To keep resolutions, learn from a drug addict


Posted: Wednesday, January 03, 2001

The scene is ominous: Sugar cookies crumbling on the sofa cushion. Pine needles crunching into the floor. After a week of manic fa-la-la, not a creature is stirring who doesn't say: "It's time to figure out how to make positive changes in my life." Well, let me offer a post-eggnog message of tough love: You can learn a lot about making New Year's resolutions from the heroin addict.

In many ways the typical resolution maker -- and breaker -- is like the addict who can't quit. You have the will but not the way. Addicts show you how tough it can be. They are trapped. Unless they change their ways, they will destroy themselves and those around them. On one level of their brain, the rational part, they know this. But that's not enough. On another level, in the motivational circuits of the brain, the addict is controlled by an urge so overpowering that the death sentence is no deterrent to drinking too much or doing drugs.

And all you want to do is lose 30 pounds! Make more time for your family! Drink less. Quit smoking. Go to chamber music concerts, clean out the attic, learn a new language.

Take heart. The good news is that some addicts can overcome their abusive behavior and build new lives.

The effectiveness of addiction treatment is comparable to success rates for other chronic conditions, such as certain forms of heart disease and diabetes, points out Alan I. Leshner, director of the National Institute on Drug Abuse. Researchers now have a better understanding of the changes in the brain that occur with addictions. Out of this research are some lessons for you.

The first is to understand the magnitude of what you're resolving. As Leshner puts it: "If it's a core change, then it may be as fundamental as what the addict goes through. . . . Serious resolutions demand character change, personality change. That's a big deal. It's how I act, how I see myself, how I see others."

You doth protest! Of course there are differences between you and an addict. Addicts are sick. You think you're in pretty good health. For the addict, making a "new life resolution" to quit drugs and alcohol is a daily battle against a potentially lethal affliction. For you, making a New Year's resolution to swear off Godiva chocolate or start reading Proust (to get more balance in your life) can be frivolous cocktail-party chatter.

What's more, apart from the vow to give up smoking, most New Year's resolutions are not about quitting lethal substances but moderating biological necessities of food, love-and-sex, work.

Still, sometimes a seemingly tossed-off resolution reflects a serious underlying health issue. Want to shed pounds? Maybe you are slouching toward obesity, a major medical risk for heart disease and diabetes. Like the addict, you may be hostage to the part of your brain that drives you to eat when you're not necessarily hungry.

Spend more time with the family? Maybe you're one of the legion of workaholics whose identity is so tied to the job, so wrapped up in the public buzz, that you have no room for children or chamber music, no time for love or play. Unchecked, that kind of single focus is likely to lead to the doctor's office for stress-related complaints. Or to a family counseling center to deal with wounded relationships.

The study of addictions is a marriage of brain and behavior. On the street, therapists put together treatment plans including medicine and social supports to help addicts overcome their self-abusing behavior. In the lab, neurologists use imaging scans to identify the circuitry in the brain that is responsible for the abusive behavior. This research, in turn, leads to more effective treatment. Change in the addict has to occur internally in the brain as well as externally in daily behavior. The same is true of you.

This broader view of making change is based on new brain research, which has identified motivational circuits that underlie a person's basic desires for food and sex as well as cravings for drugs and alcohol. All these urges -- healthy and unhealthy -- appear to have common roots. At the Medical College of Wisconsin, for example, researchers found that the same brain pathways were activated by cocaine and sexual activity, according to a recent report in the American Journal of Psychiatry.

In an addict, Leshner explains, this circuitry has been hijacked by the unhealthy behavior at the expense of more usual sources of rewards.

Recovery from an addiction, whether it's alcoholism or gambling, involves reprogramming this circuitry and changing your reward system so that you get your kick from other sources.

"You have to retrain your brain," says Leshner. "You have to reprogram the motivational circuits and retake control of them. That's what treatment is about. You can't focus only on the behavior itself. You have to look at the whole individual -- how you function in your family, in your community, at work. You have to retrain your motivational system and get (rewards) from other sources."

The second lesson from the addict is that relapses are normal. Don't panic. "Relapse is not a failure," says Leshner. "Relapse is a trigger that you need to pay more attention." You have to have a strategy in place. "A lot of this is being systematic," says Leshner. You can't just say, I won't eat chocolate. I won't work late.

You have to have a treatment plan. A regular schedule of events with the children to get re-engaged with the family, for example. Or a comprehensive exercise-and-diet program to help you gain control of your weight.

When do you know you've made a successful New Year's resolution? When "the intervals between relapses get longer and longer until people recover," says Leshner.

Maybe this is not the moment for the Big New Year's Resolution. Maybe you don't need a personality change. But don't kid yourself. 'Tis the season to take stock. And if you decide to make a core change in your life, the drug addict is a good role model. Treatment works. You can change.

Abigail Trafford is a columnist and writer for The Washington Post.

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