Alcoholism, not alcoholwasm

I am moved to write this blog and to continue writing about Alcoholism in general due to a newspaper article I read in the last few months by the writer, Tanya Gold, a recovering alcoholic with 15 years recovery.

https://www.theguardian.com/profile/tanyagold

I was inspired by her honesty in discussing her alcoholism and candidness in how it manifests on a daily basis.

It reminded me of the expression I have heard in AA meeting, “I deal with my alcoholism, not my alcoholwasm”

We deal in recovery with this one day of alcoholism.

This illustrates that this condition, this “strange illness  of mind, body and spirit”, to quote Bill Wilson, needs to be addressed and recovered from today. We need to maintain our emotional and spiritual balance on a daily basis as alcoholism is a condition which “progresses” in recovery too. It progresses via the accumulative effects of emotional distress.

It does not stay dormant waiting to be reactivated. If we relapse it does not go back to the point in our early or first drinking – instead it begins where we left off,  plus the added on value of the years it has progressed in recovery. So those with long recoveries of decades are in real danger from relapse.

However, this “progression” by which I mean our condition not only remains and becomes more chronic even in recovery.

I believe that our recoveries also “progress” over the years and the tools of our recovery greatly increase. As such it is possible to have multiple decades of recovery by following relatively simple steps. This is a message of hope. We do recover and although it is simple, is not easy. To admit defeat, to deflate our ego to such an extent that we can ask for help is very difficult for many.  Many of us have had traumatic, abusive upbringings too which means it is very difficult to trust others, even other recovering alcoholics.

Plus we all have a voice in our head that often runs contrary to us staying in recovery. We have a voice that whispers falsehoods into our ears in the hope that they eventually distress us enough to return us to drinking.

In her wonderfully honest piece, Tanya Gold states that her alcoholism “has relatively little to do with alcohol, which is merely the drug with which the alcoholic treats herself. It is, rather, a way of thinking, and continues long after you have stopped drinking. It is a voice in the head: a malevolent voice that wants you to die”

This ties in with a couple of ideas in the book, Alcoholics Anonymous, known as the “Big Book”, which states that alcohol is a symbol of our malady and that the problem of alcoholism “centers in the mind”.

It is what is going on, in between our ears, in our brain, in our thinking and emotional reactions to the world, in how we are affected by people, places and things. This is our alcoholism. Or mine anyway.

I am not sure this is what occurs with all alcoholics or just with some?

It certainly does with me.

Then I started thinking that this distorted, at times self defeating and deluded thinking, must be prevalent in the vast majority of alcoholics? If not why come to AA or other self help groups or to seek treatment?  If it is only alcohol that is one’s problem, why not just stop?

AA and other groups are usually for those alcoholics who need help in staying sober and in recovery, primarily because their alcoholism is often a mental health disorder. A thinking disorder, an affective disorder, a personality disorder etc etc often co-occurring with other disorders such as Generalized Anxiety Disorder, PTSD and so on. All of which manifest in distorted and deluded thinking.

Mental health difficulties usually manifest as thought disorders.

In alcoholism there are layers of deception in the whispering of their inner voice. It is this deluded inner voice that sends alcoholics back to drinking after periods of recovery. There is a deluded voice in the alcoholic brain that can contribute to your death, to killing you.

This is alcoholism.

It is a voice in one’s head that sounds like our own voice so it is very difficult to ignore or resist at times.

It often speaks of half truths, misrepresentations and misperceptions of reality. As Tanya Gold, states it is  a “malevolent voice that wants you to die”.

I have heard “old timers” in AA in the US called it “a psychopath in my head”.  In the UK it is often known as the “fanatic in the attic”, it is the voice of chronic, severe malcontent. It is an alcoholic voice that wants to drink because ultimately  it has been programmed to respond to sobriety in the way it does, to lead the alcoholic back to drinking. It thinks the best way to survive reality is to drink. It never stops thinking that way. It is more like a psychotic care giver, whose care kills.

So this is why the voice in your alcoholic heads seems to want you to die. Although this is surely  against the very notion of one’s own survival?

Does this mean that alcoholism is a malevolent, even diabolical voice, like a possession or does it mean that it is the inner, internal voice of a brain that is suffering an extreme mental health condition?

Thought disorder is not uncommon in a variety of mental health problems. In major depression there is constant rumination, in anxiety disorders catastrophizing, in certain types of OCD constant obsessing. These can all have, and sometimes share, what are known as cognitive distortions.

Cognitive distortions are a sign of mental health problems, a manifestation of them. My wife has PTSD and this anxiety disorder has similar traits to alcoholics.

Many alcoholics also have co-morbid conditions too, such as anxiety disorders, PTSD etc.

However, there is more to alcoholism that it’s co-morbidities, although these can obviously affect thinking too.

Alcoholism has what I call a motivational voice and resultant thinking.

This motivational voice rarely shouts in your ear, let’s drink!? After years of recovery it whispers little sweet nothings, little deceptions, untruths, falsehoods and tries it’s best to sound like you, often convincingly so.  It becomes “cunning, powerful, baffling” to quote the Big Books description of alcohol. Alcoholism, even in recovery, is described in this triplet.

Other conditions may have a similar motivational voice.

For example in OCD, a condition which some have called a behaviour addiction as the sufferer is “rewarded” to do certain compulsive actions to relieve the distress of their thinking.  The reward is a relief from distress. Hence it is negative reinforcement and not a positive reinforcement.

OCD sufferers sometimes have thought action fusion, a feeling that thinking about a certain action is almost the same as doing it.

I suffered this in early recovery in relation to drinking and relapse. It was as if I had practically had a drink just by thinking about it. It felt like an abstinence violation effect although I had not drank, just thought about it fleetingly.

In fact, I had not consciously thought about drinking, the thought happened to me, without my violation.

So we have profound similarities here. But differences too.

I relate to OCD as my drinking at the end was completely compulsive and automatic. It was prompted purely by the urgent need to relieve a constant emotional distress; this is chronic addiction. It was not the chemical itself, which had lost much of it’s intoxicating power, it was the extreme distressing emotional pain that prompted my drinking.

I believe that the alcoholic brain, even in recovery struggles automatically to find balance, or homeostasis. This is the nature of mental health issues, this imbalance.

This imbalance is manifest in distorted, often deluded thinking.

I believe that the “progression” of the condition of alcoholism is expressed and represented in how we continue to have thought disorder in recovery, even long into multiple decades of recovery. Our thinking continues to be “dis-eased” or disordered.

This is what I believe Tanya Gold was highlighting. This malevolent voice in our head that wants us to die is a brain whose survival networks or circuitry have become usurped, hijacked and taken over by the actions of addiction on the brain.

Alcoholism is not a separate voice, it is voice which is a read out of what I call the extended reward system in our brain. This is also called our motivational networks. It is there to help us survive by highlighting the actions and behaviours which are optimal for our survival so that we remember to do them again, hence it includes brain networks including and beyond simple reward, such as emotion, memory, attention and behaviour (especially motor regions, to get us to do that action).

In chronic alcoholism these networks have become under the control of our addiction. Addiction becomes ingrained in our brains in these networks of the extended reward system.

Addiction becomes embedded by our reactions to drugs and alcohol. It becomes embedded via the actions of stress chemicals upon these circuits and on a variety of neurochemicals in our brain. Extreme levels of stress chemicals dig the furrows of addiction in our brains. They  also create urgency in our behaviours.

This appears to be the result, in alcoholism, of an hyperactive amgydaloid region of the brain, which is implicated in fear processing and which alerts the brain to pump more stress chemical into our brains, creating more emotional distress and fear based thinking, which is often distorted and deluded.

Our brain thus becomes out of sync, imbalanced and off kilter. In active addiction it often achieves a transient balance of fleeting homeostasis by returning to an action that relieves distress (the emotional manifestation of heightened stress chemicals in the brain). Hence addiction increasingly becomes a compulsion, a compulsion being an automatic behaviour which relieves distress.

George Koob, an esteemed researcher in this area of addiction, particularly the increasing role of stress chemicals in the addiction cycle,  suggests that the addicted brain becomes increasingly allostatic in the progression of the addiction cycle. The homeostasis is more fleeting and the process of allostasis more prevalent.

At the endpoint of addiction he has suggested that, and consistent with allostasis, as the brain introduces “experience, memories, and the re-evaluation of needs in anticipation of physiological requirements” instead of one bit of the brain doing one function, the brain employs various areas of the brain, and various functions simultaneously to drive a behaviour, to regain homeostasis.

In a normal brain,  allostasis is the bridge process from one homeostasis to the next, as with hunger creating an allostasis which prompts a search for food to regain satiety, a homeostasis. In increasing addiction, this process of being motivated to act becomes increasingly “feverish” or pathological. There is more seeking than actually feeling homeostasis. What satisfied us before, decreasingly does so. As a result, we repeat more and more that allostatic process that use to work before but now does so decreasingly. The result is more and more to achieve less and less, all driven increasingly by the distress that drives this process. So ultimately it is the distress that drives this addictive behaviour not the drugs or alcohol.

It is distress than suggests an “optimal” behaviour for survival and is no longer simply reward based. In science terms, we have moved from a positive, reward based, reinforcement, to a negative, distress-based, reinforcement.

But distress is not a good leader or decision maker and it continually creates more negative reinforcement. We increasingly act to escape aversion, fear based thinking, negative emotions and self perception.

In addiction, the brain, when distressed especially, will recall experience, search through relevant and related memories in order to find a way to relieve that distress – which is to drink in the case of alcoholism.

This is why in early recovery, in particular, recovering alcoholics are inundated with thoughts and memories about drinking as very early recovery is very distressing. This will happen in an automatic, compulsive manner.

Another part of the brain which deals which attention will lead our eyes and noses, and thoughts constantly towards places where we can find alcohol.  Distress makes the need to find a transient homeostasis via drinking intensely immediate.

Negative self perception, ingrained in well furrowed self schemata and very emotionally distressing, can also prompt relapse via this process of allostasis and the recruitment of various circuitries to convince us we might as well drink as we are useless and don’t deserve any better.

Another US researcher Rex Cannon in an EEG study,  looking at the brain frequencies of recovering alcoholics, highlighted a possible role for negative self perception in relapse.

It found that by measuring their brain frequencies, when thinking about drinking and when thinking about self perception that there was a change in the frequency of their brain waves. In both cases, thinking about drinking and negative self perception, Cannon et al observed that widespread alpha power increases in the cortex, commonly seen by use of certain chemicals, were also present and in the same areas of a common neural circuitry for his study group during their reports of ‘using’ and ‘drinking’ thought patterns as well as in negative self perception.

This is a process of allostasis, the brain frequency replicating in brain frequency, a transient homeostatic solution to this distress, i.e. drinking or using.

These reports of ‘using’ and ‘drinking’ thought patterns as well as in negative self perception which appeared to bring the brain into synchrony, if only for a brief period of time, suggesting this to be the euphoria addicted individuals speak so fondly of and one possible reason for difficulty in treating these disorders.

In relation to using thoughts they suggested that “if the brain communicates and orchestrates the affective state of the individual in response to contents and images relating to self and self-in-experience – it is plausible that a large scale feedback loop is formed involving not only perceptual processes but relative automatic functioning.

This process reinforces the addicted person to become habituated to an aroused cortical state (i.e. increased alpha/beta activity) and when there is a shift to ‘normalcy’ (or recovery/sobriety) it is errantly perceived as abnormal thereby increasing the desire or need for a substance to return to the aroused (perceived as normal (or desired)) state”.

This would surely have a profound impact on addicts attempting to contain normal negative emotions when there is an automatic desire state, like a “neural ghost” suggesting, unconsciously, an alternative to wrestling with these torturous sober realities.

I have seen a similar process in some alcoholics in recovery who relapse. They seem to disappear into themselves, like they were being lured by some internal, inaudible siren, into a self drowning.

A submerging into this illness.

It may be that indulging in one’s negative self perception recreates a neural based virtual reality. One is almost bodily transported back in time, in a neural sense, back in to the drink and not fully in sobriety, however fleetingly.

It does leave a neural taste for it, a torturous transient desire.

The problem is that it happens to you without you asking it! You can be invoking a negative self schema automatically without wanting to reawaken this neural ghost.

But that is alcoholism in a nutshell. It happens to you without your express permission. It takes over the brain step by step, while impairing ones’ ability to observe this progression.

That is why we are are the last to know.

The self has been ‘hijacked’ so it is nigh impossible to figure this out without the help of others.

It is others that lead you out of the fog, as one has become lost to oneself. If nothing else, in early recovery especially, it is a dangerous place to visit, the self and it is safer to spend as much time as possible outside of it and working with others!

This negative self perception is also allied with poor emotion regulation as the ability to process and control our emotions deteriorates in the addiction cycle too. Stress dysregulation of the brain often manifest as this emotion dysregulation. It becomes so severe that we “regulate” even the most basic negative emotions” by external means, i.e. by drinking or using.

So in early recovery, our brains scream out for a relive to distress and this situation is not helped by not really having the skills to deal with our distressing emotions and the accompanying negative self perception.

So what does this have to do with deluded alcoholic thinking? Everything. Thoughts are often the result of how we feel about ourselves and how well we deal with negative emotions. Our thoughts are often a reliable read out on how we are feeling about ourselves.

Alcoholic thinking is also a level, or layer to alcoholism. For example, fear based thinking is a product I believe of emotional reactivity which is the result of an overactive amgydaloid region of the brain. These can be the product of not only  genes but also environment.

All are recruited, as with attention, perception, memory and thinking to get the alcoholic brain back to drinking.

As the years of recovery roll by, this may not seem obvious anymore, but it is the game plan now, and forever. This is alcoholism, not alcoholwasm.

One of my first insights into what alcoholism is, or rather what my alcoholism is was walking in a park, after treatment, when I realised that my thoughts, if I let them roll, always led to a place of emotional pain and to negative self perception and the fleeting thought of a drink.

My thoughts, low self esteem and thoughts all seemed to loop around my head getting increasingly more distressing.

I rang my AA sponsor for help and he said ” great, now you have have a good glimpse of what you illness is!”.

My brain and heart and soul all went “Phew!”

I once heard a recovering alcoholic in the US share that this was the main reason he drank…”to go phew”. The main reason I gave my wife for my drinking was to escape myself.

My sponsor knew the score, then I knew it. I know it and then forget I know it. That is alcoholism.

Some people in AA meetings have mentioned this is alcoholism too, so how come it is not more publicly known?

Why is it when people talk of alcoholism they talk of chronic liver damaged alcohol addiction or drunk tramps lying on park benches?

Why do we not talk about it as a mental health issue?

Why is it not treated as such? Why are there no real effective ways of detecting and diagnosing it earlier and using prevention strategies to treat it before it is often too late.

Why is it that alcoholism appears to be a mental disorder, in the opinion of some, that people somehow choose to have!?  Or in other words, according to some, it is a mental health difficulty, that is caused by being morally weak.

It doesn’t make a whole lot of sense when you put it like this does it?

In AA, it is often said by recovering alcoholics that they would not wish alcoholism on their worst enemies.

It is that bad.