Triggers: The Science

Did you know?: The Recovery Therapist is in long term recovery For me that means that I have been clean and sober for 27 years. (33 as of the re-write)

I want to share a scenario from 27 years ago. I had long since left the pattern of drinking in bars. I gave up recreational drugs and the overuse of prescription drugs– yours, mine, whatever –  at some point before. I had been through a pattern of drinking where I had to drink before I went out drinking with friends, tried to moderate my drinking when I was out drinking, and ensuring I had arranged to have “enough” to drink at home when I was done being out drinking. Perhaps some readers can relate?

Eventually, being social was not my goal, and I had enough of M.C. Hammer being blasted in my ears and I stayed home. And drank. But by then, I knew something was “wrong” with me. I also “knew” that it wasn’t alcoholism. ** My mom was a (sober) alcoholic. Indeed, she had been a high functioning alcoholic before she got sober in 1968 (and stayed sober until she died in her 70’s).  I had grown up with One Day at a Time and The Serenity Prayer and other trite AA sayings and

I.did.not.want.to.be.an.alcoholic.**

So, I began a pattern of trying to “get my life together.” I’d gather all my stuff in a central place in my apartment. I’d gather cleaning supplies and various containers. I’d have a clipboard, a planner, and a starter to-do list. I’d turn on music and I’d clean, organize, and plan. Fueled by a case of beer. I did this endlessly, day after day, week after week. By the time Pepsi-Co/Kentucky Fried Chicken felt it was time to release me from their employment, I had plenty of time to “get my life together.”

Let me bring you forward with me 27 years. 2 weeks ago, the weather was beautiful in Katy, Texas. I finished my weekend job at home with a major health insurance company. I opened the windows to refresh the air. I began gathering clutter from closets, drawers, and other areas of my home that needed to be tidied, sorted, and organized. I turned the TV onto a music channel, settling on classic 80’s.

There I was singing loudly (and off key) to Journey’s “Don’t Stop Believing” when the thought came that “I should have a beer.”

Bang! Triggered. I had not thought about drinking in more than a decade.

So, what really happened? Am I in a “bad place?” In 12-Step terms, is “my program” off the beam? Am I at continual risk of drinking, even 27 years later?

To understand triggers, to really understand triggers, you need to understand the science of addiction. Here is a link to an excellent video with a panel of some of the leading addiction scientists on the topic of addiction.

If substance use disorder is actually an illness (and it is), triggers are part of the symptomology. As such, in order to understand triggers, we need to understand the brain. Let’s think of the brain as a map. That map is written by our life’s experience. Areas of population and action  are created by the habits and activities that we do frequently and/or the moments that are heavily loaded with sensory experience, emotion, trauma, or significance. The more frequently a person participates in a pattern, the more that brain develops neural pathways to that activity. The more pathways, the more ways the brain’s communication system can find or access pathways to that pattern.

When a person is triggered, from the science standpoint, the brain has been activated on some established neural pathway. If not disrupted, that trigger can lead an addict to the populated place of using/drinking. That is why and how being around old friends and settings are considered risky. That is why treatment centers and 12-Step settings suggest that members in recovery change “people, places, and things” because to treat an illness, you need to use science.

2 weeks ago, my innocent evening of trying to organize my place had enough components to ignite atrophied but present neural pathways. I was alone, I was organizing and tidying. I had a vague goal of getting some stuff together and creating a master to-do list. I think what kicked my brain into being triggered was the music: it was literally the same music I listened to originally when I was beer-saturated trying to get my act together. The scenario was enough to be a catalyst to my brain.

Fortunately, I am aware of, mindful of, and in constant action regarding habits that keep my brain – with its chronic, relapsing brain disease – in a healing state.  It was that the science of the trigger happened in the (brain) context of a recovered brain. Let me put that another way. I was triggered not because I am weak but because science is strong. Likewise, the trigger did not create a mechanism in which I was propelled into drinking because, again, science is strong.

But what if that brain was NOT in a proneural-beneficial  state? What if I did not have “enough” healing habits and behaviors and the trigger was not fleeting, but gained momentum and awakened nearby pathways? That is what happens when the brain of a person with a substance use disorder has ceased to be stimulated towards proneural-beneficial activity. Remember that drinking or using is the LAST ACT relapse. The first act is a conscious decision to remove and not replace some component of brain treatment.

For example, relapse may include a person with a substance use disorder who:

1. Stops exercising
2. Stops treating anxiety or depression
3. Begins eating poorly
4. Stops meaningful work
5. Stops fun hobbies or recreation
6. Discontinues contemplative practices (yoga, meditation, Tai Chi, prayer, journaling)
7. Discontinues social support

If a person in recovery removes the activities that create healing, the brain defaults to the illness and at some point, that default will take the person back to using  or drinking.

This is not a dismal blog post; I have not been struggling for 27 years. But it is a real blog post; even at 27 years, I am still at risk. Any human with an illness that is chronic, or lifelong has to be vigilant and mindful and – while it’s not their fault they have the illness – it is their responsibility to be responsive to the needs of recovery the disease demands.

My disease demands that I do enough brain positive activities and habits so that when triggered, I am not led further into that part of the brain, but instead able to access the pre-frontal cortex and not wake the dark neighbors in the substance use vulnerable brain.

I will be writing a series on triggers; they are a complex topic. Watch for upcoming posts on triggers and how they function and what to do about them.

In the meantime, if you are someone or know someone who is high functioning but has a substance use issue or other unhealthy coping, contact me for an evaluation.

**

This blog will at times use quotes that mention addiction, substance use disorder, alcoholism, alcoholic, addict, and drug addict. Some of this research used is useful and necessary even though clinical language has progressed to remove stigma and present person-first. When possible, the I will use substance misuse, substance abuse, and substance use disorder interchangeably to refer to the diagnosable, criteria based clinical disorder. When referring to a person who has a disorder, this paper will use “person with a substance use disorder” or similar phrasing to establish person first orientation and de-emphasize stigma and disease identity. However, at times, terms will be used that will be consistent with the time frame in which they were utilized to provide context and demonstrate ideas.

**Person-centered language note: As a leading clinician in substance use disorder assessment, treatment, and recovery, I am committed to elevating the language around mental health and substance use disorder. This means I will use “alcohol use disorder” rather than “alcoholic.” It means I will use “person with a substance use disorder” rather than “addict.” I minimize my use of the term addiction because it carries stigma, often people have their own relationship with the word accompanied with misinformation. I use the term recurrence or return to use rather than relapse. However, it’s important that people searching for help get connected with services that benefit them. In this regard, people are not searching “am I a person with a substance use disorder?” They are searching “am I an addict?” They do not search, “can a high functioning person have an alcohol use disorder?” They search “am I a high functioning alcoholic.” They don’t search “treatment for people who have a recurrence” but do search “how do I stop being a chronic relapser?” As such, I want to affirm people with substance use disorders with my care, which includes language but I also need to structure my business in a way that google searches find my material.