Mothering and Recovery Three
Adaptive vs. Maladaptive Stress Alleviation
Dr. Edward Slingerland, a professor of philosophy at the University of British Columbia, has a book out: Drunk: how we sipped, danced and stumbled on our way to civilization. I have yet to read the book, but I have watched an interesting lecture of his on the topic that can be found here .
The basic premise he presents is that the persistence of using alcohol in our civilizations isn’t an evolutionary mistake, rather humans purposefully apply it as a tool to knock down brain function, in particular that of the prefrontal cortex, where the brain’s executive functions reside such as: planning, attention, focus, problem-solving, etc.
The benefits of alcohol knocking down prefrontal cortex function is two-fold (at a 0.08 blood alcohol level – very far from falling down drunk): 1) we become less capable of lying, and 2) we are much more accurate at detecting the lies from others. Additionally, creative thought is enhanced. The drawbacks of alcohol consumption at any level are of course the significant physical damage of organs and increased risk of many types of cancer. Dr. Slingerland pointed out that both weed and the micro-dosing of various psychedelics are problematic because there is such individual variation in response. Metabolizing alcohol in the body is a pretty repeatable and predictable formula for all humans and, except for those with the genetic mutation of a condition known as Asian flushing, everyone has broadly similar physical and subjective experiences when under the influence of alcohol as well.
We use alcohol as a social lubricant. We experience easier connection with others because we are all more truthful and we can also detect lies with more accuracy which makes for an easier time of building trust all around. While we can experience positive emotions and relaxation connecting in these ways, biologically alcohol does not place us in a physically unstressed or destressed state.[1]
It’s quite possible that our term “stress management” really reflects us knocking down or manipulating executive functions in the brain to create either the mistaken cognitive impression that we have destressed, or to realize a temporary but valid physiological reprieve from the impact of extended high and dysregulated levels of glucocorticoids in the body.
As mentioned in part one, fasting and starvation create the mistaken cognitive impression of destressing for those with eating disorders, but biologically the body has high levels of glucocorticoids as well as impacted clock genes acting poorly on hormone rhythms. Even something that decreases the brain’s HPA-axis activity (the fulcrum of glucocorticoid production), such as an anxiolytic like benzodiazepines, will stimulate corticosterone levels under some conditions.[2]
We use all manner of tools to knock down and impair the executive functions of the brain. We place these tools on a hierarchy of good to bad. However, that’s just a cultural interpretation of the costs vs. benefits of using the tool itself. Going for a run after a tough day at work is defined as highly adaptive and yes, it too knocks down prefrontal cortex activation. [3],[4] Exercise is always touted as an excellent stress management tool—all benefit and no cost. But there are costs to exercise and they’re simply not weighted in the same way in our culture as the costs of, for example, using weed. Physical activity acutely increases the risk of cardiovascular events,[5] no more so than today during an ongoing pandemic wherein the offending pathogen causes (present tense) ongoing and cumulative (with each new infection) cardiovascular damage.[6]
What about meditation? Meditation is yet another brain function modulator or manipulator that is rated akin to exercise in that it’s viewed as an excellent stress management tool with no risk. Rates of adverse effects due to meditation range from 3.7% to 33.2%.[7],[8] Meditation may increase levels of depression, anxiety, panic, the re-experiencing of traumatic memories, dissociation, executive dysfunction, headaches, body pain, insomnia and social impairment.[9] And what of glucocorticoid levels with meditation? A mixed bag. The results vary because glucocorticoids have a rhythm throughout the day, as with all clock-gene impacted hormones. Some studies show improvement in daytime levels, but not waking or sleeping levels, and other studies show the opposite.[10],[11] It means that while you may realize a true physiological and biological reduction in stress hormones, your mileage may vary and the effects are not sustained longterm while the stressors in your environment persist.
I am not suggesting that all executive function manipulations or impairments, for the purpose of managing stress, are to be avoided. I am saying that weighting the costs and benefits for each individual is an exercise in subjectivity. If you happen to be someone who has a panic attack when trying to meditate but you take an anxiolytic medication for decades with no signs of dependence or adverse effects, then in real terms taking that medication has more benefit vs. cost to you than meditation will ever have. However, in most cases, there is absolutely no way to predict whether any one individual will face the cost of using a particular brain modulating tool or not. We are all going to use our own life experiences, family histories, subjective moral judgments and internalized cultural norms to define which of these tools we are willing to consider or reject outright.
But for you as a mother with an eating disorder pursuing recovery and raising kids, it helps to address any unconsolidated or partially consolidated trauma at the outset, and then figure out what stress management techniques (impairment tools) are going to be adaptive or maladaptive for you.
Comorbidity Skews the Adaptiveness of Brain Manipulation Tools
Our World in Data suggests for the population at large, alcoholism, or alcohol use disorder, sits at between 1-5%.[12] For those with PTSD it’s anywhere from 10%-63%. Of course, alcohol use disorder is equally more present for those with anxiety and depressive disorders than for those with no such conditions as well.
The World Health Organization estimates the prevalence of PTSD in our population globally is 3.9%.[13] The prevalence of PTSD with comorbid eating disorders ranges from 18.4% to 24.6%.[14]
The worldwide prevalence of substance use disorder is 0.77% (alcohol is not included in that figure).[15] Those with PTSD are two to four times more likely to have co-occurring substance use disorder when compared to those without PTSD.[16]
Getting treated for trauma is priority one precisely because so many brain manipulation tools get piled on to try to alleviate unconsolidated traumatic memories in one’s life. Unconsolidated trauma renders the use of any brain manipulation tool a need and not a want and predisposes it to being maladaptive rather than adaptive for stress alleviation.
In Part Four we will look at the value of clamps on these brain manipulation tools on April 4.
Yang JH, Kweon SS, Lee YH, Choi SW, Ryu SY, Nam HS, Park KS, Kim HY, Shin MH. Association between alcohol consumption and serum cortisol levels: A Mendelian randomization study. Journal of Korean Medical Science. 2021 Aug 2;36(30).
Mikkelsen JD, Søderman A, Kiss A, Mirza N. Effects of benzodiazepines receptor agonists on the hypothalamic–pituitary–adrenocortical axis. European journal of pharmacology. 2005 Sep 20;519(3):223-30.
Tempest GD, Eston RG, Parfitt G. Prefrontal cortex haemodynamics and affective responses during exercise: a multi-channel near infrared spectroscopy study. PLoS One. 2014 May 1;9(5):e95924.
Heiland EG, Tarassova O, Fernström M, English C, Ekblom Ö, Ekblom MM. Frequent, short physical activity breaks reduce prefrontal cortex activation but preserve working memory in middle-aged adults: ABBaH study. Frontiers in Human Neuroscience. 2021 Sep 16;15:719509.
Goodman JM, Burr JF, Banks L, Thomas SG. The acute risks of exercise in apparently healthy adults and relevance for prevention of cardiovascular events. Canadian Journal of Cardiology. 2016 Apr 1;32(4):523-32.
Smer A, Squires RW, Bonikowske AR, Allison TG, Mainville RN, Williams MA. Cardiac complications of COVID-19 infection and the role of physical activity. Journal of cardiopulmonary rehabilitation and prevention. 2023 Jan 1;43(1):8-14.
Farias M, Maraldi E, Wallenkampf KC, Lucchetti G. Adverse events in meditation practices and meditation‐based therapies: a systematic review. Acta Psychiatrica Scandinavica. 2020 Nov;142(5):374-93.
Taylor GB, Vasquez TS, Kastrinos A, Fisher CL, Puig A, Bylund CL. The adverse effects of meditation-interventions and mind–body practices: A systematic review. Mindfulness. 2022 Aug;13(8):1839-56.
Britton WB, Lindahl JR, Cooper DJ, Canby NK, Palitsky R. Defining and measuring meditation-related adverse effects in mindfulness-based programs. Clinical Psychological Science. 2021 Nov;9(6):1185-204.
Heckenberg RA, Eddy P, Kent S, Wright BJ. Do workplace-based mindfulness meditation programs improve physiological indices of stress? A systematic review and meta-analysis. Journal of psychosomatic research. 2018 Nov 1;114:62-71.
Rogerson O, Wilding S, Prudenzi A, O’Connor DB. Effectiveness of stress management interventions to change cortisol levels: A systematic review and meta-analysis. Psychoneuroendocrinology. 2024 Jan 1;159:106415.
https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder
Ferrell EL, Russin SE, Flint DD. Prevalence estimates of comorbid eating disorders and posttraumatic stress disorder: a quantitative synthesis. Journal of Aggression, Maltreatment & Trauma. 2022 Feb 7;31(2):264-82.
Castaldelli-Maia JM, Bhugra D. Analysis of global prevalence of mental and substance use disorders within countries: focus on sociodemographic characteristics and income levels. International review of psychiatry. 2022 Jan 2;34(1):6-15.
McCauley JL, Killeen T, Gros DF, Brady KT, Back SE. Posttraumatic stress disorder and co‐occurring substance use disorders: Advances in assessment and treatment. Clinical Psychology: Science and Practice. 2012 Sep;19(3):283.
Image in synopsis: Flickr.com: MCAD Library
