Ask Dr. Rick About:

Abuse & Addiction

Regarding neuroplasticity, how are our brains rewired after stopping alcohol consumption?

In the nervous system, low resilience can be the result of several things, including an overreactive amygdala, weakened hippocampus (which helps regulate the amygdala), poor connectivity between the prefrontal cortex (PFC) and the amygdala, and low activity of the parasympathetic nervous system (PNS). On the other hand, high resilience can be the result of these parts of the brain operating in opposite ways, such as having high activity in the PNS. Positive changes in these four brain regions or systems can be produced by sustained mental/psychological practices, such as those explored in my book Resilient.

What do you think of using negative reinforcement to lose weight and end food cravings?

This technique is classic counter-conditioning, where one tries to replace a reward associated with a stimulus (e.g., cookies, chips) with a punishment. The bottom-line would be whether it works for you.

The little I know about fitness, weight loss, etc. is that leaning toward the good (e.g., feeling healthy, living longer) tends for most people to be a more sustainable motivator than leaning away from the bad (e.g., pictures of unappealing obese people on the refrigerator), in part because negative motivators are a fast-track to self-criticism, etc.

Any words of wisdom regarding addiction? More specifically, how to “help” an adult child?

About addiction and adult children, I am no expert at all. I could offer only standard common sense thoughts, including reaching out to professionals who specialize in this area, considering going to meetings of people who have relatives with addiction issues, reading on this topic, maintaining your own boundaries, having compassion for your child and yourself and any others who are involved, naming the truth as appropriate, and resting in love as much as you can.

What advice would you give to parents whose teenage child is experiencing relationship issues in school: being bullied because of physical appearance?

I think it’s really important for the adults to find out quite concretely what is going on, and then for the school authorities to make it very very clear to the kids involved, and usually also to their parents, that bullying won’t be tolerated at all, full stop. Kids do not “work it out.” Bullying is cowardly oppressive behavior by people with more power against people with less power, and it can leave scars for a lifetime. Teachers and other school authorities typically don’t like to get involved with this – it’s messy – but, too bad, they have to. Justice requires the exercise of authority, in any setting.

Meanwhile, you can help the teenager develop inner resources to reduce the impact of the bullying, like a strong sense of being cared about by others, of personal worth, and of recognizing that the bullies are frankly full of shit and talking out of their own feelings of inadequacy and meanness.

I've experienced emotional abuse, a serious brain injury, PTSD, anxiety, and depression – and I find it hard to meditate. Any suggestions?

In terms of things that might help, I’m assuming you have done sensible standard things like therapy. In terms of some options that might be helpful, you could look into:

  • Neurofeedback
  • Sensorimotor training (e.g., Baniel Method, Feldenkrais)
  • Functional medicine type assessment of your overall physiology, and then systematically optimizing it as best you can
  • Using an emotionally positive and stimulating object of attention for meditation – such as love for others, contentment, gratitude, bliss after pranayama – and marinating in happiness, both to help steady the mind and to potentially help tip your brain more toward positivity

And of course, keep knowing and feeling your own obvious goodness.

What actions should neighbors take if they suspect something amiss in their neighborhood?

A person can call anonymously into Child Protective Services (CPS – sometimes with a different title, depending on the state and county) and describe what they have seen. CPS can then decide whether to ask the person to make a “report” in which they give their name, after which CPS can decide what to do. In this way, the neighbor making the call can get a reality check on whether the experienced people at CPS think something is a real issue or not. (And if others have also called CPS with concerns about a family living nearby, coming together they add weight.) This is not about “reporting on” your neighbors but rather passing along what you see and hear to people whose job it is to make sense of and act on that kind of information.

How can someone deal with cruelty, in their mind? How can one stop the mind from ruminating on horrible images of violence, without going back into denial?

First, I share your concerns about hurting other beings for one’s own pleasure.

Second, in a sense you are speaking about trauma in general and how to clear it from the mind. This is a big topic, and I’ll just say here a few things that might help:

  • When the painful imagery or related thoughts arise, willfully shift attention elsewhere, especially to things that are stimulating and engage attentions, such as jumping up and down, eating something good, or giving/receiving love.
  • Focus on the emotions and sensations of compassion, drawing awareness away from imagery or inner speech.
  • Remind oneself what one is doing to help things get better; engage attention to this in rich ways such as reviewing actions or interactions and feeling what’s good about them (not just having an idea that one has sent money to a worthy cause).
  • Have confidence that over time painful imagery does tend to fade or at least not preoccupy one, though it can still get triggered.
  • If it helps, try EMDR or related trauma therapies.
  • You might be able to get value from the Buddhist teaching about the emptiness of all experiences, no matter how wonderful or awful. Experiences exist in some sense, but they are transient, insubstantial, made of parts, and arise due to causes, and therefore they are “empty” of absolute self-existence. In a sense, they are like clouds, not bricks.

What advice can you give to someone whose partner abuses drugs or alcohol?

Alcohol is a problem. If a person can’t do it moderately they can’t do it at all. The AMA considers the upper limit to be 2 drinks/day for men (note that a “drink” is pretty small: 1.5 ounces of liquor or 5 ounces of wine or 8 ounces of beer), or 14 drinks a week. If your partner is past 14 drinks/week routinely and won’t stop, that’s alcoholism.

Are you going to Alanon meetings and/or seeing a therapist experienced in this territory? If not, you should. Also read a good book or two. The core theme is to be compassionate but individuated from the addict.

Your partner’s drinking is about him or her, not you.

How can you take the high ground and ``stay right when you are wronged`` when dealing with an abusive partner? That high ground to them only signals weakness.

This is a deep and natural question, one that I’ve mulled a lot over the years.

My two cents is that the more abusive the partner, the more important it is to take the high ground, wrapping oneself in a mantle of dignity, strength, and self-respect. Plus the high road may well include very powerful, even fiery words and deeds. And if this just increases their attacks, well, that seems like pretty unmistakable information that it could be good to change the relationship.

Also, the approach I suggest is not very entwined with what goes on in the mind of the other person. If they want to interpret me taking the high road as weakness, that’s their interpretation, not mine. Also, there are many examples of people taking the high road in face of very, very abusive people and governments – and generally that high road is seen as a very strong move by both abusers and onlookers.

How do I handle an adult child who's continually making bad decisions, has drug and alcohol issues and ends up back in jail?

These are just about the hardest sort of situations I know. I’ve never had to live through anything like this myself, so whatever I say is tentative and respectful; there is so much I don’t know here. You may already know everything I say below.

  • I’ve seen parents draw boundaries as needed around certain behaviors – e.g., call 911 if an adult child gets physically threatening, not letting the child live with them, not having long phone calls with someone who is drunk – while finding a core of love inside for the person no matter what. Sometimes the boundary takes the form of “we can do X for you (e.g., buy you a basic used car, keep you on our health insurance) but not Y (e.g., bail you out of jail, lie to the police for you).
  • It’s super important that both parents be aligned with each other. Otherwise the adult child splits them.
  • Stay as unreactive as possible. (Yep, very hard). It only pours gasoline on the fire, and can be used to discredit you.
  • Be skillful about the drug/alcohol issues. They seem central.
  • Give him as little to resist as possible (e.g., unwanted advice he won’t take anyway).
  • Taking care of your own well-being (both parents) helps you sustain efforts for your child. Get support from others: minister, friends, relatives, therapist, Al-Anon. Take a breath and focus on your own life, like going for walks, spending time with your own friends, having fun, reading a book, meditation/prayer, going fishing, knitting, etc.
  • Take the long view. Also realize that so much here is just out of your hands.
  • One thing to add is that if parents do set a boundary, unless on reflection it was just not a good boundary (like a rule laid down in the heat of anger), then it is important to keep it, and to back each other up, otherwise it is worse than no boundary at all since it undermines the parents’ credibility.
  • If you and your partner have not sat down with a sensible neutral third party – e.g., lawyer, minister, therapist – to make clear agreements with each other about your child (or at least know for sure what you are in conflict about) – you should do that, unless you can quickly make agreements that stick on your own.

How do you deal with a situation in which a perpetrator repeatedly abuses the victim?

The situation you describe really touches my heart – and yes indeed, it is one of the greatest challenges to the topic of forgiveness.

First of all, whatever one does regarding forgiveness, safety comes first, for oneself and if relevant, for others. So I hope you are doing what you can to get out of a relationship with someone who is abusing you, or shrink the size of it so that it no longer contains abuse.

Second, sometimes a person just can’t forgive, in any way, shape, or form. It’s too early, the wound is too great, what happened seems unforgivable. If that’s true, it’s true. Then around the non-forgiveness could be a disengagement from pouring gasoline on the fire of outrage, resentment, fault-finding, self-criticism, etc. And skillful action as appropriate, such as to enlist the useful aid or support of others.

Third, if the first level of forgiveness is possible – releasing, disengaging from resentment or anger, yet without a full pardon – then a person could help herself to experience and stabilize that state of mind. For example, to do this myself, it helps me to know that a perpetrator has suffered, too (usually at the hands of others). Sometimes it helps to seek justice; knowing that you have done what you can for justice – if only to protect others from the perpetrator – and perhaps knowing that the perpetrator is indeed facing justice of one kind or another, can help a person set down the burden; you did what you could and now it’s out of your hands.

Last, whatever you are doing with forgiveness, it helps to take a good step each day toward your own better life. This helps pull your attention into positive actions and their benefits, and draws it away from the perpetrator and the abuse. As you put steps between you and the trainwreck behind you, it can play a smaller and smaller role in your life. As the saying puts it: “Better to light a single candle than to curse the darkness.”

I am having a difficult time understanding your use of the word “fault” in your JOT Admit Fault and Move On. The word fault seems unnecessarily blaming and critical and I wonder if the word “responsibility” might be easier for your readers to take on.

You’re right, different words can land in different ways for different people. In my own case, I think of “fault” in its ordinary sense, including error, causing harm, and responsibility: “it was my fault that the plate broke since I dropped it on the floor.” Personally, I do have faults: I do make errors that are my own responsibility, many of which cause harms. I can use this word without it necessarily implying any sort of inappropriate remorse or shame.

Separately, my personal view is that I am actually not always doing the best I can, nor are others. I see many times where I could have chosen more wisely; I usually see this in the frame of self-compassion and self-guidance rather than self-shaming, so the seeing of my “fault” in these cases ends up helping me feel better about myself than worse.

Reflecting on the common saying – “They were just doing the best they could” – I think there are two levels of meaning to it.
At one level, the deterministic unfolding of reality, whatever happened was determined by preceding causes, so in this sense there was no “better” alternative to what happened.

But at another level, people have a high degree of volitional choice over the causes they set in motion. In terms of values, some of those causes are beneficial and some are harmful. For example, feeding children is beneficial and starving them is harmful. Feeding children is better than starving them. At this level of choices and values, people who starve children are not doing the “best” they can. In more mundane but more common terms, being patient with my children is more beneficial than getting cranky with them; therefore, when I am being cranky with them, I am not doing the best I can.

At this level of choices and values, there is also the dimension of effort. There is a difference between making efforts to set beneficial causes in motion, and not making much if any effort at all. In common experience, we value efforts to cause the good, such as diligence, conscientiousness, and aspiration. Efforts to cause the good are better than no efforts. In this area as well, someone who is not making reasonable efforts to cause the good – to drive safely, to study for the test, to understand his or her partner – is not doing the best he or she can.

In our personal lives, and in society altogether, if we don’t recognize distinctions between beneficial and harmful, effortful and neglectful, better and poorer – or blur or obscure these distinctions with euphemistic language – that’s a steep and slippery slope toward waiving moral responsibility.

So, in a nutshell, what is true at the deterministic level gets mistakenly applied to the moral level if we say – to use an extreme example to highlight the point – “Oh, Hitler was just doing the best he could.”

I chose that word “fault” deliberately, to be a little provocative. I do think that faults occur in myself and others, and actually our discomfort with seeing and naming them gets in the way of clearing them from the space and moving on. If I drink too much holiday wine and start tossing a beautiful dish up in the air and it falls and breaks on the floor, and my wife says, “Hey, it’s your fault that my grandmother’s dish got broken,” I’d have to agree with her. And if I were to say, “Wait a minute, I was just doing the best I could,” and she replies, “No way, that was far from your best,” I’d have to agree with her in this regard as well!

Dr. Ramani Durvasula is a licensed clinical psychologist, author, and expert on the impact of toxic narcissism. She is a Professor of Psychology at California State University, Los Angeles, and also a Visiting Professor at the University of Johannesburg.

The focus of Dr. Ramani’s clinical, academic, and consultative work is the etiology and impact of narcissism and high-conflict, entitled, antagonistic personality styles on human relationships, mental health, and societal expectations. She has spoken on these issues to clinicians, educators, and researchers around the world.

She is the author of Should I Stay or Should I Go: Surviving a Relationship With a Narcissist, and Don't You Know Who I Am? How to Stay Sane in an Era of Narcissism, Entitlement, and Incivility. Her work has been featured at SxSW, TEDx, and on a wide range of media platforms including Red Table Talk, the Today Show, Oxygen, Investigation Discovery, and Bravo, and she is a featured expert on the digital media mental health platform MedCircle. Dr. Durvasula’s research on personality disorders has been funded by the National Institutes of Health and she is a Consulting Editor of the scientific journal Behavioral Medicine.

Dr. Stephen Porges is a Distinguished University Scientist at Indiana University, Professor of Psychiatry at the University of North Carolina, and Professor Emeritus at both the University of Illinois at Chicago and the University of Maryland. He is a former president of the Society for Psychophysiological Research and has been president of the Federation of Behavioral, Psychological, and Cognitive Sciences, which represents approximately twenty-thousand biobehavioral scientists. He’s led a number of other organizations and received a wide variety of professional awards.

In 1994 he proposed the Polyvagal Theory, a theory that links the evolution of the mammalian autonomic nervous system to social behavior and emphasizes the importance of physiological states in the expression of behavioral problems and psychiatric disorders. The theory is leading to innovative treatments based on insights into the mechanisms mediating symptoms observed in several behavioral, psychiatric, and physical disorders, and has had a major impact on the field of psychology.

Dr. Porges has published more than 300 peer-reviewed papers across a wide array of disciplines. He’s also the author of several books including The Polyvagal Theory: Neurophysiological foundations of Emotions, Attachment, Communication, and Self-regulation.

Dr. Bruce Perry is the Principal of the Neurosequential Network, Senior Fellow of The ChildTrauma Academy, and a Professor (Adjunct) in the Departments of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine at Northwestern University in Chicago and the School of Allied Health at La Trobe University in Melbourne, Australia. From 1993 to 2001 he was the Thomas S. Trammell Research Professor of Psychiatry at Baylor College of Medicine and chief of psychiatry at Texas Children's Hospital.

He’s one of the world’s leading experts on the impact of trauma in childhood, and his work on the impact of abuse, neglect, and trauma on the developing brain has impacted clinical practice, programs, and policy across the world. His work has been instrumental in describing how traumatic events in childhood change the biology of the brain.

Dr. Perry's most recent book, What Happened to You? Conversations on Trauma, Resilience, and Healing, co-authored with Oprah Winfrey, was released earlier this year. Dr. Perry is also the author, with Maia Szalavitz, of The Boy Who Was Raised As A Dog, a bestselling book based on his work with maltreated children, and Born For Love: Why Empathy is Essential and Endangered. Additionally, he’s authored more than 300 journal articles and book chapters and has been the recipient of a variety of professional awards.

Dr. Allison Briscoe-Smith is a child clinical psychologist who specializes in trauma and issues of race. She earned her undergraduate degree from Harvard and then received her Ph.D. in clinical psychology from the University of California, Berkeley. She performed postdoctoral work at the University of California San Francisco/San Francisco General Hospital. She has combined her love of teaching and advocacy by serving as a professor and by directing mental health programs for children experiencing trauma, homelessness, or foster care.

Dr. Briscoe-Smith is also a senior fellow of Berkeley’s Greater Good Science Center and is both a professor and the Director of Diversity, Equity, and Inclusion at the Wright Institute. She provides consultation and training to nonprofits and schools on how to support trauma-informed practices and cultural accountability.

Sharon Salzberg is a world-renowned teacher and New York Times bestselling author. She is widely considered one of the most influential individuals in bringing mindfulness practices to the West, and co-founded the Insight Meditation Society in Barre, Massachusetts alongside Jack Kornfield and Joseph Goldstein. Sharon has been a student of Dipa Ma, Anagarika Munindra, and Sayadaw U Pandita alongside other masters.

Sharon has authored 10 books, and is the host of the fantastic Metta Hour podcast. She was a contributing editor of Oprah’s O Magazine, had her work featured in Time and on NPR, and contributed to panels alongside the Dalai Lama.

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