A recent study in the American Journal of Psychiatry (Blaine et al, 2020) looked at the decision-making process in people with alcohol use disorder as it changes over time during abstinence. Essentially what it showed was that in people with alcohol use disorder, there is a disruption in the circuit of the brain that is linked to decision making, and the closer it is to their last drink, the more disruption. The research involved imaging studies which allowed them to assess the level of disruption and determined that the severity of disruption lessened the longer the subjects abstained from alcohol. The hope is that they will be able to use these imaging studies to assess those who are at highest risk for relapse which could help guide the level of treatment intensity, especially in early recovery.
Ultimately the goal would be to develop medications that could target these areas of the brain, but we are a long way from achieving such a treatment.
What this means is that the longer you abstain from your drug of choice, the more these circuits that disrupt your decision making will heal, and at least in theory, the less likely you are to relapse. This is a concept that is discussed at nearly every AA meeting as we hear from people in recovery who have years and years of sobriety as they articulate how the process slowly becomes less difficult. There is always benefit in being able to apply objective data to this concept and reinforce one of the more important ideas of recovery, that this will get easier with time. Especially for those in early recovery, the more they can buy into this idea, the more likely they are to push through the more difficult days.
The other concept that this study addresses indirectly is that when you relapse, these areas of your brain are again affected, and this increases the likelihood of poor decision making, and further exacerbating your relapse. This is why it is so important to have a sober community that can help you through a relapse. Because although relapse is a part of recovery, when you are in the midst of it, it can be an extremely vulnerable time, and it can be very difficult to recover once those pathways have been altered, and you are back into your previous habits and ways of thinking.
It is an important part of early recovery to understand that your thought processes and judgement have been severely disrupted by drugs and alcohol, and the healing process unfortunately takes time. It is wonderful that we are starting to see more attention being given to early recovery, as it is such a challenging time to get through. Just to have the knowledge of understanding what is going on with your mind and body as they heal can be very beneficial in your recovery.
Blaine, Wemm, Fogelman, Lacadie, Seo, Scheinost, Sinha Association of Prefrontal-Striatal Functional Pathology With Alcohol Abstinence Days at Treatment Initiation and Heavy Drinking After Treatment Initiation The American Journal of Psychiatry 28 Aug 2020 published online
