How Addiction Can Impact On Relationships & Life Balance
Most of us spend our daily lives thinking of ourselves as some kind of a single unit. For example, we tend to think of our body as one thing which doesn’t seem to change much from day to day, and our body as being bound up with our thoughts and experiences; all together these leave us with some kind of a feeling about who and what we are.
But is this feeling that we are some kind of single thing actually true?
Let’s start by considering your body.
The various different organs in your body are made up of very large numbers of cells. For example, your liver is made up of approximately 200 billion cells. But these are not the same cells every day. Over a period of about 9 months they are completely replaced by new cells. If we consider the cells on the outside of your skin, these are replaced completely every 20 days or so. If we consider the lining of your gut, the cells that make up this lining are completely replaced every 2 to 4 days. And talking about your gut, there are about 100 trillion bacteria in there which your body needs to function healthily. These bacteria are also dying and being replaced by new bacteria all the time.
Although it may seem from the outside that your body is changing very little from day to day, this is just not the case. But there is something about your body that changes very little: the relationships between the different parts. While the cells that make up these parts (organs and systems) are changing the whole time, the relationship between those parts – how they work together to maintain life – changes very little. The cells that make up your organs and systems are dying and being replaced by new cells the whole time, but the relationships between them remain quite stable. If those relationships break down, you become ill, and if they break down severely, you die.
What about your brain?
We tend to think of the brain as a single organ. However, in reality it is made up of many different ‘sub-organs’, which, just like the different organs which make up the body, need to work well together for us to remain well. There are many examples of people who have suffered an injury to a specific part of the brain or to the nerves connecting the different parts, which can result in very unusual behaviour. For example,
- If the nerves (wires) connecting the right and left sides of the brain are cut, this can result in one side of the body being unaware of the other side – for example, if you try to do the buttons up on your shirt, you might find that your right hand fights your left hand in the process.
- The famous case of the man with damage to part of his brain which resulted in him seeing his wife and believing she was a hat.
- Brain damage resulting in a complete lack of awareness that part of your body belongs to you – for example the man in hospital who believed a joke had been played him by a nurse leaving a severed leg in his bed – he tried to throw the leg out of the bed, but it was his leg and he ended up on the floor.
My point is that, as for the body, if the different parts of your brain are not working in harmony with each other, you become ‘ill’ (at least as far as the rest of us are concerned).
The examples of poor relationships between different brain areas given above are obviously very extreme. However, there are more subtle examples which may be much more relevant to many of us in our everyday lives.
Unlike most of the cells in your body, those which make up your brain (called neurons or nerves) do not tend to die and be replaced. However, the connections between them are continuously changing, and changing depending on your experiences. For example, the part of the brain which coordinates fine finger movements becomes visibly larger (from many more connections being built) if you practice the piano every day for a year or so. The same thing in different brain areas occurs when you learn to ride a bike.
One part of our brain (the amygdala) is concerned with the processing of fear and anger. In children who have experienced severely unpleasant situations, especially if those have been ongoing for long periods of time, the amygdala becomes overactive and actually increases in size due to formation of many more connections between the neurons it consists of. The overactive amygdala is wired up to parts of your brain and body which release speeding-up hormones into your blood, leaving you in a state of constant alertness (and then stress).
Just as the increase in size of the part of the brain responsible for fine finger movements may be helpful for the piano player, the increase in size of the amygdala may be helpful for the child living in an abusive household by leaving the child more alert to danger, and thus more able to protect itself from harm. But whereas there is no downside for the piano player if they cease to practice piano, there is most definitely a downside for the traumatised child when they are no longer in the abusive household.
Just as the piano player has ‘programmed’ themself to play piano, and this ability remains many years after they last practiced (think of riding a bike if you don’t play piano), the traumatised child will have a lifelong tendency to anxiety, stress, and difficulty in forming stable and loving relationships with people later on in life who are no threat to them whatsoever. Quite apart from these unpleasant effects, the high levels of ‘speeding-up’ hormones circulating through the body throughout life cause (by dysregulating the immune system) damage to body organs and lead directly to reductions in lifespan.
In short, the ‘relationship’ between the traumatised child’s brain structure and the inner (body function) and outside world (interactions with people) was a helpful one in the short term but has become unhelpful now the situation has changed.
The more we think of ourselves as the sum of our inner (body) and outer (other people) relationships (as opposed to thinking our ourselves as some kind of unchanging unit), the greater insight we can develop into who we are, and into our health.
Those relationships are changing in small ways every second of every day, and sometimes there are dramatic and sudden changes to them.
Why should relationships need to remain in balance? What has this got to do with our health and survival?
A small earthquake occurs in a mountainous region of the world. Hundreds of large boulders roll down a hill. Most smash into the ground at the bottom of the hill and split into tiny fragments – they cease to exist (as large boulders). By a quirk of fate, one boulder hits the hill at just the right angle, its course is diverted, and it comes to a gentle halt just on the edge of a rocky outcrop. It remains there, an unusual sight for people passing, for thousands of years, before the wind and rain slowly weather it, reduce it in size, and it too finally ceases to exist.
It was very unlikely to occur, but because unlikely events do sometimes occur, one boulder survived for much longer than the others because it came to rest, literally in balance with its immediate environment.
This is an example of what physicists call the second law of thermodynamics. Let’s forget the fancy title. What it says is that, overall, things get more disordered with the passing of time, and that’s just the way of the world. Overall, and by a long way, there were less intact boulders, but by a quirk of fate one survived by finding itself in perfect balance with its immediate surroundings. But then look at a longer time span, and the surviving bolder also ‘died’ in the end. You can only temporarily beat the second law of thermodynamics!
This applies to life just as much as boulders. As I write this, we are in the middle of a coronavirus pandemic. By a completely random process, millions of variants of the virus are emerging which may help a new version of the virus to continue to infect us even if we have had a vaccine. Nearly all the mutations arising will not help it survive, or quite likely will make it impossible for it to survive. But it takes just one mutation out of millions to work well for that virus to start infecting more and more people, and for its population to grow. New strains of the virus replace old strains, and the ones predominating at a particular point in time are those most in balance with their surroundings at that point in time.
Actually, no one can quite work out whether viruses are living things or not. But when it comes to humans, we seem pretty certain we are alive. Just like the surviving boulder, and just like a virus bypassing a vaccine, human beings have emerged from other animals by i) a quirk of fate and ii) because they just happened to be in balance with their environment at the point in time the quirk of fate occurred. This was first explained by Darwin in his theory of evolution, and later by our understanding at the level of genes (random mutations just like the virus) as to how this occurs.
We are here in the first place because we happened to be in balance with the environment when we emerged, and to continue to survive we need to remain in balance with our environment – both internally (body) and externally (the outside world) – as that environment changes around us. If we fall out of balance we will perceive that as feeling unwell or unhappy, and in the worst case (but eventually inevitable) scenario, we will die.
What has this got to do with addiction?
Different addictive drugs have different effects in the body and in different brain regions and pathways. However, they have one thing in common – they all cause the release of a naturally occurring chemical called dopamine in the Nucleus Accumbens. Whether you are energetic (cocaine; amphetamine; ecstasy), or relatively sedated (alcohol, heroin), the underlying positive nature of the experience is associated with dopamine release in this area of the brain – a feeling of satisfaction or pleasure. It is the combination of these sensations that leads to the overall experience (e.g. feeling ‘all powerful’ after taking crack cocaine; feeling ‘wrapped in cotton wool’ after taking heroin). From a ‘brain science’ perspective, this is ‘why’ people take drugs. It’s pretty obvious really – after all, I’ve never heard of anyone who actually took a drug to feel bad.
Earlier, I mentioned the fear and anger centre in the brain called the amygdala, and that this centre can become overactivated for life and actually grow physically larger in people who have experienced severe psychological trauma in childhood. As it happens, the amygdala is very closely wired to, and physically merges into the brain’s main reward centre – the nucleus accumbens.
People with an overactive amygdala are much more likely than others to have a tendency to counteract all the fear and anger by the use of addictive drugs, which can reset balance through release of dopamine in the nucleus accumbens. In this instance, the difference between people who choose to use drugs and use them occasionally, and those that are driven to use drugs and use them repeatedly is not that they are fundamentally different kinds of people; it is that the latter type of person needs to use drugs repeatedly, directed by their fundamental programming to achieve and maintain balance. In contrast, many people who are lucky enough never to have experienced difficult childhoods actively dislike the experience of taking addictive drugs – it takes them out of balance.
You may ask what the problem is with using drugs repeatedly if they help to reset balance in the user?
There are two main reasons, already discussed above: i) many parts and systems in the body and brain are individually programmed to achieve and maintain balance, and ii) we are made up of many different parts which need to maintain balance between themselves.
The first of these reasons is associated with the development of ‘tolerance’ to pleasurable effects of drugs. In its adaptive attempts to keep everything the same as before – to retain ‘balance’ or ‘stability’ or ‘normality’ – the brain’s reward centre (nucleus accumbens) becomes less and less responsive to the pleasurable effects of drugs the more you use them; the outcome of this process, is that if you use drugs repeatedly, you will need a larger and larger dose to achieve the same effect. In theory, this may have no downside, apart from the financial cost of the drugs. If by using more and more drugs you can still counteract the fear and anger, why should that be a problem?
The second reason provides the answer to that. The different parts of the brain and body have developed at different times through evolution, and in some cases have been more or less cobbled together. They happen to work well in their relationships with each other in ideal circumstances, but those relationships can be quite easily strained. In particular, different parts of the brain and body develop tolerance to the effects of drugs at different rates, if at all in some instances.
For example, the part of the brain which controls our breathing when we are asleep (you would stop breathing and die when asleep if it stopped functioning) is sedated and slowed down in its function by drugs which are sedative in action such as benzodiazepines, barbiturates, alcohol and heroin. The more barbiturate you take on a regular basis the more tolerant to this slowing of breathing effect you become. However, the tolerance in the breathing centre of the brain develops more slowly than that developed to the pleasurable effects of the drug in the nucleus accumbens. The outcome is that as you up your dose of barbiturate to achieve the same feeling of ‘cotton wool’, you place yourself at greater risk of accidentally going to sleep and stopping breathing. The same is probably the case for heroin and may be less so for alcohol.
If we take the example of alcohol, while you drink more and more to achieve the same level of pleasure as before, some body organs completely fail to develop tolerance to the increased levels of alcohol. Your pancreas and liver may start to fail, you are more likely to develop cancer of the gastrointestinal tract, your brain in general, and your memory in particular, may be damaged.