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A lesson in brain science for the family

November 2, 2015
by Roland Reeves, MD
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“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.




Thank you for this article. I have tried very hard to help families understand the compulsion to start using again after a period of abstinence. The DVD "Pleasure Unwoven" helps some, but we need all of the tools that family members can share. This afternoon I will share this article with the son of a man who is in residential care. Hopefully he can share it with his siblings and other family members.
It's so hard to convince people that alcohol causes irreversible changes in the brain. We need as many teaching tools as we can get.

Thanks for this article, I appreciate how understandable you have made the process that are brains go through when creating an addiction. I can't tell you how often I have seen families and friends struggle with a relative that is facing again and again a familiar addiction. Many of the support system behaviors would be so much different if they could only understand the permanency of changes caused by addiction, and the need to help an individual avoid the addictive pathways altogether in order to avoid falling back into addiction. Thanks again, great post!

The following protocol increases drug use and abuse, loss of trust in medical profession, addictions and harm reduction.
The lead clinicians stubbornly refuse to change this life threatening protocol of chest compressions only for drug OD. Causing an increase in in morbidity and mortality as well as making the clinicians and everyone else victims.
Live human study chest compressions only for drug overdose.
My letter Emergency Medicine News Dec. 2015

Beyond grey medical literature live human study in Ontario, chest compressions only for respiratory emergency Can. J. Public Health 2013;104(3):e200-4
'Development and implementation of an opioid overdose prevention and response program in Toronto, Ontario.' http://static.smallworldlabs.com/hsf/user_content/files/000/000/169/355cc02324a166bb8abf31174c141f69-cjph-20131043200-4.pdf

Was also published in the 2015 AHA & ILCOR CPR guidelines about this life threatening intervention.
Read all comments under this deputation Toronto Board of Health https://youtu.be/QhsDjmI9H9c

Best Wishes


Roland Reeves MD

Physician, T R Reeves



Roland Reeves, MD, provides medication assisted treatment for the practice T R Reeves, MD, in...

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