Breaking the cycle of addiction
Sobriety is a subjective thing, I’ve come to realise. I quit drinking – and its accoutrements – six years ago. But in that time I’ve cycled through intensive bouts of energy drinks, coffee, cigarettes, over-the-counter medicine and speedy prescription drugs from the internet – all the while valiantly avoiding alcohol.
It’s known as cross-sensitisation and it’s like playing Whac-A-Mole: as soon as you notice your overuse of one stimulant and thump it down, another pops up in its place. But you don’t always notice. When moving office a few years ago, I found six half-empty packets of cold and flu tablets in my desk that I couldn’t recall buying, although I guess I must have bought them because I’d been taking the recommended dose all day, every day, for months.
As is usually the way, Alcoholics Anonymous has a slogan for this: “dry drunk”. One so afflicted has quit booze, but simply turns to new vices or impulses. It may take the form of 13th stepping, the expression for seducing newcomers at meetings, or shopping sprees, or Candy Crush until dawn, or rigorous smoking.
But how do you squash your compulsion? And the pop-up compulsion after that? A 12-stepper would tell you the answer is in attending meetings, which provide spiritual guidance and structure, but then those meetings start to become as omnipresent in one’s life as alcohol. Al-Anon, Narcotics Anonymous, Sex and Love Addicts Anonymous, Debtors Anonymous – for some people, doing the rounds of “the rooms” is an addiction in itself.
To get a grip on cross-sensitisation we have to understand the role of dopamine. Dan Lubman is professor of addiction studies and services at Monash University and the director of Turning Point – the alcohol and drug centre that I attended when I first stopped drinking. I put him in the awkward position of talking shop with someone who is also the case study of this article.
“The reward centre is a learning mechanism that all animals have, which reinforces things that are important for survival,” says Lubman. “It rewards us with a dopamine release around eating, drinking, sexual behaviour, looking after our young. What drugs of abuse do is artificially induce dopamine release by tricking the brain into thinking that this behaviour is critical for survival.”
Over time, the use of alcohol and drugs can result in a pathological over-learning by the brain. Dirk Hanson, the author of Chemical Carousel: What Science Tells Us About Beating Addiction, says, “Sustained heavy drinking forces the brain to accept altered levels of neurotransmission as the normal state of affairs. It may grow more receptors at one site, less at another. It may cut back on the production of these neurotransmitters altogether, to make the best of an abnormal situation. Take the alcohol away, and the new checks and balances are thrown into disarray.”
In the beginning of the process of abstinence, Hanson says, the brain is stubborn. It will insist on strenuous dopamine release, by hook or by crook. It’s not insistent that this be from alcohol or drugs, not when nicotine, caffeine or risky behaviour work as triggers.
Risky behaviour. We automatically think of sex, but it may also explain why I volunteered at a winery last vintage. The thrill of getting Le Grand Coq Noir shiraz splashed up my arms as I worked the hose, or the first explosion of sulphur and chardonnay when I pulled out the bung of a barrel, felt like Russian roulette. There’s also the factor that dopamine is released from predicting a reward.
Trying to police my need for dopamine is starting to feel like an eating disorder. I’m constantly denying myself even innocuous things such as coffee – because if I allow it, the dialogue in my head ramps up to an obsession: You’ve only had three, you could have another. Okay then, later. How about now? How about now? No wonder during Prohibition people kicked back twice as hard, so that drug addiction in major cities rose by 44.6 per cent.
According to the Institute for Addiction Study’s Dr Kevin McCauley, quitting one substance but allowing others is a mistake. When cocaine users quit that drug but continue to drink, they’re creating spikes of dopamine that keep their craving constant. Similarly, those who use nicotine or caffeine are creating “small but real” spikes.
That makes sense. I promptly took up smoking upon quitting drinking, and anyone who’s been through a detox will report back that the courtyard is the place to be. Turning Point runs a smoke-free detox, and Lubman confirms, “If you’re constantly chasing that artificial stimulation from nicotine, you’re not allowing the reward system to naturally recover.” He adds, “Most people who die from addiction and mental health die of smoking-related problems.”
Another factor conspiring against the newly sober, wobbly-legged foal is anhedonia – an inability to derive pleasure from things.
“What happens – if you use drugs and alcohol for a long time – is part of the reward system becomes reset so you get this phenomenon of hedonistic allostasis,” Lubman says. “Essentially it’s like resetting the thermostat in your house. It used to be on 20 degrees, but it’s dropped down, making it much harder to release dopamine.”
Anhedonia is a depressive state that can be triggered by rodeo-riding the reward circuits, but it can also occur through trauma or being stuck in an environment without any control and which begets no stimulation of the reward system, be that at home, school or prison. The cruel irony is that someone might use drugs to lift them out of the sort of teenage anhedonia that can come about through circumstances, then emerge at the other end, decades later, in a version that’s drug-induced.
But there’s good news, according to Lubman: “We’ve done research identifying that it takes about three months for the reward system to normalise and for you to start enjoying yourself again.” In other words, stop trying to keep the system at artificially high levels with stimulants and the urges should wear off.
“Things that predict long-term recovery are meaningful activity, supportive social networks and altruism,” Lubman says. “We live in a world that tells us: be individualistic, don’t rely on anyone else … but we’re essentially social beings. When you’re addicted to something, you stay in one group with a common social identity that reinforces that narrative about what you’re like, which protects you from challenging that view. It’s important to know how you fit into a larger social network.”
That makes sense. A year into my sobriety – humour me, please – I found myself on the edge of an abyss. What was the point anymore? I realised I needed to do something drastic if I was to stop myself from tumbling. A friend’s father was dying of cancer, in considerably more existential pain than me. As the disease took away his ability to sail boats, he took up the cello. When that, too, was taken away, he took up chess – and so on, until he was reading a book of quantum physics on his deathbed.
Taking his cue, I began a year-long mission to try something new every day, from flying a plane to working on train tracks. Apart from the focus that went into setting up these tasks and then documenting them on a blog, it swerved me into the path of communities I would never normally have met. It was the most rewarding move I could have made. Well, that and smoking.
“Yes,” Lubman beams. “There was stimulation, the feeling of being challenged, a sense of growth.”
At this point, I offer my theory that my new-found interest in volunteer work, choirs and group activity may be a mad stab to release the bonding chemical oxytocin – perhaps as a stand-in for dopamine. He quickly debunks that. “Feeling connected to groups releases dopamine,” he says.
Then every road comes back to dopamine. But, Lubman warns, “The danger here is that we demonise dopamine, when it’s important for our wellbeing. It’s only when certain behaviours artificially raise it that we get into trouble.”
So here we are. The first change to make, upon concluding this article, was ditching the smokes. This means – if I hold Lubman extremely faithfully to his three-month theory, and if I’m vigilant about not getting a “cold” or “flu” – my thermostat will reset in 89 days. Looks like it’ll be a long winter.
This article was first published in the print edition of The Saturday Paper on Aug 1, 2015 as "Twisting my sobriety". Subscribe here.