It’s a common misconception among those entering treatment that their goal is to stop drinking or using. However, ending your substance use is the beginning of a much longer journey. Once the brain starts to heal, life comes into focus, and with the clarity to see the far-reaching effects of their addiction, people realize they are in a truly transformative process.

We begin to form both negative and positive ideas about ourselves at a very young age, all influenced by genetics, environment, past experiences and society. As we grow, those ideas become a pattern of thoughts that form well-worn pathways in our brain. These make up our self-perception, or, our personal narratives.

“We gather data from every experience to support our personal narrative,” says Michele Pole, PhD, Director of Psychology at Caron Treatment Centers. “An otherwise neutral event will be interpreted either positively or negatively, depending on the observer’s personal narrative. A person with a positive personal narrative will have a healthy and balanced perspective. Someone with a negative personal narrative will fixate on what they inferred as a slight, or rejection. For those in treatment or recovery, a negative personal narrative lowers self-esteem, which has a strong correlation to addiction.”

Retraining the Brain with Cognitive Behavior Therapy (CBT)

One approach to retraining the brain to establish a more positive personal narrative is Cognitive Behavior Therapy (CBT), which can help patients challenge those negative thought patterns. Pole uses CBT and involves acceptance therapy.

“Part of acceptance and commitment therapy is practicing the acceptance of dominating, negative thoughts using mindfulness meditation, instead of trying to eliminate them,” Pole says. “This concept is derived from the idea that the more we try not to think about something, like elephants, the more we can’t help obsessing over it. Rather than fighting the narrative, we can accept the thoughts as just what they are: thoughts. They’re not facts. They’re not directives. They’re not who we are. They’re simply a function of our brain firing in a certain way. This is effective in addiction treatment because people are more vulnerable to relapse when they don’t have tools for addressing intrusive and negative thoughts.”

Mindfulness meditation, part of third wave CBT, allows patients to acknowledge cravings and self-destructive thoughts, accept them as nothing more than thoughts, and then refocus.

“Rather than thinking, ‘I can’t do this. I’m never going to be able to stay sober, I might as well just drink,’ mindfulness teaches us, ‘I am noticing a thought telling me I can’t do this. I accept that, but it’s just a thought.’ If we can learn to observe our thoughts objectively, without judging them, it’s going to allow us to let them dissipate naturally, rather than attaching onto them and falling into the negative narrative.”

There is no cure for addiction, but Pole says with these techniques patients report: “Life will always have challenges. However, life in active addiction is much harder and only gets worse; recovery is an opportunity to work on yourself every day.” CBT and mindfulness also give the gift of a sense of self-efficacy, an empowering notion that ensures us when things get rough, we can manage it without turning to drugs or alcohol.

Neurofeedback Complements CBT

Neurofeedback therapy, which shows a patient how his or her own brain is functioning in real-time, often compliments CBT in addressing negative thought patterns and improving self-esteem. With that information, treatment providers can give patients a very simple view about how their brains are functioning in a specific area. Once patients know when their brain is overactive and why, they have an opportunity to learn how to change that with the recommended CBT strategies.

“Neurofeedback gives us information to help us regulate our own brain function. Self-regulation is a key term in this whole process, which I think is really advantageous for those in recovery,” says Dr. Jonathan Harris, Corporate Director of Neurocognitive Services at Caron. “However, there’s good evidence that it can take months for the brain to normalize or re-regulate.”

Neurofeedback is a type of therapy that uses brain imaging technologies, such as electroencephalography (EEG), to measure the activity in certain areas of a patient’s brain on a moment-by-moment basis. A visual scale representing the amount of activity is then presented to the patient on a screen, so she can learn to make the association between how active her brain is and her thoughts and emotions in that same moment. The goal of neurofeedback is to help a patient learn how to change the way his or her brain is functioning, a process that underlies how he or she is thinking and feeling.

“I think this area of neuroscience will continue to develop more advanced and clinically accessible tools,” says Dr. Harris. “Looking at where the field is now and what we have accomplished over the past 20 years, we have a huge amount of knowledge. Understanding the neurobiology of addiction is the groundwork from which we can build clinical tools that will continue to evolve treatment.”