IX

Dependency Starts … and Ends … in Your Brain

What we have learned from medical science studies over the last decade or so is that dependency and unhealthy habits can result from the interaction of two primary factors—your genetics and your environment. Specific genes and various combinations of genes have been identified that make a person more susceptible to toxic compulsions and as a result, can make quitting or controlling those compulsions much more difficult.

In late 2011 the American Society of Addiction Medicine changed its long-held definition of addiction to now call it “a primary, chronic disease of brain reward, motivation, memory, and related circuitry.” For the first time, gambling and other “process” compulsions were lumped together with alcoholism and drug dependence as behavioral symptoms of this brain disorder. This recognition came a half-century after the American Medical Association first declared alcoholism a disease.

In my conversations with the experts, they overwhelmingly agreed that toxic compulsions are a very complicated illness. Two kids can grow up in the same family where there’s a genetic predisposition toward alcoholism or addiction, yet one of them goes down that road but the other one doesn’t. Why? Did the addict tolerate the environmental influences less well than his or her sibling? This is where the illness is individual-specific and gene-specific, not family determined. There are many different environmental impacts, and the way an individual processes those has a lot to do with whether that person will have a problem or not. That’s particularly true with the primary triggers of anxiety and depression, which animate all of the Seven Toxic Compulsions. Some people learn to control and process their anxieties and moods more effectively, while others feel compelled to self-medicate with one or more toxic behaviors.

You’ve already seen in Part One of this book how interconnected all seven of the toxic compulsions can be. If you’re a pathological gambler, for example, you probably also have a problem with nicotine dependence, drugs, or alcohol. Now I want to bring you up to speed about the latest findings on the causes of these compulsions. With this understanding as a roadmap, we can devise and recommend treatment strategies that truly address the roots of this brain illness. Keep in mind that what follows are generalizations based on the prevailing scientific evidence about genetic and environmental influences on the developing brain and the impact of chronic compulsive use over time.

The Bad News: You Unknowingly Ran a Gauntlet

There is an entire subterranean origin to toxic compulsion risk levels that you grew up with. These unconsciously acquired risk factors wait in ambush and can eventually emerge to hijack your life. I’ll bet you never knew or suspected that you ran a gauntlet of hidden trip wires from the moment you were conceived, through your experience in the womb, and then after birth and into the awkward years of adolescence. If you got through this gauntlet without acquiring a susceptibility to one or more of the Seven Toxic Compulsions, you deserve congratulations. You were blessed with a head start to winning the good health lottery.

Genetic programming: Genes are molecular units of heredity; they are the code for traits and tendencies you received at conception from your parents. As discussed earlier in this book, geneticists continue to discover individual genes and combinations of genes that indicate a heightened susceptibility to developing one or more of the Seven Toxic Compulsions. At least 25 genes that determine your susceptibility to alcoholism have been identified. Other genes are known to dictate your cravings to overindulge in certain foods and sexual behaviors. The first time you smoked a cigarette it was a gene that helped determine your initial sensitivity to nicotine and whether you’re a ready candidate for developing dependence.

“About 50 percent of the variation in the risk for developing various addictions can be accounted for by heredity,” said David J. Linden, a professor of neuroscience at the Johns Hopkins University School of Medicine, editor-in-chief of The Journal of Neurophysiology, and author of The Compass of Pleasure: How Our Brains Make Fatty Foods, Orgasms, Exercise, Marijuana, Generosity, Vodka, Learning, and Gambling Feel So Good. “There is no single ‘addiction gene,’ and it is likely that a large number of genes are involved.” Linden pointed out how carriers of an A1 variant gene are “significantly more likely to become addicted to alcohol, cocaine, or nicotine,” and carriers of a gene that decreases D2 dopamine receptor function in the brain are “more likely to develop addictions to both substances (such as alcohol, nicotine, opiates, and food) and behaviors (such as compulsive gambling or compulsive sex).”

It’s extremely important to state (as I will again later in this book) that your genes are not necessarily your destiny, because it’s your environment (including your thoughts and behaviors) that acts to either reinforce or neutralize any genetic predispositions. “Given what we know about the genetic predispositions for and biological substrates of addiction, it’s easy to conclude that we’re all slaves to our genes and our brain chemistry,” observed Prof. Linden. “That’s simply not true …. Yes, our genes and our neural circuits predispose us to certain behaviors, but our brains are malleable, and we can alter their neural circuits with experience.” Such experiences include talk therapy and mindful meditation.

Womb influences: You’ve probably heard of fetal alcohol syndrome, in which a mother’s alcohol consumption affects the fetus and results in the child being born with many of the symptoms of alcoholism. You also probably know that an expectant mother smoking cigarettes raises the risk that her child will be born prematurely, with low birth weight, and with the symptoms of nicotine dependence. These are all well-documented scientific facts. The same pattern holds true for drug abuse by pregnant women. Remember the news headlines a few years ago about the birth of crack-cocaine babies? So if your mother drank alcohol, used drugs, or smoked while you were in the womb, your susceptibility to these habits has been intensified.

Infant trauma: Trauma is an emotional or psychological wound from a stressful event or period in one’s life that can be felt at either the conscious or unconscious level of awareness. Up until two years of age, if your mother or other caregiver didn’t pay attention to you because she was an alcoholic or you had a sibling to whom she was paying more attention to—or whatever the reason—and you never connected and adequately bonded with her, such neglect has an environmental effect on the right frontal lobe of your brain. This is the area that determines how you connect to people. You will spend the rest of your life trying to connect and if you can’t do it with people, you’ll try through substances or compulsive behaviors.

There is an old AA saying that the root cause of our alcoholism is our defective relations with others. That is exactly what pioneering clinician scientist Dr. Allan Schore of the Department of Psychiatry and Biobehavioral Sciences at UCLA’s Geffen School of Medicine is beginning to prove. His research on “attachment theory” shows the importance of the unconscious forces that drive human thoughts, emotions, and behaviors. In response to a caregiver’s neglect, an infant develops one of two response patterns: hyperarousal (from experiencing high levels of anxiety) or dissociation (from feelings of disconnect from self or surroundings). Either of these relational trauma patterns can be associated with the child developing an inability to self-regulate the intensity and duration of emotional states, which results in a compulsion for self-medicating later in life.

Childhood trauma: Trauma during adolescence and the effect of those traumas on the developing brain can compound the harm of infant neglect. Divorce can be trauma for a child. Moving can be trauma. An abusive, alcoholic parent can produce trauma in a child. There are levels of trauma, and some kids have a greater capacity to adapt and tolerate than others. Because the human brain continues to develop until about the age of 21, there are many opportunities for traumatic damage to be inflicted.

Dr. Charles Whitfield, a psychotherapist and trauma recovery expert, observed how “strong to overwhelming” evidence exists to show that problems with alcohol, drugs, smoking, and eating disorders all can be traced to childhood trauma. Though links to gambling, hoarding, and sexual compulsions have yet to be thoroughly documented, Whitfield suspects these compulsions will also eventually be found to have a genesis in childhood traumas.

It wasn’t until I was about 17 years into recovery that I started to understand my own post-traumatic stress disorder, which most alcoholics and addicts have. What I went through as a kid—alcoholism in my home, my parents’ divorce, the public murder of my two uncles—gave me PTSD, and though it wasn’t as severe as what a soldier experiences on a battlefield, it still necessitated my search for treatment.

“Post-traumatic stress disorder is often mistaken as depression,” said Dr. Whitfield, “and it’s this PTSD from childhood traumas that triggers dependencies, which might start off as bad habits. A complicating factor is that the psychiatric drugs often prescribed for these compulsions are essentially all addicting. Psychiatry doesn’t like to talk about that. These drugs (antidepressants, antipsychotics, and mood-stabilizers) have introduced a major wrench into the wheels of recovery from substance abuse and dependence. Well over half the people who take them can’t stop without experiencing bothersome to severe withdrawal reactions that resemble various kinds of ‘mental illness.’ These psychiatric drugs also commonly cause weight gain, anorgasmia [inability to achieve orgasm], oversedation or overstimulation, and a numbing of our minds and emotions. And they don’t work well for many people—people who are being prescribed a string of more psychiatric drugs, even while they become less functional overall in their lives.”

According to Whitfield, anxiety and depression, the two most common “triggers” said to initiate dependence or a relapse from recovery, are the two most misdiagnosed symptoms of the traumas experienced early in life.

The Good News: You Can Retrain Your Brain

Despite the gauntlet you went through, despite the damage that may have been inflicted on your brain and in your thinking from chemical imbalances and chronic abuse, you still retain the capacity to rehabilitate your mind and your life. Damage can be reversed and dependencies and cravings can be subdued by engaging in practices that manipulate the plasticity of your brain to reshape your thoughts and behaviors.

It almost sounds too good to be true, but believe me, this is all firmly rooted in the latest scientific findings. In just the past five years scientists have made remarkable discoveries indicating that even though after about the age of 21 the adult human has a brain that seems to be fully formed, that brain still malleable. You can still change its structure. It still has the capacity to be altered and changed as a result of our thoughts, behaviors, practices, and rituals.

The term that brain scientists have come up with to describe our innate transformational capacity is neuroplasticity. I’ll defer here to several experts for a more detailed explanation.

In their book You Are Not Your Brain: The 4-Step Solution for Changing Bad Habits, Ending Unhealthy Thinking, and Taking Control of Your Life, Dr. Jeffrey M. Schwartz and Dr. Rebecca Gladding wrote: “Neuroplasticity is the ability of the brain to take on new functions based on a person’s changing needs and actions. Neuroplasticity includes any process that results in a change in the brain’s structure, circuits, chemical composition, or functions in response to changes in the brain’s environment.”

Dr. Daniel J. Siegel, codirector, UCLA Mindful Awareness Research Center, further elaborates this in his book The Mindful Brain, discussing how you can focus your attention in specific ways to activate your brain’s circuitry to change the connectivity of its neurons. One of the tools to address toxic compulsions, which I describe later, is mindful practice of focused attention and awareness. This takes advantage of your brain’s neuroplasticity and expands its potential to heal areas of the brain that contribute to your cravings and compulsivity.

“Neuroplastic changes not only reveal structural alterations [in the brain],” wrote Siegel, “but they are accompanied by changes in brain function, mental experience (such as feelings and emotional balance), and bodily states (such as response to stress and immune function).”

We commonly see neuroplasticity at work in a person’s ability to recover from a stroke. Blood flow decreases in certain parts of the brain during a stroke, resulting in damage to that area. Damage to the motor cortex, for example, can produce paralysis, whereas damage to the brain’s speech area can impair talking. Physical therapy helps the stroke victim to “teach” other brain areas to assume control over walking or talking, giving those brain areas a new function, which is neuroplasticity in action as a natural brain mechanism.

Taking this natural self-healing capacity one step further is the concept of self-directed neuroplasticity, or using our willpower to decide how and why our brain will be rewired. Research psychiatrists Schwartz and Gladding defined it this way: “Using the power of focused attention, along with the ability to apply commitment, hard work, and dedication to direct your choices and actions, thereby rewiring your brain to work for you and with your true self.”

Warping your brain with chronic abuse of any of the Seven Toxic Compulsions is an example of neuroplasticity being used in a harmful way. Conversely, your understanding and subsequent use of self-directed neuroplasticity gives you the opportunity to reverse the damage, and it empowers you to engage in only healthy behaviors.

Throughout the remainder of this book, I’ll provide practical “tools” that have been recommended by experts, based on their research and/or clinical practice, to assist you in managing and recovering from the Seven Toxic Compulsions. Many of these tools were designed, or have been accidently discovered, to take advantage of neuroplasticity to retrain your brain so you can live a healthier life.

Welcome to the new frontier!