Brain Changes That Can Lead to Drug or Alcohol Relapse
Relapse is the general term used to describe a return to drug or alcohol use by people recovering from addictions to those substances. Experience of a relapse is a common event in the recovery process, and mainstream sources estimate that as many as 90 percent of all recovering addicts relapse at least once before attaining long-term or permanent periods of abstinence. Some people think of relapse as an indication of weak character or as some sort of failure of willpower. However, in reality, it has a strong physical basis in the long-term brain changes associated with addiction.
Alcohol and addictive drugs gain a foothold in the lives of drinkers and drug users because they produce specific changes in the balance of chemicals that keeps the brain functioning properly. Critical to this chemical balance are a group of substances called neurotransmitters, which are created inside the brain’s individual cells, known as neurons. When neurons release neurotransmitters, these chemicals travel to other local neurons, attach to their surfaces, and trigger changes in their activity levels. All of the brain’s basic processes result from the coordinated transmission and reception of various neurotransmitting chemicals.
While drugs and alcohol alter levels of a number of different neurotransmitters, the onset of substance abuse and addiction stems largely from alteration of three key neurotransmitters, called dopamine, serotonin and glutamate. Under normal circumstances, dopamine activates pathways in the brain called reward or pleasure pathways, which produce pleasurable sensations in response to life-sustaining activities such as eating and procreation. Serotonin helps balance the brain and regulates things such as mood, pain perception, the urge to have sex, and the natural day/night sleep cycle. Glutamate excites neurons throughout the brain and keeps them in a receptive state that’s critical for learning new information, forming and keeping memories, and thinking logically; this neurotransmitter also helps activate the brain’s pleasure pathways.
Addiction-Related Brain Changes
Essentially all addictive substances create increases in the brain’s pleasure-producing dopamine levels; some produce relatively moderate increases, while others produce drastic increases that far outweigh anything available through any other means. However, if you take a dopamine-increasing drug often enough, your brain will adjust and reduce its dopamine production. In practical terms, this means that the “high” associated with any given level of substance use fades over time. The road to addiction typically begins when substance users increase their intake in an attempt to recreate the pleasure levels they felt when they first started drinking or taking drugs.
Many commonly abused drugs also increase serotonin levels in the brain; among other things, this elevation tends to create an uplift in mood and a sense of well-being. However, as with dopamine, the brain eventually adjusts to higher serotonin levels. When this adjustment occurs, the mood-lifting effects of the substance in question fade away. Some substances of abuse increase glutamate levels, while others decrease them. In either case, long-term alteration of the brain’s glutamate supply will trigger unhealthy changes in the substance user’s normal thought processes. One critical change is the tendency to reorient learning and memory so that they center on drinking and/or drug taking, as well as on the social rituals that commonly go along with these activities.
Because of the brain changes that foster addiction, the National Institute on Drug Abuse and other authorities in the field now view the condition as a chronic disease. This means that, even during recovery, an addict is dealing with the long-term repercussions of a physical disorder, not short-term character failings or deficiencies of will. On this physical level, the path toward relapse begins when neurotransmitter-related alterations in pleasure-sensing, mood stability, and thinking return an addict to appealing aspects of previous drug or alcohol use, while simultaneously discarding or discounting thoughts or memories of the damaging real-world consequences that come with that use.
In some cases, these dangerous mental processes are conscious; however, in many other cases, they manifest unconsciously. In either situation, they can produce effects that include such things as a sudden, unexplained lack of interest in maintaining sobriety; a return of the urge to deny the problems that come with addiction; a return of the symptoms normally associated with drug or alcohol withdrawal; and a return of the poor judgment and evasive behaviors typically present during active addiction. If these attitudes and behaviors go unaddressed, relapse is a common end result.
Putting Drug and Alcohol Relapse in Context
Just like addicts, people with chronic illnesses such as high blood pressure, diabetes and asthma experience relapses in which they stop following their treatment routines for at least a short while. In fact, the National Institute on Drug Abuse explains, people with asthma and high blood pressure relapse from treatment at slightly higher rates than drug addicts. When viewed from a physical perspective, this comparable rate of relapse makes sense, since addiction is also a chronic illness. It also means that, just like people with other chronic illnesses, addicts can view a relapse as nothing more than a temporary setback in a lifetime’s course of effective disease management.