Lisa Frederiksen is the owner and brains behind breakingthecycles.com—a website and blog that exists to help end the stigma, misinformation and shame so often surrounding addiction. Lisa also conducts presentations, workshops and training programs at schools, businesses and rehab facilities across the country.
We were able to pull Lisa way from her busy schedule and drill her with important questions surrounding addiction and recovery.
I don’t think I’ve ever talked with someone so enthused about addiction and recovery. I think you’ll find her answers intriguing and motivating.
Addiction through a Loved One’s Eyes
A: In 2003 one of my loved ones went into residential treatment for alcoholism. This plunged me into a world of unfamiliar terms, the idea of co-dependency, accusations of enabling—which felt very judgmental—and the concept of alcoholism as a disease.
I quickly had a “fix them and we’ll be fine” mentality. So the idea that the family needed help was a huge surprise to me.
It was an overwhelming time. I found myself very angry, frustrated and feeling like, “I knew it. I knew it. I knew you needed treatment!”
At the time I was very involved in women rights advocacy, research writing, speaking and had published several books in those areas. I decided to shift those same skills into trying to understand what I was now living, not the least of which was to prove that addiction wasn’t a disease.
This was because years ago I’d struggled as a bulimic and anorexic for 12 years. But I had learned to “re-eat,” so I believed my loved ones (as I would come to accept, I had many loved ones and close friends who abused or were dependent on alcohol in my life) could learn to re-drink, after all you don’t need alcohol to survive.
A: Exactly, yes.
And that’s where the science of it all came in. It was incredibly freeing to realize, ‘wow, that’s how this all works’—and that they weren’t doing this to me because they didn’t love me. It was due to the brain changes caused by alcohol abuse and addiction; changes that changed their behaviors.
Seeing Addiction as a Brain Disease
Q: Clearly there is a lot more information on addiction and rehab now than there was in 2003. If you could take something back to your struggling family 11 years ago, what would it be? Why?
A: I’d tell them addiction is a brain disease.
That information freed my mind, and enabled me to let go of much of my anger, frustration and laundry list of wrongs the loved one had committed. When you realize that it was an impaired brain behaving that way, you’re able to separate the behaviors from the person you love.
Q: Those things seem to be a package deal. How do you separate a person and his/her behavior?
A: You need to understand that with the use of drugs or alcohol comes an entirely new brain.
Brain imaging technologies of the past 15–20 years allow us to now see that substance abuse and addiction change the brain, and it’s those brain changes that cause the behavioral changes.
And that’s because everything we think, feel, say and do is determined by how our brains are wired (how our brain cells talk to one another and to and from cells throughout the body via the central nervous system). Drugs and alcohol interrupt that “wiring”—that “talking,” if you will. So a brain with addiction means we’re dealing with a different brain that doesn’t work the same way.
So clarity for the addict | alcoholic comes by removing the substance and healing the brain.
Q: Define your thought process quickly for me. Was it ,“Ok, I forgive this person,” “Phew, there’s an excuse,” “Or, what a relief there’s a scientific explanation?”
A: The later one. And believe me, it isn’t instantaneous; it takes a lot of time and research.
But that’s what’s so fantastic about this new research: it helps all of us—the family, the addict | alcoholic and society as a whole—better understand the nature of this brain disease. It allows us to let go of the shame and stigma and the denial and anger.
Forgiveness will come with an understanding that there couldn’t have been any other outcome. So stop thinking about what your loved one could have done, and focus on addiction as the disease it is. This will give your loved one a great deal of power to heal their brain and live their lives in long-term recovery.
What Causes Addiction?
Q: Lots of questions have surrounded pinpointing what causes an addiction in the first place. Where should we place the blame?
A: Disease by its simplest definition is something that changes cells in a negative way. Breast cancer, leukemia, or heart diseases are obvious examples. When cells change in our organs, the health and function of that organ changes too.
How does addiction change the brain?
Addiction changes the way cells in our brain communicate, and that change starts with substance abuse chemically and structurally changing the brain. This in turn makes that particular brain more vulnerable to its risk factors, of which there are five key ones.
All drugs and alcohol reach the brain through the bloodstream. As chemicals, drugs and alcohol interrupt the brain’s normal chemical balance, which is how brain cells communicate with one another. When you interrupt that communication, you interrupt the way the brain normally works, which is what changes a person’s “normal” behaviors into what I call drinking | drugging behaviors—the insane, circular arguments; verbal, physical and emotional abuse; driving while impaired; making unwanted sexual advances; blackouts—anyone who has experienced a person’s drinking behaviors knows what I mean.
Risk Factors of Addiction
With the understanding that drug and alcohol abuse change the chemical and structural make-up of the brain, we can talk about the five key risk factors that lead to addiction.
(1) Genetics
Just as we are predisposed to eye color, hair color etc, we are genetically predisposed to differences that can change how our brain and bodies interact with drugs or alcohol—as well as how it’s wired (e.g. mental illness) or how it wires (e.g. during brain developmental processes). For instance, one person may genetically have higher or lower levels of dopamine, serotonin neurotransmitters or receptors, or lower levels of the enzyme in our liver that breaks down alcohol.
So it’s not that there’s an “addiction gene” identified yet, but there are genetic differences in how we, our brains, our bodies, interact with and process alcohol.
This is why it’s helpful to look into your family medical history. If a parent, grandparent or sibling has addiction, it increases the odds you may develop it as well.
(2) Childhood Trauma
We’re born with on the order of one hundred billion brain cells. We don’t come out behaving like adults. So we know our brain cells are wiring, adjusting and changing, in part, because of the experiences life brings.
If a child is growing up with verbal, emotional or physical abuse (i.e. versions of childhood trauma)—which is common in families with a parent who has undiagnosed or unhealthily discussed substance abuse—the insanity of trying to make sense of the trauma changes the circuitry development of that child’s brain and the way he/she interprets the world. This in turn can change how that child’s brain will interact with alcohol or drugs, if used—especially during the teen years.
(3) Early Use
Q: “40% of young people who start drinking before they are 15 years old develop alcoholism.” What do you think creates this vulnerability?
A: It’s due to the brain developmental changes that occur from ages 12–25, which include puberty, cerebral cortex development and the pruning and strengthening process.
Around 12 years old, for example, the brain goes through puberty. Three important things happen during puberty: hormonal and physical changes create a desire for sex, we turn to our peers and we have a drive to take risks. Teens are especially vulnerable to making “poor decisions” until next two developmental processes are complete.
The next big brain developmental changes don’t start until around age 16 and they take until around age 25 to complete. This is the development of the cerebral cortex—the “thinking” part of the brain, the part of the brain that controls reasoning, judgment, motivation, learning and the networks (cells talking to one another) that can take complex problems or situations and break them down into doable parts or make “wise” decisions. The cerebral cortex is also the part of the brain that puts the brakes on the risk-taking behaviors.
Finally—also during this time of cerebral cortex development—the brain is conducting its third developmental process: pruning and strengthening. This means the neural networks (brain cells talking to one another) that are being used get strengthened and those that aren’t get pruned (not strengthened). During this stage, what we do repeatedly is “hard wired” into our brains—not that it can’t be changed, but it’s the “default route.” This is why 18- to 20-year-olds include the highest percentage of alcoholics of any age group in the U.S.
(4) Mental Illness
(5) Social Environment
Going Beyond Drinking Limits
Q: You have said many times that alcohol has the ability to literally change the brain. At what point does that begin to happen? And at what point is that change permanent?
A: Depending on the alcohol concentration, a standard drink is anywhere between 1.5 to 12 ounces. Typically a full grown woman can safely drink up to 7 standard drinks a week, with no more than three on any one day. And a man can safely drink up to 14 standard drinks with no more than four on any one day.
When you step outside those limits, you want to seriously think about what you’re doing.Q: Does a standard drink have an effect on your mind?
A: Well it won’t make you an addict or alcoholic, but it does influence your brain’s reward pathway. And it takes your liver about an hour to process each standard drink; in the meantime, it “sits” in your brain changing brain function.Q: So you go beyond “low-risk” drinking. What is your risk?
A: Your risks are developing an alcohol abuse problem, causing drinking behaviors, which harm yourself and others, and perhaps developing alcoholism.
And the more you exceed “low-risk” limits, the more you “teach” your brain that it “needs” alcohol (or whatever the substance is).
Changing Our Response toward Addiction
A: It makes us realize we have to interrupt much faster, and much sooner—especially with teens. The old idea that you have to hit rock bottom before you can begin to recover is out.
In stepping in sooner though, we need to be effective. The yelling and the shaming, and the ‘If you loved me you’d stop,’ is not going to help. If they could stop, they would—they don’t like your yelling either nor are they proud of their behaviors.
So the family needs to have patience. They need to step back, learn about the disease and find healthier ways of expressing their concern and discussing the real issues.
Remember, people aren’t their addiction; they are people who have a brain disease called addiction.
Q: I could see an addict using the word “disease” as a tool to say, “There’s nothing I can do about this,” or as a way to justify their addiction. So first, have you seen this happen?
A: No, not in my experience. Not to say that it’s not out there, but I have not heard that.
Q: Interesting. What would your thoughts be if something like this did happen?
A: The reality is, when you understand the mechanism of addiction, you realize that it is still entirely up to you to fix it. It’s not going away if you continue to drink or use drugs. And that’s because the drug or alcohol chemicals kick the embedded brain maps (neural networks—brain cells talking to one another) that formed around everything involved with the addiction.
So then you have to ask this person, ‘do you like the behavior that comes with your addiction?’ Of course the addict will say no. Then you need to say, the only way to change this is to remove the substance and treat the disease.
The substance has literally hijacked your brain into thinking that it does something for you that nothing else can. In fact the desire to drink or use a drug can eventually become 3 to 5 times more intense than our instinctual brain wired, life-sustaining desire to eat food when hungry.
Addictions can only be fixed if you stop consuming the substance and treat the addiction like we treat other diseases.
Q: What is one word of advice you have for someone who was recently told addiction is a disease?
A: It’s going to take time.
It’s going to take time to heal and to re-wire your brain.
You don’t heal a brain in 28 days—you can do a lot of healing by detoxing and rehab, but you can’t do all of it, so you need long term continuing care. And that’s because you need to unwire the addiction-related brain maps and push new ones around substance-free behaviors, address underlying risk factors (e.g. treat a mental illness) and heal the actual brain, itself—chemically rebalance it, for example.
Think about it—if you break your leg, we give you months to fully recover. If you have open-heart surgery, you’ll be treated and watched closely long term.
So I would say to them, you now understand what this is about. We need to heal the organ that controls everything about you—your brain.
So the assumption that you can permanently heal a brain in 28 days simply isn’t true. It’s going to take time. It’s going to take time, but along the way there is so much joy and wonder to be had in one’s life!
Q: A family member recently found out a loved one has an addiction. What would you tell them?
A: Understand the disease, and know that you’ve been affected too.
The ongoing stress of dealing with a loved one’s substance abuse repeatedly activates the brain’s fight-or-flight stress response system. This causes a host of emotional and/or physical ailments (depression, anxiety, sleep problems, stomach ailments, memory problems… it can even lead to substance abuse).
So you’ll need to take steps to heal and rewire your brain to move away from any unhealthy coping patterns. In my case, I participated in a 12-step program for family members, spent several years in therapy with a therapist specializing in family addiction and immersed myself in this brain and addiction-related research.
You have a right to a happy life—not an existence where your emotions are dependent on whether or not your loved one uses.
Q: We’ve talked a lot about what family members can do, and you’ve written a few books on this topic. Which would you recommend to someone dealing with a loved one in recovery?
A: Loved One In Treatment? Now What!
I intentionally made it a short book because at the time one needs it, everything feels so overwhelming.
The first half deals with addiction and what the alcoholic|addict can do to recover and the second half approaches the addiction from a family member’s perspective and what they can do to improve their own health and lives, as well as support their family member.
It should be a helpful tool for anyone in the middle of struggling wiht a loved one’s addiction or just wanting to know more of what this is all about.