By Lisa Martinovic
In battling addiction, neuroscience offers a complementary and alternative approach to twelve-step programs.
Cutting-edge 21st century neuroscience and a certain Depression era, Christian-based self-help fellowship might make strange bedfellows, but they have one thing in common: when it comes to the treatment of addiction, both rely on the brain’s innate capacity for transformation.
This may come as a surprise to those who think that Alcoholics Anonymous and other twelve-step programs are all about ‘turning your will and your life over to the care of God.’ Countless people do precisely that, but sobriety doesn’t happen in the absence of a tremendous amount of real-world footwork. And footwork, be it psychotherapy or working the steps, is what changes your brain and paves the way from addiction to freedom. I know this because I lived for eighteen years as a dedicated twelve-stepper, followed by fifteen years of self-directed sobriety. Understanding the science behind how we make monumental changes in our lives will help anyone who wants to clean up — with or without God.
Back in 1982 I needed monumental change and I needed it badly. I was living in San Francisco’s Mission District. It was decades before the tech boom, and the Mission was still gritty and low-rent. I’d been an alcoholic from my first drink some ten years earlier, and went on to get strung out on meth, opiates and, most devastatingly, crack. Toward the end, I was under no delusions about the fact that I was a raging, out-of-control addict, headed for an early death. Though the prospect of sobriety struck me as a life too boring to be worth living, I decided to give it a whirl. I had nothing to lose.
The apartment where I hit bottom was right on top of a Valencia Street storefront that housed the longest-running AA meeting in the city. Known as The Divine Dump, it was home to a rough assortment of last-chance drunks, many of whom lived at the nearby Salvation Army. I was a young woman, middle class reared and university educated, but I had fallen so far so fast that I fit right in.
Since every AA group is autonomous, each has its own culture. What I especially loved about ours was that we were all invited to interpret “God as we understood Him” quite liberally. Members deified doorknobs, light bulbs, pet Chihuahuas. Some were dyed-in-the wool atheists like me. Others had lost the God of childhood somewhere on the road to their own personal hell. To be sure, there was a preponderance of members who spoke of God as depicted in traditional Judeo-Christian teachings. I never felt any pressure to adopt their “understanding,” though I did try it on for size. Eventually I settled on something comfortably vague that I called the Creative Life Force.
But secretly? Secretly I always felt that I cleaned up because I made a decision and stuck to it.
However we made peace with “the God thing,” many of us got sober and stayed sober while many more did not. I went to twelve-step meetings on a near-daily basis for some ten years: AA, NA, OA, CA, WA, DA, SLAA, CODA and Al-Anon. Now, after a decade and a half of charting my own course, I’m still happily sober — and more emotionally sober than I have ever been. Still, my years first as a hard-core addict and then as a born-again twelve-stepper were formative, so I’ve never stopped wondering: by what mechanism do we get sober? Neuroplasticity offers some answers.
Whether or not you believe in God — indeed, whether or not God exists — we all have the capacity to change our behavior, our thinking, and the very structure of our brains. Applying the principles of neuroplasticity can help you get sober and stay sober. If you feel the presence of God in your life, or choose to invoke a God you don’t know in hopes that he or she will come to your aid, more Higher Power to you! But to augment your chances for success, or for an altogether different approach to sobriety, consider directing your brain.
How it works — neurologically
Simply put, neuroplasticity is the phenomenon by which the brain changes itself through experience. It does so by strengthening the neural connections (synapses) associated with a particular course of action every time we take that course. Visualize your brain as an untamed continent and you are the first person to forge your way across it. You’re probably going to look for the path of least resistance, skirting the highest mountain peaks and roughest river crossings. As you trample through the brush you’ll leave the beginnings of a trail in your wake. Should you ever make this trek again, for the sake of minimizing your ordeal, you will likely follow the same path. The more often you do so, the better defined it becomes, and the less likely you will be to brave unknown territory or take unnecessary risks. Why would you? You’ve navigated terra incognita and made it to the promised land. You won!
The brain is similarly biased towards efficiency. Say you’re a shy, insecure teenager at your first party with the cool kids. You feel awkward, tongue-tied, and extremely uncool. Someone offers you a drink. Before long you are relaxed, then giddy. By the end of the night you’re making out with the hottest boy in class. You judge the adventure a huge success — and your brain sets up a powerfully reinforced neural pathway through the wilderness of your teens. Why would you choose to be timid and vulnerable when a few drinks unleash your confident, sexy beast? So you go to party after party, imbibing drink after drink, and with every episode the neural pathway that tells you this is the way to deal with your psycho-social limitations becomes more entrenched. What started as a shortcut becomes your default, then your habit, then your addiction. The more often you walk this path, the harder it becomes to walk any other.
Years later your life is in shambles. You’ve tried and failed repeatedly to get it together. In desperation you turn to AA. Though its founders considered it a spiritual program, the twelve-steps are also a master class — a practicum — in neuroplastic change.
Neuroscience tells us “neurons that fire together wire together.” Activities we perform habitually and simultaneously, such as unwinding with Ben and Jerry’s at the end of the workday, become neurologically linked by association in our brains. Do that ritual often enough and you will be very uncomfortable when one day you arrive home to an empty freezer. But here’s the key: for good and for ill, neuroplasticity cuts both ways. It reinforces self-destructive habits if you keep doing harmful things and it builds healthy habits when you start turning your life around. Your choice.
Just to begin weakening the neural connections that paved your road to ruin demands multiple lifestyle changes. Addicts who sank as low as I did can’t just eliminate drink or drugs. We have to avoid the people, places, and situations associated with our addiction. (Don’t trigger those neurons!) Then we have to replace them with alternatives, which is where twelve-step programs come in. Going to meetings becomes something to do instead of getting loaded. Meetings also keep our focus on the habits we want to build until they become as automatic as drinking or using once was.
Or is it brainwashing?
There is much grumbling on anti-twelve-step listserves about the interminable amount of time spent reading, reciting, and discussing AA’s official text (known as The Big Book), its steps, and traditions, as if it’s brainwashing. Well, in a sense it is. But so are Sunday school, Fox news, and boot camp. Everything that we do or think, see, say, or hear — everything — changes our brains, either strengthening existing connections or forging new ones. Sober or addicted, we train our brains 24/7. The question is: are we doing so consciously?
If you drank every day for ten years, that’s 3,650 times you reinforced the neural pathway that associates alcohol with relaxation or fun or sex or whatever else you used it for. Drinking releases feel-good neurochemicals. So do vigorous exercise and creative challenges — too much work if there’s an easier, softer way. When it comes to triggering the release of yummy endorphins and dopamine, your brain became a one-trick pony. It’s going to take a while before sobriety feels comfortable, let alone pleasurable. Which is why most people need support trading their neural superhighway for what is initially a mere footpath to recovery. It could be inpatient treatment, therapy, an exceptional network of family and friends, or a twelve-step program.
Perhaps the most prevalent alternative to twelve-step programs is Cognitive Behavioral Therapy (CBT), a form of psychotherapy used first to prevent relapse when treating problem drinking, then adapted for every other addiction you can name, and administered by everyone from big-name rehabs to your neighborhood therapist. CBT does not concern itself with moral turpitude or God’s will; instead, it narrowly focuses on teaching the addict coping skills such as avoiding high-risk situations, handling cravings, and self-monitoring. Learning and practicing new skills engenders neuroplastic change, regardless of whether you achieve it with a therapist, a sponsor, or through sheer force of will.
There is no consensus as to which approach is more effective, twelve-step or CBT. Success rates in twelve-step programs are extremely difficult to quantify precisely because they comprise anonymous amateurs. But they do have one huge advantage over any form of professional therapy: they cost nothing. No money, doctor’s referral, insurance approval, or intake appointment is required. You just show up and get started. Of course, many people feel the need for a clinical setting, or enforced accountability. If they can afford it, therapy or rehab may be better options. Even at that, CBT practitioners often suggest their clients also attend twelve-step meetings to reinforce the often overlapping skills they’re learning in therapy and increase their chances for lasting recovery.
As with any new practice, consistent participation in twelve-step programs gradually and methodically builds new neural networks. Every sober foray into a situation you used to get high for — first date, party, being alone and lonely — strengthens your capacity to do so again. Thanks to your malleable brain, the more you do something sober the easier it becomes. But, using my earlier example, you may need to muddle through a thousand situations sober before it comes as naturally as it did when you were drunk. It’s hard for most of us to stick to our resolve that many times. But with the support of others it is possible.
AA contends that because our willpower has “failed utterly” to get us sober, we have no recourse but God. Really? Well, what does every participant at every meeting find every time? What is the common denominator? Not God, but other people getting sober. We find community. The generous support of other human beings carries us when we cannot carry ourselves. A strong case can be made that it would be easier for an alcoholic with AA but no God to get sober than for an alcoholic who has God but no recovery community.
At its best, twelve-step offers:
a physical and psychic container within which addicts are supported to change;
living proof, in the form of sober members, that recovery is possible. This provides a neural imprint, a model for the brain to latch onto;
coping strategies and practical techniques to get through rough patches;
friendship, solidarity, and hope — as transmitted by dopamine and oxytocin. These chemicals strengthen neural pathways to reinforce new behaviors;
the constant repetition of twelve-step language that systematically replaces the thought patterns that got us into so much trouble (“stinking thinking”) with thoughts that support us to be our most honorable and mature selves. It’s true this language is steeped in the Christian ideology that rankles so many. Nonbelievers find solace in the unofficial AA adage: Take what you like and leave the rest. (You won’t find that workaround in The Big Book, but you will hear it in meetings, to the consternation of some AA fundamentalists.)
Ultimately, instead of losing ourselves in a bar, casino, or gallon of ice cream, we find ourselves in meetings.
Are meetings forever?
From the very beginning, I challenged certain aspects of the twelve-step party line. I argued in meetings, debated with sponsors, and fumed to friends about concepts like “powerlessness” and “character defects.” But the basic framework of the program did work for me so I kept coming back and kept staying sober. Ten to fifteen years in, I started to chafe. Though I wasn’t aware of neuroplasticity at the time, I felt — I knew — that I had changed on a fundamental level. So did I still need to go to meetings to maintain my sobriety? Our community was rife with people who had returned to meetings after trying and failing to stay sober alone. We were constantly warned that catastrophe awaited anyone who stopped working the program. (Such fear-mongering is but one of the reasons twelve-step is called out as a cult by detractors.)
Around this time I was studying the work of Carolyn Myss, a medical intuitive who objected to the way people identified with, fetishized, and stayed stuck in their wounds (e.g., rape, child abuse, addiction) even after years of solid recovery. She agreed that twelve-step groups were useful — up to a point. Like the Buddha’s teachings, they are “meant to help you cross over the river. Once you get to the other shore, set them down and go on with your life.” Which you can do once you embody the teachings. This felt true for me. Though I never made an official break with twelve-step, I found myself going to meetings less and less often until eventually I stopped altogether. The habits that I had practiced with such devotion for so long had made permanent changes to my brain and behavior. And they live in me to this day.
I would not suggest that everyone should ultimately graduate from twelve-step. It’s just what worked for me. Millions of people all over the world continue going to meetings because they love them and are nourished by them, because they have found their tribe. You can be secure in your sobriety and still want to commune with others who share your path and be of service to those who suffer. It’s very much like the way people build their social lives around church, school, or social movements.
The Big Book’s worst call
So why don’t the twelve steps work for everyone? The Big Book claims:
“Those who do not recover [in AA] are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves.”
Ouch! Also simplistic, mean-spirited, and untrue. People fail to get sober despite fervent prayers, rigorous honesty, and faithful twelve-stepping. We fail because we are human and fallible. We fail because it’s hard to change. How many people can’t stick to a diet or exercise program even when their lives depend on it? And those of us who do not experience the “sudden and profound” impact of God, as did AA co-founder Bill W. (replete with “a sense of victory… utter confidence… peace and serenity”) must rely on the power of community in combination with the wise use of mind and will.
Recovery’s chicken or egg question
The genius at the core of how AA works is succinctly expressed in one of The Big Book’s personal stories: We don’t think ourselves into a new way of acting, we act ourselves into a new way of thinking. And, I would add, a new way of being in the world. It is the actions we take that change who we are.
The science has finally caught up with AA, and for that matter, Aristotle, who observed much the same thing some 2,000 years ago: “We become just by performing just actions, temperate by performing temperate actions, brave by performing brave actions.” Indeed, in 2015 the National Institutes of Health published a peer-reviewed manuscript that describes how working the twelve steps changes one’s molecular neurobiology — the very foundation of the case I’m making here.
Are we lab rats or evolving beings… or both?
When I said earlier that I secretly thought I got sober by making a decision to do so, that was only the first step. By which I mean my first step, not the first of twelve — admitting powerlessness over one’s addiction — of which I’d long ago become convinced. I had decided to clean up many times before, always without success. The difference this time was availing myself of a sober community, a highly structured support group. I got a sponsor, did meetings and readings, step-work and service work. I took actions often enough and consistently enough that I changed the way my brain functions. Repetitive actions give rise to neuroplastic change, which is the bedrock of behavioral change. These changes happen no matter our opinion of them, for the brain is essentially amoral. It has no preferences; it merely implements change in response to how we live our lives.
I hate to break it to you, but in terms of the pure physics of brain function, we are really not so different from lab rats learning how to get the cheese at the end of a maze. But many of us want more than the cheese. Unlike the “dry drunk” — the guy who’s on the wagon but still indulges in dysfunctional behavior — our goal is not mere abstinence. We want to be decent, loving people once again — or for the first time! This is why we make “a searching and fearless moral inventory of ourselves… admit the exact nature of our wrongs… make amends…” and the other step work.
In so doing we activate the ineffable qualities that make us human: empathy, compassion, courage, love, and curiosity. In turn, we buttress our resolve to stay sober, for we don’t ever want to return to a life where those qualities were in such short supply.
Hope for the Godless — and a surprise ending
So where does God come in? For those who believe, God is the force that replaces willpower and directs their will, without which sobriety is not possible. Generations of AAs have enjoyed the experience, and I would never challenge their reality.
Yet millions more have either been unable to achieve “conscious contact with God,” or found the whole notion so antithetical to their worldview as to prevent their participation in AA altogether. For those who recoil at any talk of God, make the experiment: apply yourself to a twelve-step program with the knowledge that, with or without God, you are embarking on the path to change, ably abetted by your neurological architecture.
If you’re like me, and you diligently worked the program despite your skepticism, and for years you “sought through prayer and meditation to improve conscious contact with God” and still haven’t heard God whispering guidance into your waiting ear, do not despair! There are many ways to work a successful program of recovery. Whether or not you hear the voice of God, working the steps changes who you are on a cellular level. If, somewhere down the line, God comes to you, great. If not, you and your neurons are still and ever on the way to wholeness.
Towards the end of The Big Book, the Spiritual Experience section explains that one need not have an “overwhelming God-consciousness” experience to achieve sobriety, that for most alcoholics the transformation is of the “educational variety,” developing slowly over a period of time. But here’s where it gets interesting: “With few exceptions our members find that they have tapped an unsuspecting inner resource which they presently identify with their own conception of a power greater than themselves.” Whoa — that’s quite an interpretation! If what we have found is an inner resource, why externalize it? Why not rejoice and claim it as our birthright? Might this resource — this strength, wisdom, and moral compass — be part and parcel of who we are and have always been?
Whatever its provenance, this resource is yours now. May you use it wisely.