Albert Einstein is reputed to have said, “The brain that causes the problem cannot solve the problem,” yet we still expect addicts to make decisions that reflect normal thinking.  Using alcohol or other drugs repetitively changes the brain – both its structure and its function – in ways that persist long after the drug use has ended.  It is a common belief that when addicts are sober their thinking is normal, and their brains are altered only when they are actively using drugs.  But, the addicted brain does not return to normal between periods of alcohol or other drug use.  Many changes in the brain take months and even years to reverse themselves.

            Anyone with a close relationship to an alcoholic or addict is astounded over and over again by what seems to be a disregard for personal responsibility.  However, addiction basically robs the addict of the ability to be consistently responsible.  Similarly, it is assumed that negative consequences will eventually turn addicts around (“hitting bottom”), but their brains are ignoring consequences because of the structural changes in those brains.

            Research on methamphetamine and cocaine shows that these drugs stop brain cells from growing stronger and building more complex communication networks.  As a result, addicts don’t learn from their experiences.  The capacity to learn is blocked even after the drug use is stopped.

            For addicts, recovery is not simple abstinence.  It’s about healing the brain, remembering how to feel, learning how to make good decisions, becoming the kind of person who can engage in healthy relationships, and becoming willing to accept help from others.  Addicts cannot identify their own delusional thinking.  The identification – and the motivation to get help – must come from outside the addicted brain.

            Recovering from addiction is never easy.  Success in addiction treatment is a function of time in treatment, and time in treatment is often a function of coercion – being forced into treatment by a loved one, the criminal justice system, workplace requirements, or medical intervention.  Research indicates that 3 months in treatment (outpatient and/or residential) is the minimum threshold for addiction treatment to be effective.  Longer treatment is even better.

            Families begin to worry about relapse before addicts are discharged from treatment.  These fears are well-founded.  The decision-making regions of the addict’s brain are still defective.  Judgment is poor.  The ability to weigh risk against benefit is faulty.  These brains still have trouble learning from past mistakes.  Understanding the limitations of the addicted brain in early recovery makes it easier to understand the first rule of recovery, “Just follow the directions!”  In other words, you can’t trust your own brain.