Why do I keep choosing this drug over my kids? Why do I keep relapsing even though I went to rehab and I go to meetings? Why does my addicted loved one say one thing and do another? How can they be so cold and insensitive to the pain they are causing our family? The answer to these questions lies in understanding addiction neuropathways.
As an addiction specialist, I am frequently presented with these types of questions. At the core of these questions is profound confusion about the behaviors associated with addiction. Also, inherent in these questions is a sincere desire to understand, help, and change. My aim in this article is to offer useful and practical information in understanding this disease.
There is a ton of information out there about substance use and addiction that can be overwhelming. The ASAM (American Society of Addiction Medicine) defines addiction as “a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestation. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.” There is a lot more to this definition and you can find more information at www.asam.org. The biggest takeaway from this definition is that addiction is a complex disease of the brain AND body, with many contributing factors, that results in a loss of control, causing significant harm over time.
Different substances act differently in the brain to create addiction. In some way, most of them involve dopamine. There are experts in this field who have devoted their entire careers to understanding the neuroscience behind addiction. It is a rapidly growing field and it is exciting to see what we are learning. From the standpoint of loving or helping someone struggling with addiction, we desperately seek to understand them. The complex neuroscience of addiction offers that understanding, but isn’t exactly digestible, or necessarily helpful, to ordinary people trying to help their loved one. A book I highly recommend for anyone wanting to better understand the neuroscience of addiction is Never Enough by Judith Grisel.
Let's Talk About Addiction Neuropathways
First of all, what is a neuropathway? In simple terms, a neuropathway is the route a neurochemical takes to activate the brain. In the picture above is the trail that cuts through a pasture and connects my house to my barn. This trail was not there when we bought our property. Eight years later and many feet traveling to and from on this trail, it can now be seen from space using Google Earth. Even covered in snow, the indentation of the trail is visible. I’d imagine that after several years of being left alone the trail would eventually be reclaimed by grass and alfalfa. But, the worn rut would remain. In just a short time, a few trips across the overgrown trail, and the path would emerge again. This trail is like an addiction neuropathway, the more it gets used the deeper and stronger the pathway becomes. In recovery, the goal is to stop using the pathway. We need to find a healthier way to get to the barn. This trail, quite literally for me, is the easy way to the barn. In the last few years, I’ve started taking the “long way” around because I am trying to get my steps in. But boy that shortcut trail across the field is tempting, especially when it’s snowing, or I’m tired, or I’m rushed. Think of recovery in the same way. We abstain, find sobriety, engage in healthy behaviors and the addictive pathway goes quiet. Meanwhile, we create other healthier pathways. BUT, the old addictive pathway never fully disappears. Much like a few trips down the trail, a few drinks with friends and the pathway quickly reappears, because it was there all along.
One of the simplest ways to understand addiction is through addiction neuropathways. Much of what follows is based on the work of Dr. Patrick Carnes and can be found in his book, Facing the Shadow. There are three primary neuropathways: arousal, numbing, and fantasy. There is a fourth neuropathway that is intertwined with the others and seems to act as an inverse control mechanism: deprivation.
Arousal Neuropathway
The arousal neuropathway is about achieving pleasure and intensity. Examples of this are stimulants like cocaine and methamphetamine. Behaviors like high risk sex and shoplifting can also activate this neuropathway. This pathway offers a “solution” to deep emotional pain and suffering. It is not uncommon for people who utilize this pathway to be in a chronic state of dorsal vagal shutdown. Meaning, their nervous system is so overwhelmed that it has now gone into a state of collapse. Folks in this state will tend to isolate themselves from others and describe symptoms of severe depression. It makes sense that relief from this deep place of despair and isolation are substances and behaviors that produce arousal. And that is exactly what stimulants do, they activate the sympathetic nervous system, which produces immediate relief from the dysphoria of nervous system shutdown.
Numbing Neuropathway
The numbing neuropathway works in the opposite way of the arousal pathway. It produces a calming, sedating, and analgesic effect in the brain. Alcohol, xanax, and heroin are substances commonly associated with this neuropathway. Behaviors like compulsive masturbation and over-eating can also activate this neuropathway, producing a calming and numbing experience. Again, the goal can be traced back to nervous system dysregulation. This neuropathway is used to manage chronic anxiety or sympathetic activation. If you have ever dealt with extreme anxiety you know how distressing it is. Anxiety is your nervous system in fight or flight. It can feel like a whole mind and body experience of nervousness, restlessness, fear, and overwhelm. Without enough internal and external resources to cope, the obvious solution is substances or behaviors that can induce calm. In the short-term, substances and behaviors can be very effective at regulating a hyperaroused nervous system. In the long-term, the brain adapts to these coping strategies requiring more and more of the substance or behavior to achieve the same numbing effect, resulting in addiction.
Fantasy Neuropathway
The fantasy neuropathway is all about escaping. Reality is commonly altered through drugs like LSD (or other hallucinogens) and marijuana. Behaviors can also activate this pathway. According to Dr. Patrick Carnes, “behaviors like obsession and preoccupation, when combined with the right rituals, can actually create a trance state. The addict literally enters an altered reality (Carnes, 2010, p.311).” Love addicts are all too familiar with this neuropathway. They often find themselves pathologically obsessed with a romantic attachment. They can get lost fantasizing about their future together, what their children will look like, even planning their dream wedding, even after just a few dates. At the core of this neuropathway, the client finds their real life, their real identity, their reality too much to bear. They are filled with intense shame and will go to great lengths to escape their body. Many addicts that utilize this pathway describe learning how to escape reality at a very young age. They were usually exposed to childhood experiences that they were unable to cope with. Children are easily able to dissociate from reality through imagination, fantasy, and make-believe. Without adequate support, guidance, nurturance, the need to dissociate or escape can become so necessary for survival, that children will carry it into adulthood.
Deprivation Neuropathway
The final neuropathway we will discuss is deprivation. This neuropathway is all about control. Examples of this include anorexic spending, compulsive under-earning, sexual anorexia, and food anorexia. Clients that endorse extreme forms of deprivation also endorse deep rooted fears of scarcity or insufficiency. They believe they are lacking in some way that is intolerable to the psyche, i.e. too fat, too unattractive, etc. To counteract the terror of “not enough” they will engage in rigid or controlling behavior. This extreme level of control can actually produce states of euphoria and superiority. We also find this neuropathway activated in response to out of control behavior in other aspects of their lives. This is most obviously seen in the binge-purge cycle of disordered eating. A period of out of control binging is followed by a period of restrictive eating or extreme exercise. But it can manifest simultaneously with other behaviors and substances as well. For example, a client who feels sexually out of control may engage in anorexic spending. Or, after a client achieves control over their substance use, they may act out compulsively with food or sex. As mentioned earlier, this pathway is often paired with the other addiction neuropathways.
Combination of Neuropathways
It is important to understand that one or all of these addiction neuropathways may be active in someone struggling with addiction. Additionally, the same drugs or behaviors can activate different neuropathways in different people. Opiates for example may activate the numbing pathway for a lot of people, but in some people it can activate the arousal pathway. The same is true for behaviors. Compulsive masturbation paired with pornography can activate the arousal pathway. While in others it can be used for numbing, and still for others it can be used to escape. This is deeply unique to the individual. Judith Grisel writes, “while in the end there might be as many different paths to addiction as there are addicts, there are general principles of brain function that underlie all compulsive use” (Grisel, 2019, p.4). Working with a skilled mental health clinician can help uncover what neuropathways are being activated by what substances and/or behaviors. Dr. Carnes supports this approach, “in terms of recovery, it may be more important to know which neuropathways are involved than which addiction is being used to access it” (Carnes, 2010, p.310). As we begin to uncover what neuropathway(s) are being used, we can understand the deeper core issues being soothed by the addiction. Only then, can the transformative healing work begin.
Neuropathways and Relapse
If you’ve struggled with addiction yourself, or you have supported a loved one through their addiction you are all too familiar with the devastating experience(s) of relapse. Understanding the different addiction neuropathways helps us understand more about relapse and relapse prevention. Let’s go back to the earlier analogy about the trail to my barn. You went to rehab and have finally kicked heroin. You learned that you used it primarily to numb out the relentless anxiety that you’ve had since as long as you can remember. Things seem to be going well, the trail has started to grow over. Except now without the heroin, the anxiety is really loud, despite your best efforts to cope. Before you really even notice it, you find yourself binge eating, doomscrooling on social media, and again you’re caught in this trap of trying to soothe yourself with anything available. You may convince yourself that a few drinks at the bar with friends is okay. Though you are not using heroin, you are still walking the trail to the barn, and you have been all along. It is just a matter of time before heroin is again the only effective means to get to the barn. Relapse is VERY difficult to avoid, if the addictive neuropathway is still active in some way. Sustainable, long-term, recovery requires the old trail to grow over and new trails to form. We can’t do that if we don’t address why we were traveling that trail in the first place. In this example, it is anxiety and nervous system dysregulation that lead to using. So, you go back to therapy and begin to address the anxiety. You learn that your anxiety is associated with a history of being unsafe as a child. That lack of safety followed you into adulthood and you found yourself repeating similar childhood traumas, because that is what was familiar. The chaos was the norm. But also, the chaos was too much. Once you address that need for safety, do the deep trauma work, you can begin to heal.
Individual Therapy For Lasting Recovery
As a trauma and addiction specialist, this is what I am passionate about! I can help you find sustainable, long-term recovery. Together we will identify the neuropathways at work. I will compassionately help you talk about your past and the traumas you’ve experienced. I will be a witness to your pain. We will uncover deeper patterns of coping and unmet needs. We will create new neuropathways that support your long-term healing and recovery. I will hold you accountable AND be your biggest cheerleader. You will find freedom from your addiction and finally live a life filled with joy and connection. You can click the link below to begin the confidential intake process and I will reach out to you ASAP!
About the author: Hayley Leishman, LCSW, TRS, CSAT, CMAT is a trauma and addiction specialist based in Holladay, Utah. She has the specialized training and experience to help you or your loved one find lasting recovery from addiction.
References:
American Society of Addiction Medicine. (n.d.). American Society of Addiction Medicine. https://www.asam.org
Carnes, P. (2010). Facing the shadow: Starting sexual and relationship recovery (2nd ed.). Gentle Path Press
Grisel, J. (2019). Never enough: The neuroscience and experience of addiction. Doubleday.
