Innovative Treatment Addresses Neurobiological Basis of Addiction, Recovery

By Staff Writer

For a long time in our nation's past, drug addiction was viewed as little more than a failure of will power or lack of character. Thankfully, recent decades have seen significant advances in our understanding of the neurobiological nature of addiction, which has been accompanied by an increasingly widespread acceptance of the fact that addicted individuals aren't "failures," but are instead suffering from a disease that requires effective medical intervention.

The effort to increase public awareness of the true nature of addiction got a boost on Oct. 3, 1997, when an article titled "Addiction is a Brain Disease, and It Matters," appeared in the journal Science.

Authored by Alan I. Leshner (who was then the director of the National Institute on Drug Abuse), this article has been hailed by many drug rehab and addiction recovery experts as a milestone in the effort to understand addiction. For example, 10 years after Leshner's article appeared, addiction expert William L. White described the essay as "a seminal article ... [that] was the opening salvo in a decade-long research and public education campaign to re-educate the public about the nature of addiction."

Though Leshner no longer serves as the NIDA director, the agency continues to advocate on behalf of the neurobiological nature and effects of addiction, as is evidenced by the following passage from the NIDA website:

The initial decision to take drugs is mostly voluntary. However, when drug abuse takes over, a person’s ability to exert self control can become seriously impaired. Brain imaging studies from drug-addicted individuals show physical changes in areas of the brain that are critical to judgment, decision-making, learning and memory, and behavior control.

Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviors of addiction.

Addiction Is a Disease, Not a Weakness

If you or someone you love is suffering from a drug addiction, it is important for you to understand that the need for addiction treatment is not a moral failure, nor is it evidence of personal weakness. Drug addiction is a disease that affects both the brain and body.

But there is good news. As experts have gained greater insights into the bio-psycho-social nature of addiction, they have been able to develop targeted treatment techniques that have resulted in more effective drug addiction recovery programs.

One residential addiction recovery program that has done a particularly effective job of translating science-based insights into results-oriented treatment techniques that address the neurobiological impact of addiction is Passages to Recovery, a wilderness rehab program for young men in Utah.

Three Components of Effective Recovery

According to Lucy Taylor, who serves as the clinical director of Passages to Recovery, research has established that to significantly reduce the relapse cycle, an effective drug addiction treatment program should provide clients with the following three components:

1. Novel experiences
2. 90 days of primary care
3. Supportive relationships

"The longer someone can be in a sober living environment where drugs and alcohol are not available and they are compelled to remain sober and work the program, the better chance they have of staying clean," Taylor said. "Once they get past a year of sobriety, the chance of them staying sober is incredibly high. At Passages to Recovery, we help with the first 90 days, and get them to a place where they can practice recovery."

At Passages to Recovery, the 90-day experience is divided into two segments:

• Passages I consists of an extensive (and novel) wilderness experience that provides clients with the opportunity to begin their recovery in a supportive and challenging environment that is free of the chaos and stresses of everyday life. "The wilderness is a great place to get sober," Taylor said. "It's a wonderful place to get rid of the negativity around you, and start making positive decisions about your life."

• Passages II, which is conducted at the program's Valley Site and within the community, extends the basic lessons that were taught in the wilderness and teaches clients how best to apply their newly acquired skills to the world they will encounter when they leave treatment. Passages II also focuses on the neurobiology of addiction, teaching clients about the nature of their disease and engaging them in therapeutic interventions that are designed to heal the damage that their substance abuse had inflicted upon their brains.

"We used to think that the brain didn't heal from the damage of substance abuse, but now we know differently – it can heal and re-establish healthy neuro-patterns," Ms. Taylor said. "We start to see some tremendous shifts happen during Passages II. It's an incredible process."

More than Mere Survival

When young men arrive at Passages to Recovery, they undergo an assessment process that takes about a week. Then they complete the Passages I wilderness experience, which is followed by a family workshop. Thus, by the time they enter Passages II, they are already more than halfway to their initial goal of 90 days of sobriety.

Having been drug-free for nearly two months, clients are already beginning to experience improved brain functioning – a healing response that is further developed by a series of therapeutic activities that form the core of the Passages II program.

"We work a lot on internal conflict resolution with psychodramas, or role-playing situations," Ms. Taylor said. "We'll set up situations where our students have to confront challenges that are similar to ones they may face in the future. What we're looking for are the auto-responses – are they being triggered by the events that they're experiencing, and will they end up using again, or despite being triggered, are they able to say no? Are they able to respectfully extricate themselves from the dangerous situation?"

Over time, the young men who are completing the second phase Passages to Recovery's residential addiction recovery program begin to experience the neurobiological improvements that are essential to long-term recovery.

"As we start to see those auto-responses occur, we also begin to see more of the frontal lobe kick in," Ms. Taylor said. "We can see that they're reacting and then making different decisions, and it's obvious that with changes in the neuropathways, using is no longer automatic. Their responses aren't just about survival – they're now able to make decisions."

In addition to marking an important biological improvement, these results also signal a significant cognitive enhancement – one that heralds an increased likelihood of achieving lifelong sobriety.

"When somebody's an addict, their drug of choice is all about survival," Ms. Taylor said. "But in Passages II we get them to the point where the healthy decision maker, the frontal cortex, is back in the loop. They're making choices again."

Comprehensive Improvements

As impressive as these neurobiological improvements are, as the clients progress through Passages II, they are doing much more than developing their cognitive abilities.

"Passages II is about taking responsibility and developing the skills that will help them lead a sober life," Ms Taylor said. "The days are busy, as we work on five general areas: physical, social, emotional, cognitive, and spiritual."

During Passages II, clients complete a variety of activities to address all of these areas. In addition to psychodrama work and conflict-resolution instruction, highlights of the second half of Passages to Recovery's 90-day residential addiction treatment program include the following:

• Guided imagery, yoga, and meditation classes
• Team sports and regular visits to a local gym
• Daily 12-Step meetings
• Community service projects
• Educational seminars
• Written assignments
• Art, music, and other creative outlets
• Opportunities to pursue other areas of interest
• Daily self-evaluation sessions
• Research into aftercare options
• Meetings with therapists
• Phone updates with family members

"Passages II is a highly structured program, and their days are pretty packed." Ms. Taylor said. "We want our clients to understand that when you're in recovery, your day needs to be well scheduled, and you need to be able to find balance between maintaining your recovery and taking care of your other responsibilities."

It is this ability to take responsibility while also finding balance and serenity in an often chaotic world that Ms. Taylor said is the ultimate goals of the Passages II experience.

"Passages II is the key to taking things a step further. This is where they learn to transfer what they've learned in the wilderness to the rest of their lives," she said. "Learning how to manage and find the balance in every area of life is the gift of sobriety."