Rescuing the Addicted Brain

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The impact of addiction on the brain is both catastrophic and comprehensive. When the brain is damaged by an addicting chemical, its executive functions—including judgment, decision making, and impulse control—are hijacked to meet the demands of addiction. The addicted brain doesn’t try to save the addict. Instead, it kicks into high gear, employing its extraordinary powers to keep a steady supply of alcohol or other drugs flowing to the brain.

With the brain’s go-switch on full throttle and its braking mechanisms disabled, how is recovery from addiction even possible? How can the brain be rescued from itself?

The rewired, addicted brain needs time and experiences that will rewire it yet again, this time in service of a healthy, loving and productive life. This rewiring becomes possible when we combine the insights of medical science and spiritual practices, including 12 Step programs.

I have seen this partnership between science and spirituality work with people from every walk of life, even people whom society has written off as hopeless addicts. In my retirement, I work as a volunteer at a shelter for homeless addicted men. Many have lost everything that we think motivates people to recover— health, family, friends, and meaningful work. It is honestly a miracle that these men are even seeking a new life, and, of course, they are at extremely high risk for relapse. Yet, by combining medical and spiritual approaches, we find that a significant percentage are finding their way to recovery.

For example, medical science has confirmed the critical role that monitoring programs can play in recovery, with recovery rates for pilots and doctors going over ninety percent. These programs combine a carrot-and-stick approach. People who fail drug screens can lose their licenses or even go to prison; people who pass can keep their jobs. In our program with homeless men, those who pass their screening tests get to stay in the program and participate in the extensive “wrap around” services that help them have a full recovery.

At the same time, we know that recovery is significantly enhanced by the spiritual and psychological maturity that comes from working the 12 steps. For this reason, I have created a detailed questionnaire that helps homeless men work the 12 steps slowly and carefully.

It was James who taught me just how slow and careful 12 step work must be. When we started our Vanderbilt addiction treatment program, like most 30-day programs, we rushed people through the first three Steps. Then we left patients on their own to find an AA or NA group and work the rest of the Steps. Today, with our knowledge of how poorly the brain works during early recovery, we know that all this was too much, too soon.

In The Craving Brain: Science, Spirituality and Recovery, James describes in illuminating detail his long journey through the 12-steps. This slow, painstaking process bought him the time and experience he needed to rewire his brain—this time, not for addiction but for recovery. For James, as for some of our homeless men, the result was a spiritual awakening, a sense of surrender and letting go, that further empowers addicted individuals to stay on the long road to recovery