In 1949 neuropsychologist Donald Hebb introduced his oft-cited maxim, “Neurons that fire together, wire together,” and thus ignited the then-radical but now well-established concept of neuroplasticity. Neuroplasticity is the model of brain “re-wiring” once thought impossible. What has come from this science is that the brain is incredibly “plastic”, that is, changeable. Thus, retraining the brain via “exercise” is now a crucial part of therapy for dementia, stroke paralysis, and impaired cognition from these and other illnesses. Neurons that used to fire together, but no longer do, can be retrained to do so again.
Neuroplasticity in Action
As you read this very article, you are establishing new connections (synaptic networks) among the neurons in your brain. Your brain is now different than it was before reading it. If you re-read the sentence, it will fire the same synapses again, strengthening the bonds among them. It used to be accepted that the brain was hard-wired. Now, with the acceptance of neuroplasticity, we know that is far from the reality. Stroke victims have learned to re-route their synaptic networks to restore function to an affected limb. Re-enacting imagery in the mind has helped people to perform physically thereafter. And brain exercise has improved attention, executive function, memory, and even intellectual processing speed.
It has been determined that envisioning an action uses the same neurons as the ones that fire to actually perform that action. Mindful exercise (“effortful learning”) helps solder the neural networks for better retention. This has been used to advantage in athletes who simply imagine their athletic routines daily and nightly, with measurable improvements noted the next day. This portends well for re-establishing dormant neural circuits that have been blunted by illness or addiction.
The Nature of Addiction—Destructive Re-wiring of the Brain
Addiction is a destructive re-wiring of the brain in that it does so at the expense of the brain functions cited above. Just as neurons that fire together, wire together, the brain is also a “use it or lose it” architecture of neuronal networks.
The addicted person is on a mission: to acquire a substance upon which he or she is dependent—at any cost, be it financial, social, marital, legal, or physical risk to self. Dependence is closely linked to tolerance, that is, the need for more drug to render the same effects. For alcohol addiction, there is the additional damage to the liver, heart, and kidneys that add extra morbidity to an already dangerous condition.
The addicted brain, likewise, is on a mission: to keep releasing dopamine more and more as the addiction down-regulates the dopamine receptor sites over time. This meddling in the areas of the brain for emotion and memory—and their connections with the pre-frontal cortex—will dominate the primary brain mission—to think clearly.
Addiction and cognitive problems are problems circling in a chicken-and-egg loop. Those with cognitive challenges, i.e., ADD, PTSD, depression, anxiety, trauma from birth injury, mental illness, genetics, childhood trauma (adverse childhood events), etc., are all at increased risk for addiction. The genetic predisposition to addiction and substance abuse will often reveal it to run in families.
On the flip side, persons suffering addiction can develop these same cognitive deficits due to the addiction that ravages their neurophysiology. Thus, addiction is a spiral downward at both the physical and the cognitive level, and it becomes bigger than what the individual can address. Whether the chicken or the egg is seen as the driving force, it is more important to address both simultaneously for any solution to be viable.
Solutions for Addiction
Addiction is a multifactorial affliction which creates a perfect storm of concurrent disorders (mental illness with physical dependence), often with life-threatening sequelae either from continuing down the self-destructive spiral or from withdrawal when drugs, funds, or legal freedoms stop. For this reason, the solution must also be complex.
- The first solution is the addicted person’s self-identification of his or her problem. Alternatively, an intervention may be necessary.
- Once under care in an appropriate facility, the medical needs from weaning the involved substance are first and foremost.
- Once that danger subsides, the psychological dysfunction can be treated.
- Thereafter, ‘aftercare‘ becomes important, to preclude remission via group/family therapy and training to avoid or navigate through the triggers that can result in relapse.
There is often overlap between the physiological and psychological, so they may not follow in discrete steps, but more likely a continuum in a facility familiar with addressing both. Finally, re-wiring the brain to regain cognitive skills that have been blunted by the toxicity created by the addiction.
New Technology to Interface with the Brain’s Ability to Re-wire
Brain exercise and brain training such as with the NeuroTracker training protocol can help re-establish those brain circuits that have decayed from an imbalanced onslaught of dopamine and other addiction neurotransmitter aberrations. As such, addiction is one sphere in which NeuroTracker training is very useful as a technology that can assess and improve many factors of brain function: attention, executive function, memory, and processing speed. With the NeuroTracker cloud-based technology, progress can be supervised and tracked.
Whether used in wellness, performance, learning, or addiction, it gives the brain the neural prowess that is either lacking or which needs improvement. It has proven useful in decision-making under changing circumstances, which can help prevent relapse when a rehabilitated person encounters triggers after treatment.
According the journal, Basic Clinical Neuroscience, “Cognitive rehabilitation could be considered as an efficient supplementary treatment approach that can be used in addiction medicine (and) neurocognitive impairments in substance users.”
NeuroTracker allows mental exercises to improve learning abilities for those with learning difficulties, currently in use at McGill University, Université de Montréal, the University of Victoria, the University of Regina, Université Paris Sud, the University of Iowa, and others. It is used to lengthen both attention span and enhance the depth of attention and has been implemented in both medical and sports partner organizations.
With reinforcement that strengthens the gains of neuroplasticity, combined with good sleep hygiene, it helps make new or restored skills migrate from short-term memory to long-term memory, and ultimately, into the subconscious itself. Such things that were once automatic (e.g., driving, day-to-day logistics and time management, and sports coordination) but had been lost, can be restored. The technology can also interface with several participants such that entire groups can be followed in a unified supervision and then compared and contrasted between the individual and the group.
By strengthening the neural circuits that are obtunded by addiction, their restoration aids in fighting the addiction itself. Cognitive training can recruit the brain’s reinforcement to counter the mental problems associated with addiction. Behavior is so crucial to rehabilitation, that unless the cognitive problems are addressed, too, the program can be doomed for failure.
Although addiction cannot be “cured,” cognitive retraining will be seen as a crucial component of preventing relapse due to the blunted sensorium with which addiction is associated.
About Dr.Gerard M. DiLeo
Dr.Gerard M. DiLeo is a medical reviewer and contributor for Addictions.com. He is a medical doctor, and Certified Life Care Planner. Dr.DiLeo is also a published health author for McGraw-Hill, as well as has contributed health articles to newspapers and regional magazines for over 30 years. He was in private practice in the New Orleans area during these years, serving as Chief-of-Staff at a regional hospital twice.
Dr.DiLeo was the Director of Pelvic Pain at the University of South Florida where he treated intractable pain and helped patients navigate the opioid pitfalls of chronic pain management. He also was a member of the American College of Pain Medicine and International Pelvic Pain Society. He is an inventor (catheter stethoscope) and innovator in pain management, authoring guidelines for those at risk for addiction and introducing successful interventional pain protocols into the problem of pelvic pain, which has traditionally sidestepped such interventions in lieu of major surgeries.
Dr.DiLeo was in academic practice for five years, lecturing medical students, residents, and attending staff on chronic pain, from the classroom to the Grand Rounds theater to continuing medical education for primary physicians and specialists in private and hospital practice. He is currently writing full time for professionals and laypersons alike, backed by his lengthy experience in pelvic dysfunction specifically and pain management in general.
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