The Science of Behavior Change and Recovery from Drug or Alcohol AddictionAnna Ciulla
Over roughly the last decade, the science of behavior change has become a hot topic of research in the medical field— and it is easy to see why. The more we know about the mechanisms of positive lifestyle changes, the more we can influence healthy choices, habits and behaviors that are critical to better health.
The same holds true for recovery from substance use disorders (SUDs). The more we know about the physical, social and neuropsychological processes that drive positive behavioral change—the “mechanisms of behavior change”—the better we can target our treatment approaches.
Moreover, some of the same research that is currently shaping new public health approaches to improving hygiene, nutrition and other health-related behaviors can also be applied to helping people achieve lasting sobriety from drugs and alcohol. This article will introduce you to this latest research and its potential implications for treating addiction and improving recovery outcomes.
The Brain-Based Mechanisms of Psychotherapeutic Change in Recovery
A lot of research has been done regarding how substance abuse changes the brain. Far less inquiry has been given to how psychotherapy changes the brain, however—and, specifically, the brain-based mechanisms of positive core change that underlie recovery. A June 2013 special issue of the journal, Psychology of Addictive Behaviors, undertook some preliminary exploration of this question. Using different neuroimaging tests, the researchers wanted to learn more about the brain-based psychotherapy mechanisms of change with respect to a range of addictive behaviors, including drinking, smoking, cocaine and marijuana use, and pathological gambling. What follow are a couple key findings.
Mindfulness Therapy for Nicotine Cravings and Its Neurobiological Effects on Behavior
One study, for example, looked at the impact of mindfulness training on nicotine cravings, by using neuroimaging scans to trace the neural effects of mindfulness training. Through mindfulness training, the study participants were taught that they could ride out a craving by understanding it as a temporary physical sensation and not a life-or-death need to smoke. Simply sitting through a craving, as opposed to acting on it by picking up a cigarette, over time disrupted the addictive learning process.
Meanwhile, neuroimaging scans were undertaken of the brain’s “default mode network” (DMN), a large network of interacting brain regions that has been implicated in addiction. The scans showed that after eight weeks of an intervention known as “Mindfulness-Based Stress Reduction,” there was decreased activity in the DMN. Strikingly, too, this deactivation of the DMN resulted from three different types of meditation: concentration, loving-kindness, and choiceless awareness. These findings led the researchers to conclude that mindfully attending to cravings can indeed slow down the brain’s DMN, so that over time the brain circuit itself may change, fostering a new sense of self that excludes the old narrative of smoking.
Contingency Management for Adolescent Substance Abuse – The Neurobiology of Abstinence
In another study, researchers wanted to know how insights into the science of decision making could improve contingency management treatment approaches that, through motivational incentives, seek to award positive behaviors like abstinence in teens with substance abuse issues. (Like mindfulness, “contingency management” (CM) is a widely used behavioral therapy for addiction and SUDs.) Of specific interest was a type of decision making that is often used in CM and is known as “delay discounting.”
Delay discounting involves weighing the value of immediate versus delayed reward, and has been used to predict future substance abuse in at-risk teens. Thanks to their higher brain plasticity in regions of the brain that are involved in delay discounting, adolescents with SUDs can benefit from CM interventions that offer immediate awards for brief periods of abstinence, according to the findings. The hope is that with greater understanding of the neural mechanisms of delay discounting, future CM approaches will be better able to target the executive functions that influence behavioral choices like drinking or doing drugs.
The Brain Region That Motivates Behavior Change
Research published just last year by researchers at the University of Pennsylvania, Yale University, Columbia University and Duke University has provided more clues about the nature of the brain’s involvement in changing routine habits and behaviors. There it was discovered that stimulating one region of the brain in particular, the posterior cingulate cortex, led to changes in routine behavior. In fact, by studying the firing rates of neurons in this central region of the brain, the researchers found they could actually predict when a change in behavior was about to occur: the neurons would amp up their firing and then peak just before the change took place.
A New Approach to Changing Hygiene, Nutrition, and Exercise-Related Behaviors
“Behavior Centred Design” (BCD) is the name for a new approach to changing behavior that has been successful at encouraging healthier habits in areas like hygiene, nutrition, and exercise, according to a September 2016 article in Health Psychology Review. BCD seeks to create a desired behavior, by first assessing the target behavior and then creating the right environment for it. That includes identifying both the key drivers of behavior and the interventions that encourage them, in order to positively reinforce the desired behavior (so that it becomes routine).
Both of the above two findings are so recent that the implications for treating addiction and substance abuse have yet to be explored. Still, what they do suggest is that there is promising potential for developing more effective, targeted interventions for substance abuse in the future.