Years ago, Bob Newhart had a skit on his show in which he portrays a therapist. In the skit, a young woman enters his office seeking services for several distressing issues she is experiencing. Bob informs her that for a mere $5.00 he can help her solve all her problems. What a deal! However, as the session unfolds, we learn that no matter the issue the young woman discusses, Bob’s response is always the same. “STOP IT!” He goes on to explain to the young woman that if she wants to change her life, then she should just “stop it” and do something different. If only changing our lives was that easy!
“Stop it” doesn’t work for people struggling with addiction
What we know from research on human behavior is that to successfully attain long term behavioral change an individual must first grapple with several questions. Is this change important to me? Am I confident I could make the change if I decided to? Am I ready to begin?
All three factors need to be in place to realize a life-altering change such as recovery and sobriety from drugs and alcohol. Let’s suppose an individual feels that living a sober lifestyle is incredibly important to them. Are they also confident in their ability to do so? If not, what needs to be in place to increase confidence? Perhaps more education and information is needed or additional supports need to be in place to successfully start their journey. It is also important to remember that sobriety and recovery can be important to someone, and they can be confident they can be successful, and still not be ready to begin!
The Neurobiology of Addiction
What we also know about addiction is that it the use of drugs and alcohol affects the biology of an individual. Research in the neurobiology of addiction has proven that the brain is significantly impacted by drug and alcohol usage. The use of drugs and alcohol interferes with our ability to process the “feel good” chemical in our brains called Dopamine. When our brains are deprived of dopamine our bodies enter into survival mode. A dopamine restricted brain tells individuals that they may die without their drug of choice!
Neurobiologists studied patients with a functional MRI and what they found was astonishing. Patients were deprived of water for three days, or food for five days, and then underwent an MRI to measure their cravings. Remember, after three days without water or five days without food people are at risk of death. The results? The functional MRI showed cravings the size of a baseball for patients who had been deprived of water for three days and were facing life-threatening dehydration. The cravings were the size of a basketball for patients that had been deprived of food for five days and were facing death by starvation.
The researchers then placed patients who had been in recovery for a period of 30 days, 60 days, 90 days, or one year. What they found was that the craving for dopamine and drug of choice far outweighs cravings due to starvation or dehydration. The MRI showed cravings the size of a BASEBALL FIELD! In fact, cravings did not decrease until two years since last use.  What this tells us is that our brains need for dopamine (i.e. the drug of choice) is far greater than the need for food or water. Withdrawal causes a survival response in the body. That is a powerful thing to fight and directly impacts readiness to embrace sobriety.
Obstacles for justice-involved individuals
Well intentioned as it is, the criminal justice system often forces justice-involved individuals to “stop it” without taking into consideration both the individuals level of readiness and the neurobiology of addiction. When working with individuals with substance use disorders, it is vital to remember that folks are fighting biology! A comprehensive plan which includes psychological treatment, such as cognitive-behavioral therapy, and medication assisted treatment is considered to be a gold standard for successful recovery from drug or alcohol abuse. Without the proper tools and supports in place it is nearly impossible for an individual to just “stop it.”
The staff at the Marquette County Office of the Public Defender’s are dedicated to helping people begin a successful recovery journey. Our staff is well versed in providing much needed support and linkage to community resources. Each of our clients have access to ongoing support including education and referrals to treatment facilities that can provide comprehensive therapeutic interventions. Please see the Mitigation page of our website for more information or to get in touch with our Mitigation Specialist.
 Stinson, J. D., & Clark, M. D. (2017). Motivational interviewing with offenders: Engagement, rehabilitation, and reentry. The Guilford Press.
 Ray, L. A., Meredith, L. R., Kiluk, B. D., Walthers, J., Carroll, K. M., & Magill, M. (2020). Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis. JAMA network open, 3(6), e208279. https://doi.org/10.1001/jamanetworkopen.2020.8279