In my private practice my path is to remove obstacles blocking my patient's path to reaching their full potential. Many of the people who walk thru my door are in various stages of either substance abuse, substance dependence and other issues that take on the appearance of an addiction. I am very careful to refrain from labeling my patients as I find labeling is not helpful and only adds to the feelings of shame most of my patients are already experiencing from their inner critical voice.
In working with my patients one issue continues to bind them together and that is their inability to set healthy, flexible boundaries. Many of the self proclaimed addicts I work with also admittedly suffer from issues surrounding their codependence. As a result many would describe themselves as typically having very unhealthy interpersonal boundaries. Those of us raised in dysfunctional families often find the concept of healthy boundaries to be a revelation in our recovery. One of the first steps I introduce to my clients on their path to recovery is how to develop and implement boundaries. In doing so the first statement I teach them is as follows:
No is a complete sentence...
In helping my patients develop healthy interpersonal relationships I have received much feedback from my clients. They are often some of my most influential teachers. Below is a list that I have created and edited over the years that I have been informed has been helpful to my clients. Many items on the lists you may recognize from your own past. The purpose of the list is to simply bring consciousness and awareness to your own personal "operating" system and ask yourself if you identify with any of the statements have they proved to be obstacles in your pursuit of happiness?
Signs of Unhealthy Interpersonal Relationships
Recommend readings on boundaries
Thom Kessler, LMFT, RAS
Introducing the Human Brain
The human brain is the most complex organ in the body. This three-pound mass of gray and white matter sits at the center of all human activity—you need it to drive a car, to enjoy a meal, to breathe, to create an artistic masterpiece, and to enjoy everyday activities. In brief, the brain regulates your basic body functions, enables you to interpret and respond to everything you experience; and shapes your thoughts, emotions, and behavior.
The brain is made up of many parts that all work together as a team. Different parts of the brain are responsible for coordinating and performing specific functions. Drugs can alter important brain areas that are necessary for life-sustaining functions and can drive the compulsive drug abuse that marks addiction. The brain areas affected by drug abuse as follows:
How does the brain communicate?
The brain is a communications center consisting of billions of neurons, or nerve cells. Networks of neurons pass messages back and forth to different structures within the brain, the spinal column, and the peripheral nervous system. These never networks coordinate and regulate everything we feel, think, and do.
How do drugs work in the brain?
Drugs are chemicals. They work in the brain by tapping into the brain’s communication system and interfering with the way nerve cells normally send, receive, and process information. Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter. This similarity in structure “fools” receptors and allows the drugs to lock onto and activate the nerve cells. Although these drugs mimic brain chemicals, they don’t activate nerve cells in the same way as a natural neurotransmitter, and they lead to abnormal messages being transmitted through the network.
Other drugs, such as amphetamine or cocaine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters or prevent the normal recycling of these brain chemicals. This disruption produces a greatly amplified message, ultimately disrupting communication channels. The difference in effect can be described as the difference between someone whispering into your ear and someone shouting into a microphone.
How do drugs work in the brain to produce pleasure?
All drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who abuse drugs and teaches them to repeat the behavior.
How does stimulation of the brain’s pleasure circuit teach us to keep taking drugs?
Our brains are wired to ensure that we will repeat life-sustaining activities by associating those activities with pleasure or reward. Whenever this reward circuit is activated, the brain notes that something important is happening that needs to be remembered, and teaches us to do it again and again, without thinking about it. Because drugs of abuse stimulate the same circuit, we learn to abuse drugs in the same way.
Why are drugs more addictive than natural rewards?
When some drugs of abuse are taken, they can release 2 to 10 times the amount of dopamine that natural rewards do. In some cases, this occurs almost immediately (as when drugs are smoked or injected), and the effects can last much longer than those produced by natural rewards. The resulting effects on the brain’s pleasure circuit dwarfs those produced by naturally rewarding behaviors such as eating and sex. The effect of such a powerful reward strongly motivates people to take drugs again and again. This is why scientists sometimes say that drug abuse is something we learn to do very, very well.
What happens to your brain if you keep taking drugs?
Just as we turn down the volume on a radio that is too loud, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number of receptors that can receive and transmit signals. As a result, dopamine’s impact on the reward circuit of a drug abuser’s brain can become abnormally low, and the ability to experience any pleasure is reduced. This is why the abuser eventually feels flat, lifeless, and depressed, and is unable to enjoy things that previously brought them pleasure. Now, they need to take drugs just to bring their dopamine function back up to normal. And, they must take larger amounts of the drug than they first did to create the dopamine high—an effect known as tolerance.
How does long-term drug taking affect brain circuits?
We know that the same sort of mechanisms involved in the development of tolerance can eventually lead to profound changes in neurons and brain circuits, with the potential to severely compromise the long-term health of the brain. For example, glutamate is another neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate for this change, which can cause impairment in cognitive function. Similarly, long-term drug abuse can trigger adaptations in habit or non-conscious memory systems. Conditioning is one example of this type of learning, whereby environmental cues become associated with the drug experience and can trigger uncontrollable cravings if the individual is later exposed to these cues, even without the drug itself being available. This learned “reflex” is extremely robust and can emerge even after many years of abstinence.
What other brain changes occur with abuse?
Chronic exposure to drugs of abuse disrupts the way critical brain structures interact to control behavior—behavior specifically related to drug abuse. Just as continued abuse may lead to tolerance or the need for higher drug dosages to produce an effect, it may also lead to addiction, which can drive an abuser to seek out and take drugs compulsively. Drug addiction erodes a person’s self-control and ability to make sound decisions, while sending intense impulses to take drugs.
Thom Kessler, LMFT, RAS
Marriage & Family Therapist and Registered Addiction Specialist