Over 18 percent of the US population suffers from symptoms of an anxiety disorder. This number is growing under the stress of the COVID-19 pandemic and the mental health challenges therein. In a recent survey of adults who have a substance use disorder (SUD), 20% struggle with a secondary anxiety or mood disorder.
The Part of the Brain Responsible for Substance Use
The brain is the overseer of a person’s daily routine. Many popular substance abuse remedies fail to get to the core of the problem because they focus on the wrong part of the brain. These activities will address the prefrontal cortex (PFC), which engages willpower and conscious thoughts.
On the other hand, troublesome habits, like using a substance when experiencing anxiety, are centered primarily in the limbic system. This part of the brain operates on a subconscious level and is often blamed for such behaviors as continuing the use of drugs for temporary relief, even though the logical part of the user’s brain knows the long-term result of the drug use is that it might be ruining their lives.
Fear-based learning combined with uncertainty produces a rush of adrenaline which worsens things. To overcome this dilemma, bad practices, such as worry, must be broken and eliminated over time.
Addressing Anxiety and Establishing New Rewards
Getting your thoughts on paper and mapping the chain reaction that leads to the negative emotions and drug use are a good first step. When a patient is suffering from anxiety that leads to substance use, they often experience the following:
- Their anxiety is triggered at routine time (ie. in the afternoon, or during an interaction with a specific person)
- This fear-based worry causes them spiral into negative thoughts
- They will use a substance to temporarily reduce the negative emotions they are experiencing
Therefore, a drug habit develops depending on the gratification the user receives. If the habit is strong, the user finds satisfaction in the activity. The only way to overcome this feeling is to be aware of it and consider how it makes you feel. The path from usual habit to addiction is short. That is why recognizing the signs of addiction is the first step to preventing you from falling into a downward spiral of drug use.
That will help you change the reward.
Modifying Your Reward System
Let’s look at an example.
When a person smokes as a young person, the reward initially may be feeling independent, defying their parents, or fitting in.
As people get older, they almost universally come to the conclusion that smoking is not appealing or pleasant. For example, the odor may be off-putting. However, after months or years of establishing a connection between the positive feeling and the activity, their prefrontal cortex will not be able to override the demands of the limbic system.
The Analogy of the Rider and the Elephant
A rider and an elephant analogy is used by psychologist Jonathan Haidt to illustrate this kind of scenario.
The limbic system in the brain is like an elephant, and the prefrontal cortex (PFC) represents a person riding on the elephant’s back.
Even though the rider of the elephant thinks he or she has the upper hand, the elephant is still in control. If you want a lasting change, you have to teach the elephant something different.
While the logical prefrontal cortex section of our brain is useful for decision-making and planning, we tend to overestimate its control over your behaviors.
So, how can you get this subconscious part of the brain to comply with your commands? You have to retrain it and give yourself new rewards.
Asking Key Questions
It is helpful to come from a place of curiosity. Curiosity allows you to ask pertinent questions, such as:
- “What parts of my body are affected and how am I responding?”
- “What can I do to help this behavior?”
For instance, let’s say you start to feel upset or anxious. With practice, you can recognize your emotions, interrupt the response, and ask yourself, “What, really, am I feeling and what is the point of using a substance to blunt these negative feelings?” This interruption allows you the opportunity to replace the old response (or “reward” of drug use), with new, empowering responses.
The idea is to address one bead at a time from chain of negative responses and replace it with a more positive and beneficial response. It is good to recognize and reinforce the improved response. For many people this comes in the form of “counting days” (without a smoke or a drink) and/or collecting chips in early sobriety. The recognition by others in the support groups setting can be a powerful motivator.
Professional Help Can Be Invaluable
It does take time to get rid of poor habits, and many people backslide (or relapse) along the way. The help of a professional can be transformational for those who are ‘stuck’ in their attempt to change. In the absence of a professionally trained counselor, a 12-Step sponsor can provide support, and the program of Alcoholics Anonymous has had much success by encouraging ‘one alcoholic to help another.’
About the Author: Scott H. Silverman has been helping men and women recover from mental health disorders for almost 40 years. He is the CEO of Confidential Recovery, an outpatient treatment program in San Diego that specializes in sustainable recovery from addiction.
