Tenth Slice of Cheese: Hedonic Rehabilitation
Memo to Self: “Learn to play"
Addiction is a dysfunction in the brain’s hedonic system - basically, a broken pleasure sense. The repeated and intense use of rewarding chemicals and behaviors to the point of intoxication, and the dopamine spikes in the brain that accompany them, damage the brain’s ability to experience normal pleasure from normally pleasurable activities. This is called anhedonia.
Fortunately, the dopamine system can heal, and normal “hedonic tone” can be restored. One of the first steps is to remove the repeated insult of intoxication. Once large and fast dopamine spikes stop, brain receptors for dopamine begin to normalize.
But this takes more than abstinence. If the dopamine system is to fully recover, it is crucial to put normal dopamine releases - from normal pleasurable activities - back into the equation.
This may sounds a little strange, but a big part of recovery is practicing pleasure - engaging in healthy, rewarding activities that release normal amounts of dopamine, and restore hedonic tone.
I call this “hedonic rehabilitation,” and there is increasing evidence that a major source of recovery resilience is setting aside time to deliberately engage in healthy, rewarding activities that compete with continued drug use, and make recovery fun.
I wonder if you/we need to learn new ways to celebrate and to reward ourselves?
Work is easy, but play …?
LeClair Bissell, MD
Sanibel, Florida; 1998
Hedonic Rehabilitation: What we did at LeMont
There is a wonderful tradition in many Utah families of setting aside one night each week for the family to be together, and usually to engage in a fun, recreational activity. This is done deliberately, consistently, and undistracted by appointments, television or media.
At Le Mont, we wanted to continue this tradition in a way that made sense from a recovery point of view. We set Wednesday nights aside for everyone in the house, residents and staff, to have dinner together, and then engage in what we called Men’s Night Out. All of use would pile into the van and go night skiing. Or paint-balling. Or go-kart racing. Or to play miniature golf (some activities were more popular than others).
We followed the recommendations in the Kelly and White book, Addiction Recovery Management, and set aside time to deliberately engage in normal, healthy, rewarding activities - things that made recovery fun, and that could offset the value of continued drug use. It had a highly salutary effect on the morale of the house, it brought us closer together as brothers in recovery, and I think it helped all of us repair our brains a little bit.
There is an increasing field of recreational activities for people in recovery across the nation. Let’s hope it continues to grow.
Examples of recovery-oriented recreation and physical activity: