How emotional regulation helps in reducing addiction
Drugs can have a severe impact on the human brain. These changes also make it difficult for a person who has an addiction problem to stop consuming them. And sometimes, even after a holistic treatment, they end up relapsing.
Triggers like having a consistent withdrawal state, experiencing stressful or traumatic events, flashbacks and other reminders of substance use, may become major reasons for relapse. In the scientific community, these triggers are also known as cues.
Drug Addiction and Cues
In drug addiction, cues associated with addiction may produce cravings in individuals that are susceptible to relapse. Cues can include any craving stimulus like watching someone smoke in a movie, walking past a regular bar, or a place and object reminding the individual of their drug use.
Environmental stimuli associated with drug addiction can also become a major reason for inducing previous behavioural patterns like drug cravings or triggers.
Role of Cues in Drug Seeking Behaviour
Stimuli paired with reward or reinforcers have greater abilities to influence behaviour, including drug abuse. These stimuli also serve a discriminative or modulatory function, informing the human brain of the availability of a reward.
Several studies have shown that when a neutral stimulus is consistently paired with a primary reward like food or drugs, it can come to elicit responses thereby becoming the conditioned stimulus. The repeated pairing transforms the stimulus into a drug-associated conditioned stimulus.
For instance, a person always uses a particular glass to consume alcohol. The glass, which is a neutral stimulus, may become a reminder of alcohol use during abstinence as the person may start associating.
A study conducted by the National Institute of Drug Abuse (NIDA), USA, gives detailed insights into how cues help in relapsing.
How Do Cues Help in Relapse?
A recent study conducted by the NIDA researchers on drug abuse (cocaine specifically) offers uniquely powerful insights into the behavioural patterns of an addicted brain. Even though the subject was observing abstinence, the researchers found that the brain shows similar activities upon encountering cues of drug self-administration.
The response observed correlated to time and intensity with the brain’s cue-induced relapse to cocaine-seeking. The nature of the response observed was powerful imagery urging people to obtain the drug, even foreclosing the brain’s ability to consider other courses of action.
The drug-seeking response occurs in the nucleus accumbens (NAc) of the brain – a part that receives signals from the brain’s motivational and decision-making circuits and relays them to the motor circuits.
Known as Synaptic Potentiation (SP), the response makes the brain more sensitive to incoming excitatory signals. The increased sensitivity alters the NAc output to the brain’s motor circuits to promote the initiation of drug relapse behaviours.
The cues are often woven into the environment or lives of people consuming drugs that make it hard to avoid, thereby enhancing the chances of relapse.
Cognitive Appraisal and Reappraisal
A recent study conducted by the Proceedings of the National Academy of Science (PNAS – USA) assessed whether drug-related attention processes can be disrupted by cognitive reappraisal or not.
Cognitive reappraisal is an accustomed emotion regulation approach, which is presumed to expand prefrontal cortex mediated cognitive control like thinking, reasoning, or remembering (conscious intellectual activities).
The study administered physical psychophysiological patterns like late positive potential and gaze duration (including past behaviours). It also focussed on the reduced regulation of natural bias to cues relating to drugs outside of the motivational or self-regulated cognitive reappraisal window.
The results were achieved by using a task designed to expand robust detection of detailed trial-by-trial disorders in cue reactivity in individuals with drug addiction.
Study Brief:
A relapse in addiction is often accelerated by the increased attention bias to the cues relating to drugs. These are reinforced by a subcortically mediated shift to habitual (motivational) respondings and decreased prefrontal control (part of the brain responsible for inducing signal reactivity).
The modification of attention bias is fundamental and a target for subduing relapse. The study included the use of electroencephalography (EEG) and eye-tracking with a task that evaluated drug cue reactivity, instructed self-regulation, and immediate effects or spontaneous attention bias.
Electroencephalography (EEG) is used to detect electrical activity in the human brain using tiny metal discs attached to a person’s scalp. The brain cells communicating via electrical impulses are shown as wavy lines on the EEG recordings.
The results of the study conducted showed that cognitive reappraisal, a facet of prefrontal control, reduced spontaneous attention bias to drug-related cues in individuals with addiction.
It further suggested that emotional regulation techniques may also be effective in disrupting compulsive drug addiction behaviours.
Cognitive Appraisal and Reappraisal
In cognitive behavioural therapy (CBT), numerous skills help modulate overwhelming emotions, especially arising due to drug-related stimuli.
Cognitive Appraisal and Reappraisal are techniques used to recognise and regulate overwhelming emotional patterns. These techniques also help in regulating drug-seeking behaviours.
Cognitive reappraisal is a technique that involves recognising negative thinking patterns and changing their course to feel better. Recognising the emotions attached with drug inducing behaviour makes it easy to address cues and relative negative emotions.
On the other hand, cognitive reappraisal is a reinterpretation of an emotion eliciting condition in a way that modifies its meaning and emotional effect on the human brain.
Considering how emotions change over time, cognitive appraisal and reappraisal may have their primary impact on various emotion-generative processes. It can be specifically helpful for individuals who currently suffer from drug addiction or are on the verge of relapsing.
Understanding with an Example
Imagine taking a wrong turn in your neighbourhood and reaching ‘chai vali tapri’ or the place where you smoked multiple cigarettes daily. Now your current environment can most likely induce cues or triggers to relapse into nicotine addiction.
Your first response may be of thinking about those memories when you smoked cigarettes with your peers multiple times a day. While your primary appraisal includes avoiding walking towards that place or thinking about abstinence or changing your course, these are often accompanied by secondary appraisals.
More often than not, primary appraisals are affected by simultaneous secondary appraisals. If they are positive, you may not stress or worry about your old memories of the place. However, if these appraisals are negative, you may end up ‘smoking just one cigarette and then relapsing, at last.
This is an example of environmental and emotional effects on a person’s relapse. While primary appraisal helps in mitigating the risks of such a situation, secondary appraisals play an equally critical role.
Let us take another example of the same alcohol glass you used in the past to consume alcohol. In the case of cognitive reappraisal, the glass is a cue but you may otherwise think about alcohol as juice.
Where cognitive appraisals reduce the reactivity to drug cues, reappraisal helps self-regulate attention bias that also includes the reactivity to drug cues.
Attention bias is when your brain pays more attention to one part of your environment than the other. For instance, you might focus on the reminders of drug abuse more than the cues and relapse itself.
The researchers involved in the PNAS study suggest that these results could contribute to the development of a readily deployable cognitive behavioural and personalised intervention strategy for people battling with addiction and relapse.
Effectiveness of Emotional Regulation for Reducing Drug Addiction
Emotional regulation offers individuals an ability to avoid drug relapse and assistance in controlling drug reuse temptation.
At present, drug abuse and addiction are responsible for worldwide social and psychological behavioural problems. Data suggests that 200 million people worldwide abuse drugs, which is almost 5% of the entire human population on planet earth. Drug addictions have also significantly impacted their social, psychological, and family relationships.
Whether performed in an automated (motivational) or controlled environment, emotional regularity consciously or subconsciously can change the severity of drug abuse effects or relative relapse.
A study conducted on emotional regulation for drug addiction suggested that a disorder in emotional regulation and low tolerance were primary reasons for an individual’s relapse or continual consumption of drugs. Negative emotions and failure to manage them acted as stimuli for drug abuse relapse in people with low tolerance.
The research concluded that the implementation of emotion regulation helped reduce cues and craving beliefs in individuals with drug addiction. The response may vary for different individuals but end results were observed to be of similar essence.
Final Words
Emotional regulations refer to a person’s efforts to minimise the kind, time, experience, expression, or severity of behavioural, experiential, and physical processes of emotions. As emotions play a key role in the everyday functioning of humans, disruption in their regulation significantly harms social and psychological presence.
Emotional regulation specifically becomes critical for individuals currently battling drug addiction or having relevant histories.
Considering every situation from different angles of cognitive appraisal and reappraisal can help reduce drug addiction and improve the flexibility of the human brain’s functioning.
Sources:
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https://cogbtherapy.com/cbt-blog/2014/5/4/hhy104os08dekc537dlw7nvopzyi44
DTNext (June 2, 2021). Emotional Regulation Technique May Be Effective in Disruptive Compulsive Cocaine Addiction. PNAS Study. DT Next News.
Front. Behav. Neurosci (09 February 2018). The Winding Road to Relapse: Forging a New Understanding of Cue-Induced Reinstatement Models and Their Associated Neural Mechanisms. Frontier in Behavioral Neuroscience.
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Front. Syst. Neurosci (19 September 2014). Cognitive reappraisal and expressive suppression strategies role in the emotion regulation: an overview on their modulatory effects and neural correlates. Frontier in Systems Neuroscience.
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NCBI PMC. Hamed Choopan, MSc. Seyed Mohammad Kalantarkousheh, PhD. Yousef Aazami, MSc. Younes Doostian, MSc. Ali Farhoudian, MD. Omid Massah, MD. Addict Health (2016 Apr; 8(2): 68–75). Effectiveness of Emotion Regulation Training on the Reduction of Craving in Drug Abusers. NCBI PMS Study.
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Reviewed by
Rajnandini Rathod
M.Sc. Psychology,Research Associate at RehabPath
Rajnandini is a psychologist, keen on bringing awareness and uplifting the stigma attached to mental health in India. She completed her Master’s in Psychology with considerable experience with people with addiction problems. She co-initiated an online counseling platform during the pandemic to assist people with their rising mental health concerns. She is also working on various research projects and likes to spend her spare time making illustrations.
