How To Fix The Reward System
When the reward system is broken, there is nothing you can do. We don’t have replacement parts. You can’t swap out a damaged thalamus and put in a new one.
Clearly, there is only one thing to do: don’t get sick. Don’t have a stroke or get any disease. Just stay healthy and you’ll be just fine.
When a reward system is hijacked by drugs, the key thing to do is nothing. No cocaine, no meth, no alcohol, no marijuana, no LSD, no opioids. Just do nothing.
Now it turns out that doing nothing is hard work. Staying clean and sober has to become your primary concern. Yes, you can work. Yes, you can have fun. No you can’t do drugs.
The brain is relatively plastic. Soft plastic. It can bend and change its shape to adapt to the environment. It can heal itself from hijack, mostly.
Remember how the reward system highlighted the drug as most important and everything else as less important? It takes a while for that to reset. And it probably never resets completely. Addicts can relapse. After years of being sober, addicts can still relapse.
If it is irrationally difficult to give up coffee, think of how much more difficult it is to discontinue cocaine or alcohol. All of those environment cues have what feels like a magnetic pull. They draw you without your consent.
Alcoholics can’t imagine why anyone would not drink all they can. They see people in restaurants leaving behind a glass of wine that’s half full. Who does that? How is that possible? Druggies don’t get it.
The point is that every time you take a drug, your free will diminishes. The first time you got high was your choice. You had your demons too but the choice was yours. But every dose you take lessens your free will.
The first time was because of you. Maybe you wanted to party. Maybe you wanted to forget life. You may have a father who didn’t show love, people who expected more from you than you had to give, or a neurotic need for love and attention.
Some of the risks factor for starting drugs include your social environment (everyone at work goes out to drink) and childhood trauma (abusive parents, sexual abuse, hostile family life). You might want to blame your addiction on these factors but they are only nudges.
Some say that it’s not the drugs. It’s the escape. Edgar Allan Poe said; “I have absolutely no pleasure in the stimulants in which I sometimes so madly indulge. It has not been in the pursuit of pleasure that I have periled life and reputation and reason. It has been the desperate attempt to escape from torturing memories, from a sense of insupportable loneliness and a dread of some strange impending doom.”
Edgar was only partially right. Drugs offer an escape but that’s not all they do. They affect your brain so that you’re not thinking right.
You started taking drugs. It was your free will choice, or free-ish at least. So feel free to blame yourself for starting.
But then, give yourself a break. Every dose lowered your free will. Has that sunk in? The drugs changed your reward system. They changed the very system that you rely on to make decisions.
Addicts don’t think when they steal money or rob someone. They are problem solving. They are compulsively trying to reach a goal: getting high. It’s the drugs.
The good news is that you don’t have an addictive personality. There is no such thing. It’s the drugs. Drugs don’t care if you are rich or poor, live in the city or country, have a great or horrible family, are popular or lonely, or are good looking or ugly. They impact everyone.
Yes, you might have a genetic predisposition. A family history of alcoholism suggests that you shouldn’t start drinking. A family member can mess you up. One famous actor got hooked on drugs because he was given marijuana by his father, at the age of 5.
But after you are hooked, it’s not the rotten role models, genetics and social pressures alone. The drugs change your brain.
You had your demons but if you want to blame yourself, limit it to the preliminaries, before you got addicted. Don’t blame yourself completely for being an addict. You must also blame the drugs.
The reward system is so powerful that there are some things addicts should expect when they decide to get clean. First, they have to stay away from triggers. Anything that will make them (think of it as forcing them) to take drugs again may well have to be removed.
There are many triggers. In drug rehab they often don’t say which drug was their drug of choice because the word itself can be a trigger for some people.
Triggers can also be people. Addicts often have to give up their old friends. Hanging around people who are currently high can be a trigger. It can be surprisingly difficult to choose between sobriety and friends.
The same is true of family members. You can’t divorce your siblings but you might have to stay away from them. Sometimes you have to find substitute family members.
You can see how important it is to have a strong support group. Usually friends and family are supportive on the person going into rehab. They say “Good. I’m glad she is finally doing something about it.”
But if an addict relapses, the support is harder to find. The more relapses, the less optimism and support the individual gets.
It may take more than one rehab to get sober. Rehab is an educational process. It requires your consent and active participation. There are no locked doors. You can leave whenever you wish. You actually do have to want to succeed for the process to work.
Rehab usually begins after detoxification, which lasts about a week. Detoxification is done in a hospital environment because getting off drugs requires special care. Each drug needs different treatment protocols. There are medications that can ease the shakes. But it can be dangerous, and in the case of alcohol deadly. Alcohol detoxification isn’t for amateurs.
Rehab focuses on the things all addicts have in common. It helps challenge the false beliefs we carry. It helps people assess triggers and take steps to avoid them.
The length of rehab varies. In general, rehab is too short. The longer the treatment, the better it is. Effective treatment seems to need a minimum 90-day but 150 or 180 days is better. Addicts need time for the environmental and internal cues to settle down. They have to let the brain recover.
Six months is enough time for the tolerance and cravings to diminish. Patients will typically feel good and ready to leave. There is sort of a let-me-put-this-behind-me attitude. Internally, the addict seems to think that they have been cured and are ready to go back to their lives.
Going back to your life can be a challenge. You will feel better before you are. You will think you are in top form but your brain is not ready for big decisions. The reward system still can’t be trusted.
Patients will feel so good and be so impatient to restart life that they make the mistake of making big changes in their lives. They might fall in love with other patients. This is a mistake.
Your brain is not ready to make good decisions for 3-5 years. During this period of time you need to rely on your friends and family for their feedback. You can’t trust the reward system, so trust them. Get the advice from others.
Best success is if seclusion in rehab is followed by two years or so of structured treatment. Group therapy is often the tool of choice. In addition to AA meetings or other support groups, patients should be followed closely by the rehabilitation center’s professionals.
Treatment for addiction takes time. Recovery is optimized with a program that provides two and a half to three years of treatment (moving from inpatient to outpatient to occasional follow-ups). It takes that long for the reward system to mostly recover and for triggers to trigger less.
Triggers are important because of those chains we talked about before. We use chains to help us learn a new song but they are at work in an addict’s life as a series of events that lead to relapse. It is difficult to stop a chain, so the focus is put on avoiding or eliminating the triggers.
Five years of nonuse is when addicts transition to advanced recovery. You have had five years of maintaining abstinence, so trigger have less impact and you have learned ways to cope with them. Most of drug dreams are gone, and you have learned to stay sober when you are happy and when you are sad. You’ve dealt with most of the demons that got you started on drugs, and you’ve formed strong ties with people who have had similar experiences and with those who haven’t
You might still have some missing pieces. The years you are on drugs don’t count for emotional maturity. If you were 16 when you started drinking and 27 when you stopped, you still have the maturity of a 16-year-old. You haven’t learned to handle the stresses and happiness of real life. You have some catching up to do. At the five-year mark, you are well on your way to recovery.
Isn’t that incredible? Five years to get your reward system back to normal or close to normal. It doesn’t mean there won’t be unexpected cravings and triggers. But by this point you know how to handle most situations, when you are being nudged, and where to go for help.
There are many approaches to recovery. If one isn’t working for you, try another. Find something that works for you.
Take a look at the 12 Steps usually used in rehab.
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