Why choosing to go to treatment is often more challenging than it seems

Last week my blog post explored different approaches to seeking treatment and how various factors in a person’s life – family, work, legal pressures – might convince or compel them to attend treatment for a substance use disorder (SUD). This week, I will continue with this topic, looking more closely at the factors that influence a person’s ability to seek treatment for themselves.

The main questions at the heart of both of these blogs are:

• Does a person have to want to go to treatment in order to begin the journey to recovery?
•  Why is taking the first step toward recovery so difficult for so many people?

These are not easy questions to answer, though many have tried.  There is no denying that it is often incredibly challenging for a person with a substance use disorder to admit that they need help, let alone take steps toward getting treatment for their mental health condition. It is also true that, in many cases, the impetus to seek help for an SUD does not initially come from within the individual who is struggling with it but from the outside in the form of an intervention at home or at work, a police intervention, or a court order.

Yet, for many, there remains a stigma surrounding treatment that is not entered 100% voluntarily. Many of us are unwilling to even try to persuade another person to enter a recovery program or seek treatment for their problems. For some, the lingering fear of burning family or friendship bridges or of forcing a loved one to do something against their will prevents any kind of intervention from taking place. For others, concerns around the ethics of mandating treatment under law makes court-ordered therapy or rehabilitation an unappealing or undesirable prospect. 

To overcome these fears, we must consider the different ways in which substance use disorder – as well as any other mental health condition – affects a person’s thinking patterns, often making it impossible for them to seek treatment of their own accord. This week, I will examine the reasons why individuals who are struggling with substance use disorder may be unwilling or unable to seek treatment for themselves and how we can use this knowledge to reframe our perception of treatment that is initiated by outside intervention.

Changed Brains; Impossible Choices

A person who is struggling with substance use disorder is not themselves. This is true, in fact, of any mental health condition because the nature of a mental health condition is that it changes a person’s thinking, feelings, or behavior (or all three) in ways that make it difficult to function as they would normally. [1] In the same way that a persistent high fever makes it challenging – if not impossible – to complete normal day-to-day tasks, think logically, or control one’s emotions, so too does a mental health condition. 

This is particularly true when it comes to SUD: neurobiology research has shown that alcohol and drugs dramatically affect brain chemistry. Within minutes of entering the body, these substances activate the reward circuitry of the brain and deliver a jolt of intense pleasure to the individual. If this substance use becomes routine, it takes a surprisingly short amount of time for the connections in the brain to be rewired to expect the jolt of pleasure. 

Over time, multiple brain regions that are responsible for judgment, decision making, learning, and memory begin to physically adapt to this new circuitry. The behaviors of the individual thus begin to reflect this new brain structure in which the pleasure derived from the substance is at the center of every circuit. [2] 

These changes to the structure of the brain are not permanent: fortunately human brains have a high degree of neuroplasticity, which means that their structure can change, grow, and shift over a lifetime to adapt to different environments, learn new skills, and account for changes to the body over time. [3] However, while in the grips of a substance use disorder, the pathways of a person’s brain will be organized in such a way that they feel compelled to seek out the substance over and over again, which is known as neuroadaptation. In addition, because the parts of the brain used for judgment and decision making are also neuroadapted, an individual will find it very difficult – if not impossible – to view treatment as a positive thing. [4] 

Help from the Outside: Important Interventions

Considering the biological reality of substance use, it is not surprising that SUD frequently prevents individuals from wanting to begin treatment or from even admitting that there is anything wrong. Looking at the neurobiological basis of substance use disorder also helps us understand why intervention – either at a family, friend, work, or state level – is not only a valuable way of helping an individual recover but also often a crucial tool for beginning the long process of overwriting the neural circuits that are structured over time by substance use. 

Occasionally, those around an individual who is struggling with an SUD may feel defeated by the knowledge that their friend’s or loved one’s addictions are wired into the brain. Research has shown that feelings of impotency or hopelessness are fairly common in those who view substance misuse as a biological issue. [5] However, the conviction that SUD is inevitable and unchangeable because it alters brain chemistry is not misguided because just as the brain changes to expect drugs or alcohol, it can also be retrained not to expect them. 

While an individual who is struggling with SUD may find it impossible to embrace this change, their friends, family, and wider community are not biologically affected in the same way. Therefore, outside suggestions of treatment (or mandates, in the case of an employer or a court of law) are often the best way to ensure that a person with diminished mental capacities can still get the help they need. 

If you or someone you know is struggling with substance use or a mental health condition, please contact us today. We are here to help.

Sources:

[1] National Institutes of Health (US); Biological Sciences Curriculum Study. NIH Curriculum Supplement Series [Internet]. Bethesda (MD): National Institutes of Health (US); 2007. Information about Mental Illness and the Brain. Available from: https://www.ncbi.nlm.nih.gov/books/NBK20369/

[2] Learn.Genetics, (2022). Drug Use Changes the Brain Over Time. University of Utah. https://learn.genetics.utah.edu/content/addiction/brainchange/

[3] Lebowitz, M.S. (2014) Fixable Or Fate? Perceptions of the Biology of Depression. Journal of Consulting Clinical Psychology. Jun; 81(3); 518-527. doi: 10.1037/a0031730

[4] Surgeon General, (2016). The Neurobiology of Substance Use, Misuse, and Addiction. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. US Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK424849/

[5] Deacon, B.J. (2013). The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review.