Turning Darkness into Light: The Journey of Recovery from Addiction
By Dr. Jan Malat, Interim Chief, Addictions Division
Two years ago this December when the power outage left our city in darkness, my patient was alone with nowhere to go. Like many families of addicted patients, his family had distanced itself after many years of relapses and broken promises. He ended up spending several days with his neighbours, playing board games with their children under the candlelight. My patient experienced a level of contentment and connection he hadn’t felt in years. He was deeply moved by this experience and said very poetically, “we turned the darkness into light.”
This clinical example symbolizes the importance of something positive helping addicted individuals find their way out of the darkness of their addiction. This can be a wide variety of things: an important relationship (e.g. child, spouse, family member, pet), a reclaimed idea, value or religion, a small goal, a glimmer of hope, positive activities such as hobbies, exercise and volunteering, an improvement in housing or the living environment. These positive experiences encompass the concept of recovery from addiction and mental illness as it is defined by SAMHSA (Substance Abuse and Mental Health Services Administration) – the emphasis is on having a dignified life with meaningful experiences despite struggling with a chronic, relapsing condition.
However, the road to recovery can be a very bumpy one. Initial attempts at sobriety often fail. A fresh start in a new job is sabotaged by the addiction as it gains new strength feeding on more income, other addictive behaviours fill the void left behind by the initial addiction, a crushing weight of guilt and traumatic memories emerges from the fog of addiction as the brain regains clarity in early sobriety. It is very difficult to resist the comforting, familiar call of the addiction and the community of using “friends,” even if it offers only a brief reprieve from the shame and despair. It is no surprise that our patients remain trapped in a vicious cycle of escaping back into more substance use to dull the pain that has been caused by the addiction itself – this is the dark side of neuroplasticity (the brain’s ability to reorganize itself in response to experience by forming new neural connections) – thousands of repeated cycles of use have powerfully ingrained these addictive behaviours – it happens so automatically it is almost like a reflex in the brain.
Although there is a lot of truth that an accumulation of negative consequences (i.e.“hitting bottom”) compels people to consider sobriety, it is equally important for individuals to have some hope and positive experiences during their early efforts at recovery. An important first step is to detoxify their shame and self-criticism. My patients often feel weak and demoralized, they have let themselves and others down repeatedly. I rely on neuroscience to help them appreciate that their brain functions very differently than a non-addicted brain. The addiction has hijacked and rewired their brain’s natural reward system – it has fooled their brain into thinking that they will “starve” without the addictive substance – they are compelled to search for their substance the way a starving person desperately searches for food. The addiction has altered their personality to achieve this one, singular goal. There is no choice or pleasure when an addiction has reached this level of severity.
My patients, accustomed to many years of criticism and punishment, often feel confused when I suggest they search for healthy ways to reward themselves. I explain that they need to discover new, healthy routines to fill the chemical and relational void created by the addiction. This is the bright side of neuroplasticity – new behaviours and habits can be learned with vigorous practice and repetition. As these new behaviours become more habitual over time, they begin to compete with the powerful pull of the addiction. This is why I try to encourage my patients to attempt a period of at least six months of abstinence if possible, in order to have an opportunity to solidify their new habits.
One of the most gratifying parts of my job is witnessing my patients transform their lives in far-reaching ways after achieving sobriety. They tell me how they have reclaimed their healthy self again, rediscovered meaningful activities and revived healthy relationships – the darkness has finally been turned into light.