Addiction and Recovery: The Brain’s Limbic System and 12-Step Programs



Interruption of the death-spiral of addiction to alcohol or drugs requires complete abstinence and time to allow brain neurotransmitters and hormones to recover. Levels of neurotransmitters in the addicted brain have been altered, and restoring them to normal takes time — usually weeks or months. Although there are several medications that can facilitate early recovery by replacing neurotransmitters or blocking receptor sites, residential treatment programs and 12-Step programs remain the best-proven methods to achieve sustainable recovery. Residential treatment programs, usually 30 to 90 days, are optimal to begin the lifelong process of recovery. The alcoholic or addict brain needs time to heal. Initially, neurotransmitters need to be naturally re-established. Once the brain begins to heal, hormone levels will begin to normalize.

Twelve-Step programs state that by working the 12 Steps, engaging in meetings and being of service to others, the obsession to drink or drug is “removed,” and is the “miracle” of a “mysterious” process. Working the 12 Steps of all 12-Step programs involves surrendering to a higher power and “letting go” of fear, resentment, guilt, self-pity, and self-loathing. These emotions are known to be associated with stress physiological states, as exemplified in high autonomic nervous system tone: high blood pressure, elevated respiratory rates and elevation of cortisol levels.

Twelve-Step programs advocate engaging in a relationship with others in fellowship of the specific program. They rely on the “power of the group” and relationship with a sponsor for success. Recovering individuals usually attend several 12-Step groups per week as an integral component of their recovery program. It is said within circles of recovering addicts and alcoholics that “meeting makers make it,” and those who stop attending meetings are substantially more susceptible to relapse into compulsive drug use. This begs the question: Why is the social experience of the recovery group so integral to recovery?

Prominent sociobiologists such as Nobel laureate E.O. Wilson have long accepted the axiom that socialization behaviors are hardwired into the brains of many mammalian species, from rodents to canines, primates, and humans, and are absolutely necessary for survival of their species. These species nurse and care for their young and engage in other socialization behaviors promoting survival. What is the neuroscience and physiology behind our instinctive social nature?

Functional magnetic resonance imaging (fMRI) studies of humans and primates in socializing paradigms show activation of the limbic reward centers of the brain, the same centers activated by the drug of choice, during positive, empathetic socialization tasks. Thus, it is can be hypothesized that the positive, empathetic socializing experience of the 12-Step group makes the addict feel good, and why it is the foundation for recovery for the addict or alcoholic. Several empirical studies support this hypothesis and indicate that social reward is processed in the same brain reward centers in the limbic system as non-social reward and drug addiction. Studies in rodents highlight the importance of ventral striatal (reward center) dopamine for highly socially motivated behavior such as maternal care, mating behavior, and social attachment.

Data from functional MRI studies in humans exhibit ventral striatal activations for a variety of rewarding social stimuli such as beautiful faces, positive emotional expressions, own positive social reputation and maternal and romantic love. Additionally, a recent study has shown activation of the limbic reward centers in anticipation of positive social feedback. These findings are in line with studies showing neural pathway activations in anticipation of rewarding nonsocial outcomes such as money, food, or mood-altering drugs. These observations highlight the importance and motivational potential of social stimuli. They also form the basis of our understanding that the “power of the group” may be as strong as the power of the addiction.

Hormonal changes in the recovering addict and alcoholic likely contribute to the healing power of the group. Oxytocin, the small peptide hormone known to be secreted in lactating mammals and to cause uterine contractions in childbirth, has been implicated in maternal-infant bonding. Several lines of study implicate oxytocin in promoting socialization outside of the mother-infant relationship. Oxytocin has been nicknamed the “comfort hormone” or the “tend and befriend hormone.” Oxytocin has relaxing and calming properties in animals and humans and acts to counter the stress hormone cortisol.

Numerous lines of research have shown that the processes of empathetic social interactions and spiritual practices stimulate the brain’s limbic reward centers and normalize hormonal imbalances, and can hypothesize that these “natural” rewards replace those of the addictive substance. With empathetic socialization and spiritual practices, stress is reduced, lowering the blood cortisol level, and increasing parasympathetic tone and stimulating oxytocin release.

Recovery from addiction requires hard work. It takes time and effort to recapture the reward centers of our brain, as well as their closely associated higher cognitive centers. It takes time for the brain to rewire and hormonal imbalances associated with addiction to normalize. Since 1935, the year Alcoholics Anonymous was formed, millions of seemingly hopeless alcoholics and addicts have recovered through their efforts in 12-Step recovery programs.

Louis Teresi, M.D. was a grateful recovering alcoholic and author of the book, “Hijacking the Brain: How Drug and Alcohol Addiction Hijacks Our Brains the Science Behind Twelve-Step Recovery.” Dr. Teresi died unexpectedly on April 26, 2017 at the age of 59.

This article is updated from its initial publication in Brain World Magazine’s print edition.

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