Whenever I take a couple of weeks between postings I start to feel home-sick for my blog. I miss you guys. I miss having something to say to you — something that’s at least a bit thought-provoking and interesting — and I miss your comments. Whether lengthy and rich with content or brief musings, reactions on the fly, your comments engage me, teach me something, or remind me of things I’ve thought about, insufficiently, or simply touch me with some shared emotion, maybe a recognition of past or present feelings and struggles of my own. And of course, after all this time, I’m getting to know many of you, becoming familiar with your personal style of questioning or arguing, extending or contextualizing, trying on ideas, accepting, rejecting, fitting, refitting – one way or another joining me in a deep exploration of addiction and trying to understand its massive reverberations in our lives.
But I’ve started teaching this term, and the last two weeks have been something of a blizzard: reading, preparing slides, lecturing to 200-plus undergraduates at a time, and then coming home to my own kids, still only six but starting to ask big questions. From a teaming mass of unnervingly young, stylishly dressed, device-laden, Dutch-speaking, half-interested (on average) post-teens to my own little haven of unnervingly witty six-year-olds with ever-changing constellations of teeth (new and old).
But now here’s a free couple of hours, and I’m ready to serve the first course of something I’ve been cooking up for awhile.
In my recent posts I outlined four stages leading from unguided daydreaming to the ironclad compulsion to get or do the thing you’re addicted to. Here are the steps in summary:
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Mind |
Brain
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| Daydreaming | || | Thoughts flowing freely without direction | Default mode network: including posterior cingulate and medial PFC |
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| Impulse | || | Switch to attractive image of addictive goal and urge to pursue it | Amygdala (AMG), ventral striatum, VTA (motivation-targeted dopamine/DA) |
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| Goal-seeking | || | Rapidly-growing anticipation, concrete action plan forming, driven by craving | Orbitofrontal cortex, ACC, ventral striatum, VTA, AMG, hippocampus |
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| Compulsion | || | Shift from anticipation of reward / relief to urgent need to act at once | OFC and v.s. deactivation; dorsal striatum, AMG, DA from substantia nigra/motor loop |
Note that the brain column is pretty skeletal. Most (but not all) of these brain bits have been fleshed out in earlier posts and/or the book. Also note that I’ve skipped any step labeled “cognitive control attempts” — because I think these evolve in stages as the addictive urge evolves, with or without success.
So here’s the question: what is the time scale? How fast do we move through these steps, from the first fluttering of addictive images, interrupting our innocent fantasies, to a lurching momentum — gotta have it, gotta do it?
And the answer is: there is more than one scale. I count at least three different time scales for moving through steps 1 to 4.
A lot of natural phenomena have a property called self-similarity. That means that the same pattern gets repeated at different scales — whether in time or in space. Examples include the geometrical motif in the fronds of a fern, the curvature of beaches within bays within inlets that give shape to a shoreline, and the clustering of nests within communities within societies. Those natural forms show similar patterns at different scales — in space — from small to large. But we see the same kind 
of thing in time: for example, the back-and-forth cycles of advance-retreat in a conversation or argument can also be seen in the large-scale progression of a relationship: when one or both partners oscillate between confidence and surrender over weeks or months. And ocean waves break in dramatic clusters, leaving periods of relative calm, while the small wavelets within them follow the same rhythmic pattern of interspersed bunches. Maybe you’ve heard of fractals — patterns within patterns within patterns: where you see the same geometrical images at very different scales, all expressions of some common theme, some common structural principle.
Well this is all a bit dense, isn’t it? And what does it have to do with addiction…and the brain…and the way our lives unfold over time?
It’s going to take another post or two to flesh this out, but here’s where I’m going with it.
In addiction, we see this pattern: attraction leading to craving, leading to pursuit, leading to…a brief period of pleasure or relief, followed by more attraction and craving. In other words, wanting leading to getting, leading finally to loss or emptiness, which leads once more to wanting. For example: craving booze, drugs, or food, leading to binging, leading to saturation or tolerance, and then loss or maybe even withdrawal symptoms, then running out of the substance or the money to get it, leading to more emptiness, more craving. And this kind of cycling is fairly well recognized in the addiction field. A prominent review of addiction neuroscience has this to say:
Three major components of the addiction cycle have been identified — binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation (craving) — and incorporate the constructs of impulsivity and compulsivity…
But the first amazing thing is that this pattern, this cycle, can be seen at different time scales.
The slow scale tracks our hero as he or she develops a fondness for some substance or activity, leading to repeated experimentation, leading to a period of more intense experimentation, greater amounts, more potent concoctions (beer to vodka? painkillers to heroin?) as the fondness turns into strong desire turns into addiction. Self-control is easy to come by in the first month or two; but a couple of years later, once you’ve gone all the way, self-control is a plastic bag you’re chasing in strong wind.
The fast scale tracks our hero as he or she wakes up one Saturday morning, lies in bed daydreaming, suddenly gets hit with vivid images of doing it, tries to chase them away, fails, starts to crave, starts to plan, lifts up the phone and starts dialing…so that by early afternoon he or she is pacing frantically, waiting for Mr. Dealer to pick up the phone.
It’s the same sequence! The same sequence of psychological states, and — here’s the second amazing thing — the same sequence of brain stages. With one difference. The slow scale traces the development of addiction, the development of that unholy love affair, and the gradual brain changes that support it. The fast scale traces (the microdevelopment of) an addictive episode, or, we could say, the activation of the addiction on one particular Saturday morning.
And what about the brain changes? At the fast scale, the wiring pattern of your brain isn’t changing; that’s already set. Rather, the wired-up brain regions become activated — in roughly the same order they got wired up — and that happens fast! Because you are the proud owner of a set of biological connections, giving rise to a familiar cascade of feelings and actions, that took years to develop. At the slow scale, what fired together time and time again ended up wiring together. Remember Hebb’s Law? And now, what got wired together over months and years quickly starts to fire together — over seconds and minutes. Enjoy the ride: that downhill cascade that takes just an hour or two, and that’s self-similar to the developmental cascade that took years to complete.
As for a third scale, stay tuned.
My next post, coming much quicker than this one, I hope, will flesh all this out in detail. I think I finally get it, and I’m serving it up all month.
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
A parent I know related a tale that illustrates this from a layman’s perspective – the holistic time frame of living. Her son is an active heroin addict who kept (keeps?) a journal of some sort over the years. At some point they sat and did a retrospective of his life as he moved deeper into addiction. She was struck by how his productivity, his activity – his life really – dwindled over time in a tidy progression to virtually nothing but seeking the drug. She described his life review as an inverted isoceles triangle.
So, as his brain cycled through the increasingly familiar paths of daydreaming > impulse > goal seeking > compulsion, it picked up speed, and his life’s diminution accelerated at a similar pace, until the consuming activities of addiction muscled out life’s other activities.
Fascinating. My mind is filling up with geometrical images, something I tried to give up when I was much younger.
The ever-increasing speed of the decline, in developmental terms, may or may not correspond with increasing speed of the acquire-use-loss cycle that would happen every day or two. I’d be interested to know which is true.
I picture the inverted triangle as a cone (a triangle in 3D), and the acquisition-loss cycle as a little train racing around the circumference of the cone, sinking lower and lower, as the circumference gets smaller and smaller. Sounds like a geometrical image of hell!
Inverted cone and train on a downward, spiraling track – such a benign amusement park image, but in reality so hellish. On reflection, the anecdote I related, as I related it, is more linear than geometric, though I’m not entirely sure I get the “dimensionality” of your hypothesis. Addiction seems on the surface like any other ~learning~ process, where repetition yields proficiency, speed and acceleration. Guess I’ll need to wait for your next installment…
Next installment coming soon. And I KNOW I need to clarify some things. But I don’t think learning is very often linear. I studied “dynamical systems approaches” for a few years, and one thing I came away with is that learning curves are most often exponential (curved). I see this as most likely in addiction, where you have the impression that you’re suddenly rolling off a cliff.
You’re right that the shape of the cone and the progression of the spiral COULD be linear. But I rather imagine it as a cone that starts off gradually curved and ends up steeply curved, sort of like a witch’s hat. In which case, the spiral would have to get smaller in an exponential way as well. Not really self-similarity, is it?
What you really need, to make the model work, is pauses: both in the real-time and the developmental progression. When I was an addict, I would often go for days, weeks, even months a couple of times, being clean. But when I’d given myself over to it, there were pauses at a different scale: e.g., one last time, tonight, then holding out for most of the next day, then fuck it, ok, then tonight will be the last time….etc. There are even smaller spirals within those spirals, as with coke and short-acting drugs like Demerol. But….I’m giving away my next post.
Hi Marc, great to see a new post!
This pattern of addiction you describe here is indeed fractal in nature. Its like a storm within a storm. And perhaps there is even a further level, because the actual using itself acquires a pattern after the drug acquisition. And then in recovery we see this same pattern in reverse unfolding over time on multiple scales.
I think that this pattern you mention is described fairly well by the iRISA (Impaired Response Inhibition and Salience Attribution) Model proposed by Volkow and Goldstein. I was talking about this last night in a talk I did last night: http://addictioncapetown.blogspot.com/2013/02/sex-drugs-and-no-control.html
and said that this cycle and the underlying neurology is also seen in behavioural addictions.
I also had this to say, which seems to be matching your line of thinking: “Addiction seems to include aspects of both compulsive and impulsive behaviour types. I would suggest that it may start as impulsive and move towards being compulsive, often vacillating between the two. Similarly, sexual addiction both gratifies and repulses the patient, often giving the briefest moment of respite after hours, or even days, of obsession and ritual, shortly followed by deep shame and repeated promises of “never again!”
Lots more to think about, as usual.
Hi Shaun. Just a quickie for now. As far as I can see, the iRISA model captures the cycling at the scale of minutes or hours — what we often refer to as real time — but not the scale of development. What I think is particularly cool is that it’s approximately the same sequence of states, but it unfolds at two (at least two) vastly different time scales. In other words, the pattern of BECOMING addicted is a slow version of the pattern of going through a single episode of craving-binging-loss, etc, etc.
Have other people talked about this? If so, I’ve missed it.
Regarding the mix of impulse and compulsion, yes, I think this is crucially important. I finally found a paper that does a great job of showing how compulsion becomes the leading edge of impulse, so to speak, at the brain level. Which means that the function of the dorsal striatum becomes the front door for the activity formerly activated by the ventral striatum. This is important because the strategy for beating a compulsion seems very different from the pattern of avoiding impulsivity. But more on that later.
Marc
You right, I don’t see anything that proposes this formally. Interestingly I have always seen this exactly as you describe it. I will e-mail you a diagram I did a while ago in which I have tried to reflect this. It’s almost a ball spinning within a spinning ball – within a 3rd spinning ball!??!!
The micro is a reflection of the macro – Fractal Ecosystems. Interesting stuff – order in the chaos.
Look forward to more.
Hi Shaun
Thanks for the link. Your article seems well written and has several good points, e.g. about Carnes’ too easy equation of antisocial acts and paraphilias as the ‘extreme’ of sex addiction. I think it’s a remnant of the old AA doctrine of “the progressive nature of the disease”, which has some truth, for some cases, but in my opinion fails as a generalization because of poor foundation in the evidence (of the global picture, not just of those who turn up at AA meetings).
It was interesting that you present 12-step “S” meeting as adjuncts to therapy.
I’ve got over 150 under my belt, and find they claim the exact opposite: therapy is the adjunct to peer supported, self-instituted life changes. Is there any way to adjudicate claims, here. Is it only a turf war?
It’s appropriate to mention the ‘neither’ option, both here and below, based on data such as Fletcher’s ‘Sober for Good.’ People do move past problems, quite often w/o therapy or ‘treatment’. I must say ‘treatment’ gives me some chills, and causes reservations about excuses: I’m thinking of articles that say, “Celebrity X, after crashing his car into another and nearly killing several people, has been cleared of all charges with the understanding that he will seek ‘treatment’ for…”
One passage of yours is rather puzzling, in that it seems at first to agree with ‘less therapy’ and ‘more treatment’, and to believe in some such distinction. A few sentence later, though you’re recommending “cognitive behavioral therapy”! Are you implying it’s not ‘therapy’ and is more ‘treatment’. Does the distinction make sense? To take an analogue, is not ‘physiotherapy’ a ‘treatment’ of some physical or functional problem?
shaun //many of those seeking treatment for sex addiction feel that they need less therapy and more treatment. According to Robert Weiss, one of the major complaints received from patients is that therapists don’t understand how destructive their behaviour is. [..].
The types of psycho-interventions that have shown to benefit sex addicts are cognitive behavioural therapies, //
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You say, //The treatment of sex addiction is hard. Like with all addictions we are expecting the individual to move from instant gratification with delayed (possible) consequences to instant turmoil with future (possible) satisfaction. //
Something like this was/is surely the general goal of psychoanalysis and ‘dynamic psychotherapy.’ In Freuds famous phrase: //Wo Es war, soll Ich werden.” // Certainly, as you say, ‘a difficult task’.
I think you laid out some of the issues around compulsivity, impulsivity and ‘addiction’ and thank you for drawing my attention to the APA’s ultimate rejection of ‘hypersexual disorder’– presumably having already rejected ‘addiction’ and ‘compulsion.’ There are lots of foundational issues, here, including the more basic, what is [psychological] disorder?
I find myself leaning *away* from the term ‘addiction’, esp. where it takes on a life of its own as ‘disease’ (and further ‘disease requiring “treatment” ‘. Having listened to dozens of ‘sex addicts,’ the presence of underlying issues is quite striking, as you yourself mention. Hence in many cases, for example, it seems plausible to say, the main disorder is depression; there is an associated, derivative syndrome of sexually compulsive ‘acting out.’ There is, here, as you say, a harm to be curbed– like wandering dark alleys at night– but not exactly a ‘disease’ or ‘disorder’ to be treated for as such.
(All the later DSM’s confound these matters.)
There are many issues, not all of which are immediately relevant to this thread or Marc’s blog which possibly could be discussed in outside avenues.
Thanks again for your post and article.
Hi Nik,
I have responded to your comments on my blog at the original link as I don’t want to hi-jack this post of Marc’s. Thanks
Thanks. I commented there as well.
Hi Marc
A pleasure… always reading your post.
I was just wondering if the brain eventually rewires itself? I am tormented with night dreams, not so much using dreams just very vivid dreams that seem some how to transfer into memory while i’m awake.
Sometimes in the morning when I wake up, it’s hard to snap out of that night terror. I also have sever pain do to disc disease and take no medications.
I could easily stay dwelling on the negative affects of these issue, but I use laughter and humor to open up other path ways of pleasure, every morning it’s a cycle I go through.
So my question is: Do we eventually awake up to new brain pathways? Or is it always going to be a consent battle to keep the brain in happy thoughts?
Regards Richard
Hi Richard. You sound like a really interesting guy. I’m sorry you have to go through that every day, but it sounds like you’re good at it, and it makes you strong, doesn’t it?
First, your brain has already gone through a lot of changes or you wouldn’t be able to do what you’re doing.
Second, brains do change on many scales, from day to day, but also from year to year as we get older and our perspective and life goals change gradually.
Third, the damn trouble is that dreams, maybe like those you describe, keep activating synapses that you wish would dry up and blow away. I still have drug dreams, fairly often, but that may be because I have not been so stoical about my back problems and I do take painkillers from time to time. And yes, they tend to aggravate old wounds — psychic wounds, that is.
But I find the back and forth, between strength and weakness, reality and make-believe, fascinating to watch in myself. I try to “study” it in a way when I meditate. Maybe that’s all we can hope for. Change as much as we can change, and then sit back and just watch the show.
Oh, I should also mention that meditation has been shown to change brain function in many respectable studies, and this certainly squares with my experience: feeling a lot more peace, stillness, confidence, and so forth, and letting negative thoughts come and go without sticking.
Here are some recent articles, fully downloadable: http://scan.oxfordjournals.org/content/8/1.toc
I often tell people that I have an addict’s mentality–if some is good, then more is better. And EVEN MORE is EVEN BETTER. For me, that pattern is true for anything that is pleasurable.
Also, your mention of having a mental image of the desired substance as the start of the craving process reminded me of a finding I ran across recently: that mental imaging can also stop the craving process.
http://www.psychologicalscience.org/index.php/news/releases/the-psychology-of-food-cravings.html
Interesting article. I bet the participants did not struggle with actual eating disorders, though. There was NO WAY I was going to shake thinking about particular foods in the pursuit of food in a binge state. That being said, it does remind me of some of the intervention strategies recommended by practitioners. For example, if you can stop the pursuit of food/addictive substance just long enough to have a cup of tea, focus on the warmth and flavor of that tea, you can sometimes halt the pursuit of that substance. This act involves acknowledging all the sensory and visceral experiences at that moment, something that is potentially ignored when addictive disorders shift from ventral control to more dorsal control?
I also wonder if the OFC gets activated in states like this again. Since the OFC is often involved in processing the expected outcomes of goal pursuit, I wonder if this region starts to re-evaluate the outcome of engaging in a compulsive act. We may begin to ask ourselves, “do I really want to do this? I’m going to feel terrible afterwords and will accomplish nothing.” I don’t know if this experience translates to others, so I’m interested in your feedback!
Hi Marc
Am back after weeks of craziness as my best laid plans for building my house during the slow season for the trading biz blew up in my face.
Interesting that you have borrowed a particle physics/mathematical term (fractal) although its definition is very broad.anyway so why not?
I never daydream..only think about problems so I can’t speak to #1 but taken as a whole it sounds like you are actually agreeing with me in that addiction is a lifelong project and the easy part (if there is an easy part) is the early stages when the mind is onc
I don’t think you quite finished what you were saying, John. But welcome back from your weeks of craziness. I certainly do think addiction is a lifelong project — at least for many people. But there are also many who really do change. They change what drugs or booze or sex MEAN to them and how they experience themselves when they’re under control.
In any case, I certainly agree that the early stages of addiction are a picnic compared to the later stages. When compulsion starts to take over, it gets really really hard to quit.
Hi Marc,
I wanted to ask for some clarifications. You’ve spoke of
ML: //four stages leading from unguided daydreaming to the ironclad compulsion to get or do the thing you’re addicted to.//
Earlier, you said, ML //A final stage that I think is applicable to most people and most addictions: When addiction tightens its grasp, impulse turns to compulsion, and that’s when you just can’t stop – or so it seems.//
Can the stages, which you also call ‘states’ or ‘steps’ be applied prospectively or predictively? This position is that of AA which–while limiting itself to ‘true’ alcoholism– speaks of the ‘progressive’ (inevitably so), nature of the disease. This would be somewhat like progression of syphilis, through its stages,
WedMD characterized this as follows: ##If not detected and treated, syphilis may then progress to the tertiary (late) stage, the most destructive stage of syphilis. During this stage, syphilis may cause serious blood vessel and heart problems, mental disorders, blindness, nerve system problems, and even death. It may begin as early as 1 year after infection or at any time during the infected person’s life. About one-third of untreated people who are infected with syphilis will have the complications of tertiary (late) syphilis. ### [http://www.webmd.com/sexual-conditions/tc/syphilis-what-happens]
This progression, of course, makes sense, because there is a ‘bug’, a spirochete, that lingers and reproduces itself Your metaphor of the ‘addiction’ tightening its grasp makes it somewhat like a ‘thing’ or ‘bug’ that is going to stick around.
Putting it a little differently, what is the determinism or compulsoriness between stage n, and n+1. Between 1 and 2, by your description, I don’t see much determination. But your remark about tightened grasp of the addition, seems to suggest much more determinism. Perhaps you’re saying there is increasing determinism.
On the other hand, might the states make sense *retrospectively*? Given that you ended up where you did, (or I did, where I did), you traversed a certain path. If that is the proposal, then for example, the likelihood of a person who is at stage 1 going all the way to stage 4, is NOT very high. The analogy with syphilis would NOT apply, where 1/3 reach the tertiary stage, if untreated.
From my limited experience, I do see how retrospectively things may seem to have a progressive, determined, quality; I think i know where the AA is coming from; likewise the SAA. The vantage point pushes us to believe that there was compulsory progression: “not much I could have done would have prevented my arrival at this ‘endstage.'”
On the other hand, less biased methods of data collection suggest that many who started with a substance or activity, did not progress (depending on the ‘addictiveness’ of the substance). Further, the cases of ‘stopping’, which seem to exist for all stages count against the inevitable or compulsory progression idea. Indeed on your own account, you stopped, having reached the stage when the addiction most had you in its grasp.
These are fascinating threads, and I hope you’ll keep on with your questioning of the formulas and nostrums floating around about the ‘disease’ of ‘addiction.’
Hi Nik. I’ve tried to clarify more about the structural changes in my recent post. I know I only skimmed the idea in this post. So, yes, these brain changes are progressive in a determined way, in my view. But that does NOT mean that one is determined to go all the way to the end stage — compulsion. As you say, people can stop at any of the stages. The inevitability of stages does not mean that stages must inevitably follow through to the end. So — as you acknowledge — that’s where the analogy with syphilis breaks down.
Fires have stages. From ignition, to combustion of primary fuel, to combustion of whatever remains after the primary phase, to ashes or coals, whatever. Yet fires can go out at any of those stages, if the wind isn’t right or the fuel isn’t sufficient to support a good updraft. (I’m no expert, but that’s how I’d tell it)
So I think that AA is just plain wrong about the inevitability story. A lot of people find that they’re drinking too much, take a break, slow down, and remain social drinkers for the rest of their lives.
By the way, nice pun in the title – didn’t go without a chuckle!
Thank goodness. I hate it when my puns are ignored.
Marc- I just stumbled on your blog today. I am ADHD and have a general interest in neuroscience, neuroplasticity, brain fitness stress management…oh yeah, I said I was ADHD. I read an article today about a Doctor/Pharmacist in Los Angeles CA who will soon be on trial for murder due to irresponsible prescribing practices. One of the college kids who died drove over 700 miles round trip to get to this particular doctor and pharmacy before the end of term break. He died the next day from and overdose of Oxcy/Xanax/Alcohol at a party about 24 hours before he was due home. It seemed ludicrous to me that the Doc would be charged with murder, and I started thinking that it has been 30 years since I have been in school so I should check up on what neuroscience is saying about addiction. It seems we are studying everything with fMRI’s these days. So that is how I ended up here. I have read a few of your posts, and I am not qualified to say, but you certainly seem like an expert to me.
One thing jumped out at me, perhaps because I am unfamiliar with your work: the chart above with MIND in one column and BRAIN in the other. Are you using mind as a way of talking about that part of the brain processes that we are as yet unable to explain? Some of your other comments led me to believe you believe that it all happens in the Brain (and body obviously). As an atheist, I look at things like “free will” , mind, spirit and soul as ways we talk about experiences that we can not adequately explain with today’s science. We will one day I am sure, but clearly our brain is processing millions, hundreds of millions of bits of information while our attention (another term of convenience?) is on one, or just a few. Clearly our brains and other organs are functioning and making decisions about data, making adjustments, sending and receiving messages etc without our “mind” ever knowing.
I was having a conversation with a friend who is a philosophy professor about some border collie pups I saw working together to solve a problem. I was a little stunned to find out that he still thought of animals the way Descartes did, meet puppets that were no more sophisticated that a single cell organism (stimulus-response). When I said something about the dogs emotions he was completely lost. One of his questions was, “but what about the soul?”.
Sorry, a lot of verbiage to ask the simple question about “the mind”.
I recently had a very close friend relapse. This was not her first relapse, but this relapse was different. She had been clean for over 2 years…whereas her previous relapses were after a short period of clean time. I wasn’t living near her when it started, but I would hear about the progression of her active addiction via close friends and family members. I would reach out and offer help, but as we all know..you can’t help someone who doesn’t want it.
Luckily, she just recently went to detox and will be moving to a halfway house in a few days. I spoke to her on the phone yesterday, and you can already tell that the drugs are out of her. They had completely taken over her personality and behaviors. As we were talking, she told me how simple decisions she made eventually lead to her relapse.
She used drinking as a coping mechanism, and really just replaced one drug with another. Everyone seemed okay with this because alcohol seemed like the lesser of two evils when compared to heroin. Her parents are alcoholics and were previously addicted to stimulants. She didn’t see a problem with drinking either because she felt it was better than sticking a needle in her arm.
Anyway, one of her friends began dating an active heroin addict. She did not support the relationship, but she tolerated it. As expected, her friend also became an addict. My friend was exposed to things she had avoided for 2 years, but she truly thought she was strong enough. She went to her friend’s house and found needles, she would see people high, etc. Exposure to these things triggered something in her brain and activated an area that had been dormant for some time.
And this is where the time scale began. She described it as much faster than the development of her initial addiction. I would say this time scale lies between the short and fast one. Her brain had already been wired for situations like this, and seeing the needles and users triggered her brain to revert to her active addiction.
By the way, I plan on buying her your book. She would really benefit from reading it.
As always, thank you,
Megan