Pathological Learning
An aspect of the disease of addiction 

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One of the most problematic aspects of maintaining recovery is the long-standing cravings to use the medication.  Months or years later, people still find themselves thinking about the drug or suddenly wanting the drug for no explicable reason.  It seems that the triggers to use are extremely pervasive and difficult to ignore.  And what's more, it seems that our desires to use occur without triggers.

To understand this, one must understand learning.  If you remember, way back in high school, you learned about classical conditioning.  Dr. Pavlov trained his dog to salivate to a bell.  By pairing a bell when he gave the dog a steak, the dog learned that the bell meant food.  The bell was a "trigger" for the dogs response which was salivating.  The learning was rewarded (reinforced) by the meat. 

When applied to drug use, a trigger might be a person, place or feeling and the response is the craving for the drug.  The drug "high" is the reinforcement for the learning. 

Normal learning process relies on internal reward.  Dopamine is the chemical that rewards us when we learn.  The first time we eat at a good restaurant, or get an unexpected reward such as being paid as a kid for shoveling a driveway, we experience a sense of pleasure from an unanticipated reward.  We also learn to repeat the behavior.  Dopamine release moderates this response.

But after a while, we no longer get the same pleasure.  The food may be good but we expect it to be.  We expect to be paid when we shovel the snow and may no longer look foward to shoveling snow as much.  The reason this feeling wears off is that dopamine no longer flows.  Once a behavior is well learned, it is no longer associated with dopamine release.

Now, if the food turns bad or if we no longer get paid for our work, we quickly learn that our behavior is no longer rewarded.  We stop it.  The behavior is extinguished.

However, when we use drugs, the dopamine surges are much higher and much more prolonged than what occurs naturally.  Also, even after the 500th time using a drug, there is still dopamine release.  This means that the stimulation to learn is huge.  The behavior becomes so well learned we cannot unlearn it.  Not after we learn about how much pain is associated with drug use, not after we spend months or years away from the drug.  This is pathological learning.

Triggers can be quite subtle.  A study was once done on alcoholics.  They were given a video to watch with no apparent alcohol references.  Than, images were flashed for a fraction of a second in a process consistent with subliminal advertising.  The alcoholics could not describe what they saw, and were unaware of the images.  Yet, they developed significant alcohol cravings.  The pathologic learning process resulted in an excess response to even a minimal trigger.

We don't need to despair, the responses can be unlearned (extinguished).  The first time an alcoholic in recovery walks by the bar, he will fight the urge to go in.  But the 500th time, the cravings will be less.

However, one needs to be exposed to the trigger to extinguish the response.  Thats why some patients relapse even after they have been away from home for months or years.  They never learned to get used to a specific person, or a specific area of the neighborhood.  They also need to learn new behaviors and responses to these triggers when they get home. It is doable but is difficult and takes time.

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Stuart Wasser
11/10