There was one thing about my drinking that I simply couldn’t understand. I was perfectly capable in every other aspect of my life but for some bizarre reason I couldn’t control my drinking. I drank more than I should, I drank more often than I should, and I drank at times and places that I shouldn’t. This inability to control my drinking was beyond confusing. It seemed like I didn’t have an “off” switch when it came to alcohol, and it turns out that this is actually the truth.
When an urge to drink comes on us it doesn’t come because we’ve willed it to, it comes entirely automatically… there is no conscious involvement at all. Sometimes we will get a gentle longing for a drink, sometimes we get the idea that a drink would be really good now, and sometimes we get the flat-out, primal scream: “I need a drink!” All of these are cravings and they are all caused by the same mental mechanism; all that differs is the intensity.
Cravings don’t come randomly; they are “triggered” by parts of the brain that are collectively known as the “reward system”. The reward system is a group of connected parts that work together to encourage us to do things that aid our survival and to discourage us from doing things that could be dangerous or harmful to our survival. It is a self-learning system that operates entirely automatically. The reward system isn’t unique to humans; indeed it evolved long before we did. The component parts of the reward system lie right next to the brain stem and evolved before our distinctively human cognitive capacity. Our awareness of self and analytical capacity not only evolved after the reward system, it evolved independently of it. Our higher cognitive functions are not directly connected to the much older reward system and this is why we are unaware of its operation. But older does not mean lesser. It directs our behaviour not with language or ideas but with feelings and tis makes it incredibly fast and incredibly compelling. The reward system was such an enormously successful evolutionary advance that almost every animal on the planet has it.
The reward system is where our problems with alcohol begin and intensify, but its actions are invisible to us. The only part of its operation we are aware of is the craving sensation, whether this is a gentle, romantic idea that a drink would be pleasant, or the wordless scream that demands we have a drink “now!” Cravings may appear to pop up in a fickle manner, but they aren’t random at all and neither is their intensity. Cravings are launched when we find ourselves in circumstances that we have drunk before, and the intensity of the craving is determined by how many times we have previously drunk in that circumstance.
The reward system works by invoking feelings of wanting, longing for, or desire for things that are beneficial to us, and then motivating us to approach them. For things that may be harmful we experience feelings of disgust or fear, and we are motivated to move away. But we aren’t born knowing all the things that help or harm us; we learn new ones as we go along… this is why the reward system was such a huge evolutionary advance over instinct. As our life experience grows we encounter more and more things that are good for us or bad for us, and the appropriate behaviour for each circumstance is remembered: approach or move away. In this way we progressively improve our chances of survival. When we meet something beneficial or harmful that we’ve come across before; a circumstance, place, thing, etc. then our brain automatically encourages us to follow the action that was successful before; e.g. approach and eat, or hide or escape. When we take the action our brain has suggested as the way to act in this circumstance then then nagging urge that encourages us is stopped abruptly and we feel an instant sense of relief. If we were being encouraged to do something beneficial for survival then we first feel the motivation to act in a certain way and are then rewarded with a sense of relief when we do it. If we are being encouraged to avoid something harmful then we feel fear, dislike or disgust to make us move away, and again, we feel relieved when we do so. The motivating urge to act in a pre-determined way comes from the release of a chemical in our brain called dopamine.
In alcoholics the reward system latches onto alcohol as something very beneficial and urges us to drink when it is available or nearby. It recognises circumstances that yield alcohol and forms a new process for each of them, we call these “drinking triggers”, and each time we drink in a new circumstance then a new trigger is formed; we end up with thousands of them. But another feature of the reward system is that it reinforces successful triggers. If we were encouraged to seek alcohol by a trigger, and then did so, then this trigger was a successful one. Successful triggers are more valuable than unsuccessful ones and the brain strengthens the successful ones. If a trigger is successful in securing the outcome sought then its power is increased: more dopamine is released and this makes the motivating urge stronger. If we take the action we are being motivated to perform then the dopamine release is stopped immediately. If the motivation urge was powerful then the sense of relief when it stops is also powerful. The “aaahhh!” sense of ease and comfort that we get on taking our first drink does not come from alcohol (it happens far too quickly for this to be the case) it is the reward system in operation. That surge of relief comes from the abrupt absence of dopamine and this is the “reward” component of the “reward system”.
Evolution made the reward system impart urgency to doing things that benefit survival. However, something beneficial like a food that is available now might not be found again for some time, so the reward system encourages us to take advantage of the opportunity while it is present; but it also encourages us do so efficiently. If for example there is a bird in the middle of a field of fruiting berry bushes then there are berries all around it. There is good food in every direction but it would be inefficient in terms of energy use for the bird to pick berries randomly from all corners of the field. So the reward system evolved to use energy efficiently by encouraging the bird to take the closest ones first. The motivating urge launched by a trigger is stronger when its subject is closer than when the subject is more distant. In terms of alcohol this means that a craving to drink is far more powerful when we are close to the triggering circumstance. But it also means that if we begin drinking in a location where alcohol is freely available then we experience another craving for a drink as soon as we have finished our first one. Once we have started drinking in a circumstance where alcohol is available then our reward system demands that we continue. This encourages us to drink more and to drink for longer than we intended when we began.
Every new circumstance in which we drink forms a new trigger and our brain constantly scans incoming information looking for triggering circumstances that have been met before. Directly seeing or smelling the subject of a trigger will make that trigger fire, but triggers are by no means limited to this direct identification. A flying bird may not be able to see the actual berries on a bush but it can see that the bush is of a type that bears good fruit. And the bird may be so far away that it can’t even see the bush but it can see the terrain that bushes of this type grow. The bird forms triggers for the berries, bushes of the correct form and for the terrain that supports this type of bush and we do exactly the same with alcohol. Yes, we form a trigger to drink whenever we see or smell alcohol but we also form a trigger for a place at which we’ve drunk previously and we also form triggers for the roads that lead to that place. Over an extended period we accumulate hundreds and hundreds of triggers that urge us to drink. The cravings brought on by these triggers grow stronger each time we act on them and they grow stronger as we draw closer to the trigger’s location. But the reward system can be fooled regarding closeness. The reward system evolved before the existence of pictures, photographs, television etc. and it evolved before our human ability to visualise and imagine. To the reward system all of these things are recognised as real. It cannot distinguish between a glass containing alcohol and a picture of a glass containing alcohol; both cause cravings to be launched. Photographs of alcohol and images of people drinking will bring on cravings and even imagining these things will cause the related triggers to fire. We can bring powerful cravings on ourselves by simply daydreaming about drinking.
Whether or not drinking becomes compulsive rather than chosen depends on the vigour that the drinking triggers acquire. The intensity of a craving is determined by how close we are to the circumstances of the trigger and also by the number of times that this trigger has been successful in delivering alcohol. The more often we drink in response to the craving initiated by a trigger then the more powerful that trigger becomes. This means that the next craving we get from that trigger will be stronger. The reward system encourages us to drink more and it encourages us to drink more often, and if this continues unchecked then the triggers strengthen without limit and we become addicted. But everybody has this reward system, so how come that everyone that ever has a drink doesn’t become alcoholic?
Triggers exist to encourage some behaviour and discourage others, but a single subject can have multiple triggers for different circumstances. For example, we might have two triggers for lemons; we may feel the urge squeeze some lemon juice over fried food, but we would recoil strongly from the suggestion we should eat a whole one. Just like the example of the lemon most people have some triggers that encourage them to drink and other triggers that urge them not to. Normal drinkers have triggers motivating against drinking too much and they have triggers motivating against drinking at the wrong times. They have triggers linked to the discomforts of drinking too much; hangovers, vomiting, and loss of control, and they have triggers relating to the unwanted consequences of drinking; failing to meet important obligations, doing things that are regretted or shameful and so on. It is the balance of these competing triggers that most often prevents them from drinking unwisely. But alcohol-avoiding triggers do not form properly in us. We get the strange feeling that we seem to have no “off” switch when it comes to alcohol but we have no direct way of knowing that this is quite literally true. Other people are motivated to avoid drinking or to avoid drinking more, but we never are. Our drinking switch is permanently fixed in the “on” position. It is the absence of these alcohol-avoiding triggers that launches us on a catastrophic trajectory.
In the absence of drink-avoiding triggers finding alcohol becomes increasingly important. The urge to find and move towards it becomes stronger and so does the sense of relief we get when we secure a drink. Each time we drink alcohol in response to the craving launched by a trigger then the reward system increases the importance of that trigger. It is a vicious cycle that leads to us drinking more and it strengthens even further every time we drink: the act of drinking increases the demand to drink. Without the drink-avoiding triggers to hold this in check our reward system enters a runaway state which propels us along an ever more urgent pursuit of alcohol. The condition ALWAYS becomes more severe; never better.
It is the reward system that creates the urgency of the motivation to drink but a secondary effect locks that course in place and gives us the illusion that we are drinking because of loneliness, anxiety, fear, depression, poor-self-image etc.
The primary effect of alcohol on the brain is that it slows it down; a secondary effect is that it causes serotonin to be released. The serotonin is what makes us feel happy, relaxed, and sociable when we drink; these are the upside of drinking. But the slowing down causes loss of judgement, loss of balance, slurred speech and so on, and when we drink regularly and heavily then our brain adjusts the way it operates to try to combat these dangerous effects of alcohol. What happens is that the brain boosts release of a range of chemicals that speed up our thinking, increase our alertness and make us more ready to respond to danger. These work fine when we are drinking; they reduce the impact that alcohol has on us (which is why we have to drink more to get the same effect) but they are applied wholesale, throughout the day, so these chemicals are still at work when we are sober. This leaves us feeling on-edge as though we are expecting something to go wrong, a racing mind, restless, and anxious. Our mood is changed too. When we drink regularly then our brain recognises that it is getting more serotonin than it ordered, and it slows down its release. This causes our mood to be lowered when we are sober. These chemical changes that are made to try and keep our brain working optimally are called alcohol-tolerance. The combined effect of alcohol-tolerance is that our mood becomes depressed, we become less sociable and we are anxious, worried, restless, irritable and lonely when we are sober. But there is one thing that will fix all of these problems, and that is to have a drink. A drink will relax us again, make us more sociable, and make us happier. Once we have become alcohol-tolerant then we need to drink to lift ourselves to feel normal!
Once we have become alcohol-tolerant then when we are sober then we feel the effects of the changes fully; we feel miserable, stressed, alone etc. But a drink will fix all of these symptoms. A drink will make us happier, more relaxed, less care-worn and more socially engaged. So we drink to offset these and bingo!… our brain makes new drinking triggers for each of these emotional states. Once this happens then we drink to relieve our fear, anxiety, loneliness etc. because we are triggered to drink by these emotions, and we get these emotions simply by being sober. This is where the illusion “I drank because… fear/ anxiety/ stress/ depression/ loneliness” comes from. It is an illusion because often these emotions are themselves caused by us being sober once our brain has adapted to long-term drinking.
Once in this position we are trapped. Our reward system strengthens the drinking triggers every time we act on them and we have now added some catastrophic ones: we have added triggers for every imaginable form of distress. Fear, anxiety, loneliness, worry, confusion, frustration and hopelessness all acquire drinking triggers and our alcohol-tolerance makes it inevitable that these triggers will be fired. They will fire because the chemical changes in our brain leave us anxious, vulnerable, lonely etc. whenever we are sober. So as soon as alcohol leaves our system we get these adverse emotional responses and these immediately fire triggers that urge us to drink. This is where the urge to drink in the morning comes from. The reward system forms into a self-reinforcing loop with respect to alcohol and then our alcohol-tolerance cements that in place: our entrapment is complete. We end up drinking to relive the symptoms that are caused by drinking and these symptoms present themselves whenever we are sober. But drinking more makes the symptoms of alcohol-tolerance even more severe, so we drink more and we drink more often… which worsens our symptoms. Our spiral down into hopelessness becomes inevitable.
This is the pathway into addiction for most people. So what do we do with this knowledge? Understanding how our addiction forms and what drives it means that we can focus our effort where it will bear fruit instead of putting our efforts into combatting false “causes”. We have not become alcoholic simply because alcohol is an addictive substance… that is not the reason. Yes, alcohol is addictive, but it is not addictive to everyone. Normal people might strengthen drinking triggers by drinking a lot but they also form counterbalancing drink-avoiding triggers. We do not. If someone is drinking heavily to relieve negative emotions caused by some circumstances in their lives then if those circumstances are relieved then the drink-avoiding triggers will bring their drinking back to a regular state. They do not permanently lose the ability to control their drinking like we do. That doesn’t happen to us because they have an “off” switch, but we do not. We drink the same alcohol as they do, but in us the drinking triggers enter a runaway state, and that doesn’t happen to them. It is not the alcohol that is different, it is us. This is a fundamental piece of knowledge for recovery. My problem isn’t other people, places or things. It is not what happened in my past, it is not that alcohol advertising that makes me drink nor is it simply that alcohol is addictive. Other people have problems, other people see the same media promotion of alcohol, and other people drink the same stuff… but only some become addicted.
The problem is me; I am different. Different is not the same as weak, faulty or broken; we are only these things if we choose to see ourselves that way. Our problem is not alcohol itself but an alignment of personal characteristics that makes us susceptible to addiction; all addiction. When it comes to addiction our reward system responds to two internal characteristics that are unusually strong in us: we greatly value the advantages of something over its disadvantages, and we greatly value something now over something later. Neither of these is a flaw or a failing. Lots of people are thrill-seekers: they value the rush of excitement more highly that the risk of things going wrong. And lots of people value something now far more highly than something later… we call this impatience. But if we have both of these characteristics and they are both expressed strongly then we have a reward system that will behave unhelpfully when it comes to addictive substances and behaviours… it can tip itself into a runaway condition. There is nothing broken about the way that we value the advantages of something over its disadvantages: that quality in us is not particularly unusual, neither is strongly preferring something now over later. Both of these characteristics are expressed strongly in us but fall within the normal range. We are no more “broken” than someone that is unusually tall or unusually short. What we do have though is a conjunction of strong characteristics that gives us a huge susceptibility to addiction, and that problem won’t fix itself… but if we don’t fix it then it will become increasingly severe and destroy us.
When we realise that the problem is within ourselves then we see too that the solution also lies with us. Changing other people does not fix the problem, changing jobs does not fix the problem, moving somewhere else does not fix the problem, winning the lottery does not fix the problem. All these things do is move us away from a few triggers… but we will quickly create new ones for our new circumstances and all the old triggers still remain exactly as they were. While we may remove ourselves from a few triggers relating to certain places or people for example the other triggers remain in full force: triggers relating to times of the day, triggers relating to adverse emotions, the sight of alcohol, the sounds associated with alcohol, places where alcohol is sold, and so on. Changing where we live, our jobs, or our social circle only prevents a very few triggers from being fired; all the other triggers still operate exactly as they did before. We can’t move away from our addiction because our addiction comes with us. The triggers of the reward system, once established, remain in place forever. This is a feature of how the brain works: what has become known cannot become unknown. Once a trigger has been formed then it can never be removed and neither can its associated motivating urge. But while a trigger can never be removed the strength of the motivating urge that it invokes CAN be changed… and this is our way out.
The reward system aids survival but in the wild the availability of something beneficial like an important food can be unpredictable and the reward system accommodates this variability. For example, if we’d learned to sit under a tree because good fruit fell from it then the reward system would urge us to return to the tree and look for more food and this urge would strengthen each time we found food there. But if the tree stopped producing fruit then we would visit there forever if the motivating urges did not change and this would be an inefficient use of our energy. So the reward system evolved to be adaptable as well as compelling. Firstly, the cravings that are invoked have a limited time-span. If there isn’t any fruit available at the tree when we visit then the urge to continue to search there fades after several minutes and so we lose interest and move on. Secondly, if things stop happening the way that a trigger anticipates then the importance assigned to that trigger is lowered. In exactly the same way that a trigger strengthens through repeated success it is weakened by repeated failure. When a trigger consistently fails to return the object sought then the importance of acting on it (the intensity of the craving launched) is reduced. The brain can’t unlearn that something has been identified as something to be sought out, but the importance of securing it CAN be changed, and it is by successively denying cravings that we reduce their intensity.
By successively denying a craving the reward system recognises that the likelihood of a particular trigger being successful is less than anticipated and the urgency given to seeking out its subject is progressively reduced. This is an incredibly important piece of information for anyone attempting to stop drinking:
EVERY TIME WE RESIST A CRAVING LAUCNCHED BY A TRIGGER THEN THE INTENSITY OF THE NEXT CRAVING INDUCED BY THAT TRIGGER IS DIMINISHED. This is how we escape addiction.
If this did not happen then the cravings would remain at their peak intensity forever and we would eventually fail because of the enormous effort required to continue fighting them off. We do not manage to stop drinking because we get better at resisting the cravings, though we do get better at navigating them, we are able to stop drinking because over time the cravings fall to an intensity that we can overcome without undue effort.
If we are able to sustain our effort to stop drinking then all of the effects of alcohol-tolerance reverse themselves out. The first of these that we notice is that sleep returns. After that we will notice that anxiety fades and the churning of our mind calms down. There is nothing we have to do to make the fear, anxiety, restlessness, racing mind and hopelessness disappear. Out brain will restore itself as long as we don’t drink.
Success lies in overcoming cravings for a sustained period. Whether this craving comes as a romantic notion that a drink would be nice, or whether it comes as a primal scream that demands that we drink, now the process is the same. First we get the urge to drink that has been launched because we have found ourselves in the circumstances of a trigger: a time, place, emotion, sound, memory, or daydream of a situation when we have drunk previously. The intensity of the will depend on how many times that particular trigger has been successful in delivering alcohol and how close we are to the circumstances of that trigger. Our brain automatically encourages us to drink and our attention is focussed on securing alcohol. What we have to do is interrupt that automatic process and override it. We have to recognise that this urge is NOT what we actually want to do: our brain is deceiving us. We have to recognise the unwanted motivation and reject it. We have to do this time-after time, hour-by-hour, day-by-day. A single failure to intercept and overcome this urge will cause us to relapse. Our resolve to fend off these cravings is finite but our brain’s ability to present them is infinite. It is an exhausting process at first as the cravings come back-to-back and beating them seems like a game of whack-a-mole, but every time we overcome a craving is progress. We reduce the challenge of these cravings by taking the power out of them; one craving at a time, one trigger at a time. It seems at first that we are making no progress, the challenge seems relentless, but each craving we overcome brings us closer to the point that we can get past them without breaking our stride… and that is the goal with cravings. We can’t stop them completely, the triggers remain forever, but we can reduce their power to a point that the cravings they create no longer interfere with our day.
At first the challenge is relentless but over time it eases as more and more triggers are stripped of their vigour. Occasionally we find ourselves in the circumstances of a trigger that still has its full power, a powerful trigger that belongs to a circumstance we haven’t met for a long time, and we get a shocking out-of-the-blue craving. These are alarming and intense but most often we get past them fairly confidently because by the time we are hit by these cravings our resolve is usually in good shape. As time passes more and more of our drinking triggers have their vigour stripped away and we no longer have to constantly fight off the demands that we drink. It takes time, but it happens and for as long as we don’t drink this is guaranteed to happen. And for as long as we don’t drink then our mood and sense of well-being will come right too; this too is guaranteed. What we most need to be able to do is to stay the course but this is incredibly difficult to achieve. The cravings can seem impassable and they sap our resolve but our minds have other forces that conspire against us too. If we resist the cravings then all manners of mistruths and misdirects flood our mind… and they continue for longer than the severe cravings. Our minds throw lies at us that tell us we’ve got the problem under control now, that we probably weren’t actually that bad anyway, and a dozen others. These ideas chew away at the core beliefs that underpin our sobriety… that it is necessary, that it is possible, and that it is worthwhile. These corrosive ideas are just as likely to bring about relapse as the cravings. Research has shown that of all the things that we can do to help ourselves into an enduring recovery the most valuable is being involved in a recovery group. Which type that group is is of lesser concern. The most important thing is that we keep regular contact with people that have themselves recovered from addiction. These people provide proof that the effort is worthwhile, evidence that recovery is possible and their stories demonstrate why it is necessary. Staying in contact with people that are themselves recovered keeps the task front-and-centre in our minds until we are able to manage the challenge alone.
So after all this reading there are the key takeaways:-
- We do not drink because we are weak. We drink because we are compelled to by automatic mental processes. These processes are explicitly evolved to direct our behaviour, and in us these have been unhelpfully associated with alcohol.
- When we drink we strengthen drinking the drinking triggers that we act on and in us there is no balancing set of drink-avoiding triggers. We actually do not have an “off” switch.
- The intensity of the urge to drink enters an unconstrained runaway state, continuously gaining strength.
- Our brain responds to regular and heavy drinking by changing the release rates of important chemicals and these leave us unhappy, stressed, restlessness, anxious, hopeless and feeling alone. We develop powerful drinking triggers for each of these emotional states but we also experience these states whenever we are sober. Our addiction becomes locked into a vicious cycle.
- Drinking triggers slowly lose their vigour when they fail to deliver alcohol and the intensity of the cravings they launch diminishes. If we resist a craving then it will rise to a peak intensity but then subside.
- When we stop drinking for a continuous period then the feelings of being unhappy, stressed, restless, anxious, hopeless and alone fade away.
- The effort of resisting cravings is enormously demanding and relentless at first but subsides over time. Our mind also plays psychological tricks to try to make us drink again but belonging to a recovery community is the best way to sustain our effort until we can manage it alone.
Stopping drinking is difficult. Anybody that says it isn’t difficult is either deluded, doesn’t know what they’re talking about, or trying to sell you something. It is hard, but it is not impossible; lots of people do it. It is necessary because it we don’t break free of this addiction then it will destroy us and it is worth it because we regain worthwhile lives. We don’t drown from falling in the water, we drown from staying there. Start where you are, with what you have. Take all help available and keep going. When your mind tells you it can’t be done, when it says it isn’t necessary or it isn’t worth it then your mind is lying to you; keep going. Identify the lies as they come, call them out… and keep going.
© Copyright 2020 David Horry