Why You Can’t Think Your Way Into Not Drinking

Why You Can’t Think Your Way Into Not Drinking

I’ve observed a tendency in my clients that they believe because they have achieved so much, they “should” be able to address their substance use disorder themselves. My clients are mostly high functioning persons with an alcohol use disorder** or substance use disorder**, people who are over-using alcohol, drinking too much, using too many or too much substances. They have homes, relationships, jobs, material comforts, and other stability and security. They tend to assume that because their problem is a behavior, they can change it with thinking. 

After all, my clients have changed many things with thinking. They’ve planned for their education, for their businesses, for moves, for children, for children’s educations, for financial decisions, for career changes and growth, for fitness challenges, and for hobbies and recreation. 

But managing the use of psycho-active substances doesn’t work that way. Here’s why. The misuse of substances starts and ends in the brain, which is, of course where you think. But the reason that a particular brain wants “more” isn’t due to faulty thinking; faulty thinking is often a symptom of the problem.

Let me explain.

Addiction research has revealed that overuse or misuse results from the following broad categories:

1. Trauma – often childhood trauma. Known as “developmental trauma” (meaning it happened when the brain was still developing), trauma changes a person. When a person witnesses, experiences, or participates in something negative or significant outside the realm of expected and anticipated range, it’s trauma. The person’s brain reacts. When a brain reacts, it does so with a chemical reaction, and that reaction changes the neural pathways of the brain, and the patterns that determine mood, perception, and somatic (body) experience. It changes how the body may experience sensation, psycho-active substances, relationships, pleasure, bio-states such as sleep, pain, fear, and hunger. The impact of the trauma is often correlated with the severity of the trauma and/or the length of the trauma. For example, a catastrophic weather event such as Harvey did in Houston, TX will have a short term component and a moderate length after effect. Combat related trauma can have a series of events, and also become chronic. A child experiencing the hostile divorce of their parents has a long term trauma, but it can be severe because it’s experienced in a young, vulnerable, brain. In any case, the changes in the brain brought on by trauma shape the brain, then that person, and pre-dispose that person to have a hyper-response to psycho-active substances or compulsive behavior.
2. Interaction with a substance – Surgery or medical trauma can be a precipitant for the development of a substance use disorder. This is the origin of a significant percentage of the opiate crisis. The structure of opiates are more likely to create an addictive response in a wider range of brains (even in brains less likely to have an addictive response), which is why we see people who have never been observed to have had a problem develop a problem and why persons formerly in long term recovery relapse after a medical event.
3. Heritable vulnerability – There is an observed and documented predisposition towards having a hyper-response to substances that “runs in families.” Some researchers and clinicians speculate that the predisposition is dormant until switched on by interaction with a substance, trauma, or co-occurring mental illness.
4. Reward insufficiency – Some research suggests that a percentage of persons who regularly mis-use substances do so because their brain’s reward system functions differently. These persons do not experience reward at the same level of pleasure and joy as the typical reward response, and the function of psycho-active substances gets hardwired by neurotransmitters (feeling chemicals) as pleasure. In the case of dopamine, for example, it can carry the brain-message that “this was better than expected, send more.” Often the term “salience” is used when discussing this theory of substance mis-use.
5. Learned behavior (habit, conditioning) – The brain operates on hard-wired behaviors. You likely put your pants on putting the same leg in first every time, for example, and you probably do the same things in the same order when you come home or when you get up. If you’ve ever tried to start or stop a habit, you’ve become aware of learned behavior/conditioning. If you come home and immediately make a drink, that is behavior you’ve taught your brain. “420” became a thing because of habit and conditioning.
6. Co-occurring mental health issues– When a person has co-occurring mental health issues such as depression, anxiety, or bi-polar they often find relief from the symptoms of those illnesses when they use psychoactive substances; at least at the beginning. As tolerance builds and the person needs to use more, more frequently, or more intense substances the relief often becomes elusive, but by then, the habit has become established and hard-wired into the neural patterns of the brain. At that point, the person has both the original mental illness AND a substance use disorder.

So, what does that science lesson have to do with my original statement that you can’t think your way out of over, miss, or addictively using substances? Literally everything. Thoughts are insufficient to effect change in any of the line items 1-6. What is necessary are new habits of behavior, new habits of thinking, new events, and new experiences that create their own neural pathways and establish a new, healthy chemical pattern that changes the person. 

Just “not drinking” is not enough. 

That’s why someone who just attends AA meetings (and does nothing else) relapses to problem drinking. That’s why someone who uses marijuana problematically struggles to remove the points of the day where they used it. That’s why opiate users (in combination with the physical realities associated with that drug) find themselves shortly organizing the next dose.

The treatment has to include activities, habits, and interactions that are profound (severe, if you will) enough to register a change to the brain. They have to continue until they become hardwired, and the earlier “problems” (1-6) become treated, or atrophied, or transcended.

You need to do things differently. Things that are more than “thinking.” And probably more than one thing, depending on your situation. “I’ll go to church” is insufficient (and passive). “I’ll stop” is not treatment, it’s just the state of your body that allows the treatment to have a better chance.

Think of it this way. Like other complex illnesses (cancer, diabetes) you need to treat it with an aggressiveness to match the aggressiveness of the illness. You need to treat it with a multidimensional approach. This needs to include interactions and events and activities that have significant brain impact and some that will become habits that will “groove” into your brain and create the needed resulting neurotransmitic (I made up a word) changes. 

Long Term Recovery

And it needs to continue, or the illness (the brain that seeks the substances and reacts with craving towards them) gets bigger than the brain that is quelled without them.

“Thinking” or simply “insight” or “self knowledge” is insufficient” for that.

What does change the brain in profound ways are:

1. Exercise, which incidentally helps most co-occurring issues also.
2. Contemplative movement. I wrote about it here.
3. Laughter. I wrote about it here.
4. An intentional gratitude practice. I wrote about it here.
5. Creativity.
6. Service and Volunteering. I wrote about it here.
7. Forgiveness and Not Being Resentful. I wrote about forgiveness and not being resentful.
8. Personal Transformation.
9. Meditation and mindfulness.
10. Meaningful activity and purpose (work, hobbies, political activity)

None of these are a “one and done.” They need to be practiced, cultivated, and curated until they are part of your everyday life; they are hard-wired into your brain informing your neural activity, and your neurotransmitters are carrying the messages that are created by these habits.

Return to use** happens when a once abstinent and brain healed person’s brain experiences a change in chemistry in which the old/atrophied pattern strengthens and the one created by the new habits and identity are muted, diffused, or reversed and the brain once again allows relief from psychoactive substances and then the substances themselves create the pattern of misuse.

You can’t think your way into a treated brain. 

Contact me for help if you are worried about your relationship with substances (or are a family member of someone who misused substances).

**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.