I got back yesterday around noon. What a relief it was to be home! India is overwhelming in so many ways, with poverty and raw need topping the list. To get back to this calm, orderly place was a reprieve and a pleasure, tinged with guilt at leaving all that suffering behind.
For anyone just tuning in now, I was at a week-long “dialogue” with the Dalai Lama on the theme of “Desire, craving, and addiction.” I was one of eight presenters, each of whom gave a talk to His Holiness (as he is called) and to the surrounding experts, monks, movie stars and what have you. All the talks are posted here. My talk is here. I want to tell you about two of the talks I found most fascinating and most relevant for people struggling with addiction.
The first was by Matthieu Ricard. This guy is amazing, He’s a Frenchman turned Buddhist monk for the last 20 years or so. He has a shaven head, glasses, and eyes that are kind and beaming with intelligence. And he’s humorous, human, and incredibly knowledgable at the same time. He just finished a thousand-page (!) book on altruism, he’s very close to His 
Holiness and sees him often, he’s participated in studies of brain states related to meditation, and he says his favourite thing to do is retreat to his retreat in the Himalayas — where he meditates all day long and essentially alone (there are a few other monks around, but they don’t talk to each other). Yet he spends most of his time running the Karuna-Shechen organization, which has established roughly 140 projects aimed at improving the lives of children in Tibet, Nepal and India. Please check out his talk. Or, if you don’t have time at the moment, here’s a summary:
Matthieu talked about the elements of Buddhism and general mindfulness (including but not limited to meditation) that can be of practical use to recovering addicts — or addicts who are trying to quit. He talks about the roots of suffering in our determined, unshakable view of ourselves as the center of the universe. That’s the primary delusion. And it requires us to be constantly protecting, improving, and caring for this self — this selfish self. In fact we’re willing to give up our freedom and control, just to continue to feed this self with drugs, booze, or whatever we think will protect it.
Matthieu recognizes the fundamental importance of craving in addiction. Craving and attachment. Here are his three suggestions for getting on top of it:
1. Apply a direct antidote: Find a mental state that is incompatible with craving. That is, focus and/or meditate on the unattractive qualities of the thing you’re addicted to. For example, focus on freedom, which is directly incompatible with the out-of-controlness provided by the addictive substance. Or maybe focus on the anxiety that accompanies withdrawal and on how that anxiety creeps in, even while we’re high and supposed to be having fun.
2. Examine the nature of craving itself: The fact that you’re craving doesn’t mean that’s all there is going on in you. Since you are aware of your craving, there must be a part of you that is outside the craving, looking in. By continuing to experience this awareness, through mindfulness or simply reflection, that part of you — the part that is outside the craving — will continue to grow. While you are looking at the craving, you will notice that, yes, it’s strong, but it is just a feeling, it comes and goes, there is nothing permanent of concrete about it. So you don’t have to obey it after all.
3. Use craving as a catalyst: This may be the most difficult, says Matthieu, but it can work for some people. There is a feeling of strong clarity that comes with the onset of craving. Stay with that feeling. It is a version of your energy, your wish for betterment. Go with that momentum in a direction that’s opposite to what we normally do. Use it to strive for betterment rather than relief. Easier said than done, he admits. So are the other two suggestions. But they can work.
Matthieu concludes that the cumulative nature of addiction, building on itself over time, means you can’t stop on a dime. It took time to build up this habit. It will take time, and effort, to overcome it. But how do you find the motivation to change? This is a tough one. He says: look for it in the way you’d look for inspiration. You try different environments, find different people to talk with. He even talks about the role of neuroplasticity in shaping both the habit and its undoing. It’s good to listen to him talk. His humility comes out in recognizing that these ideas are not directly translatable into clinical methods. Yet they are strong ideas, and that gap is waiting to be filled. That’s where Sarah Bowen comes in.
She was the last speaker of the week, and she and I agreed that we liked being the bookends — the conference starting with me and ending with her. My talk mostly posed the problem, hers, the solution. Without the need of concepts such as disease or brain hijacking to thoroughly address addiction and recovery.
Sarah Bowen is focused and rational. A good listener and a sharp thinker. She’s attractive, 30-something, and nothing resembling a Buddhist monk (or nun). She’s a clinical scientist devoted to the development of Mindfulness Based Relapse Prevention (MBRP), the first and only treatment approach that is built around mindfulness training. Sarah inherited this nascent program from her mentor, Alan Marlatt. But she is taking it to new heights, I think, and conducting well-controlled outcome studies to prove it. Here is Sarah’s talk. And here’s my summary:
MBRP is modeled on Jon Kabat-Zinn’s very effective programs for stress reduction, recovery from depression, and coping with chronic pain. This is where East meets West with a bang, generating success after success where Western psychiatry was left flailing. The program Sarah has developed uses group process (and the sense of companionship it entails) to take addicts through orderly steps of training in mindfulness, awareness, and self-compassion. This link is intended for clinicians but it provides MP3 instructions on each of the steps. Very helpful! The goal is not to get rid of craving but to be aware of it, understand it, see through it, and move beyond it. As a bonus prize, people who go through the program actually report a reduction in the intensity of craving as well as a drop (or cessation) in substance use. And these outcome statistics are gathered through well-controlled, scientifically valid studies.
Skills for tuning your attention, letting craving come and go, relaxing in response to stress, and talking to yourself in a more compassionate way are methodically developed through a series of exercises, performed by each individual in the group context (over an eight-week period) and guided by a moderator who is already advanced in her own mindfulness practice. A compelling example is “urge-surfing,” a mind-set that allows you to coexist with your cravings in an almost playful way, moment by moment, while staying upright. Then these skills are systematically brought to bear on life outside the treatment setting — so they can be accessed when it counts most, when you’re home alone at night or 
whenever and wherever you’re at your most vulnerable. I can’t provide more detail in this summary, but I urge you to check out the talk. Not only does MBRP translate Matthieu’s ideas into concrete practices, but it is shown to be far more effective than other treatment approaches — even for people who have bottomed out in their lifestyle or…their lack of a lifestyle. When asked to suggest a treatment course for addicts, this is the program I’d feel most confident recommending — if only it were available more widely. Maybe some day it will be.
That’s enough for this very long post. I have more to tell. I didn’t even get to the neuroscience presentations, nor the string of objections Nora Volkow voiced in response to my (you guessed it) contention that addiction is NOT a disease. Nor the singular perspective offered by the Dalai Lama himself. Coming soon…
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
Great blog, Marc. What an event! You are SO lucky! I can’t wait to watch the films.
Thank you, really appreciated this blog.
PS. Can’t wait to see your discussions with Nora Volkow. Good on ya, for challenging the philosophy
Hi David. Thanks for the good vibes. I tried to challenge the philosophy without challenging her directly. The whole thing was supposed to resonate with togetherness rather than dissent. But I guess I failed. My comment happened to be the last before lunch, so she had no time to respond directly. Which was a shame, I guess. But I did approach her afterward and got quite an earful. Some of her points rang true to me, but others did not.
Hey Marc. Glad you are home ok. Ive watched this thing beginning to end and its terrific. And you my friend were a star inspite of looking like a deer in the headlights at the start. It must have been annoying to have so many stoppages for HH translation and comment.
I too thought Ricard and Bowen were highlights . But Id add Volkow. Now I dont really like Nora much nor her rigidity about brain disease. But I couldnt help but like her here- she was very human- passionate for sure and she often looked like she was about to jump into HH’s lap- and told a really powerful story.
One last thing – Smart has been using urge surfing for years- Alan Marlatt was on our board .
BillA
Hi Bill. I too was swept away by Nora’s presentation. As you say, passionate, lively, and very present. She believes in what she says with total conviction, she speaks from the heart, and she’s built a pretty powerful model with no rough edges. When I talked with her afterward, she was as convincing as before. But this was after my challenge of her disease model, and I felt that she wanted to crush me like a bug (just as I’d feared) — an unnecessary encumbrance. Let’s just say she impressed me more than I impressed her. I’ll summarize her talk next post.
Thanks for the good feedback. My nervousness magically vanished by the time I was a few minutes into it. HH really has an amazing presence. You feel him being right there, listening carefully, vigilant but not at all critical. That’s probably what did it.
As for urge-surfing, thanks for the update. I didn’t know that SMART and MBRP were such close cousins, and it’s good to hear.
Marc, You brought the very human voice and face of addiction, concern, thought, care to the conference.
Take some time for yourself. We got it! Thank you for this.
Thanks, Janet. Yes, it has been a bit hectic. I didn’t mention my three days in Kolkata (Calcutta) — but that was the crowning glory of stress and disorientation. What a place! I’m just glad to be back….and to catch up with my blog in fits and starts.
Marc, first I’d like to express my appreciation again for your efforts to help others. The summaries you wrote here are very helpful… I agree with you to some extent and agree with Nora Volkow to a lot more extent. I feel like though, you and she are looking at different angles, you both right from where you stand… It almost feels like she is looking at the elephant’s head and you look at the tail… Maybe the addiction issue is too complex that it should be looked into by different stages of addiction, such as age, background, history, length… I wish you and she can spend more time together, spend a weekend somewhere, where no distraction. With the combination of the two of your brains and knowledge and experience, some good solutions may be found… People are dying.
I like solutions, such as the mindfulness. Solutions help people.
Hi Jenny, The chances of Nora Volkow and I spending time on an island together are highly remote, unless we are catapulted there by a cyclone. But yes, we are looking at different parts of the elephant — very true. Anyway, it doesn’t really matter whether we agree or not. The point is that good debate produces improved insights. That’s true of anything, I suppose, but especially of science. So….we’ll keep plodding on and hope for the best.
HI Marc,
I’m pretty new to your work but I recently read your book and started following your blog. I’m also a student of meditation and MBSR so am excited about the intersection of your work and meditation. I am trying to learn about addiction and recovery but I’m fairly new to it. I have this book and I’m wondering if it’s worth a read. It’s called “The Truth about Addiction and Recovery” by Stanton Peel and Archie Brodsky. You might not be in the business of criticizing other’s works but if you have a polite opinion, or if anyone else on this blog does, I’d be curious to hear it.
thanks, -barb
I don’t always see eye-to-eye with Stanton Peele’s arguments, but his work is always provocative and interesting, and more times than not he is right!
Stanton Peele’s books were among the first I encountered in early sobriety when I was looking for a secular alternative to AA. 7 Tools to Beat Addiction (2004) is the book my local library has on the shelf and I cannot deny that much of it resonated.It was helpful. The Truth about Addiction and Recovery (with Archie Brodsky and Mary Arnold, 1991) provided stimulating things to think about a year further into sobriety when I was finally able to get my hands on a copy. I really like his advocacy of individualized treatment as opposed to a one-size-fits-all approach.
Shaun’s summary parallels my thoughts about his work, though. For a long time I couldn’t quite put my finger on what it is about his writing that scans wrong. Dr. Peele, Ph. D., J.D. may be one of the earliest critics of the ‘disease theory of addiction’ … he’s certainly fond of proclaiming it. And there is the heart of my problem with his work (I freely admit it is my problem). Too often, he seems more interested in staking claim to intellectual ownership of ideas than he does in sharing them. Just my opinion, but his Psychology Today blog often contains an undercurrent of condescension, self-promotion, sarcasm, snark, and bombast that undermines his message. There is a certain irony to seeking a “polite opinion” about his work.
Thanks Shaun, Chris, and Guy (below) for your comments about this book. I can see some of what you are saying as I read the book. I also get a little concerned that it might have a kind of right-wing, simplistic viewpoint with the notion of personal responsibility. But it also strikes me as an encouraging message, so I will continue to read, for now.
Chris, Thanks for such a thorough and seemingly balanced critique. This is valuable. I’ve only read Peele’s first book, but I tune into his blog and other articles from time to time. I have to admit I like the guy — and not only because of the anti-disease model. Sometimes a bit of bombast fits an old codger with a stark and provocative message just right. Maybe I’ll work on that myself…
Hi Barbara, Welcome to the blog. It seems you’ve got your questions answered by other readers far more thoroughly than I could have.
I’m not sure exactly how “my work” fits with meditation. I’ve put out a few basic insights, like about self-trust as an antidote to delay discounting, but I don’t really have a model per se. Maybe it will come together in my next book. I guess I see addiction (and recovery) as a developmental phenomenon, not a disease, and meditation is a way of getting inside the control room of one’s thoughts and feelings, hence steering the developmental process. Something like that.
Hey Marc – just a brief note here, I am also busy doing some outlines of the talks, but time is short! What I found interesting from Berridge’s and Volkow’s talks is that while they explained a lot about neuroplasticity and brain changes, I saw little evidence of disease or pathology. I saw an extreme form of “normal” behaviour. This seemed to be supported by the other talks I have watched so far.
Will catch up later when I have finished summarizing all the talks.
Fantastic job you did!
I am a fan of THE TRUTH ABOUT ADDICTION AND RECOVERY – this book is on my recommended reading list ! ! !
Good to know, Guy. Is there much in it that was not expressed in Diseasing of America?
See link below:
http://lifeprocessprogram.com/the-truth-about-addiction-and-recovery-why-it-doesnt-make-sense-to-call-addiction-a-disease/
Thanks a lot Shaun (a month later). The thing is, that Volkow hammers home the notion of brain damage. She used the word “damage” a number of times, and she means it. I really don’t see the evidence for that, as noted in my recent post.
Kent is more on the fence. I talked with him about the “disease” debate, and he sees it as porous. In other words, he thinks the label may apply in some cases but not in others. Sounds similar to your position…
“Everything has a crack in it: that’s how the light gets in.” Leonard Cohen
Mindfulness, detachment, stress reduction, and meditation are all great tools for relapse prevention. But first has to come a breakthrough, a moment of clarity, a surrender, a giving up the fight, a spiritual awakening, a breakdown of denial, a gift of desperation, a movement from precontemplation, that flash or glimmer of light that provides the crack in the shell of classical and operant conditioning that gives the obsessional/compulsive behavior its life. Until then all these tools, like all intervention strategies, are ineffective.
Perhaps where the neuroscientists and the Buddhists, the ‘disease’ and ‘non disease’ factions meet is pre and post epiphany.
Hi Nicolas, your comment makes good sense. -Jenny
Nick, would you care to unpack that last bit at some point?
Anyway, you know that I like your “crack” line…and love the song. But I’m not sure I’d characterize it as giving up.
Yes, well back in my salad days if someone asked what taking LSD was like, we used to say “If you gotta ask, you’ll never know.” Snotty, superior, holier-than-thou, I know, but there are ineffable experiences that can’t be adequately described, where you wake up to an unsuspected dimension of life, maybe that’s what spiritual means. Its relevance to addiction is the moment of clarity or spiritual awakening that is a revelation of the reality of one’s condition and can spring the trap that one is caught in and that is given.
I once lived on an island ten miles off the Maine coast in a so-called Gestalt Community headed by a déclassé shrink who’d been turned on to Gestalt by Fritz Perls and claimed to have seen more therapeutic progress made in twenty minutes of Gestalt than in years of psychoanalysis. Anyhow, one day I had to go to the mainland to pick up some workshop participants. It was dawn and the ocean was as calm as it ever gets with long slow rollers, so I had the throttle wide open. Out of nowhere, in the middle of the ocean, the sound of the motor faded and I was suddenly at the still point of the turning world (as T.S. Eliot calls it). To the East the water was blue and yellow; to the West gray and green, but I could sense the rotation and hear a grinding as if of huge planetary rocks, and I broke into tears.
With acid or the other hallucinogens the revelation was more of the interconnectedness of things and of their beingness being just like yours, an escape from ego, or something.
Jenny, can you help?
I can hear the silence. But the wheels keep turning. I used to visit this pet store in Toronto where they had a monkey that was housed in a wire cage held together by cotter pins and wing nuts. The monkey learned to dismantle the cage and the owners came in to find him sitting on the disassembled pile of cage parts. He hadn’t gone exploring or tearing the place apart, just sat there. The external bars had gone, but not the internal ones.
So the addict can give up the alcohol or other drugs, but is still trapped in the cage of anger/resentments/self will/ character defects/shortcomings/ego (compile your own list). The real freedom comes from the burden of self being lifted where paradoxically one can be true to him/herself. I don’t know if you can hold it, but you can glimpse it.
Hey Mac
I just love the video, and would like to say for me, knowing how addictions or substance abuse works on the mind has become key in my recovery. For so many years I was starving for knowledge, and today finding the answer and especially being able to share with others what I have learn, is the back bone to my recovery. If say you where to be like a narrator in my book and let people know what I was going through, at the time as they where reading and your professional meanings and your knowledge and understanding about how the brain works, would I think be a total eye opener for most.
Regards Richard Henry
Hi Richard. I was just talking to a group of teenage recovering addicts, and they LOVE the knowledge part. It really turns them on and gives them something to sink their teeth into. So….yes, the knowledge is a great key!
Marc – I too am a fan of MBRP – the limits of the study is the 8 session treatment period – at 120 days MBRP is no more effective than treatment as usual. More work is necessary.
I find these posts interesting to read. I have been an on-again, off-again cocaine addict (or user but I will stick with the more harsh addict word even though that might show my propensity towards self-loathing that probably does me more harm than good) since about 1998. I have been through 8 different rehabs and about to go into my 9th on November 23rd. I have stayed sober for as long as 6 month since 1998 and have never been an everyday user. I still enjoy having a few beers while watching Sunday football with others at local establishments and playing pool at these same establishments while imbibing too. That is considered a no-no at AA but I can get away with it without resorting to coke use most of the time. I do have to be careful about it but have learned some mental gymnastics to calm and overcome the cravings that sometimes come upon me when drinking alcohol.
Since I am going into the rehab in a couple weeks I would like to try to learn how to implement some of the stuff that you talked about here. How do I go about learning more about it, ie where do I begin? I have developed the conviction that addiction is not a disease too but more due to theological reasons than medical and physiological reasons. However, I find the post’s Marc writes about to be very convincing from the medical and physiological perspective. I also find it interesting that it does not really matter what type of metaphysical beliefs you have in regards to overcoming your addictions. That is, if the data that Marc writes about is accurate and true.
HI John, those mental gymnastics you mention — I think that’s pretty much the main act no matter what perspective you’re coming from. Different groups use different sorts of gymnastics, but in any case you’re developing and strengthening skills, pure and simple.
When you ask about implementation, I’m not sure what you mean. I don’t have a recovery “program” of any sort. I just try to report and comment on scientific findings that are relevant to addiction and recovery, and I have a few insights developed from the interface of experience and science. For myself, mindfulness/meditation was always the best way to go…and even that has a number of variants. I think Sarah Bowen’s technique (MBRP) captures the most important exercises beautifully.
Marc, Thanks for your reply. That’s what I like and respect about you – you are open minded for good debate and discussion, for better understanding. You are a good scientist. And like your humor. Will keep follow and read your blogs (and others’ thoughts), although your “mind-bending” articles are sometimes hard to read. 🙂
Marc, Thanks for your reply. That’s what I like and respect about you – you are open minded for good debate and discussion, for better understanding. You are a good scientist. And like your humor. Will keep follow and read your blogs (and others’ thoughts), although your “mind-bending” articles are sometimes hard to read.:)
This is fascinating, Marc! I admittedly know little of the MBRP school of thought, or even Kabat-Zinn’s teaching, I know mainly of meditation in the Buddhist sense, and obviously am always learning there. I have read a little on studies done on Tibetan monks and the physiological effects of meditation, and, well here is the fastest google result: http://news.harvard.edu/gazette/2002/04.18/09-tummo.html
Interesting stuff, isn’t it? I’d love a good Marc Lewis perspective. I usually don’t ask questions and just go sit (Zazen), but I am sometimes curious.
Hi Persephone. Yes, interesting stuff, and powerful. I don’t usually ask questions so much as explore “inner space” — let’s go look at that dark ominous cloud over there. Oh my, that’s a lot of fear, Phew! Stuff like that. But I think most roads lead to the same Rome: a place of peace and insight.
wow!..