Prescription for Alcoholics

"Paradoxical causal loops are the ultimate mind-bending concept of systems thinking,

where the cause becomes the effect and the effect becomes the cause."

- Donella Meadows

“Take your medicine!” is a nagging command we all hated as kids, but for alcoholics this sounds like the world’s nicest invitation.

With substance addiction, the *medication for the treatment of its symptoms is paradoxically the very cause of the “disease” itself. Alcoholism is the “disease”, yet alcohol is also the only proven *medication that is able to provide instant reliable and predictable therapeutic results against the ever-present nagging and even possibly dangerous symptoms of it. Literally, when dealing with alcoholism (or addictions to certain other chemically addictive substances) - a sudden stop in taking your *medication can make you sick. This withdrawal induced sickness can range from mild to strong. In the most severely chronic late-stage cases of alcoholism - it can even be as deadly to quit drinking cold-turkey as it would be for somebody with Type 2 Diabetes to suddenly quit taking their insulin.

Upon being diagnosed with the “disease” of alcoholism, the best recommended prescription is a daily dose of pure abstinence from your medication which is alcohol. Your diagnosis (which is subjective) and your adherence to your resulting prescription, these will be most effective if not diagnosed and prescribed by only other people’s opinions but also by your own opinion. Diagnostics and the efficacy of the resulting prescription (which is to take zero of your medication) are very soft sciences at best to begin with - without self-admission being part of the diagnostic process, there will be little to no hope in taking any level of control over the “disease”.

This circular and self-contradictory fact of alcohol simultaneously being both the cause of the alcoholism and the only proven *medication for its symptoms, combined with the fact that the only effective prescription for the treatment of the"disease" itself is to not take its *medicine - this reminds me of a childhood memory.

My friends and I built a half-pipe in the woods when we were teens to skateboard on. We lived on the thing. In those woods, throughout those years, I got poison ivy a bunch of times. It itched like crazy, like mosquito bites on steroids that never quit. But sometimes it felt almost worth having it because scratching the itches did more than just satisfy the itch - it could actually feel good, amazing even. From all the scratching, the rashes would open up causing them to spread. Causing my poison ivy to further inflame and cover even more of my skin, I'd continue scratching to satisfy the growing surface area of rashes, further spreading it - scratching it sometimes felt amazing. With each case, once it had spread all the way out of control, the only solution was to totally stop scratching. The itching was nagging and unrelentingly persistent - it felt impossible not to scratch. One key point where this comparison ends though is, poison ivy contains zero chemically addictive substances.

I don’t know what to call this absurd causal loop problem where the cause becomes the effect, and the effect becomes the cause. Call alcoholism what you want - but be it just a plain old nasty habit or full-blown disease, it’s ultra-paradoxical.

“Addiction is a progressive narrowing of the things that bring you pleasure.”

- Andrew Huberman, Ph.D.

At a glance, the term ‘dopamine’ can sound like a drug reference because the 1st syllable is pronounced ‘dope’. Dopamine’s actually a natural chemical produced and dispensed in the brain. It’s what regulates the senses of pain vs pleasure, and motivation vs reward. The brain produces it on an ongoing persistent basis, the goal to always remain at the same ambient level. Like an air conditioner that’s always set at the same, say, 73 degrees. Whenever your brain’s baseline dopamine level is at 73 degrees, that’s when you feel ‘normal’ - 73 degrees is your ‘normal self’. Your brain throttles its dopamine production as needed, always aimed at its normal baseline level - like if it’s hot outside and the house gets up to 80, your AC kicks into full gear until it returns to 73. Once back to the normal ambient 73, your AC then stops pumping - only kicking back on each time it goes back above 73. Alcoholism is a broken AC - whenever your brain’s ambient dopamine level is off balance, your AC fails to kick into gear, it will not naturally return you back to your normal 73 degrees. Alcoholism is a dopamine deficiency, a deficiency in your brain’s natural dopamine production (caused by over exposure to alcohol). And paradoxically, the only proven *medication for it is alcohol itself - it is the only thing that is able to reliably, instantly and predictably return your deficient dopamine level back up to your baseline (back to your normal 73 degree self).

What’s the purpose of dopamine in the first place? Evolutionarily speaking, it’s about survival. Dopamine production and regulation is a highly evolved autonomic nervous system function that writes out the map of your entire sense of motivation. Your map continues to be written in real time and throughout your entire life. It maps out road markers that help you steer clear of danger (avoid pain), and it provides you turn by turn directions towards success (attain pleasure). These road markers (for avoiding danger) and turn by turn directions (towards success) are all written in by the brain, by using dopamine spikes. Every pleasurable experience (such as winning a reward) causes a brain rush, burning in a data-point onto your map of ‘yes please’ - let’s try to remember this way here again in the future. And every painful experience (such as getting into trouble) causes a brain rush, burning a data-point onto your map of ‘no thanks’ - let’s try to avoid this way here again in the future. These road markers and turn-by-turn directions are bookmarked experiential learnings of what’s likely expected (good or bad) from any upcoming possible future destination - it is your map of the world that optimizes your avoid-pain and attain-pleasure motivations (instincts) so as to be most fit for survival. Alcoholism's a broken mapping system - broken by overexposure to alcohol which gave you a much too abundant and easily begotten artificial supply of dopamine spikes, each spike a thumbtack outlining what looks like a very helpful shortcut on your map, but the shortcut is actually a short circuit. And paradoxically - without the very *medication that caused your motivational system's mapping bugs in the first place, you feel nothing but car sick and lost.

Alcoholism’s a deficiency of native dopamine production, and it arrests one's entire healthy sense of motivation versus reward. The best prescription for the treatment of the "disease" itself is one dose of daily abstinence from it.

Over time - your brain's native dopamine production levels will return to its natural born ambient state of 73 degrees, and your navigational system will become debugged. The duration, frequency, and daily dosage of your active usage of your substance of addiction will dictate how much time it will take you to return to "normal". For context, I am 50 years old, was an active alcoholic for at least 25 years (chronically for the last 6 of these 25), and am currently 26-months and a few days free from alcohol (as of this writing on 11-4-23) - and I am only now beginning to feel a return to my full true "normal" self. The first three ingredients are time, time and time. In addition to time - hobbies and exercise that I personally enjoy have easily without doubt been the two most therapeutic things, specifically ones that require my intense focus or effort. Because rendering enjoyment from things that require intense focus and effort drive the process of neuroplasticity, which in this case here is the redrawing of your brain's healthy motivation/reward maps and the resetting of your brain's native dopamine production levels back to "normal". Neuroplasticity got you into this mess, and it didn't happen overnight - it took years of preoccupied focus and tireless effort towards making sure to never not have your *medication around. Likewise, neuroplasticity will, and I mean definitely will get you out of this mess - over time (which yes, will take longer than you wish) - given that you stick to the prescription.

*medication

With normal "diseases", medication is the treatment. But alcoholism is a paradoxical “disease”, the only known medication for the treatment of its symptoms is alcohol. Beyond the treatment of just the symptoms, the most effective prescription for the "disease" itself is a daily dose of 100% abstinence from its medication.