Obliterated, annihilated, wasted, gone. There’s a reason so many descriptions of heavy substance use and addiction make reference to a loss of self – because that’s what happens. We’re all familiar with the loss of certain things that are part of being intoxicated or high: the inability to remember events, the temporary loss of rational thought, the challenges in controlling one’s actions or emotions.
But other kinds of losses occur for people who are heavy substance users. And these losses are much more insidious and devastating – they are the ones that cut at the very heart of who someone is.
The loss of self that comes one drink or one pill or one toke at a time. Slowly and inevitably it happens.
How else can we explain the loving parent who drives their children to school intoxicated? Or the person who never thought they would exchange sexual favours for drugs? How about someone who gives up on a dream about sports or music or education because their substance use has escalated?
Neuroscience can help us understand this painful loss of self as well as providing some insight into what drives the behaviours that create such devastation in the lives of those who struggle with addiction. Substance misuse and addiction take a heavy toll on brain functioning and the complex systems that regulate our thoughts, feelings, behaviours, emotional response – even how our body functions.
Researchers explain that much of the power of addiction lies in its ability to hijack and even rewire brain circuits that are meant to help us survive.
Numerous Circuits Involved in Addiction
The negative impacts of substance misuse occur throughout the interconnected systems of our brain. The more someone misuses a substance or substances, the more significant the effect on their brain. Dr Nora Volkow talks about an “expanding cycle of dysfunction” where the adverse effects of substance use become progressive – more of life is negatively impacted as these brain systems are affected by regular use. It starts to explain how the chaos of addiction takes hold – and how the loss of self happens.
My previous post Pleasure Hijack: How Substance Use Hijacks Your Brain, explored the impacts of substance use on two vital brain circuits: the reward system and the stress-response system.
In Pleasure Hijack, I explain how chronic substance use impacts the process of addiction in these ways:
It desensitizes the reward circuit making pleasure and enjoyment more difficult to experience.
It increases the “anti-rewards” including painful emotional and physical states including anxiety, depression, shame, and irritability.
Chronic substance use leads to a heightened stress-response as well as decreased ability to handle stressors.
These changes in the brain help explain why those with a substance addiction struggle to cut down or stop using even if they desperately want to.
But the reward system and the stress-response system are not the only vital systems in our brain that are impacted by substance use – there are three other brain systems involved in addiction. We need to understand them if we want to have a good grasp on what contributes to addiction and what helps explain the loss of self it brings.
Self-awareness is the capacity to know of ourselves – it is knowing and understanding our own thoughts, feelings and motives as well as our personal strengths and weaknesses. Self-awareness includes the ability to identify our internal experiences such as emotions and bodily sensations. Another critical aspect of self-awareness is the ability to determine whether a situation is safe or unsafe.
Self-awareness is the capacity to have an accurate sense of who I am, how I am interacting with what’s around me, and what it’s like to be “me”.
Most people are familiar with the idea of “denial” – it’s often just a deficit in self-awareness. For those who experience addiction, this lack of self-awareness shows up in many ways:
They often cannot recognize the problem of addiction in the first place. “I’m fine.” “I’m not the one with the problem.” “It’s not that big of a deal.”
They tend to blame other things for the serious negative consequences they are facing. “My boss was a jerk.” “I’m just sick (rather than hungover).” “I’m being mistreated.”
There can be a lack of awareness about the life-problems creating the problematic use of substances. “I just like to party (rather than looking at the underlying issues like grief, trauma, or mental health issues.)
There can also be a lack of awareness about cues or triggers (emotional, situational, or relational) that trigger using. “It just happened.” “All of a sudden, I was at the liquor store.”
Many cannot pick up on cues of danger or risks associated with behaviours such as binge-drinking, safety issues like driving while impaired, or high-risk sexual practices that happen while under the influence of substances.
The struggle with self-awareness is widespread for those in addiction.
Less than 5% of people with a substance use disorder accurately perceive their need for treatment.
Only a small percentage of people who are heavy substance users define their using as problematic even when they face devastating negative consequences such as the loss of a job or relationship or serious health concerns from substance use.
This capacity for insight and self-awareness may be limited for a variety of reasons that include the direct consequences of heavy substance use on brain function. The research in neuroscience clearly shows how substance use and addiction hijacks and even rewires important brain circuits that are meant to help us survive – including the brain circuits responsible for giving us an accurate sense of self-awareness.
But other reasons contribute to challenges with self-awareness. A history of trauma is common among those with substance misuse and addiction disorders. The research is clear that a history of trauma (especially childhood trauma) negatively affects how the brain functions.
Trauma is also responsible for disruption in the sense of self that often exists for those with addictions.
Besides trauma, there may be co-occurring mental health issues that impact self-awareness. Anxiety and chronic stress also play a significant part in de-activating vital areas of the brain that contribute to accurate self-perception.
We need to be curious about the underlying reasons for lack of self-awareness rather than believing an addict “chooses” to ignore the problem.
We hear lots about self-regulation and how vital it is to our ability to function well. It involves all aspects of who we are: emotions, thoughts, behaviours, our physical body, and our relationships. Self-regulation is seen in a wide variety of daily experiences:
Our ability to feel but still have control over challenging emotions like anger or anxiety.
Being able to have healthy patterns with sleep, appetite, and other bodily functions.
Having tools to manage disruptive thoughts or impulses.
Having the ability to regulate unhealthy behaviours such as substance use.
Self-regulation is an essential function of the human self – it’s another crucial way we define ourselves. Self-regulation contributes to our sense of comfort or safety within ourselves – it helps us be “at home” within ourselves.
Here is where substance misuse and self-regulation collide: Those who have difficulties regulating emotional pain tend to engage in behaviours such as over-eating, smoking, substance use, or gambling as a way to manage their emotional distress.
Dr Bessel van der Kolk has extensively studied the connection between challenges with self-regulation and early childhood trauma. His research shows that early traumatic experiences can overwhelm a child making it more challenging to develop the ability to self-regulate their emotions, reactions, and thought processes.
Trauma also makes it more likely that someone will turn to substances or behaviours as a way of regulating painful emotional and physical experiences.
And this is how self-regulation and self-awareness collide: self-awareness is a necessary part of self-regulation. We have to be aware of our own emotions and experiences in order the regulate them. But using drugs or alcohol as a way of “regulating” challenging emotions and bodily states compromises self-awareness, which creates even more challenge in the ability to self-regulate. This is an example of “expanding cycle of dysfunction” Dr Nora Volkow speaks of as substance use progresses. It helps us see another way the chaos of addiction takes hold, and the loss of self takes place.
The ability to exercise choice is foundational to our sense of self – it allows us to alter our behaviour to meet specific goals or follow through on plan and values. It helps us follow through on healthy lifestyle choices like exercise or decreasing our junk food consumption. It allows us to act on our beliefs and values. Self-control also enables us to make decisions according to long-term plans rather than operating on the principle of instant gratification.
Ask any person with a substance use disorder if they “know” they shouldn’t use but they still do it anyways. This demonstrates the struggle with self-control for those in addiction.
Dr Nora Volkow, a leading neuroscience researcher in the field of addiction, outlines how repeated substance use leads to changes in the brain that alters a person’s voluntary control over their behaviours. The parts of the brain responsible for self-control are disrupted leading to a decreased ability to choose not to use. The frontal cortex, the rational part of the brain, works to control destructive or unhealthy actions. Addictive substances impair this self-control mechanism.
When someone has a craving to use, the areas of the brain that create the craving are activated while areas responsible for restraining unhealthy choices are deactivated.
This “hijacking” of the rational part of the brain happens entirely outside of conscious thought – it’s also the reason that willpower becomes useless. Once again, research shows us that the impacts of trauma and chronic stress also contribute to this “hijacking” process.
All of these changes in the brain help explain why those with addiction struggle to cut down or stop using even if they desperately want to.
But this isn’t the end of the story - recovery and healing of the brain is possible! Seek support, access treatment, or speak to a therapist who can help!