only 8 to 12% of people have the genetic makeup and experience that allows a substance to commandeer this trump card position in the brain. It is as incomprehensible to the family member as it is to the addict that this obviously detrimental substance can have such power. By the time the power is recognized, the effects of the substance have been incorporated into the automatic survival instructions from our brain.

Treatment is difficult and takes time because we are trying to change fundamental brain processes that that have become primal in nature. Once a behavior has been incorporated as necessary, it cannot be removed. It is impossible to teach someone not to be able to swim. If swimming becomes harmful for some reason, the only hope of not swimming is to stay out of the water. If the plan is to wade only in shallow water to avoid swimming, there is a good chance that one day you will step in a hole or a large wave will overcome you, and you automatically start swimming. The only hope of not swimming is to replace whatever basic need getting into the water was fulfilling with something else—something equally important, and more powerful. Then, finally, one can stop.