Optimizing your brain in addiction recovery: Lifestyle affects everything! – An interview with Dr. Ralph E. Carson, LD, RD, Ph.D.
Your brain on drugs…for real!
Chronic exposure to chemical substances disrupts the way critical brain structures interact to control and inhibit behaviors. And quitting drugs is just one part of a long and complex recovery process. In fact, when people enter treatment for a substance use disorder, addiction has often taken over their lives. And that is the time when addicts need to consider major lifestyle changes if they want to heal brain function.
The brain can be restored to health
The good news is that research is showing us that the brain is more flexible than we ever thought. Today, we have the true pleasure of speaking with Dr. Ralph E. Carson, LD, RD, Ph.D., who has made it his mission to study the brain. Here, he’ll help explain how drugs and alcohol addiction affects the brain and how we can heal past abuse.
Dr. Ralph E. Carson, LD, RD, PhD, has been involved in the clinical treatment of addictions, obesity, and eating disorders for more than thirty years using a neuro psychobiological approach. With a BS from Duke University, a BHS from Duke University Medical School, coupled with a BS in nutrition from Oakwood College and a Ph.D. in nutrition from Auburn University, he IS THE AUTHORITY on how health, wellness, exercise, and nutrition can affect brain health.
Questions about restoring the brain in recovery
If you have any questions regarding optimizing your brain’s health in addiction recovery, please leave them in the comments section below. We will do our best to provide you with a personal and prompt response.
ADDICTION BLOG: What are some lifestyle patterns that most addicts have in common?
DR. RALPH CARSON: A dysfunctional lifestyle is all those who struggle with addiction have ever known. It is a life that often revolves around getting high on alcohol and drugs. It often involves an unhealthy relationship with food, erratic sleep patterns, inactivity and high level of stress compounded by poor coping mechanisms. Often, the addicted individual has a history of trauma, attachment issues (a destructive or absent family of origin) and poor affect (mood) regulation.
Trapped in the tight grip of their addiction, these individuals can’t imagine a sober life. As they abuse drugs or alcohol, they neglect important and daily health care management and thereby wreak havoc on their physical and emotional well being. Poor eating habits, giving into constant cravings, denying the body of nutrients cause further problems and inhibit repair.
Furthermore, the individual caught in addiction will oscillate in and out of post-acute withdrawal, which is characterized by difficulty concentrating, poor memory and insomnia. They are besieged with mood swings going from calm and collected to hyper and out of control; from pleasant and upbeat to miserable and depressed. Essentially, their body is under stress and the stress management acronym HALT (Hungry, Angry, Lonely and Tired) fits the addicted individual to a T.
Because – over time – there is an overall loss of interest in everyday activities and a rising complacency with, work, family, friends and social life, a change in the addicted individual’s lifestyle habits starts to become noticeable to those close to them. People who used to take a lot of pride in their appearance begin to make a change for the worse in clothing, appearance, and hygiene. In the grips of addiction, people acquire horrible sleep habits keeping odd hours, staying up late and sleeping excessively during the day.
All of these lifestyle factors cause addicts to isolate, preferring to be reclusive and private, especially when in a using mode. A whole chain reaction of internal and external systems is now in place.
Long term, other health problems evolve because drugs can have a direct toxic effect on both the brain (more on the brain later) and the digestive tract. The compromised gastrointestinal system can reduce the body’s ability to absorb, process, use, and store nutrients. The liver is often damaged which prevents the ability to excrete built up toxins from the drug of choice, once again tightening the knot of interwoven systems. This is why the most hopeful treatments tackle addiction from many angles.
ADDICTION BLOG: Can you talk to us a little about how the typical lifestyle of a drug or alcohol addict affects the brain?
DR. RALPH CARSON: The drugs themselves can cause brain damage. They trigger or interact with a whole series of destructive processes, including stress, to create a very tight web. Brain cells are destroyed and lost due to the neurotoxicity of the chemical consumed be it nicotine, heroin, alcohol, cocaine, amphetamines, etc. There is down regulation of receptors as a consequence of the outpouring of excessive neurotransmitters like dopamine during the tolerance phase.
In addition to being toxic to existing cells, the stress that is often the precipitating factor becomes chronic and results in cortisol surges that inhibit the brain’s healing capacity. Free radicals or reactive oxygen species accumulated due to stress and drug use cause disruption of the brain’s DNA system and thereby the brain’s ability to make proteins and heal.
Additionally, the repetitive behaviors become ingrained as bad habits. The impulsive nature of the disease of addiction rewires the brain so the Wise Advocate, the capacity for objective discernment associated with the dorsolateral prefrontal cortex, goes off line and is unavailable to make rational decisions. With the absence of sound nutrition, exercise, sleep hygiene, and coping skills, the brain enters a progressive downward spiral.
ADDICTION BLOG: What are some of the common ways that chemical and psychological dependency affect the brain?
DR. RALPH CARSON: Most of the worst destruction or alteration occurs to the neurotransmitters in the brain’s communication system. You may know them as chemical messengers:
The imbalances lead to mood swings, poor decision-making, loss of control, and cravings.
Cells concentrated in the hippocampus are destroyed, and these are areas responsible for memory construction and involve the activation and proliferation of brain stem cell formation. This action by drugs compromises the cognitive skills needed for thinking, learning, and reasoning.
The area of the brain that generates positive emotions such as joy, hope, and pride are depleted, while the areas of fear, anxiety, and disgust are stimulated. The neural pathways for a host of constructive behaviors are rewired so as to block out reasoning, impulse control, and appropriate decision making.
Finally, drugs directly and indirectly influence the transcription of genetic machinery – the turning on and off of DNA fails to function in its usual capacity. In essence, these neurological and physiological changes hijack the brain’s reward and impulse control system and make one’s control over the drug unmanageable.
ADDICTION BLOG: Generally, how does the brain heal itself after addiction?
DR. RALPH CARSON: There are primarily three forms of healing.
1. One is the stimulation of stem cells in the paraventricular and hippocampal area which are stimulated to proliferate and migrate to areas of the brain where healing is necessary.
2. Another mechanism is neuroplasticity where neurons are redirected or new circuits are formed. Axonal guidance redirects the nerve cell body toward new connections, and dendritic arborization causes the neuron sprout to branch, reach out, and connect with the axonal extension. At the connection of the two, there is a process of synaptogenesis such that receptors are formed and neurotransmitters are synthesized. All this occurs under the influence of neurotrophic factors or BDNF (Brain Derived Neurotropic Factor), or what some label as “Miracle Grow for the brain.”
3. Finally, if the damage is permanent, function can still be restored in another area of the brain and this process is coined collateral repair.
The process itself has several different elements. Therapeutic techniques and processes, such as 12-Step programming, can initiate and stimulate growth and repair. However, efficient, complete, and accelerated healing will not occur unless the avoidance of harmful substances is consistent and coupled with proper nutrition – which includes energy, raw materials, antioxidants, and fluids. All of this occurs during the stages of sleep that produce growth hormones which orchestrate the healing process. So of course sleep hygiene is important, though often overlooked.
As you can see, optimum healing requires good inputs from several directions. Exercise coordinates and enhances all the above contributions to the repair process. And on top of this, the need to learn coping mechanisms and reduce stress is critical. So CBT and mindfulness interventions also make a significant contribution to the healing process.
ADDICTION BLOG: How long does it typically take to start feeling better after acute drug/alcohol withdrawal?
DR. RALPH CARSON: Unfortunately during the 10-day to 2-week withdrawal and detox phase, the individual often feels worse before they feel better. Integrating all the tools proposed, however, accelerates the process.
Among the first improvements individuals adherent to the plan might observe are improved daytime wakefulness, vitality/energy and clarity of thought. Each day will be better than the last, but much of the improvement will be communicated by the recovering individual’s friends and family, who are very aware of even the most subtle improvements.
Just about everyone struggling with addiction desires instant gratification and complete recovery. So, it’s important to cultivate patience. Peers and mentoring can help the person in early recovery to recognize it is about progress and not perfection.
The amount of time before complete neural recovery varies. In other words, the time it takes for the brain to return to its original state before using is based on a number of factors, for example, the drug of choice and duration of use, the degree of commitment to the program, the strength of belief that it will work, and the ability to accept that there is no permanent cure.
ADDICTION BLOG: How big of a role do you think that serotonin and dopamine deficits play in the cycle of addictive behaviors?
DR. RALPH CARSON: Serotonin and dopamine are critical in the evolution of an addiction and the physical manifestations.
The brain is designed to balance out unpleasant experiences with pleasant experiences. Stress (unpleasant) covers a host of consequences and the availability of serotonin is responsible for keeping one calm and centered. Given that there are some problems to which there are no solutions, if one fails to balance their serotonin, the brain responds by putting out dopamine (pleasure).
Along with addiction comes reward deficiency syndrome. To addicted individuals faced with stress, this means they require even more dopamine to balance out their brains because they have fewer receptors. The more they dump dopamine there is a down regulation of the receptors to dopamine. So as they continue to use drugs or alcohol, they need ever more stimulation from the substance to provide the craved pleasure. Eventually they cannot feel euphoria at all. Now they have to take the drug just to feel normal. And this is the source of withdrawal and dependence.
So the question each and every individual working towards long-term recovery will have to answer is, “What do I need to do to replace the dopamine formerly produced by the drug that I am giving up?”
ADDICTION BLOG: Do you think that all/most addicts are depressed or anxious? Why or why not?
DR. RALPH CARSON: The motivation for survival in the human mind/spirit is a balancing act between seeking pleasure and avoiding pain. This leads me to believe that if we had no stress, no anxiety or depression, then there would be no addiction.
If one could first define, and then practice the skills and recommendations necessary to achieve happiness, one would experience complete and lasting recovery. Or physiologically speaking, the reconstruction that occurs in areas of the neo-cortex of the human brain would circumvent the addictive brain that has hijacked the primitive limbic system.
In life there simply are some problems to which there are no solutions. Unfortunately, no matter how much recovery programming they have absorbed, individuals in recovery cannot change the world and people they’ll be dealing with once they graduate from treatment and return to their previous life of reality. There will always be wild cards in play, even after we learn how to cope with stress, develop resilience to negative affect, and acquire a toolbox of coping mechanisms.
ADDICTION BLOG: What’s the ideal condition of the brain for people in addiction recovery to aim for?
DR. RALPH CARSON: To bring the Wise Advocate on line, it takes repetition of constructive behaviors. For example, a mantra of the American Addiction Centers’ aftercare program is “90 meetings in 90 days.” The idea is to reinforce constructive behavior (going to meetings) with repetition.
The ideal brain has incorporated “believable hope,” can recognize strengths and virtues and use them for the betterment of man. These actions are by way of cultivating states of mind such as forgiveness, compassion, meditation, altruism, and gratitude.
It’s also important to cultivate strong relationships with people one can confide in. This establishes a strong happiness center in the left prefrontal cortex. The center can also be enhanced through neuroscience, positive psychology, or 12-Step thinking and community. These means help us to reduce stress by letting go of those things for which we have no solutions; physiologically, we balance out the stress-reducing serotonin circuit with the pleasure-seeking dopamine circuit.
ADDICTION BLOG: What changes do we need to make to sleep, exercise, and nutrition in order to feel optimal in addiction recovery?
DR. RALPH CARSON: In addition to other aspects of a good program already mentioned, this will mean:
- Maintaining appropriate blood glucose levels, fiber, and Omega-3 fatty acids.
- Consuming 8 servings of a variety of highly pigmented fruits and vegetables per day, quality protein, a multi-vitamin and mineral.
- Avoiding too much sugar, fried food, TRANs fats, and caffeine.
One needs to ensure that they are getting 7 – 9 hours of quality sleep per night and exercising 30 – 40 minutes of enjoyable and lifestyle activity per day. This will produce a properly integrative brain that is balanced and optimally functioning.
ADDICTION BLOG: What might a daily ideal lifestyle look like? How long might it take to achieve this?
DR. RALPH CARSON: Structure, consistency, adequacy, balance, and moderation are the cornerstones of brain recovery.
Regular bed times and wake times (even on weekends and holidays) and high quality sleep. Basically, good sleep hygiene means sleep that is uninterrupted. It includes getting to sleep as naturally as possible, turning off all lights and sounds. Optimum sleep may take a while. Work on staying asleep and cultivate awareness of dreams. Seek treatment for snoring or sleep apnea!
For optimum nutrition, start with scheduling five feedings per day every 3-4 hours, for which each feeding should contain a complex carbohydrate (fiber), some protein and a small amount of fat. I would recommend no fewer than eight cups of water per day.
- Make sure that you eat a cold water fatty fish twice per week.
- Take in eight servings of a variety of highly pigmented fruits and vegetables.
- Minimize simple sugars, highly processed foods, fried foods, TRAN’s fats, caffeine, and junk foods. Exercise or be active.
- If you have a pedometer, look for at least 10,000 extra steps per week.
- Incorporate resistance work and flexibility (e.g. yoga) into your program.
- Reduce waist circumference to < 36 inches for males and < 30 inches for females. Hint: this does not mean going on a diet, especially a low carbohydrate diet such as the Wheat Belly, Atkins or Paleo, which are possibly the worst food plans for anyone with an addiction who wants their brain to heal sometime this century.
- Learn the skills of meditation and mindfulness.
- Religiously practice the principles of 12-Steps every day, which includes a strong support system.
Combining a comprehensive treatment program with personnel trained in the arts of therapy, nutrition, exercise and medicine with your strong commitment, and you should be able to accomplish these lifestyle changes in 60-90 days.
ADDICTION BLOG: How can we pace ourselves and who can we turn to for help?
DR. RALPH CARSON: The two key elements are first, hope, and second, belief in that hope or assurance. Yes, this means establishing a foundation of spirituality. The third key element is that of strong relationships.
To reiterate, people in recovery need to surround themselves with others they can confide in. That means others in recovery. Take advantage of these like-minded confidantes as your mentors, inspiration, and sponsors. They have been there and know the paths that work and those that don’t.
This necessitates going to meetings, but not just sitting there, checking off the box. An attitude of, “What are these meetings doing for me?” will not be productive. The best attitude comes from a place of service: “How I can inspire and assist others in their journey of recovery?” It’s actually empowering, not to mention engaging.
ADDICTION BLOG: Is there anything else you would like to share with our readers?
DR. RALPH CARSON: I have shared a lot of dense information and a wide range of solutions – I realize it’s a lot to communicate in a typically light forum such as the Q & A.
To read a more about these concepts I recommend the book entitled The Brain Fix: What’s the Matter with Your Grey Matter? The book is “reader friendly” but it gives you a more thorough and extensive description of everything I’ve said here. Even better, it’s designed specifically for those recovering from an addiction and who yearn to make it last. Oh, and it’s authored by an individual with the same name as mine.
Also you can look up our programs on the Internet. My center for Binge Eating Disorder is at www.FitRxBrentwood.com and our parent company, which has numerous facilities for the treatment of drug and alcohol addiction, can be found at http://americanaddictioncenters.org.
Also, if you would like to be included on a “free” weekly newsletter (no ads or promotion, merely a translation of the latest neuroscientific information into layman’s terms), please contact Marianne Messina at firstname.lastname@example.org. Just place “Dr.Carson’s Newsletter” in the subject line, and your name and email in the body, and it will come to you.