By Jeanene Swanson When it comes to addiction recovery, maintaining sobriety is a balancing act of grit, perseverance and hope. While these things aren’t easy to come by, they can all be achieved through a process of retraining the brain. Neuroplasticity is the brain’s ability to rewire itself. In addiction, more than one area of the brain is compromised: Not only is the reward pathway hijacked, but the centers of pleasure, learning and memory, and emotion are also altered. For people recovering from addiction, learning how to not react to cravings and negative thoughts and feelings can be the difference between sobriety and relapse. Some brain-retraining techniques include mindfulness meditation, cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), harm reduction, exposure or cue exposure therapy, positive psychology, and neurofeedback.
Using Mindfulness Meditation
One technique to help retrain the brain that’s gaining in popularity is mindfulness-based techniques or meditation. Jon Kabat-Zinn, PhD, founding executive director of the Center for Mindfulness in Medicine, Healthcare, and Society at the University of Massachusetts Medical School, was the first to take Buddhist meditation practices and develop a mindfulness-based stress reduction protocol for treating stress. Other protocols have been established for depression and addiction. In mindfulness meditation, the concept is simple: Observe feelings and thoughts, and then let them go without judging them or reacting to them. By learning to embrace triggers, or negative thoughts and feelings, addicted people can improve their ability to not react. Mindfulness training is the opposite of traditional therapies, which advise avoidance, such as in 12-step programs where addicted people are told to stay away from the people, places, and things that might lead them to use. This type of CBT teaches people to simply not think negative thoughts. Mindfulness is derived from Buddhist teachings, namely that life is suffering and a person must confront this fact before being able to embrace and surmount self-soothing in order to conquer detrimental behaviors such as addiction. David Black, PhD, MPH, assistant professor in the department of preventive medicine, mindfulness expert and research scientist at the University of Southern California in Los Angeles, wrote the introduction to the April 2014 special issue of the journal Substance Use & Misuse, which was focused on mindfulness-based interventions to treat substance use disorders. “Rather than getting caught in their desire to have things unfold differently, [mindfulness-based intervention] participants work at making peace with things as they are and embracing what is most meaningful in their lives in the present moment,” Dr. Black writes. Studies back up mindfulness as making profound changes in the brain, both structurally and functionally. Practicing mindfulness meditation can change the cortical thickness of certain areas of the brain, increase grey matter, and alter “functional responses to environmental stimuli, pain, emotional responding, and present-moment versus self-focused attention,” writes Katie Witkiewitz, PhD, associate professor in the department of psychology, clinical psychologist and mindfulness expert at the University of New Mexico on Albuquerque, in a review published in the journal Psychology of Addictive Behaviors in 2013. “The most common way that meditation can be helpful is through reducing ‘automatic pilot’ and allowing some space for the freedom to choose a more healthy response,” Dr. Witkiewitz writes. “Through training attention and awareness via meditation practice, individuals learn to pause and consider other options, as well as recognize that the distress and craving will eventually subside without using the drug or taking a drink.” Black also highlights research exploring what makes a behavior addictive. Knowing this, a person might be able to target other activities that can help retrain their recovering addicted brain. Behaviors that aren’t addictive are slower (which engender a state of flow, or a gradual sense of achievement), deliberate (which allows for processing of an activity through step-wise planning), and involve long-term goals instead of short-term gains that ultimately don’t add up to much or result in a loss.
Practicing Positive Psychology
In active addiction, the reward circuits are hijacked; the drug of choice becomes the only reward or motivating factor in life. In getting sober, addicted people learn how to stop using substances, not react to cravings, and prevent relapse through CBT, DBT, harm reduction, and other cue exposure training. However, getting to this baseline shouldn’t be the end goal, says Ilana Zivkovich, LCSW, LCDC, executive director at Promises P.A.T.H addiction treatment center. Thriving in recovery means living life to its fullest, and that takes more than just retraining the brain not to react to cravings. It involves creating new pathways and rebuilding the reward system so that healthy, long-term goals become just as or more rewarding than drugs and alcohol ever were. In positive psychology treatment, the aim is to teach addicted people how to rewire the reward systems in their brains after cravings and triggers have been mastered. At Promises P.A.T.H, chief medical officer Jason Powers, MD, has developed a curriculum called Positive Recovery, which is based on the precepts of positive psychology. Pioneered in the late 1990s by Martin Seligman, PhD, director of the Positive Psychology Center at the University of Pennsylvania in Philadelphia, positive psychology expands and elaborates on what makes up “happiness,” and how people can go about getting it. In a way, positive psychology is the opposite of mindfulness, which teaches a person to embrace negative thoughts and not react to them. In cognitive therapies like CBT, DBT, and positive psychology, the goal is to help people change negative ways of thinking to change how they feel. Positive psychology can be summed up by the acronym PERMA, which represents Positive Emotions, Engagement, Relationships, Meaning and purpose, and Accomplishments. People need all five of these elements in life in order to be happy. Thinking positive thoughts helps regulate mood and control behavior. Becoming engaged in a task helps attain what psychologists call “flow” or “when we’re challenged enough that we’re not bored, but not over-challenged to the point of being anxious,” Zivkovich says. Having positive and meaningful relationships can also help foster happiness, she says, and a person must have meaning or be doing something with their life that offers a sense of fulfillment. Finally, it’s important to possess ambition in order to meet personal goals and move forward in life. “Focus on the areas of your life where you’re measuring up in these ways,” Zivkovich says. “This will predict your happiness.”