Molecular Neurobiology of Addiction Recovery: The 12 Steps Program and Fellowship

98 Pages·2013·3.26 MB·English

by  Kenneth Blum

SPRINGER BRIEFS IN NEUROSCIENCE
Kenneth Blum · John Femino
Scott Teitelbaum · John Giordano
Marlene Oscar-Berman · Mark Gold
Molecular
Neurobiology of
Addiction Recovery
The  Steps Program
and Fellowship
SpringerBriefs in Neuroscience
For furthervolumes:
http://www.springer.com/series/8878
Kenneth Blum John Femino
•
Scott Teitelbaum John Giordano
•
Marlene Oscar-Berman
•
Mark Gold
Molecular Neurobiology
of Addiction Recovery
The 12 Steps Program and Fellowship
123
Kenneth Blum JohnGiordano
Scott Teitelbaum Department of Holistic Medicine
MarkGold G&G Holistic Health CareServices, LLC.
School ofMedicine North Miami Beach, FL
McKnightBrain Institute, USA
University ofFlorida
Gainesville, NY MarleneOscar-Berman
USA Neurology,Anatomy andNeurobiology
Boston UniversitySchool ofMedicine
JohnFemino Boston,MA
Meadows Edge RecoveryCenter USA
North Kingstown,RI
USA
ISSN 2191-558X ISSN 2191-5598 (electronic)
ISBN 978-1-4614-7229-2 ISBN 978-1-4614-7230-8 (eBook)
DOI 10.1007/978-1-4614-7230-8
SpringerNewYorkHeidelbergDordrechtLondon
LibraryofCongressControlNumber:2013936533
(cid:2)TheAuthor(s)2013
Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartof
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionor
informationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar
methodology now known or hereafter developed. Exempted from this legal reservation are brief
excerpts in connection with reviews or scholarly analysis or material supplied specifically for the
purposeofbeingenteredandexecutedonacomputersystem,forexclusiveusebythepurchaserofthe
work. Duplication of this publication or parts thereof is permitted only under the provisions of
theCopyright Law of the Publisher’s location, in its current version, and permission for use must
always be obtained from Springer. Permissions for use may be obtained through Rights Link at the
CopyrightClearanceCenter.ViolationsareliabletoprosecutionundertherespectiveCopyrightLaw.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexempt
fromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse.
While the advice and information in this book are believed to be true and accurate at the date of
publication,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityfor
anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with
respecttothematerialcontainedherein.
Printedonacid-freepaper
SpringerispartofSpringerScience+BusinessMedia(www.springer.com)
To
Our Children and Grandchildren may they
all live a life free of the pain and shackles of
addiction:
Jeffrey, Seth, Moses, Jia, Steve, Kimberly,
Kyle, Cameron, Nate, Jonah, Sarah, Eric,
Jacob, Dahlia, Athena, Amaron, Jenna,
Justin, Sebastian, Jesse, Giselle and Richard
Preface
The lead author of this manuscript believes that the emotional attachment of
recovering addicts to 12-step programs deserves special attention. It is important
that the readership of this Neuroscience Brief realize that our attempt to describe
thescientificunderpinningsofthispowerfulprogramwillinnowayreducerespect
for these concepts. The concepts developed not only by ‘‘Bill W.’’ (William G.
Wilson), but by other notables such as ‘‘Dr. Bob’’ (Robert H. Smith) and the
Oxford Group, have evolved based on empirical experiences of what worked for
the Alcoholics Anonymous (AA) and later Narcotics Anonymous membership. It
is with great respect and admiration that we as a group have come together in an
attempt to associate each of the 12-steps with molecular, biological, and in some
cases, neurogenetic explanations.
It is quite remarkable that Bill W., along with others, fought arduously against
all odds to deliver the 12-step message and fellowship to alcoholics starting in
Ohio, St. Louis, and New York. It is ironic that in 1939, when the Works
Publishing Company, owned by a few investors through the purchase of stock,
published the Big Book (Alcoholics Anonymous: How Thousands of Men and
Women Have Recovered from Alcoholism), the response was less positive than
expected. The end result was that Bill W. and his wife Lois lost just about
everythingincludingtheirhouse.However,realizingthatthe12-stepprogramwas
indeed saving lives, Bill W. never gave up!
ItshouldbenotedthatBillW.continuedtosmokethroughouthisrecoveryevenat
76 years of age, while dying from emphysema in the winter of 1971. From a
neurologicalperspective,nicotine,sugar,andcoffeeactivateandreleasedopamine
inthenucleusaccumbensrewardsiteofthemesolimbicsystemofthebrain.While
notminimizingtheeffectAAalsohadonhisrecovery,certainlythedepressionBill
W.sufferedduringhisrecoveryfromalcohol,a17-yearbattle,wasindeedreducedby
the continued use of all these substances. As a neuropharmacologist, I am also
interested in Bill W.’s effort to combat alcoholism through biology. When he
experimented with both LSD and Vitamin B3 (Niacin) therapy, many in the
fellowshipweredismayedwithhishopetobiologicallyassistalcoholicstogainrelief
fromtheiraddiction.Inthemid-1980s,Iwasseekingsupportforanearlierversionof
a natural dopamine D2 agonist from the AA community and was similarly and
emphaticallyturneddownbytheexecutiveofficersinNewYorkCity.
vii
viii Preface
In an effort to expand our scientific understanding of how the 12-step program
and fellowship saves lives and assists the people doing the work to better under-
stand the role of neuroscience in addiction, we have attempted to link the
remarkable benefits of each of the 12-steps with the science of molecular neuro-
biology and neurogenetics.
ItisimportanttonotethatalthoughthebookreferstoAA,duetounderstanding
the shared neurological mechanisms between alcohol, drugs, nicotine, food and
other behavioral addictions like, internet, gambling, sex and shopping, although
there are some differences, the term AA has been used interchangeably with NA
and any other behavioral self-help programs based on the 12 step and fellowship.
Acknowledgments
TheauthorswouldliketothankKarynHurley,ExecutiveDirectoroftheNational
InstituteofHolisticAddictionStudiesandPamelaGraham,adrugabusecounselor
at Malibu Beach Recovery Center for their very knowledgeable comments and
remarkable spirit. The authors are indebted to the superb editing of Margaret A.
Madigan,andfortheinsightfulandinvaluableinputfromBenThompson,aPh.D.
candidateat BostonUniversityanda12-step philosopher.Theauthorswouldlike
to specially thank the following for their unconditional support: B. William
Downs, Roger L. Waite, James Heaney, Mary Hauser, Thomas Simpatico, David
E. Smith, Joan Borsten, and Eric R. Braverman. Marlene Oscar-Berman is the
recipientofgrantsfromtheNationalInstitutesofHealth,NIAAA(RO1-AA07112
and K05-AA00219) and the Medical Research Service of the US Department of
Veterans Affairs.
ix
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Alcoholics Anonymous/Narcotic Anonymous . . . . . . . . . . . . . 6
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2 Molecular Neurobiology of Recovery with the Twelve Steps . . . . . 11
2.1 Step 1: We Admitted that We were Powerless Over
Alcohol—that Our Lives had Become Unmanageable . . . . . . . 11
2.1.1 Loss of Control (Powerlessness) and Molecular
Neurobiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.1.2 Unmanageable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.2 Step 2: Came to Believe that a Power Greater than
Ourselves Could Restore Us to Sanity . . . . . . . . . . . . . . . . . . 18
2.2.1 Genospirituality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.2.2 Sanity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.2.3 Development of a Genetic Map to Identify
Individuals at Risk for Impaired Judgment . . . . . . . . . . 26
2.3 Step 3: Made a Decision to Turn Our Will and Our Lives
Over to the Care of God as We Understood Him. . . . . . . . . . . 28
2.3.1 Will/Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2.4 Step 4: Made a Searching and Fearless Moral Inventory
of Ourselves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2.4.1 Brain Reward Circuitry Impairment During
Protracted Abstinence. . . . . . . . . . . . . . . . . . . . . . . . . 33
2.5 Step 5: Admitted to God, to Ourselves, and to Another
Human Being the Exact Nature of Our Wrongs. . . . . . . . . . . . 38
2.5.1 Understanding the High Mind. . . . . . . . . . . . . . . . . . . 38
2.5.2 Insights into the Mystery of Anxiety and Aggressive
Behavior of the Alcoholic. . . . . . . . . . . . . . . . . . . . . . 43
2.6 Step 6: Were Entirely Ready to have God Remove
All These Defects of Character . . . . . . . . . . . . . . . . . . . . . . . 44
2.6.1 Honesty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
xi
xii Contents
2.7 Step 7: Humbly Asked Him to Remove Our Shortcomings. . . . 47
2.8 Step 8: Made a List of All Persons We had Harmed,
and Became Willing to Make Amends to Them All. . . . . . . . . 50
2.8.1 Friendship. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
2.8.2 Families . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
2.8.3 Happiness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
2.9 Step 9: Made Direct Amends to Such People Wherever
Possible, Except When to do so Would Injure
Them or Others. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
2.10 Step 10: Continued to Take Personal Inventory and When
We were Wrong Promptly Admitted it. . . . . . . . . . . . . . . . . . 59
2.11 Step 11: Sought Through Prayer and Meditation to Improve
Our Conscious Contact with God, as We Understood Him,
Praying Only for Knowledge of His Will for Us
and the Power to Carry that Out . . . . . . . . . . . . . . . . . . . . . . 63
2.12 Step 12: Having had a Spiritual Awakening as the Result
of These Steps, We Tried to Carry this Message
to Alcoholics, and to Practice These Principles
in All Our Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
3 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87