Following that invitation to meet with the Dalai Lama, I’ve been looking more into Buddhism and studies that link it with neuroscience – and with addiction. In one recent article, I learned that mindfulness/meditation (let’s call it MM) changes the brain in one important way. From the treatment community, we also know that MM helps people recover from addiction. Research has been sparse so far, but there are good results with respect to smoking. So my question is this: if we know that MM changes the brain in such and such a way, and if we know that it helps reduce addiction, will we come to understand what neural processes are at the core of addiction?
An important brain region has been identified in many labs in the last few years. It’s called the Default Mode Network. This area (which includes the posterior cingulate and medial PFC) “lights up” when we are daydreaming, self-reflecting, 
imagining our selves in past or future situations, or imagining interactions with other people. In other words, the default mode is where we go when we are going with the flow and thinking in an undirected way about ourselves. Most interesting is that the default mode network turns off when we become focused on a task. When we have to do something novel or challenging, we leave the default mode and enter a focused mode, supported by very different brain regions, including the dACC – a region I’ve discussed as critical for self-control.
This particular article shows that MM changes activity in the Default Mode Network – a finding supported by other studies. The more you meditate or practice mindfulness, the more likely you are to activate the “focused” brain regions and turn off the default mode, especially when you’re required to pay attention. This article also claims that the reason MM helps people recover from addiction is because addicted individuals have too much activation of the default mode network. In other words, the images, cues, plans, ideas, associations, etc, that come to your mind when you’re addicted are more like daydreaming than focusing. You are using a brain region that DOES NOT solve problems but maintains a habitual sense of who you are.
I found just two articles that show that addicts have more activation in the Default Mode Network than other people – not a huge number of studies so far, but still… One of these showed that the default mode network is highly activated in heroin addicts, and this activation does not go down when they’ve had a dose of methadone. So whether you’re high or not, this is home base.
I’ve usually considered addiction as being too focused. After all, craving – the main ingredient of addiction – means having one goal and only one goal consistently at the centre of your attention. But it’s also true that there’s something very unfocused about addiction. Your thoughts are following such familiar ruts, without conscious guidance, and your sense of yourself is habitual rather than flexible. Oh wouldn’t it be nice if…..here I go again…not too surprising….well I don’t have to quit this week….could wait till things get less stressful, etc, etc. So maybe that unfocused state is where the addictive plan starts to form. Look at this snatch from John’s Guest Memoir:
Resting after the first set [of exercises]; I do something I should not do: I trace with my finger along a raised vein on the back of my forearm, slowly, gently, slightly, thinly smiling — the blood’s rushing to my head already anyway — tap on that one good spot a couple times, and now here comes the idea. Ohhhh… and oh fuck that reminds me of the dream I had last night.
That pretty much typifies the default mode…not paying attention, letting your thoughts go, which includes letting them go to places where they really should not go.
So, if addictive behaviour arises from a brain network that supports habitual, undirected thoughts, and if MM helps bring focus and clarity to one’s thinking, by deactivating that network, then it wouldn’t be surprising that MM is an important tool for recovery. And this kind of research, which is starting to grow exponentially, teaches us critical lessons about how treatment can tackle addiction – right in the middle of our brains.
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
Well glad to see it. One should note that mindfulness runs from Christian mystics through, protestant thinking through to Alchemy.
Even Dr. Drew made that point in passing. I have note that a lot of people simply can’t apply themselves.
I think it’s harder for some people than others. But not impossible for anyone. It usually takes me about a week of daily meditation (after a lapse) to get the clarity up and running again.
thanks for the update. I got my local library to buy a copy of your book which I just finished. Thanks fr helping me get another few hours clean, btw.
You epilogue was AWESOME.
I’m a bit surprised you weren’t more aware of this … but hey great stuff no. I am constantly surprised too how many Tibetan Buddhist concepts have valid scientific footing.
You have seen this i am sure:
http://youtu.be/Ay82wmkvFtg
from 2005
Thanks, Kevin. I am watching this video/conference right now. The guy is definitely making sense…and the parallels are fascinating.
I’m glad you liked the epilogue. My first attempt to derive pragmatic lessons for recovery from the neuroscience of addiction. In the past year I’ve gotten more and more enthusiastic about this goal. It’s more than just a shot in the dark….
I have to be mindfully aware of my every thought, my motives, true intentions, without covering up or justifying.
The way I do that, I think is taught in buddhism, is to separate my mind from my brain and become a none partial observer of my brain and what it wants.
By looking at what the brain is doing from the outside and asking myself, what is it that is truly going on? and why am I acting, craving or desiring any one particular thing.
This way I am more apt to make a healthier decision on what to do.
Giving way to consequences of the outcome of that decision.
I believe Mindful awareness is key and fighting addictions, knowing is half the battle.
Yes! I do something similar. I try to watch, as if to say: what’s going on in there? There really is a separation of subjectivity from the passing of thoughts and feelings, and I believe that is the goal of mindfulness/meditation. The clarity comes from watching it all happen, letting it happen, and seeing it in perspective.
I’ve had the privilege of working with Bill at SMART and he applied an
excellent mindfulness exercise at Sunday’s meeting. He’s “come out”
which I think is great and helpful to others in lifting shame and
stigma. May I introduce… Bill Abbott!
We had a speaker come to our regional facilitators meeting on this
topic, Dr. Zev Schuman-Olivier from westbridge.org, who is doing some
great mindfulness clinical work and research with dual diagnosis
folks. Everyone was riveted, it’s really exciting stuff!
I started a practice this week of 10 min a day using Susan Piver’s
guided meditations via her Open Heart Project. I am finding this
helpful. http://susanpiver.com/open-heart-project/
Google Scholar search on Zev’s work http://scholar.google.com/scholar?hl=en&q=Zev+Schuman&btnG=&as_sdt=1%2C22&as_sdtp=
I wanted to note that after the mindfulness exercise on Sun I felt super present in the moment on my drive home. The feel of the steering wheel, the curve of the road, the appearance of Harvard buildings across the Charles at night. It felt really different than the usual drive with a wandering mind and feeling distracted.
For me focusing has traditionally meant a lot of anxiety and being convinced I will not be able to do it, which of course hinders the ability to be successful. I’ve overcome a lot of it but I think without this practice I’m not going to really get where I’ve dreamed of being. I am still at times fighting so hard to focus that it is exhausting. I was a gifted student in grade school but anxiety seemed to rob me of some of my lucidity in about the 5th grade. I still did well but I knew I’d lost something. Part of my recovery effort is recovering this gifted mind which is still there but there’s some messiness covering it up. It’s been frustrating to put it mildly.
Thanks Suzy for ” outing ” me – LOL
But I beat you to it.
This defaut mode thing is likely the real deal. The opposite of mindful is mindless. Just think what you can do with that idea.
Ive often thought of addiction as making a serious jump for the worse when an impulsive behavior becomes a compulsive one.
This would imply the regular use of the default mode
Bill Abbott !!!
Ha seriously, when I go on autopilot things get dicey. Agree on the DMN science. Interesting we heard about this on Sat and again here in Marc’s blog. Exciting stuff!
Hi Bill (Abbott?!?!) Congratulations on your early appearance for Groundhog Day.
I am completely in synch with your idea about the switch from impulsive to compulsive. I want to give that a lot of play in my next book. Impulsiveness and compulsiveness are both more or less automatic, but compulsions are much harder to resist. You have to be “there” — ie, present and mindful — or else they catch you as they whiz by and pull you with them.
This may be where to look for the key to that paradox: addiction as too focused in one way and too unfocused in another way.
Great article Marc. Recently I conducted a very informal experiment with two recovery groups. I asked them to simply sit and be still. Those in early recovery really struggled with this exercise and reached 40seconds (and subjectively felt it was 2-3minutes) before they started fidgeting. The group in later recovery reached 2minutes before I stopped the exercise. I find this interesting and I want to see if this holds true with other groups.
I have always described addictive behaviour as walking through a field of tall grass. We tread a path and we become “programmed” to walk this path. We return to this path every time we feel “lost”. I have also long used the term “defaults” of behaviour, likening our addicted brain to the default settings of a computer. When things go wrong, we reboot to our default settings.
Further research on mindfullness techniques is warranted. Maybe NA/AA has it right: “Through prayer and meditation….”
Thanks, Shaun. What a great little experiment. These “toy” experiments often tell us more than the lofty formal experiments that get published.
And I really like your metaphor of walking through tall grass. It seems more and more that a deep understanding of addiction will come from fusing these two ideas: the idea of getting lost and wandering (as in default mode) and the idea of a narrow, automatic, constrained path of thought and action. Your metaphor captures this beautifully!
I’m glad that AA/NA got a few points from you, but of course many will argue that it’s not quite the right religion.
Calling AA/NA a religion is equivalent to calling science a religion. I hear this too often from individuals who work in Addictions; a lack of understanding of what AA/NA is. The empirical process is based off accumulation of evidence in comparison the second step of AA/NA “Came to believe…” is based off the same process; more will be revealed as you seek. Religion has theology whereas spirituality has no theology. Please read the big book of AA in it’s entirety before making statements about AA being religion. Also, do not make the same mistake as the fundamentalist who take particular phrases out of the bible to justify their beliefs; read the book in it’s entirety without a magic magnifying mind.
Getting off my soap box I wanted to say you wrote an excellent article. Keep up the good work!
However, at the same time I have to admit there is truth in your statement about AA and religion if I understand your meaning.
Hi Matthew, I appreciate your comments, and thanks for the compliment. But I did not mean to say that AA/NA is literally a religion. I understand that it’s not. My comment/phrasing was tongue-in-cheek, in response to some of the banter here on this blog. Glad to have you join us!
Best,
Marc
Yes Shaun. We all have those “go to” places and behaviors. The worn path you describe. Even if we are not “addicts”. I am the mother of an addict… and I certainly had, and have, my go to places in my brain, my heart, my mind. And Yes, mindfullness prayer and meditation do work. Awareness and fellowship. Love… and the gift of whatever serenity you can give to yourself. Janet
Great article and great comment thread. Shaun, I too have done variations on that informal experiment. Several years ago, at an NA beginner’s meeting, a man who was to become a mentor of mine pointed out how the newer folks in recovery would last about 14 minutes into a meeting before going out en masse to smoke. Since then, when leading groups I have spent more attention on the body language (esp. fidgets) during both discussion and meditation groups. My perception (and right now it’s only that) is that practitioners of meditation can sit longer, whether we are meditating or actively discussing. I now wonder if the “prayer and meditation” part of daily practice should be discussed more in our 12-step meetings..
I wouldnt confuse the eleventh step of AA with MM :
http://www.12step.org/big-book/big-book-chapter-6.html ( step 11 is to be found at the bottom of the page )
http://www.wildmind.org/applied/daily-life/what-is-mindfulness
It’s interesting the way you describe the default mode network, and its unfocused nature, as being key to the addicted brain. I have long considered that place key to my salvation from addiction in a sense. Well, in the sense that it was spending quite a lot of time going to that zone (in which I find my creative ideas, whether artistic or occasionally in analysis of my own experiences with addiction/treatment). I do tend to save that particular mental zone, however, for the times of the day in which I’m exercising, so perhaps there’s a difference to it when you are also physically focused on doing something while in the daydream state.
Conversely, I did find something akin to a meditative/mindful state in another area that involves physical exertion. The amount of focus required in certain martial arts and fight training is rather akin to meditation, which I noticed long before my trainer gave a bit of a speech on it. That, however, is the nature of that sort of activity. You have to be entirely focused and entirely present, you must shut down the default mode you describe in these situations because otherwise you risk, well basically, getting punched in the face if your focus wanders. I suppose it was a strange and less pacifistic method of finding mindfulness, but I can assure you (along with every person I train with) that it does work.
Hi Persephone! I know what you mean. There seem to be some precious aspects of default mode cognition. That may indeed be the place where we touch our dreams and find creative pathways with hardly an effort. So there definitely does seem to be some paradox here.
But the first thing to remember is that the “default mode network” is a neuroscientific discovery still in its infancy. The fact that these 10 or so brain regions show correlations in their activity during certain states of mind does NOT mean that there is only one network to talk about. Brain networks are likely comprised of multiple subnetworks. Some of these may be involved in creativity and others in…just…drifting.
I think there are moments when addictive impulses start to invade when you COULD focus your attention and fight, much as with your martial arts, and come out on top. OR you could drift with the flow and start teling yourself “why not” before you’re even aware of it. So that when you do arrive at a focus, it’s a focus on getting high.
True, and many of our emotional states that can be deemed negative do have positive flip sides. Anxiety can be the occasional flip side of great energy and drive; anger can follow along in the shadow of a positive desire for justice, etc.
I know little of neuroscience to comment knowledgeably otherwise, except to say that this reminds me of neurolinguistics, in which there is always some new area of the brain being discovered to be involved in every aspect of language processing imaginable. Of course, this is what makes any area of neuroscience so fascinating! Always something new to be discovered;)
And then there’s this:
People with low risk for cocaine dependence have differently shaped brain to those with addiction
(University of Cambridge) [For a study,] individuals who use cocaine on a regular basis underwent a brain scan and completed a series of personality tests. The majority of the cocaine users were addicted to the drug but some were not (despite having used it for several years).
The scientists discovered that a region in the frontal lobes of the brain, known to be critically implicated in decision-making and self-control, was abnormally bigger in the recreational cocaine users. The Cambridge researchers suggest that this abnormal increase in grey matter volume, which they believe predates drug use, might reflect resilience to the effects of cocaine, and even possibly helps these recreational cocaine users to exert self-control and to make advantageous decisions which minimize the risk of them becoming addicted…
They also found that people who use illicit drugs like cocaine exhibit high levels of sensation-seeking personality traits, but only those developing dependence show personality traits of impulsivity and compulsivity.
http://bit.ly/VeDMev
Thanks for pointing us to this article. I don’t have much to say about it, but the full reference is: http://www.sciencedirect.com/science/article/pii/S0006322312010049
You bring up the useful distinction between personality traits of sensation-seeking vs. impulsivity. I’ve often thought of them as related, and they probably are related, but that doesn’t mean they’re the same.
I am on board with the thinking that impulsivity and compulsivity are key. If we ascribe the loss of control over amount (of substance or behavior) to impulse and lowered inhibitions (executive function disorder?), and center it in the nucleus accumbens’ sensitization, then kindling signals the devolution from the NAcc to the dorsal striatum and compulsivity. That comprises the second level of loss of control: loss of control over initiation of the behavior. That’s when we see a hardwired closed system response to the trigger regardless of what the individual has decided, promised, sworn, or willed about not doing the substance or behavior. The behavior has detached not only from decision making circuitry but also from outcome. I think that there’s a qualitative change between the two and that that change predicts who can learn to use safely and who needs to abstain.
I used to run an impaired driver countermeasures program and we’d ask the ‘clients’ to fill out a 12-hour journal describing what happened. As well as discovering how many ghost deer and phantom vehicles there are that would materialize out of the late night darkness and vanish into the pre-dawn haze after forcing their vehicles off the road, we’d find two sorts of descriptions: the social drinkiers would see the problem as having too much to drink and getting behind the wheel, those with a drinking/other drug problem would see the problem as getting caught. They wanted to keep the behavior but eliminate the painful consequences. Some can, some can’t.
Getting better at sorting them out will improve treatment outcomes significantly.
Nicolas, I’m sorry I didn’t see or respond to this earlier. Or maybe I read it, forgot about it, dreamt something relevant, and then wrote my recent post thinking I had actually said something new on this blog.
The shift to compulsion really does seem to count as a qualitative change, and yes, you’re right of course that it’s mediated by the shift from ventral to dorsal striatum. What’s especially interesting, in relation to your comment, is that the shift to compulsivity can be charted at different time scales. It takes place within minutes or hours when craving and impulsive “exploration” devolve to the blind compulsion to use. And it takes place at a scale of months or even years, when the “social” drinker/user you describe becomes a true addict. At which point, impulsivity really doesn’t count very much, except perhaps as a bridge or conduit, and the behaviour has, as you say, become detached from both cues and consequences.
P.S. A false positive label won’t kill you; a false negative might.
I love this post, and have already gotten a lot of mileage out of it at the treatment center I work in. Whether I’m doing a lecture or process group, the subject of relapse always seems to come up. Gee, imagine that. We all accept that using is merely the consummation following the persistent courtship and foreplay of our addiction trying to “win us back”, and mend the broken relationship. When clients are talking about a recent relapse, they always seem to go right to the “straw that broke the camel’s back”. Which suggests some sense of awareness that the other straws were just as important. I like to take an almost CSI forensic approach to sifting through the straws in order to find the thing before the thing, and the thing before that, etc. Having spent decades as a chronic heroin relapser, I became somewhat obsessed with the genesis of a relapse. I mean, there has to be a point when you are walking in one direction, thinking pro-recovery thoughts, then you do a 180 and start walking and thinking in another direction. I try to encourage clients to practice walking and thinking in a mindful awareness of themselves in the present. In that state, I encourage them to ask themselves, what am I feeling?, what am I thinking?, what is my present goal ?(because we always have one or another), and what am I telling myself about all this. Again, this takes practice. This post really gave me some nuts and bolts to go along with that whole practice. They seemed to get excited that they had the ability to turn off the default mode of daydreaming, where that well-worn neural path of using lies, to a focused mode that actually exercises their ability to not follow every impulse. It has to start somewhere, and I think practicing M/M gets us familiar with that place, the genesis of the turning. So I encourage them to spend time in that state, to actually play with the button that switches us from default mode to focused mode, because it seems that’s where it may start. My hope is the more familiar they are with that place, the more they’ll learn the language of their brains, and hopefully recognize impulses for what they are. I think a lot of people think they can white-knuckle, and wait out their addiction until that balance comes back to their brains. Your book and blogs have helped me help them access the nuts and bolts of their brains, thereby effecting their ability to physiologically recover, or re-wire their brains, and they are eating it up and asking for more. Liking and wanting. Feels good, want more. The fundamental chemistry of learning. It’s awesome that we can work with our brain’s plasticity, and ability to learn, in a way that leads to awareness and growth, rather than deeper into the rigidity of addiction.
Just a few thoughts, and a big fat thanks. They are eating this stuff up. It’s either been missing from treatment, or hasn’t been taught in a hands-on practical way that really gives one hope and a reason to go one more day without using.
Thanks again,
Eric
Hi Eric. This is seriously music to my ears. There is much to discuss. I also am keenly interested in the “microstructure” of relapse. I buy the things you are saying here. There has to be a thing before the thing before….etc….. there has to be a turning point…. Or does there? When I say I buy your argument, I mean I find it really intelligent and insightful. But we must be missing something.
Maybe the clue is in your statement in which you describe a single goal at a single point in time. Some very good work in emotion theory and cognitive science suggests that we hold multiple goals at the same time. The ventral striatum’s job is to inhibit the goals which are not superordinate, so that behaviour can travel a straight, focused path. But as we now know, the v.s. is working too hard and very inefficiently when in the throes of addictive thought processes.
So….maybe we can think of competing goals which continue to face off… until one finally beats out the other. A different premise maybe, or maybe just a different perspective. There’s a lot more to say and think about here, but that’s a start.
Anyway, what’s music to my ears is that you and especially your clients are resonating to this stuff. Looking at what goes on in the brain really can, should, must help us think about the actual lived problem, the phenomenology of it. I plan to take that message to a meeting with top people in addiction, including Nora Volkow, with the Dalai Lama next October.
I find it VERY encouraging to hear you say that your guys are eating this up….and I will pass that message on.
Best,
Marc
Mindfulness sounds a lot like prayer. For me the best way for me to meditate and divert my thoughts from the default state is the Rosary. I love this information, thank you.
I think it must be something like prayer, but I’m not sure. Thanks for this compelling connection!