When is Someone “Cured” of Addiction?

It's a great question, isn't it? How long do I have to stop drinking or using drugs before I'm no longer addicted? Unfortunately, the science and experience tell us that we are never cured. However, being aware of the ability of addiction to flare up at any time is a key requirement for life-long successful recovery from addiction or alcoholism.

When I was in medical school, I thought that addiction was simply a matter of stopping to drink or use. However, having experienced it myself, I now know that it's not so cut and dry. And the science behind the brain changes that occur in addiction tells us why.

It is typical of the psychology of addiction that the brain tries to convince us that we are able to drink or use again after we've been in recovery for a while, that THIS time it will be different. But, it seldom works out that way.

The science backs up this "insanity" of addiction/alcoholism. Studies published by the U.S. National Institutes of Health have consistently shown that only about 9% of people with an addiction are capable of one day controlling their drinking or using when they are in recovery.

So, while there is no "cure" per se, with a little work people get a daily reprieve from addiction, and live long and healthy lives without the obsession of drinking or using. And it gets easier. By understanding how the mind learns addictive behaviors, we can find out how to "un-learn" these destructive tendencies and obsessions.

Alcoholism and Addiction Are Learned Behaviors

We learn to associate drinking or using with being high, having a good time, feeling a relief from obsession, and relief from our problems. Even when we reach the point where drinking or using is no longer fun, the mental association is there. However, we also learn to associate things that go together with drinking or using - such as certain people, places, or things - with the relief we once got from drugs or alcohol. 

The behaviors associated with the compulsive use of drugs or alcohol are deeply embedded in our brain physiology through a process known as conditioning, also known as learning. We learn the behaviors of addiction/alcoholism by a pairing of the behavior with a reward, a process known in psychology as classical conditioning. This is the “Pavlov’s dog” effect, where a neutral stimulus – such as the sight of the face of a drinking buddy or a street where our favorite watering hole or our dealer is located – elicits a response, in this case a memory of drinking or using, because in the past it has been paired with our drinking/using. For example, whenever, in our drinking days, we saw that street or that drinking buddy’s face we were soon after getting our obsession satisfied and experiencing the euphoria of the alcohol. We associate these things with the “fun” part of drinking or using, our pleasant memories.

"Damn learning!"

We do not associate these cues with the bad things, because they are not present when we are sick and hung-over, fighting with our loved ones, being chased by bill collectors. The "good" part of drinking or using – the high, relief of our obsession, and relief from our worries – occurs immediately when we see our cues, but the bad parts – hangover, guilt, withdrawal – occur the next day. We associate the cue with the part that happened right away - getting high or drunk - not the part that happened the next day. So, whenever we see these things in our sober days, they cue pleasant memories. Any alcoholic or addict will know how insidiously compelling these triggers can be. Classical conditioning is a powerful way that our brain learn, and it is repetition-based. The multiple repetitions of our substance use embeds these learned cues deeply in our mind. Usually for a lifetime.

These are our trigger memories, and the scary thing is that these memories are an unconscious process requiring no effort, so we have no control over them. Memory studies have shown that distracting ourselves at the time of recall can slow the recall process, but doesn’t stop the memory or reduce its strength. So, reading a book, watching a movie, going for a walk will not derail these cued trigger memories when they occur. Learning is a relatively permanent change in behavior resulting from experience, so this substance-taught learning is no small barrier to recovery. Unless we can undo these learned triggers we will experience them long into our recovery. Now let’s find out how to “unlearn” this monkey on our back.

We Have to "Unlearn" Addiction

A learned association, in this case seeing a face or location that we associate with pleasant drinking/using memories, can naturally diminish when we stop reinforcing the learned association in sobriety. In other words, when we abstain from using or drinking the learned association with our triggers will begin to fade. This is known as extinction, but this process is very slow and drawn out if not helped along, because these cues have been learned by the brain over and over again. Even if the learned association does fade, spontaneous recurrence is common. But, they can be unlearned. Our “new people, places, and things” slogan leads us to avoid triggers that may make us drink or use, but it also taps into what science calls cue-dependent forgetting, which is the decay of memories when the cues that trigger them are no longer there. There is solid science behind that old slogan.

Another recovery slogan: “remember when” teaches us to make sure we think of all the misery that our drinking or using brought on, so as to replace the dominant memories of the good times. This deceptively simple slogan brilliantly taps into science’s other effective technique for deleting undesired learning. This technique is known as interference. Interference is self-explanatory: when one memory (the bad times when we drank or used) gets repeatedly recalled it disrupts another memory (the good times). This effect is magnified if we recall the preferred memory whenever the unwanted memory tries to assert itself. However, this process won’t occur on its own, as our mind is still geared toward remembering the good times. So, it takes some work on our part, and we must actively “remember when.” Unlike the process of extinction, which is slow and incomplete, unlearning harmful memories by interference is powerful and prompt, and can have a robust effect on defeating our alcoholism-addiction.

By far the best way to engage this potent memory interference process is by meditation. Here is a guide for how to meditate and how to use that meditation to "unlearn" addictive behaviors (Click Here). Please try it. Speaking from my own experience, as hopelessly addicted to drugs and alcohol as I was, I attribute my ability to rid myself of my obsession, cravings, and thoughts of drinking and using to my meditation in early recovery. Even now, years on, if those thoughts sneak back into my head, I revisit the same meditation techniques. It also helps keep me from allowing life to get under my skin, which was my greatest trigger to drink or use.

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The Changes in the Brain from Addiction Can be Switched Back On

As we repeat the thought processes and behaviors of addiction, the brain pathways involved become increasingly stronger. Because most people spend a lot of time, energy, thought, and emotion on their drug or alcohol use, these addiction brain pathways become very deeply embedded in the brain. Especially for those who spend years in active addiction. I liken these pathways to a deep groove cut into a vinyl record. Whenever the needle hits that groove, it becomes trapped and follows the groove all the way through to the end.

Once we are in recovery, that groove dulls a bit with time, but it's always going to be there. During my research into addictions, I have met hundreds of addicts and alcoholics who have relapsed after years in successful recovery, and their story repeats itself time after time. I hear the same thing from them all: they took a drink, or a hit, and very quickly ended up exactly where they were before. They are always surprised at how quickly they ended up back using or drinking the same amount or more as they did when they were in active addiction, even after years of abstinence.

Memory formation is also called learning, and we discussed classical conditioning: a type of learning where a cue – such as a place or person or smell associated with our substance use – will trigger positive thoughts and lead us to crave our substance. There is another type of learning that is also a formidable roadblock to our recovery: this learning is called operant conditioning. Here, we learn to associate a behavior with a reward. In our case, when we do what we do to obtain our poison – jump in the car and drive to the liquor store, or a bar, or a drinking buddy’s house, or our dealer’s house, or the casino – we soon associate it with the rewards we get from our intoxicant: relief from our obsession, euphoria (dopamine release), relief from our stressors.

When we are in recovery and something stresses us or we are having cravings, our mind is inclined to recall the memories of the pleasant effect that result from our substance-obtaining behavior, and it tries its best to compel us to do that behavior as it seeks relief from that stressor. This is what happens when people say that something stressful happened and they found themselves almost unconsciously driving to the liquor store. This learning occurs from positive reinforcement, which means that our behavior of obtaining our intoxicant becomes associated with a reward: the pleasant aspect of our drinking or using. There is no negative reinforcement, which would make us learn to avoid that behavior, because the sickness and pain and remorse comes much later – the next morning – and is therefore not associated with the behavior. That is why we must make that association between the substance-seeking behavior and the misery. Otherwise, our mind will have an on-going reflexive desire to carry out the substance-seeking behavior, and our sobriety is in peril.

Science has identified that emotions can strengthen the formation of memory, and that they can also influence our recall of these memories. Emotionally-charged events are imprinted on our memory strongly. We remember vividly the birth of our children, a house fire, a big argument. Emotions can be one of those cues that brings about a trigger memory. Specifically, the more down you feel, the more likely you are going to remember unpleasant memories. The better you feel, the more likely you are to experience the pleasant memories. This explains why so many people have described life being "too good" as a trigger to relapse. It also explains part of the danger of the “pink cloud” effect that many of us experience in early recovery. (To read about the "Pink Cloud Effect" of recovery, Click Here). Again, the learned association (by our meditation) between our substance and the misery it caused can prevent this mental tendency from allowing our addiction to get the edge.

Let’s take a breath and summarize the way our disease uses our innate memory processes against us in recovery. Pleasant memories are remembered better than unpleasant ones (in fact, our brain has mechanisms for blocking out unpleasant memories), emotionally charged memories are remembered better than boring ones, and unpleasant memories fade much faster than do pleasant ones. So, in the end, we are much more likely to remember the pleasant aspects of our drinking or using, because they are more firmly implanted in our memory, they are likely to come up spontaneously even when they are unwanted, and they can persist much longer than other memories, haunting us many years into our recovery. Science and experience show that our greatest tool for taking this memory advantage away from our disease and seizing it for ourselves is by our “remember when” meditation.

When these memories of our substance-using days come up, the danger lies in what our mind will do with them. Many people somehow think that if they take that first drink or drug, this time it will be different. This time, we’ll be able to drink, or use, or gamble responsibly. This is crazy thinking! We have all tried countless times to control our use of our substance, over and over again, and have failed every time. That is why this thinking is known as “the insanity of alcoholism-addiction” (Click Here to learn more about this). This thinking is simply our mind rationalizing, trying to manipulate us into getting it its dopamine fix. Insane and illogical as it is, it occurs and it pushes many back down a dark and familiar path.

Keeping your Head in the Game

One of the reasons that support groups are helpful in helping people overcome certain problems - like addiction and alcoholism - is because they serve as a constant reminder of "who we are." When we are in recovery from substance use, we are privileged to be able to live like "normal" people again. As time goes by, the memories of the "good" parts of drinking or using become stronger, and the memories of the bad weaken. We can easily talk ourselves into partying a little, thinking it will be different this time. However, it has been the vast experience of people with addictions that they quickly end up right where they were before, even worse. Large studies from the U.S. National Institutes of Health (NIH) have shown that for alcoholics, 91% are never able to drink responsibly again, even after many years in recovery. The perecentage is probaly even higher for people with drug addictions.

By starting each day with a little self-reminder that we are people with an addiction, and that we can remain healthy and happy as long as we abstain, we keep our head in the game. By being part of a recovery support group or by keeping in close touch with other people in recovery, it helps us to keep this in our mind, and helps keep us from our mind playing tricks on us. We must not forget that we have the problem of addiction embedded in our brain, and that we must remain abstinent in order to live life like everyone else. It's who we are.

Although there is therefore no "cure" for substance addiction, people live long and healthy lives in recovery.