Neurological Correlates

The recovering alcoholics in my life sometimes act like they’re from Jupiter. (Everyone seems to be a recovering something these days. . . ) Their default position is negative attributional bias -they constantly are attacking based on presumed negative intention of others. They then confabulate to back fill facts to match their mis-reading of social cues. When I’ve presented proof positive of a good intention, the look on their face is shock — it’s really like they have to go back and call into question all of their other judgments about the world and people around them. So they grind in their heels, and refuse to cooperate. Or when everyone else is sitting around laughing at Monty Python’s lumberjack, and they chime in, “Yeh! They should try lapdancing!” a totally inappropriate comment, and the laughter stops and people just look at them, it has to be pretty confidence-shaking. They say things like, “whaddya think I am, stupid?” when they are being extremely stupid, and have a belief that the world is playing one big elaborate trick on them and everyone is mocking them.

Yet, the twelve step programs, to the extent that they go, even to pick up dates, seems to provide them with a framework to understand the world – the world which they totally don’t have the neural wiring to properly interpret.

Penn and Teller say that Twelve Step programs are Bullsh**. I say, Messrs. Penn and Teller, lighten up. If you had your white matter burnt out and constantly misread the social intentions of others, you’d be freaked out and looking around for a higher power to settle down with too.

Penn and Teller Bullsh**: Twelve Steps 1 of 3 (10:07)

Penn and Teller Bullsh**: Twelve Steps 2 of 3 (9:50)

Penn and Teller Bullsh**: Twelve Steps 3 of 3 (9:49)

I agree with the videos — the twelve step mumbo jumbo is bullsh** . I think, nevertheless, twelve step programs provide a framework for people who lack the ability to have insight into their problems.

Alcohol. Like many drugs, ingested to excess, burns out white matter neural connections over time. This results in misfiring on the social front. Recovering alcoholics have emotional deficits described as “Bottled-Up Emotions” and “Neurotic Hostility” (or, alexithymia and hostility) –

in a roiling toxic mixture of the two. There is diminished ability to accurately read the emotions of others, and maybe heightened response to real or imagined threats. (See here for a recent report). In commentary here, the frontal lobe emotional deficits are summarized:

. . .Alcoholics take longer to decode emotional facial expressions than healthy comparison groups. Not only that, but alcoholics over-estimate the intensity of emotions, and they show a clear bias towards mislabelling sad expressions as hostile. They tend to judge a happy face as reflecting a negative mood state, and fear responses are enhanced.. . . Somewhat similarly, alcoholic patients show deficits in identifying the affective component of speech prosody. . . .Alcoholic patients were impaired in processing humour.

When you go on the wagon, you may not go back to your pre-alcoholic brain. The abstinent alcoholic brain emotional deficits can be correlated to a white matter disconnect between the cognitive brain cells and their emotional brain cells. This disconnect physically constitutes white matter microstructure damage in several right hemisphere tracts connecting prefrontal and limbic systems (to paraphrase the abstract by Gordon et al.) These white matter deficits are thought to contribute to underlying dysfunction in memory, emotion, and reward response in alcoholism.

A twelve step program is just about the perfect landing for the neural void left after the white matter is burnt out. AA seems to be a perfect fit: the world just isn’t as you perceive it, and so you can give up on trying to figure it out. You think people are in a bad mood, and act accordingly, yet they are jovial. . . you never get the joke that everyone else seems to think is hilarious. . . your family, you interpret as hostile and lash out (but they are just sad to see your condition). These are significant social impairment torpedos, and it would be too much for anyone. So no wonder the twelve step programs, especially AA, are so popular: they give you permission to give up trying to figure every little thing out. You just throw up your hands and say, “Higher power”. Working the 12 steps involves:

• admitting that one cannot control one’s addiction or compulsion;
• recognizing a greater power that can give strength;
• examining past errors with the help of a sponsor (experienced member);
• making amends for these errors;
• learning to live a new life with a new code of behavior;
• helping others that suffer from the same addictions or compulsions.

If it were me, and I woke up one day with this distorted view of the world and no other explanation, I’d be a little freaked out too. The alcoholics I know say the most difficult part was that they had to think-about-e-v-e-r-y-little-thing. (A smile – was that really a smile? Let’s go through it – I got on the bus and, etc. etc. etc.) So the twelve step easily fills in the gap — what is, is, and it’s up to some higher power, now leave them alone and to let their white matter grow back. Very Zen.

So Penn and Teller, lighten up.

Just as an aside, AA’s treatment success is said, according to Penn and Teller’s resarch — to be about the same as if you didn’t get treatment. They couldn’t find any studies to show success rates — and the rate from this 1989 report is about 5% (they say). The trouble is, even if alcoholics stop drinking for a month every six months, that’s ok, and the AA meetings give them something to rely on.

Gordon J. Harris, Sharon Kim Jaffin, Steven M. Hodge, David Kennedy, Verne S. Caviness, Ksenija Marinkovic, George M. Papadimitriou, Nikos Makris, Marlene Oscar-Berman (2008) Frontal White Matter and Cingulum Diffusion Tensor Imaging Deficits in Alcoholism
Alcoholism: Clinical and Experimental Research 32 (6) , 1001–1013 doi:10.1111/j.1530-0277.2008.00661.x