HJNO Sep/Oct 2022

HEALTHCARE JOURNAL OF NEW ORLEANS I  SEP / OCT 2022 25 on substance use and addiction. In the midst of addiction being on the rise and being sub- stantiated as a brain disease, it is fair to ask, “Is there hope in the recovery process of addiction?”The SubstanceAbuse and Men- tal Health Services Administration (SAM- HSA) state that the components of recov- ery are individualized/person-centered, empowerment, purpose, and hope. 4 Hope can be the catalyst for recovery. That cata- lyst can be the ground upon which a foun- dation is established for hope to become motivation and be sustainable. The two parts of the brain that impact addiction and sobriety are the limbic system and the prefrontal cortex. 5 The limbic sys- tem is the part of our brain that is in charge of the survival of our species — the instant responses in crisis moments, which include moving someone out of discomfort and into a sense of instant gratification. Fight, flight, freeze, fornicate, and feast are often the drivers of this area of the brain. It is the first part of the brain that receives stimuli and with that data decides if there is danger or safety, and if we can make more of our species. The job of the limbic system is to keep us alive as individuals and a species. When the disease of addiction is involved, the brain believes that to stay alive it needs a substance and craves that substance in response to limbic dangers. The prefrontal cortex is the higher-func- tioning part of the brain and is the deter- miner of long-term rewards, planning, solv- ing problems, and building healthy and sustainable relationships, and it enables self-control without the impulse to escape discomfort immediately. In the brain of an addict, these two systems do not always agree with one another as one is looking for instant gratification and escape from discomfort while the other, the prefrontal cortex is striving for long-term rewards and sustainability. This tug-of-war can cause stress while depleting motivation and hope. In other terms, this is where hopelessness is cultivated. Humans need both parts of the brain to survive. We need our limbic system to respond to urgent issues and get us out of critical situations, and we need our prefron- tal cortex to build a better world as individ- uals, families, communities, and a human race. With such an enormous dichotomy between the purpose of these two systems of the brain, it is amazing the two neuro programs can work together at all. When the dichotomies of these systems are bridged, a brain has the capacity to experience emotional sobriety. Emotional sobriety is the process of the limbic system that assesses the immediate environmen- tal stimuli and decides if there needs to be immediate reaction or if there is enough safety to open pathways to the prefrontal cortex to have processed response with the concepts and planning of more long-term and positive outcomes. To build a recov- ery program, the brain must find behaviors that allow the neuropathways to move from instant gratification to long-term rewards. 6 Within the disease of addiction, the lim- bic system dominates decision making and actions. In order for recovery to work, a thought process has to transition to the pre- frontal cortex as the dominant decision and action center. For recovery to be sustain- able, prefrontal cortex thought processes followed by clear actions, and enabled by other supports such as medical inter- ventions, must be implemented in order to achieve success. Through this process, internal and external trust are developed, “Hope can be an emotional driver that brings someone to recovery, and that emotion needs tangible supports to be effective and sustainable.”