Brain Retraining Plays Key Role in SUD Recovery

Behaviors often are the result of patterns of thought and beliefs founded in one’s early years. As such, retraining the brain is a key part of recovery, as it can help substance use disorder (SUD) patients overcome the patterns that led to the development of SUD and choose new ways of thinking that can help facilitate sobriety.

At the West Coast Symposium on Addictive Disorders on Thursday in Palm Springs, California, Siobhan Morse, MHA, Universal Health Services director of clinical services and project manager for SUD, discussed the importance of brain retraining in recovery and methodologies for practitioners to implement. Morse spoke with Addiction Professional earlier this week about brain retraining’s role in recovery, brain retraining methods, and other treatment interventions that complement brain retraining.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional (AP): What is brain retraining and what role does it play in substance use disorder recovery?

Morse: We want a presence. First is this concept that substance use disorder—addiction in and of itself is a brain disorder. In fact, for the National Institute on Drug Abuse (NIDA) and the American Society of Addiction Medicine (ASAM), generally the definitions revolve around this concept of a relapsing brain disorder, which interestingly enough, if you had searched for the term “relapsing brain disorder” several years ago, the results in Google would be multiple sclerosis. Now, as NIDA has been talking more, this is becoming something a little bit more spoken of. We’re seeing that the addiction definitions will come up, as well. So, I think the most important thing, as a foundation, is that we want to establish that this is a brain disorder. At the end of the day, what we’re going to talk about is things that we can do to address the neurological aspects, the sort of systems aspects of this disease.

So, as a brain disorder, basically what we’re saying is there are these pathways, these neurological pathways, that have been created. The person with substance use disorder experiences them as cravings, as a dependence, as the withdrawal symptoms when they don’t have what they’re seeking. And so, these pathways have been created. Part of treating this disorder is to overwrite those pathways, to break those pathways that say using these drugs will help, and to replace them with, “No, I have these tools or I have another way of being.” So that’s really the overview of the conversation that we’re going to have.

AP: Can you provide some examples of methods of brain retraining used in SUD treatment?

Morse: Cognitive behavioral therapy, it’s a way of recognizing the relationship between my thoughts, my feelings, and my behaviors. That comes at it from a fairly cognitive aspect, like the frontal cortex, executive function aspect. But we begin to see, “Oh, OK, so there’s these connections that I have. How can I remake them?” We also have dialectical behavior therapy, which kind of lives maybe in a little bit of the space in between just that conscious or cognitive path and sort of a non-conscious path.

And then there’s a whole world of non-conscious methodologies that we can use. We see that in using, for example, meditation therapies or in some subliminal work that we do. And there’s a much longer list we’ll go through. Even 12-Step fits on that continuum. If we’re saying this is a brain disorder, we want to shed a light on all aspects of that continuum between the conscious and the non-conscious processes to support our patients.

AP: How does brain retraining fit within a broader SUD treatment plan to drive better outcomes?

Morse: I’ll give you an example of what something I did in early recovery. It was used at the treatment center that I went to, but this is doable by anybody. There are free subliminal affirmations or there are 99 cent subliminal, tonal forms of music. It’s sort of a meditation music with these affirmations in the background. I listened to that, and then I complemented that by 3 times a day saying my affirmation. I had the non-conscious stuff going on when I listened, but I also added in the cognitive or the conscious stuff of me looking in the mirror and saying, “I am recovering successfully.”

Especially when I used to work with patients, I also added in the idea of have you ever seen a tennis player and how they, when they make a great shot, they do something like pump their fist? That fist pump is actually a physical anchor that gets associated by the brain with something successful. So, what I would do with patients is I would say, “When you’re having a craving, you want to repeat to yourself—even if you don’t believe it—you want to say out loud, “I am recovering successfully,” and accompany that with that winner’s fist pump, because then you’re creating that physical anchor and it actually lives in the body now. And you’re bringing that to bear.

That combines a hypnosis technique called anchoring, which is non-conscious, with a conscious technique called affirmations, and it’s a response to a craving. And so that’s almost CBT, where we’re working on the feelings, the thoughts, and the behaviors associated that are all connected.

AP: Is there anything else you’d like to touch on that we have not yet covered?

Morse: No, I think we get very caught up as counselors, because I am one, in the talking therapies, and I don’t in any way ever want to discount them. They’re super, super important, having those therapeutic sessions. But the non-conscious aspects of that are the therapeutic alliance and some of the other work that we could give as homework or build into our sessions. There are a number of techniques out there that we’re not going to necessarily detail out, but that use elements or combine both the conscious and non-conscious into allowing patients to recover.

Really, my goal is just to broaden the toolbox and the perspective of people who are in the trenches and offering these amazing treatments to people and have dedicated their life to that.

Reference

Morse S. Brain retraining in substance use disorder treatment. Presented at: West Coast Symposium for Addictive Disorders; June 2-4, 2022; Palm Springs, California.