thought digestion

Before beginning my community rotation down-Cape next week, our clinical group was together one last time to meet at Gosnold - a local organization that treats addiction as a chronic disease, instead of a series of character defects. Gosnold provides a continuum of services, from acute withdrawal care to community outreach programs designed to keep graduates of the detoxification program stay in a remission period, with abstinence as a goal. Today, we got a brief overview of their philosophies and the evidence they use to fuel their practice.

Most notably, our preceptor focused on emergent neurobiology that supports their thesis that addiction is an illness of a chronic sort, characterized by exacerbations and remissions. Addiction is believed to be the cause of a dysfunction of the mesolimbic-dopamine system, or the "pleasure center" of the brain. In times of pleasurable activity, naturally occurring opioids [you may have heard of endorphins or enkaphelins? those] are released, bind to mu receptors in this system, whose cells release dopamine which causes the "feel-good" feeling.

As with most body systems, this is a negative feedback system -- think of this process as a thermostat. You set the suitable threshold, and once the desired temperature has been reached, the system shuts off. But say you've set the thermostat to 68 before leaving for work and the outside temperature reaches 89. The heating system shuts down its production altogether. Say this heat wave continues all week. The heating system lies dormant. This, too, is true of dopamine-producing cells in the brain in the presence of exogenous opioids [mind-altering substances]. The cells are quieted because the threshold of dopamine has been reached, and if the use continues, the system is overridden and becomes dormant.

Dr. Nora Volkow describes the effects of mind-altering substances in the addicted brain. Mind altering substances affect both reward and motivation centers, and cognitive processes. Using overactivates the reward and motivation centers, which hijack the cognitive processing [logic/decision-making/etc.] center. So next time you look at an addict and think, "DEAR LORD, DO YOU NOT REALIZE THAT YOU ARE RUINING YOUR LIFE," remember that perhaps they do not. The need to normalize/supplement their brain chemistry becomes a compulsion impossible to overcome without multiple intervention strategies -- just as the compulsion to, say, wash hands thirty times before eating is impossible to ignore for the obsessive-compulsive without multiple intervention strategies. For more information on her and her peers' work, she writes a fabulous blog for drugabuse.gov.

I must say, the more I learn, the more these findings put my heart at rest. When the news broke that my father was an addict, I was all, "you love cocaine more than you love me and my brothers, so fuck you and your phone calls." But viewing this problem in the framework of a chronic illness, it really takes the pressure off me. Uhm, his brain is hijacked. He wasn't standing in the doorway of our apartment, weighing his options. His compulsion was driving his decision-making. I am not to blame. I am not less than a substance. I am just an innocent bystander that he hurt in the acute phase of his illness.

What I cannot decouple from my mind is addiction and firsts. I am the direct descendent of an addict, which means I have a four-times greater likelihood of developing an addiction of my own than the next guy. But, like... that shit doesn't appeal to me in the slightest. And much like eating snails, I cannot begin to understand why it is appealing to anyone. So, sure, I may possess the phenotype that predisposes me to such things, but if I never take the first step, I never contract the disease. SO WTF!!!!

In the case of my father, I know this is also not mine. This. is. not. mine. The disease, in all likelihood, was given wings long before I was born. And I just so happened to be present for his periods of remission and reactivation of symptoms. It's a damn shame. But you know what? We approached him. We offered him options. We provided support. But he would not accept the help we were willing to give. So if I want to reunite with the man I remember as my father from my childhood, he will have to come to the conclusion that he needs help and wants to change all on his own.

Can I be angry about decisions he made before I existed? Sure. Will my anger accomplish anything? Apparently not. Slowly but surely, I am letting go. I will love him in the best way I know how. And if he ever approaches me for help, I will not refuse -- as long as the interventions are evidence-based. But until such time, THIS. IS. NOT. MINE.

phew, that feels so good to say.