“People don’t come preassembled, but are glued together by life” (LeDoux, 2002).

In the first part of this two part series on neuroscience and recovery, readers were introduced to Marcus. Marcus was physically abused by his alcoholic father until the age of 12 when he made a decision to never let anyone hurt him again. This lead to a life of difficulties with male authority figures such as policeman, supervisors, teachers and male therapists. Adding to his story, Marcus married at age 22. In the marriage, Marcus and his wife had a beautiful son named James who is currently 11 years old. His marriage ended in divorce when James was seven years old. Marcus desperately wants to make amends to his son and become a positive part of his life.

In the first article, three areas of connection or integration were introduced: integration of self; connection with others; and connection to a Higher Power of one’s choice. Clinical technique born out of research from multiple fields was utilized to assist Marcus achieve vertical and horizontal integration of self. This article discusses two other developmental considerations that must be achieved in order to help him achieve contentment in recovery — connection to others; and connection to a Higher Power of one’s choosing. These are two areas critical to recovery.

Connection to others
“Another difficulty that trauma patients have is trouble relating to others and fitting into society, which I believe is related at least in part to problems with the frontal cortex” (Bremner, 2002).
Marcus always had difficulty in establishing positive relationships. Alcohol allowed him to feel more comfortable in a crowd. In recovery, he will have to connect with others to enhance his chances of contentment. According to John Ratey, “In effect, the brain’s structure becomes the information that it receives, and so how it perceives that information determines its future state” (Ratey, 2001). Basically, by changing the people that he spends his time with, Marcus’ brain changes. As he hears the vocabulary of recovery, imitates the behavior of those with quality recovery and views contentment in others, Marcus takes on these attributes and becomes a recovering person.

In order for Marcus to establish well-being in his recovery he will need to connect with many important persons, including his therapist and sponsor. Becoming a part of a group committed to living a positive, recovery-oriented lifestyle also will be critical to his recovery.

Attachment theory
“I have modeled how severe traumatic attachments result in structural limitations of the early developing right brain, expressed in a number of enduring functional deficits, including a fundamental inability to regulate emotional states under stress” (Schore, 2003).

Symptoms trace back to intrapsychic processes-events in the clients “inner life.” A client’s “inner life” emerges from relationships with others (Verhulst, Gardner, et al., 2005). Attachment theory examines how communication patterns between parents (primary care givers) and child shape the child’s social, emotional and cognitive development. The key elements of an attachment bond are as follows:

• Enduring emotional relationship
• The relationship brings pleasure, comfort and safety
• Loss or threat of loss evokes intense distress
• The bond establishes the template for future relationships

According to Siegel, “attachment establishes an interpersonal relationship that helps the immature brain use the mature functions of the parent’s brain to organize its own processes” (Siegel, 1999). Marcus never had a positive, consistent male role model and never learned what he needed to know about being a man and a father. His disorganized/disoriented history of attachment presented an unsolvable problem or “biological paradox” (Main, Mary & Hesse, 1990). For Marcus, his therapist, sponsor or any other significant recovery relationship can act as his prefrontal cortex as they teach him how to live in the absence of drugs. Remember, we build each others brain, and attachment patterns can change at any time during the lifespan as a congruent understanding of one’s life is ascertained and understood.

Affect regulation involves the prefrontal areas of the right brain. In particular, a part of this prefrontal area called the orbitofrontal cortex regulates lower areas in the brain. This area of the brain integrates both external input from the sensory systems (visual, auditory, tactile), plus information from the internal visceral environment. “The operations of the right orbitofrontal control system involve a rapid subcortical evaluation of the regulatory significance of an external environmental stimulus, a processing of feedback information about the current internal state in order to make assessments of coping resources, and a moment-to-moment updating of context-appropriate response outputs in order to make adaptive adjustments to particular environmental perturbations” (Schore, 2003). The orbitofrontal cortex is the senior executive of the emotional brain. It regulates interpersonal and social behavior and directly connects to all areas of the brain. In fact, it is only one synapse away from the brain stem, limbic system and cerebral cortex.

A well developed orbitofrontal cortex allows one to establish appropriate personal and interpersonal control over the impulsive, more primitive brain stem. The brain stem houses many of the brain’s alarm systems, and a brain stem structure — the locus ceruleus — is the starting point for the reticular activating system. A developmentally impaired right prefrontal cortex exposed to a stressful situation can lead to problems in regulating aggression (Schore, 2003).

If a parent cannot help the child reestablish psychobiological equilibrium, the limbic system can be negatively impacted. Because of high arousal, high levels of cortisol and glutamate are known to alter the growth of limbic structures. These impairments to limbic structure and to dopamine, norepinephrine and serotonin receptors are implicated in aggression dysregulation (Schore, 2003).

Because of Marcus’s history of physical abuse, many brain areas may be smaller and less developed. These areas include the amygdala, hippocampus, anterior cingulate and prefrontal cortex. The amygdala is involved in the fear response and processes environmental threat. It triggers other brain areas to induce a physiologic and cognitive response to real or perceived threat. In persons with a history similar to Marcus’, the amygdala will often create a fear response when there is little or no threat. This leads to a form of hyperarousal called the fear response.

Fear response
Sensory stimuli generally trigger a response from the thalamus to the amygdala and frontal cortex. With a history of severe trauma, such as the physical abuse that Marcus experienced, the frontal cortex may not function properly (may be off-line). This frontal cortex will ordinarily judge the severity of the response, recall if the individual has had past experiences of a similar kind and, ultimately, what the most logical course of action should be. Without the logic of the cortex, the thalamus alerts the amygdala and the following cascade of events occurs:
As you can see from the above, all symptoms of the “fight, flight or freeze” response are represented in the above flow of events occurring secondary to Marcus’s interpretation of threat. In order to bring the prefrontal cortex (right side orbitofrontal cortex) center stage and allow it to override inappropriate response leading to aggression, his brain needs to be vertically and horizontally integrated. The focus of the first article in the series was to accomplish these types of integration.

Attachment issues are far reaching. In a 1970 lecture titled, “Self-reliance and Some Conditions That Promote It,” John Bowlby stated, “Evidence is accumulating that human beings of all ages are happiest and able to deploy their talents to best advantage when they are confident that, standing behind them there are one or more trusted persons who will come to their aid should difficulties arise” (Karen, 1998).

Therapeutic relationship
“Therefore, no society of men and women ever had a more urgent need for continuous effectiveness and permanent unity. We alcoholics see that we must work together and hang together, else most of us will finally die alone” (Alcoholics Anonymous, 1976).

The therapeutic relationship can be conceptualized as a secure attachment that promotes growth of neural integrative fibers. This growth is especially prevalent in the orbitofrontal cortex. It is also about having trusted individuals who will be there for you. One such trusted person is the primary clinician. “If one wishes the patient to trust in, and be committed to, a treatment plan, one needs to first establish a shared understanding of what the problem is and why a particular treatment approach is proposed. Furthermore, an explanation in terms of normal brain physiology and its social expression carries a different and more positive meaning than simply labeling the disorder and attributing it to a chemical imbalance” (Verhulst, et al., 2005).

Many therapists feel more like a parent to clients with a history of abuse. These clients are not able to suppress impulses and often end up with problems secondary to hyperarousal. One term that has been used to describe this phenomenon is “mindblindness” (Baron-Cohen, 1995). Daniel Siegel uses the word “mindsight” to refer to the innate capacity for perceiving the minds of others (Siegel, 1999). Regarding Marcus, could his early life experience create impairments in mindsight? The answer is yes, when the child is exposed to early forms of insecure attachment (Fonagy &Target, 1997).

Another view of perceiving the minds of others can be found in a discovery of certain nerve cells found in both the left and right cortical hemispheres. These nerve cells are called “mirror” neurons. When visual, auditory, or other forms of sensory input are perceived by another, it is as if they are seeing and feeling what you are feeling. The neurons create the sensation of “feeling at one” with another. Professor Marco Iacoboni of UCLA states, “This suggests that mirror neurons do not simply recognize actions but are also involved in decoding people’s intentions. People seem to have specific neurons that code the ‘why’ of some action, predicting the behavior of others” (Begley, 2005). These neurons are related to the establishment of the therapeutic relationship and empathy. Clinicians understand this as “intuition”.

The following dialogue gives an example of how this works in a therapy session:

Marcus: Enters counselors office without speaking
Therapist: “Marcus, you seem a little uptight today. Is there anything going on that is upsetting you?” (Therapist intuitively senses Marcus’s discomfort.)
Marcus: “Come to think of it, there are some things that really have me pissed off.”

What just occurred between the therapist and Marcus? The therapist using the “mirror” neuron system felt something from Marcus. Trusting his intuition, he related that feeling to Marcus. Marcus acknowledged the therapist’s intuition and responded in kind. This is called empathy.

A positive or therapeutic relationship is not limited to the therapist-client relationship. Sponsors, clergy, mentors, good friends, etc., can create the positive changes in external and internal environment. These changes facilitate gene expression, leading to development of areas of the brain crucial for recovery and more optimal life management skills. This especially involves the prefrontal cortex, and more specifically, the orbitofrontal cortex. The resultant increase in integration produces a more stable brain. Marcus makes better decisions about the way he lives his life-values, and beliefs are positively enhanced.

“One of the main aspects of spiritual maturity is having a connectedness with others. This is defined as having an appreciation of a common bond with all of humanity and, in particular, relationships with others. Relationships can be stifled by self-absorption, selfishness, meanness, greed, narcissism, pride, and so on. On the other hand, relationships are fostered by moving beyond individual ego worlds and participating in daily acts of self-transcendence, mindfulness of others, self-forgetfulness, generosity, compassion, listening, helping, patience, humility, and so on” (Waters & Shafer, 2005).

Connection to a Higher Power
“Faith without works is dead” (Alcoholics Anonymous, 1976).

Marcus is not asked to do much in early recovery — only to change everything and do it quickly! He has to admit that he is powerless over alcohol and drugs and that faith in a Higher Power can lead him from this insanity. For many alcoholics and addicts, the drink or the drug has become their Higher Power.

It is not hard to imagine why alcoholics and addicts in early recovery ask questions like, “What’s in it for me?” Reward and reinforcement drive addictive disorders, but what drives recovery? A large part of the answer lies in the development of successful relationships in recovery and a sound connection to a Higher Power of one’s choice.

An individual does not have to be religious in order to have a spiritual experience. The benefits of spirituality include humility, inner strength, sense of meaning and purpose in life, acceptance of self and others, sense of harmony, serenity, gratitude, and forgiveness.

Abraham Maslow was one of the first modern psychologists to attempt to measure spirituality. A devoted atheist who described belief in God as “the childish looking for a big Daddy in the sky,” he found that those who approached self-actualization had in common the experience of periodic spiritual experiences (Hamer, 2004).

In recent history it was Robert Cloninger who included a self-transcendence scale (self-forgetfulness, transpersonal identification and mysticism) in his biosocial model, because he felt that spirituality was neglected by behavioral scientists. In his most recent text, he outlines the conditions for the development of well-being. First, one must let go of our struggles and become calm. This allows our experience to more enjoyable and opens us up to growth through positive feedback. Second, to grow in awareness, we must understand our own nature and not be preoccupied with criticizing and blaming. This self-awareness creates a more calm, serene, faithful and open demeanor. Third, we must free ourselves from prior conditioning and unconditionally work in the service of others (Cloninger, 2004).

Dean Hammer states, “I do not contend that spirituality is a simple instinct like blinking or nursing. But I do argue that it is a complex amalgam in which certain genetically hardwired biological patterns of response and states of consciousness are interwoven with social, cultural, and historical threads” (Hamer, 2004). Dr. Hamer adds the element of genetics to the study of spirituality. The gene VMAT2 (Vesicular Monoamine Transporter Gene) is described as a “spiritual allele” found in 47 percent of the population. There is equality among the sexes, but the gene is found a little more often in minority groups.

Monoamines (norepinephrine, serotonin and dopamine) are produced in discrete areas of the brain and transported by a transporter. VMAT2 influences control of the flow of monoamines in the brain. The monoamines are the “feeling” neurotransmitters. It could well be that the monoamine dopamine facilitates the pleasure we feel when we have a spiritual experience, meditate or, for that matter, use a drug like cocaine or methamphetamine. Not only are spiritual experiences pleasurably reinforcing, but Dr. Hamer adds a practical element. He states, “I believe our genetic predisposition for faith is no accident. It provides us with a sense of purpose beyond ourselves and keeps us from being incapacitated by our dread of mortality. Our faith gives us the optimism to press on, regardless of the hardships we face” (Hamer, 2004).

The relationship between meditation and spirituality has been well documented. Meditation and spirituality both involve feelings of release into places beyond space and time. At the University of Pennsylvania, Andrew Newberg utilized a SPECT camera to look at the brains of people meditating. He discovered that meditation caused an enhanced blood flow to the frontal cortex and the thalamus. The areas of the frontal cortex include the dorsolateral prefrontal cortex, inferior frontal cortex and orbitofrontal cortex. These regions are responsible for thinking and planning. The thalamus and cingulate gyrus are parts of the limbic system and are involved in emotion. The aggregate of these two areas (frontal cortex and thalamus) is described as the “neurological seat of the will” and participates in goal-oriented concentration and planning (Hamer, 2004). This makes logical sense because many meditation techniques utilize a concerted focus on a word (“one”), a spot on the wall, or one’s breathing.

Newberg discovered other areas of the brain involved in meditation processes. Some areas showed a reduced blood flow. One such portion of the brain was the posterior superior parietal lobes. This is referred to as the “orientation association area” and houses a three-dimensional picture of the body. This lobe also functions in a way that allows one to distinguish between the self and the non-self. The overall effect is the inability to distinguish between the self and the non-self (Hamer, 2004). This can be understood by listening to the words of those meditating or having a spiritual experience — “I feel at one with the universe,” and “I feel a part of everything around me.” Both descriptions reflect a “loss of self” and self-transcendence.

At Laurentian University in Canada, Michael Persinger specializes in the study of paranormal phenomenon. Using himself as an experimental subject, he used transcranial magnetic stimulation to stimulate his own temporal and parietal lobes. Dr. Persinger — a self-described non-believer — experienced God and called this temporal-parietal area the “God Spot.” He believes that the biological underpinning of spiritual experience is due to spontaneous firing in the temporoparietal region. This experience, according to Persinger, creates a “sense of a presence” that can be interpreted as God or other mystical beings (Hamer, 2004).

Spirituality and healing
In August 2005, Newsweek and Beliefnet asked 1,004 Americans about their faith and spiritual beliefs — 79 percent of those polled described themselves as spiritual, while 64 percent said religious; and 57 percent of those polled said that spirituality is very important in their daily lives (Adler, 2005). In another report, nearly 80 percent of Americans said they believed in the power of prayer to improve the course of illness (Wallis, 1996). Other research has shown that increased spiritual practices are associated with improved outcome of addiction treatment and that recovering individuals show more evidence of spirituality than those who relapse (Waters and Shafer, 2005).

In order to successfully incorporate spiritual assessment and technique, clinicians must first have a sound understanding of their own beliefs. According to Miller, the clinician needs a set of proficiencies that he describes as follows (Miller, 1999):

• A non-judgmental, accepting and empathic relationship with the client
• An openness and willingness to take the time to understand the client’s spirituality and how this relates to their beliefs about recovery
• A personal comfort in asking about the client’s spiritual issues
• A willingness to learn about their client’s spiritual traditions

Spirituality and healing are closely connected. From a common sense perspective, spirituality serves as a client strength that should be utilized in early recovery. Therefore, it makes practical sense to assess a client’s spiritual beliefs and needs. Recommendations for reliable spiritual assessment instruments can be found in the Southern Coast Beacon, Part II, July 2005 (www.scattc.org). In cases where the client professes to be either an atheist or agnostic, meditation techniques can be a useful substitute.

There are many avenues that can be taken to enhance spirituality. As mentioned, meditation works in the same temporal area of the brain and utilizes the monoamine, dopamine, to create a pleasurable sensation. Of great importance to Marcus is his association with a spiritually-based 12-step program, and surrounding himself with spiritual people — remember, we build each others brain. Learning to appreciate the many spiritual moments in life will also be important for Marcus.

Living a meaningful and engaged life increases pleasure and reduces isolation, emptiness and pain. There will be nothing in life that will match his experience with alcohol and drugs. They hit the brain quickly and can cause great immediate pleasure. By the time Marcus reaches treatment, about 80 to 90 percent of his life is a living hell. Recovery is about learning to live in the present, in a connected fashion while improving 80 to 90 percent of life.

Over time, an alcoholic or an addict can learn to replace some of the anger, depression, and anguish associated with the disease of addiction. Recovery is tough but rewarding. Part of discovering the reward is learning how to laugh and have fun without being intoxicated. Norman Cousins was correct when he stated that laughter is a good medicine. Researchers, such as immunologist Lee Berk of Loma Linda University, have confirmed the positive physiological changes that can occur through laughter. Among the findings are (Liebertz, 2005):

• The pituitary gland releases its own opiates (endorphins)
• Immune cell production increases
• The stress hormone cortisol is reduced dramatically
• Levels of norepinephrine decrease
• Antibody levels increase
• The body’s anti-carcinogenic response accelerates

Closure
“And finally, we of Alcoholics Anonymous believe that the principle of anonymity has an immense spiritual significance. It reminds us that we are to place principles before personalities; that we are actually to practice a genuine humility. This to the end that our great blessings may never spoil us; that we shall forever live in thankful contemplation of Him who presides over us all” (Alcoholics Anonymous, 1976).

By using the case of Marcus, this two-part series has endeavored to integrate 30 plus years of observation and common sense with research from multiple disciplines. In doing so, it is hoped that the reader can grasp the synergy that exists between traditional recovery lines of thinking and scientific findings, from neuroscience, neuropsychology, developmental psychology (attachment theory), etc. What is ultimately important is that clinicians keep an open mind and are willing to learn for themselves and especially, for the alcoholics and addicts we serve.

Cardwell C. Nuckols, MA, PhD ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) is President of Cardwell C. Nuckols and Associates, LLC, a national and international training and consulting organization.

References
Adler, Jerry. (2005). Spirituality 2005. Newsweek. 48-49.
Alcoholics Anonymous. (1976). Alcoholics Anonymous World Services (Third Edition). New York.
Bremner, Douglas J. (2002). Does Stress Damage the Brain? WW Norton & Co. New York.
Cloninger, Robert. (2004). Feeling Good: The Science of Well-Being. Oxford Press. New York.
Hamer, Dean. (2004). The God Gene. Doubleday. New York.
Karen, Robert. (1998). Becoming Attached. Oxford Press. New York.
LeDoux, Joseph. (2002). Synaptic Self: How Our Brains Become Who We Are. Penguin Books, New York.
Liebertz, Charmaine. (2005). Live Better: A Healthy Laugh. Scientific American Mind. Vol. 16, No. 3. 91.
Main, Mary & Hesse E. (1990). Parents Unresolved Traumatic Experiences Are Related to Infant Disorganized Status: Is Frightened and/or Frightening Parental Behavior the Linking Mechanism. In Greenberg, M.T., Cicchetti, D., and Cummings, E.M. (Eds). Attachment in the Preschool Years: Theory, Research, and Intervention. University of Chicago Press. Chicago.
Miller, W.R. (1999). Integrating Spirituality into Treatment: Resources for Practitioners. American Psychological Association. Washington, DC.
Ratey, John J. (2001). A Users Guide to the Brain. Vintage Books, New York.
Schore, Allan N. (2003). Early Relational Trauma, Disorganized Attachment and the Development of a Predisposition to Violence. In Siegel, Daniel J. and Solomon, Marion F. Healing Trauma: Attachment, Mind, Body, and Brain. WW Norton, New York.
Siegel, Daniel J. (1999). The Developing Mind. The Guilford Press. New York.
Verhulst, Gardner, et al. (2005). The Social Brain in Clinical Practice. Psychiatric Annals. Vol. 35, No. 10. 805.
Wallis, C. (1996). Faith and Healing. Time. Vol. 147, No. 26. 58-64.
Waters, Pamela & Shafer, Kathryn. (2005). Spirituality in Addiction Treatment and Recovery. Southern Coast Beacon.

This article is published in Counselor,The Magazine for Addiction Professionals, February 2006, v.7, n.1, pp.12-22.

One person has commented on this article.

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kk, Unregistered

I enjoyed the article. Neuroscience and its application is where it's at. Thanks

 Posted 2007-10-26 20:37:12

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