I first got drink at 12 years old. Young perhaps, but it was Soviet-era Moscow, where my father was stationed as a journalist back in the 1980s. I wasn’t very good at drinking, though I certainly tried hard. When I was 15, I was arrested three times for public drunkenness, twice in one day. And when I moved back to US, a litany of drug and alcohol violations got me kicked out of boarding school – with the final incident just hours before my graduation ceremony, where my father was the keynote speaker (nope, no daddy issues there). At college, the morning I was scheduled to start a new job, I woke up behind the wheel, on a motorway in another state, facing the wrong way. Several years later, drunk driving and drug charges landed me in the crime log of the newspaper where I worked as a reporter. And so it went.
Fast-forward 17 years and I’m catching my breath near the 4,302m summit of Colorado’s Pikes Peak, my race bib fluttering in the wind. Bracing myself at the halfway mark of the gruelling mountain marathon, taking in the countless jagged switchbacks I’d picked across, I couldn’t help but think about the distance I’d put between Then and Now. And about the irony that after nine marathons and thousands of miles, this is how I now get high. Standing on a vast rooftop shingled with mountain peaks, the thin air fizzing my brain, I was buzzing. And grateful. I largely have running to thank for my transformation. After years of faceplants (literal and figurative) and a self-image curdled by guilt and self-loathing, a simple pair of running shoes had returned momentum, even joy, to my life and allowed me to evolve into a capable person – a genuine human being. And I wasn’t alone.
About five years into my running life – mostly solitary back-country road work – I started to come across stories about other troubled souls who had traded in chaos for running shoes: a meth-head-turned-Ironman-competitor; a recovering crack addict who once ran 350 miles in a week; an ex-convict alcoholic who would tackle the equivalent of almost six back-to-back marathons across the Gobi Desert. Later, I’d read about a treatment centre in New York’s East Harlem that trains rock-bottom people suffering from addiction to finish the New York City Marathon; another in Canada that mandates running, complete with a natural track area on the premises and an annual race named the ‘Redemption Run’. And yet another – Recovery Runners in Glasgow – that uses running to help those struggling with substance abuse and now organises a series of recovery race events over various distances.
I wrote a recovery memoir in that time, and when it was released my inbox swelled with messages: from other drunks-turned-runners, sober marathoners, freshly quit opioid addicts, the imprisoned, psychiatrists and drug counsellors. Other than some sceptical 12-steppers arguing that I had substituted one addiction for another (I decided not to go down the Alcoholics Anonymous route), all were firm believers in the healing power of the run. In something as simple as hitting the road, they, too, had felt a loosening of addictive thoughts and a sparking of positive changes in the brain and in the heart. But was there much to it beyond our personal stories and a would-be ‘swapping of vices’?
Re-lacing the brain
While most agree that addiction is a neurological disease or disorder rather than a moral failing or question of willpower, scientists still aren’t sure why certain people who experiment with drugs and alcohol become addicted while others don’t. Many point to an imbalance in dopamine (the feel-good brain chemical) and a deregulation of glutamate, the brain’s main excitatory (those that facilitate) neurotransmitter responsible for parts of our learning and memory.
Environment, genetics and stress are believed to play important roles, too. But a growing body of research suggests that aerobic exercise such as running can, in fact, rebalance those neurotransmitters, reduce sobriety-crushing cravings and even repair drug-damaged parts of the brain.
‘The studies are showing that there’s definitely an effect in the interaction between physical activity and the way that we respond to drugs,’ says Dr Nora Volkow, director of the National Institute on Drug Abuse in the US. ‘Some of the research has started to document the molecular mechanisms responsible for these interactions. That’s in the very early stages, but we don’t need to wait for all of the evidence, to cross all the T’s and dot all the I’s, before we can recommend it.’
Dr John Ratey has been preaching the lace-’em-up cure for years. The associate clinical professor of psychiatry at Harvard Medical School in Boston says that even a little bit of running can make a big difference. ‘What happens immediately when you begin to run is you get a boost in dopamine, noradrenaline and serotonin, just as if you were taking a little bit of Prozac and a little bit of Ritalin,’ he says.
Ratey, a longtime runner who logs about 15 miles per week, and a psychiatrist who has counselled plenty of people with addictions, says quitting isn’t necessarily the hard part. It’s the maintenance of sobriety, which is too often undermined by stress, anxiety and depression, things that are rife in the newly sober life.
‘Many of the great [exercise] studies have been done on smokers because nicotine, which is really our toughest addiction, acts in a similar fashion to drugs of abuse by pumping up the dopamine system,’ says Ratey. ‘Smoking cravings are intense. One of the ways of dealing with them is to go for a run or a brisk 10-minute walk. Not only is that a positive activity, it changes the brain chemistry so you are much less responsive to stressors. It just is a fact. It takes more to stress you out than it did before running.’
There is no shortage of clinical and preclinical research to support Ratey’s views. Researchers at Vanderbilt University in Nashville, Tennessee, US, set a dozen heavy-using cannabis smokers on treadmills and, over two weeks, got them to run ten 30-minute sessions at 60-70 per cent of their maximum heart rate. The result? A more than 50 per cent decrease in sparking up. Another study, led by Dr Michael Ussher at the University of London, showed that even as little as 10 minutes of moderate exercise dulled the craving for a drink among recently detoxed alcoholics. Research at the University of Colorado, US, even showed a possible reversal of cognitive brain damage in recovering alcoholics who exercised aerobically.
These are just a few of the nearly 100 studies that associate professor of psychiatry and neurobehavioural sciences Dr Wendy Lynch (pictured above) gathered into a comprehensive article titled Exercise as a Novel Treatment for Drug Addiction: a Neurobiological and Stage-Dependent Hypothesis, which was published in the journal Neuroscience and Biobehavioral Reviews. Lynch argues that, much like the development of conditions such as AIDS or diabetes, addiction takes hold in distinct phases and alters different parts of the brain accordingly. At almost all stages – initiation of drug use, addiction, withdrawal and relapse – according to the studies Lynch reviewed, exercise had a positive impact no matter what substance was being abused.
‘In the early stages of addiction, where dopamine is primarily motivating the drug use, exercise also activates dopamine release,’ says Lynch. ‘So it could serve as an alternative to the drug reward and thereby prevent future drug use.’ ‘We’ve shown that even modest amounts of exercise can reverse relapse vulnerability.’
Your brain on running
A healthy brain releases pleasure-jolting dopamine when we engage in life-sustaining behaviours such as eating and sex. The good times are then encoded in regions that control memory, new learning, and motivation, ensuring that we continue to engage in these activities.
In this simple system, drugs and alcohol can act as gremlins opening floodwalls. Dopamine flows down the reward pathway, which we experience as euphoria. Then, just as the reward-motivated brain is programmed to function, it teaches us to repeat the behavior. For the predisposed, the mind begins to burn with a new central concern: another drink, the next score. At the same time, we start producing less dopamine naturally to compensate for the tide of outside stimuli. That means people with addictions need more drugs to achieve the same high, and eventually to simply stave off the pain and anguish of a dopamine dearth. Life becomes strictly about maintenance.
When a chronic user decides to quit and shuts off that external dopamine trigger, the brain is suddenly bereft and perceives survival to be at stake, just as if faced with a lack of food. With next to nothing going on in the pleasure-jolting department, the addict’s mind and body receive bright, desperate flares of craving. Throw in depression, a bad day at work or a memory trigger – something as small as the beads of moisture running down a bottle of beer – and you have a recipe for relapse.
It’s during the early days of abstinence, Lynch says, that glutamate starts to rise and etch the directions for craving into the mind. A recovering addict who experienced heightened glutamate levels in withdrawal will see those beads rolling down the beer bottle and experience pangs of craving months, even years, after their last sip.
In 2012, Lynch and her team found evidence in a preclinical trial that exercise may reduce craving by normalising glutamate signalling. She gave a group of laboratory rats access to high levels of cocaine, essentially addicting them, then abruptly cut off the supply for two weeks. During that time, she gave one group a running wheel two hours a day while another was left alone with just their little white knuckles. During the abstinence period, the running rats pressed the empty drug-release lever 35 per cent less than their counterparts. When small doses of the drug were reintroduced, the running rats pressed 45 per cent less. (Similar results were found in a separate study conducted at the University of Minnesota at the same time.) In 2016, a second trial showed that when exercise was implemented within seven days after suspending drug use, cravings were dramatically reduced.
‘We’ve shown that even a modest amount of exercise early in abstinence can reverse changes in the brain and reverse subsequent relapse vulnerability,’ says Lynch. ‘Now, we’re trying to figure out how exactly exercise is doing that.’
One element, she says, may be an exercise-induced elevation of brain-derived neurotropic factor (BDNF), which helps make a protein necessary for brain cell communication and memory-encoding. Imagine this protein as the telephone lines between brain cells and synapses. Drugs come in like lightning, causing worn and downed cables. But scientists say a good, lung-heaving sweat can actually repair some of the drug-induced neurological damage. What’s more, BDNF might also encourage the growth of new cells critical to the brain’s ability to learn as well as to repair synapses that can stave off depression, both of which can contribute to success in recovery. One study showed that running degrades traumatic memories among mice, thus potentially blunting a prominent trigger for relapse.
BDNF may also increase levels of gamma-aminobutyric acid (GABA), the chief inhibitory neurotransmitter in the central nervous system. GABA makes us feel more tranquil and gives us a sense of well-being. Without it, a person would constantly be on edge, anxious, unable to relax – precisely how an addict often feels and behaves when gripped by cravings. In other words, GABA counterbalances the excitatory role of glutamate, acting as the brain’s brakes, in a sense.
Ultimately, Lynch says, if scientists can pinpoint when and how these various exercise-prompted changes are taking place in the brain, they could then work out how to, literally, prescribe physical activity – in precise minutes instead of milligrams – and also at exactly the most effective points along the addiction spectrum. ‘Exercise acts like a drug on the brain chemicals,’ she says. ‘But it’s a good type of drug that enhances systems that are in deficit. It re-regulates brain functions and can prevent relapse.’
Flipping the switch
When I gave up drinking back in 1998, there was no dramatic rock bottom. But just like the seemingly fateful constellation of factors that had set me down a dark path, a number of mishaps set me straight. I was exhausted. Controlling my behaviour (minimising, lying, deceiving) had become a full-time job. And despite my avoidance of mirrors (except with a rolled-up note between my fingers), I’d caught too many harsh-lit glimpses of a guy who got rock-star wasted alone in his apartment, who brought homeless men back to his place for beers, whose waking state was either guilt or stage fright, usually both. I wanted to feel different, something, anything. So just shy of my 30th birthday and with the pending implosion of yet another romantic relationship, and this time with a young child in the mix, I gritted my teeth, dug in my fingernails, and resolved to change course.
But without the gauze of booze and cocaine, my depression, anxiety and insecurities were practically blinding. Not surprisingly, I didn’t exactly part ways with my addictive mindset, my brain still triggering any dopamine blast it could. I continued to smoke heavily, gulped coffee, and ate like a pig, my hands and mouth a blur of activity. At the centre of my life gaped a bottleshaped void that I packed with pizza, burgers and ice cream. Two years later, someone snapped a photo of me on the beach. I was unrecognisable – my nose and eyes were buried under a mound of pale dough, my belly drooped down toward the sand. I was sober, but not exactly the poster boy for recovery.
‘The classic treatment of addiction is simply the treatment of the drug the patient is abusing and not addressing other health issues such as smoking or overeating,’ says Dr David Jones, a psychologist at Three Oaks Behavioral Health near Jackson, Mississippi, US (pictured above). ‘People still maintain that addictive cycle on a daily basis, that up-and-down cycle of “When do I get my next cigarette or that next chocolate bar?” It keeps patients in a state of hyper-vigilance.’
Jones, himself recovering long-term from addictions to alcohol and codeine, has been running for 40 years, and the 10-time marathoner is known to begin some group therapy sessions by taking his patients out for a few miles. Running not only softens some of the pains of sobriety, he says, but it can interrupt those displaced addictive behaviors. ‘What running does is makes you pay more attention to other issues as you’re starting to produce your own levels of dopamine rather than depending on those external sources.’
While I can’t deny it was anything more than vanity that first prompted me to break an honest sweat – in the pool, at first – I soon found myself starting to sleep better and cutting back on the chocolate and doughnuts. When I found my way onto a treadmill, little by little, other things started to click. I eventually worked up the courage to run outside, on a dirt road outside of the small Vermont town, in the northeast of the US, where I’d been living.
Those first mornings were coal-black, predawn, when no one except the cows could see me. But the miles began to steer me through sobriety’s rough patches – ones I hadn’t yet faced – blunting the depression and panic just enough for me to start unpacking the shame and guilt that still burned under my skin.
All of my apologies would be drafted at six miles an hour as I picked across roadkill and ruts. The shin splints, sore muscles and seared lungs put me in a state of penance. The rare moments that I did come upon another runner, even getting that simple wave, with its silent understanding of work and reward, was enough to keep me going. After years of drawing the curtains, I gradually began to rejoin the human race.
There may have been a transition of a different sort taking place, according to Ratey. A key marker of recovery, he says, is the psychological move between the brain’s two reward systems: the Reactive Reward System, which operates from a more primal, instinctual, short-term position, and the Reflective Reward System, which is marked by the ability to delay gratification, to make considered decisions, and to think in the long term.
‘The Reactive is more animalistic,’ says Ratey. ‘It’s your craving, you’re going for it, you’re being pushed from below. When you start running, you build additional brain connections to help break the craving and hold back the Reactive, to make it less potent. Reflective is more of a decision behaviour. You have goals and motivation, an overall wish, other activities. You’re building up the frontal cortex, which promotes new and wonderful learning to help you achieve your goals.’
John Tavolacci, chief operating officer at Odyssey House treatment centres in New York City (pictured above), is a long-term recovering addict and 22-time marathoner who founded a programme called Run for Your Life, which has offered people running and marathon training since 2000. Tavolacci says he’s witnessed not only the critical return of self-esteem, but outright redemption. So far, 350 men recovering from addictions under his watch have crossed the finish line at the New York City Marathon – and then continued moving forward toward healthier, productive lives.
‘Odyssey House is the last stop on the recovery train,’ says Tavolacci. ‘It’s not a luxury, private rehab centre. These are individuals who may have been in prison, from low socioeconomic backgrounds. There’s this history of failure, of everyone giving up on them. The Run for Your Life programme is really about showing the world you’re not useless, not part of a society that everyone gave up on. This is an opportunity to prove everyone wrong.’ And redemption can lead to belonging, both of which can translate to success in sobriety.
‘People who have addictions just want to fit in,’ says Tavolacci. ‘They’re misfits. People relapse because they don’t add anything to their life to make them feel like they belong. They go to AA. They go to NA. But nothing else. What I find is people who go through the running programme stay in treatment longer and the research says that with long-term treatment, the longer you stay in it, the more likely you are to succeed.’
The importance of that sense of belonging and connection is something that is also emphasised at Recovery Runners in Glasgow. The organisation, which launched in 2012, initially started as a programme for addiction-service users to train for the Great Scottish Run. It expanded to create a platform for them to continue running and find a focus outside their struggles. Recovery Runners now hold three training sessions per week that, crucially, are open to the wider community as well as those with addictions. They also encourage recovered addicts to volunteer and work towards coaching qualification, keeping them involved in the group for the long haul and perpetuating those all-important feelings of purpose and self-worth.
The group also recently launched its own series of races – The Recovery 3K, 5K and 10K – to foster more connections between recovering runners and those outside the group. ‘We took the step to organise our own races in the hope that we can bring together our runners with the wider running community, to help them make steps to returning to mainstream activities and improving their social networks,’ says John Milligan, a senior addiction worker for the South Glasgow Community Addiction Team who run the project.
In Ottawa, Canada, all able-bodied residents at the Harvest House treatment centre are required to run five times a week as part of the recovery programme. In the winter, they shovel snow off the track on the grounds behind the main building. In less inclement weather, they can run on the nearby network of trails.
‘When you talk about relapse, the ability to recognise stress and manage it through exercise and diet is so key to people staying sober,’ says associate programme director Gary Wand, himself a runner and in long-term recovery from addiction. ‘That’s the big transformation I see. People are recognising that I’m going to have more stress than the next guy because of my background, my history with drug and all the other related problems, but what works for me is a really good exercise programme… With running and good nutrition, we’re seeing people staying sober longer.’
Twelve steps versus twelve million
I don’t want to suggest that running is inherently a better approach than others, such as Alcoholics Anonymous. But 18 years down the road, it’s played a leading role in my life and, for whatever reasons (perhaps divine grace), I have never relapsed. When it comes to staying clean and sober, I’m a believer that we all must forge our own paths. For some, perhaps for many, running is just one of several tools. Plenty of my runner friends in recovery whom I admire and respect swear by the 12-step approach.
‘It’s like when we treat cancer, we don’t just give one chemotherapy agent, we give multiples,’ says Volkow, herself a dedicated runner. ‘Same with HIV: three antiviral remedies are given so the outcomes are much better. My perspective on addiction is the same. Addiction is a dangerous disease. It can have devastating consequences, including death, and you treat it aggressively. Not everybody responds to the same treatment approach, so in that respect it’s no different from any other medical diseases.’
To some extent I can understand why people think I’ve merely traded one addiction for another. But ultimately I find this perspective too narrow. Unlike boozing, running has never filled me with shame or regret, not once turned me into a monster. I have never stolen, lied or cheated for running. I don’t need more miles to get the same effect. The trade that took place was sobriety for addiction, a dark central rhythm recast in light.
While not enough scientific studies have been conducted on the addictive qualities of exercise, I can see ways in which running – or rather, not running – has effects that can echo withdrawal from drugs or alcohol. If I miss several days of running, I might feel a little sluggish, unfocused, sometimes irritable. I have sometimes found myself envious when I see other runners, even if I’d laced up the day before.
‘I would be cautious to say ‘withdrawal,”’ says Volkow. ‘That term is one I use with very specific connotations. But I can tell you that if I don’t exercise, I actually feel very uncomfortable. Running gives me a great sense of wellbeing and calms me down.’
Ironically, people recovering from addiction may even have an advantage when it comes to endurance sports, stemming from a personality that once chased drugs with bottomless zeal. In fact, certain ‘survival’ skills developed in addiction – tolerance for pain, single-minded focus, ingenuity born of desperation, ease with isolation, a cold comfort with humiliation – can be harnessed on that 100-mile run or Ironman triathlon.
I remember one morning back when I was still drinking, I showed up for a physically demanding job, to help move several tons of hay, after a raging bender. It was winter in Vermont and the cold only made my head ache more. I had slept for only two drunken hours and made it to the job with what felt like battery acid in my belly. I soiled myself halfway through. But despite the ever-present shakes and existential crises spooling through my mind, I kept going – partly because going home sick would be a shameful admission of a problem and partly because I knew I had a six-pack of beers waiting for me at the end. So today, to gird against giving up in the late stages of a race, I’ll say to myself, ‘You haven’t even crapped yourself yet.’
And sure, we roll with the punches. We get knocked down and continue to rise. ‘As addicts, we’re subject to being easily devastated, and those setbacks can kill,’ says Charlie Engle, author of Running Man: a Memoir, which details his journey from crack addict to endurance athlete who once ran across the Sahara Desert. Engle is an expert in the field of pain and, in his sober life, rising up against adversity (which for him included a stint in prison). It’s something he’s learned through running. ‘At least five times during an ultra, everything goes wrong,’ he says. ‘But I’ve learned that no single event is the end of the world.’ It’s not that life or the run need be perfect, he explains, it’s how we adapt to the setback – and that we continue to run.
Volkow says that an intense drive, even compulsive patterns, should not necessarily be viewed as abnormal in the context of achieving athletic goals. ‘At the end of the day, there is a reason we have the capacity to sustain effort even when it’s painful,’ she says. ‘Because it provides an advantage for survival.’
Back in Colorado, as I begin zigzagging down from the summit of Pikes Peak towards thicker, more oxygen-rich air, I think about my past, my own toughness, my brain chemicals – hopefully on the normal spectrum by now – and the life that running has given me. During my drinking and drug-taking years, despite deep-seated insecurities, I fell under the spell of my own perceived grandeur. Now, I need to continually reinforce that I am no longer that degenerate loser I once was. This conflict in me still exists – corroding at my edges – at times drifting to the surface if I stay still for too long.
In this race, as all others, I will get passed. I’ll struggle against giving up, with the limitations of my body. I’ll assess my worth as an athlete, as a person. And that’s why I run. For a sober person – for anybody, in fact – the greatest gift running can give is its ability to render us human while simultaneously showing us the strength we have.
Running down the edge of this mountain, I look around at the terrain and at other people, runners who slap me on the back as they dash by. This is where joy is found. This moment. As long as I keep running, I can remain in this state – a state not only of moving forward, but of being.