Use of Polyvagal Theory as a Science-Based Model to Support Treating Alcohol Use Disorder
Loved ones of those who are addicted to alcohol often ask the question, “Why do they drink so much?” or “Why can’t they just stop?” The answer to this question is complex, yet most will agree that the abuse of alcohol is a way to self-medicate unwanted physiological and emotional states. These may include chronic physical symptoms such as nervousness felt in the gut or chest and emotional discomfort such as feeling anxious or depressed. A therapeutic framework known as Polyvagal Theory can support us in understanding how drinking has been used to manage unwanted physical and emotional states. This is the foundation to begin to work with the nervous system to gain a sense of empowerment and feeling of well-being in sobriety.
Whether you have experienced using alcohol to alleviate unwanted physiological and emotional experiences or you are concerned for a loved one who seems to be self-medicating their pain, this article provides useful information on the beneficial work that can be accomplished through a Polyvagal Approach when treating Alcohol Use Disorder (AUD). We will also explore how Bridging the Gaps can provide a safe place for this work to begin and open the way to lasting sobriety.
What is Polyvagal Theory and How can It Help with Getting and Staying Sober?
When I began working several years ago as a counselor at Bridging the Gaps, I observed a colleague welcome a newcomer to treatment with a big smile while offering, “You are safe now.” For many who make the courageous decision to get help for their Alcohol Use Disorder (AUD), assurance of safety is essential to finding hope for sobriety. The uncertainty of what treatment will be like along with the thought of being without the coping mechanism of alcohol can be daunting. The use of the Polyvagal Approach provides a way to find a true and lasting sense of safety in sobriety. In other words, in recovery one can truly begin to feel comfortable in their own skin.
Polyvagal Theory was developed by Dr. Stephen Porges, a leading psychiatrist in the field of trauma research. His ground-breaking contribution to this body of research has provided professionals who work in treating mental health and substance use disorders a clear path to helping clients. At Bridging the Gaps, his work has enhanced our understanding of the nature of relapse triggers and what to do to prevent being blindsided by these triggers. A leading social worker and educator of this model, Deb Dana, LCSW, LICSW, has provided professionals with practical and useful exercises to support this learning process. At Bridging the Gaps, we've witnessed how this engaging and dynamic framework ignites curiosity and fosters self-efficacy in our participants, empowering them to take charge of their recovery journey with newfound confidence and insight.
The Basics of Polyvagal Theory and Treatment of Alcohol Use Disorder
It is commonly known that alcohol can be a way to numb unwanted experiences and provide “liquid courage” to engage in daily living. This appears to solve the problem of how to function within the demands of our world until it doesn’t work, and consequences pile up. Polyvagal Theory teaches us to become aware of the automatic signals provided by our nervous system and to understand the critical role it plays in regulating our responses to stress. The ability to recognize our personal responses provides room to respond to this valuable built-in physiological warning system. This is essential to prevent becoming stuck in a chronic state of being overwhelmed, stressed-out and exhausted. It is also helpful to support us in moving out of these chronic undesirable states and stop the cycle of using alcohol to calm stress or to trigger feelings of connection.
The Polyvagal Approach provides a new way of understanding how to achieve these goals while living sober. Participants in treatment learn about these states known as the sympathetic, dorsal, and ventral states of the autonomic nervous system. The sympathetic state is essential to keep us mobilized and is related to our stress responses such as fight, freeze, or flight, when threat is detected.The parasympathetic dorsal state is necessary for rest and digestion, and when chronically activated, is associated with depression and lethargy. The ventral vagal branch of our parasympathetic nervous system refers to experiences of social connection, curiosity. and safety. Developing a personal understanding of these nervous system states, along with the role of the vagus nerve, provides a roadmap to recognize clear triggers for self-medication through alcohol use. It also provides hope for a concrete way forward by using specific techniques to begin to change longstanding self-defeating patterns of behavior that are correlated with our well-established neurobiological patterns.
It's All About Safety and Connection
Our nervous system is designed to protect us and thus will guide us to seek out cues to assure us that our surroundings are safe. An example of this is our tendency to scan a social setting to pick up on cues of warmth, acceptance, and connection. It is also designed to seek out signals of danger or threat. This ability to automatically and unconsciously detect these cues has been referred to by Dr. Porges, as “neuroception.” It is important to understand that most people who have AUD will experience “faulty wiring” as a result of chronic stress and experiences of trauma. The biological system may signal that a normally safe situation is threatening. For example, when my colleague warmly stated, “You are safe now,” the newcomer may have experienced an increased heart rate, a feeling of anxiety, and thoughts of suspicion. Although the message was intended to foster feelings of connection, the person may have experienced intense discomfort. This sets up a paradox: what is designed to support getting sober, such as attending an AA meeting, may trigger intense feelings of anxiety resulting in a “flight” or avoidance response.
It is well known that treatment for AUD fosters connection and safety through group and individual counseling, interactive learning experiences, and 12-step meeting participation. This tried-and-true model is an example of another organizing principle of Polyvagal theory referred to as “coregulation.” It proposes that trust, safety, and connection are a biological need for all of us. Authentic connections to others provide a way for our body to neurobiologically fire in a manner that supports learning, change, and healing. Through the structure and emotional safety of the facilitated treatment setting, participants begin to feel different and gain a sense of confidence in engaging with sober support systems such as AA.
Bringing it All Together
At Bridging the Gaps, our dedicated team embraces an integrated approach, recognizing that the Polyvagal Theory's principles weave seamlessly through every aspect of our treatment process. This holistic integration enhances the effectiveness of our programs, addressing the complex needs of those recovering from Alcohol Use Disorder. Many of our participants have identified this framework as useful, practical, and empowering to support them in managing daily stress that could otherwise trigger the relapse process. In conjunction with teaching participants about the nature of their nervous system and engaging them with personalized Polyvagal road map assignments, the treatment team at Bridging the Gaps fosters engagement in other modalities that support rebalancing and improved regulation of the nervous system on a daily basis. This includes use of exercise, engagement in healthy meal preparation and eating practices, supporting healthy sleep practices, neurofeedback, accudetox sessions, amino acid therapy, and guided meditation sessions that include breathwork. Learning to experience an authentic sense of connection and safety with other sober individuals is fostered by daily group therapy, interactive educational sessions, experiential sessions such as music therapy, and individual therapy sessions. The alliance formed in the therapeutic relationship can begin to provide a way to support healthy “coregulation” and thus begin to support the individual in aligning with safe and supportive sober connections.
Our participants have shared that using Polyvagal-based assignments and exercises combined with the integrative modalities offered by Bridging the Gaps have provided practical and effective ways to manage sober living. Most importantly, the Polyvagal Approach provides a roadmap to getting back to ourselves where we begin to recognize what Deb Dana refers to as “glimmers.” We begin to notice and are drawn to the things and people that provide feelings of connection, safety, creativity, curiosity, and wonder. Drinking is no longer viewed as a need to fill the empty spaces within and living sober can be experienced as exciting, strengthening and fulfilling.
Denise Reaves, MSW, LCSW, CAADC | Clinical Supervisor
A BTG team member since 2011, Denise champions healing through natural and integrative approaches. Her passion for experiential learning drives personal growth in clients, making her a vital force on our clinical team.