Hello people. I’m writing this using a voice recognition app — and then editing the result. Which is pretty strange after all these years using my fingertips. I had a torn tendon in my shoulder repaired last week, and for the next 5 weeks I will have to keep my right arm in a sling. What a drag! At least I’m learning to e-nun-ci-ate more clearly. The most frequent turn of phrase in our household is “What?!” This could help.
For today I just want to draw your attention to the new look of my website. The title, understanding addiction, is clearly what we’re trying to do here. The subtitle, linking brain, behavior, and biography is meant to highlight the importance of integrating viewpoints across these radically different modes of inquiry.
Perspectives on addiction from psychological research, neuroscientific data, and biographical accounts (including addiction memoirs and stories) are so different that it seems we are describing unique phenomena or different species. But there is just one phenomenon we need to grapple with, and our understanding of that thing will be greatly enriched and articulated by unifying these perspectives.
You probably agree with me or you wouldn’t be reading this. And I don’t need to preach to the converted. Rather, I want to highlight the importance of combining perspectives for newcomers — former and recovering addicts, their families, and writers, scientists, and treatment providers. Because it just isn’t done enough. It’s hardly done at all! How often do you think addiction memoirs are read by addiction neuroscientists? How often do people mesmerized by stories of addiction and recovery delve into the brain processes going on at the very same time as those stories are unfolding? Not interested? Too complicated? Psychologists sometimes dip gingerly into each of the other two spheres, but they often don’t use what they learn to design more meaningful studies.
Noted exceptions are Gabor Maté (no, not gay bar message, not game board Maytag, not Gameboy anything!!! This voice recognition software is hilarious…I mean, at least it’s trying) and more recently Carl Hart. It can be done. It’s not all that difficult. The trick is to realize that we are describing the same human being going through the same immensely difficult and powerful transformation and to recognize that this person’s brain, mind, subjective experience, and behaviour all reflect it, though in very different ways.
I also want to encourage my readers to send your stories for me to post on the Guest Memoirs page. It’s still there. Do your part! Let’s keep reading, thinking, and telling our stories — and listening to each other.
You’ve heard of the blind men and the elephant? Each man describes what he gleans from touching a different part of the animal, but it takes all of them together to get a sense of what an elephant is. So I’ll end with a sentence from Wikipedia I got by clicking “blind+men+elephant”
At various times the parable has provided insight into the relativism, opaqueness or inexpressible nature of truth, the behavior of experts in fields where there is a deficit or inaccessibility of information, the need for communication, and respect for different perspectives.
That pretty much says it all.
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
Seems to me that Isaiah Berlin’s hedgehog and fox story is also relevant too … there sure seem to be a whole lot of hedgehogs in the field of addiction studies!
BTW, did you really want the British spelling of “behaviour” in your website header subtitle? You used “behavior” in the post … but maybe that was your app ;).
Could you summarize that for us in a couple of sentences?
And as to the spelling, it’s Canadian as well as British. Since I’m Canadian (even though most of my readers are American) it feels appropriate. But I do get mixed up a lot.
I came across the idea in an editorial on obesity in The Lancet a few years back that talked about the difference between complicated and complex problems. Rather than do a poor paraphrase, I’ll just quote part of it here:
Sorry … meant to attribute that quote. Here’s the link: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61272-5/fulltext.
Thanks for this, Beth! I especially like the line at the end of the summary “…is the result of a normal response, by normal people, to an abnormal situation.” What does that sound like?
Hey Marc
Again, we think in parallel! I have been repeating ad-nauseam to anyone in the field, especially the academics, about how important it is to “listen” to the lived experience of the people they are “treating” and designing interventions for. Often there is a massive disjoint between the various fields and a grand-canyon sized gap between the real-world lived experience and the laboratories of science and healthcare. I think this is partly what Engel tried to overcome when he first proposed the Biopsychosocial approach, but this has been silo-ed into it’s component parts, leading to reductionist approaches that fail to understand the “wholeness” of the experiences of drug use.
I have been facilitating the setting up a drug-users network, and I am hoping that our local Medical Research Council will consult with them when designing research so as to fully understand the complexities of the life of a drug user.
Hope the shoulder heals quickly!
You say it so beautifully, Shaun, and indeed I sometimes get the feelings that we are twins separated at birth. Let’s hope that the networks you and I envision will make a big difference to how information is gathered and consolidated. And the shoulder is much better already, thanks.
Hiya Marc
This was pretty much what we were talking about over curry when we met all too briefly in London last week. There are lots of really innovative things happening around the field of mental health in general and substance misuse in particular. Much of this is informed by the narrative of memoirs like yours, Gabor’s and Carl’s. Unfortunately the narrative always seems to get lost or usurped by our obsessions with outcome and data. We seem to have completely lost touch with the whole human element by leaning towards ordering tests instead of talking to and/or physically examining the people we work with. In doing this we not only overlook very simple diagnoses that can be diagnosed at a treatable, early stage, but we’re losing something much more than that. We’re losing a ritual, involving human contact, that I believe to be transcendent, transformative and is at the heart of the therapeutic relationship. We are all to quick to adopt the expert role, tell people our hypothesis about what ails them and, subsequently what they need to do about it. It’s a cultural thing and requires a cultural solution. Cultures exist because of the human stories they contain and fortunately we have memoirs like yours and many others that are beginning to replace the expert narrative and offer alternatives.
Hope the shoulder is ok. love and light x
Yes Peter
I was recently having a conversation with a couple of other people in the field and wrote this:
“I think that the way we experience drugs, or the environment in which we take drugs, is vitally important. I think that all too often interventions look at the behaviour and not the “experience”. It is the “experience” in totality that mediates the learning experience that Maia talks about. Once the behaviour is learned, the experience is usually forgotten and irrelevant. I see the role of the therapist as assisting people in making conscious decisions around drug use – slowing down the learned habitual behaviour and making a conscious decision about what it is they want to experience from the drug (if anything). With the heavy focus on time-limited EBTs in therapy the field tends to focus purely on the short term changes in behaviour rather than examining the relationship with the drug or behaviour. We need to see drug use in terms of the lived experience. I was interested to see that in Norway, where mentalisation is being used to treat addictions, the minimum recommended period of therapy is 2 years. My personal belief is that this focus on “curing” addiction is more harmful than good – rather focus on the person than the drug. Given the right space and opportunity, most people will resolve their problematic relationship with drugs spontaneously.
I was recently looking at the origins of the biopsychosocial model, a term that is easily thrown around and often is a catch-all phrase that can mean nothing, but the work of Engel is very interesting, recognizing that a biomedical approach is too limiting even for biomedical of diseases. He felt that this was more-so in psychiatric diagnosis, and that if psychiatry focused on biomedical issues alone, it would loose relevance and become meaningless. If so for biomedical disorders, how much more so for addiction, which is at the very essence of the human condition.”
Thanks Shaun and Peter! And all this great work you guys are doing reminds me of another underserved population who are mostly in the dark, and desperately want to better understand their loved one’s behavior: the friends, family and loved ones of person’s with addictive disorders. And the majority of them know very little. What many have learned hasn’t come easy, but through trial and error and battle after hard won battle, trying to help the person they care so much about.
You three are amazing. Peter, I could frame your words and hang them on the wall. If this enterprise (that the three of us seem to be embarking on) were a religion, you would be the pastor. You have a way of making the message echo and resonate long after the words are gone.
Shaun, you know the literature and the discipline-specific biases and pitfalls so well, and you are discovering, through your forays in community-based treatment, what new combinations of story and expertise can be most penetrating. I agree that people’s experiences — what Peter would call stories embedded in culture — are what we need to connect with and understand. People don’t misuse drugs when they feel at peace with their worlds.
And Matt, you continue to pick up the pieces missed by everyone else and connect them so artfully to the larger themes we are weaving. You three know this world intimately, partly because you (like me) have seen it from many sides. A good place to start!
Hello Marc and fellow travelers in this Galaxy of Addiction. It is indeed not a linear experience, as much as we may want it to be. If we can let go of our fears, and the resulting need to encapsulate addiction into a formula that we can “understand”, then we can begin to live “the answers”.
It is a journey of such great unknowing and tests everyone involved to the core. As the mother of an addict, I didn’t get better until I let go of the rubix cube I was trying so desperately to solve .. once and for all. I had to let go of what I imagined. Of what I thought was right. And my son didn’t get better in the ways I could have ever orchestrated. But he did. And it is stunning. It is not a broken puzzle with one solution and understanding. It is alive, full of heart, and very personal. And deserves a great deal of respect and care. And awe.
Be well everyone. We are all connected.
Hi Marc, Sorry to hear about your shoulder injury and glad it can also provide some humor from having to use the voice recognition software 🙂 In some ways, I see that as a bit of a metaphor for the disconnect between the different communities dealing with addiction. If you asked someone who is mostly focused on neurobiology to repeat what they heard from someone telling their personal story, their account might not sound much like what the teller originally said!
On a more personal note, thanks for the reminder to add our stories to the guest page. I really need to do that! I am so glad to have this venue to do so since what often stops me is the expectation that the ending is some sort of final “cure.” I experience my story as a continuum, all the factors in my life (most never to be fully understood) before I became actively disordered in my relationship to food, then the period of bulimic behavior, including various therapies, etc. How the behavior ended is not the conclusion. In some ways it was just the beginning of the process of getting on with my life, which continues to this day (just past the age of 65 and better than ever!). Thanks again for doing this work and creating this community!
Yes. It is infinite in scope and possibilities.
Thanks for this Marc…and Janet and Julia and Shaun and Peter and everyone who injects such insightful input to this sight and this topic. I think the field is recognizing that the diversity of predisposing factors like experience, development, culture, environment, and all manner of causes and conditions lead to the rabid habit of addiction. Accordingly, treatment needs to be consumer-driven, guided and not prescriptive, in a way that helps people discover their options from a range of alternatives. The methods that work, work because people recognize and choose them, not because they are forced.
Currently most of the treatment industry and general knowledge is fear based. We need more compassion, kindness, and less fear. Difficult, but possible. We are not trying to wipe something out… we are trying to grow something. Never stop believing.
Yes!
…and when you’re trying to grow something you go to the nursery, not the pesticide distributor! I think the implementation of roles like “recovery coach” in ER’s and detoxes, and places like “recovery centers” that are clearing houses of related services that people can just walk into…that’s going in the right direction…
Hi Janet! See the comment below by Elizabeth. It sounds like you may have something in common….
Yes Marc. Thank you. I noticed that. May I echo your encouragement that people contribute to your Guest Memoirs. It is amazing how good it is to connect the voices and share the experiences.
Thanks to everyone for all that you are doing to offer hope in the world of addiction. As a mother of an addict that has spent over $250,000 on various treatment facilities–all preaching the disease model and AA as the only cure, I have found some relief in your thoughtful and sensitive approach to the subject.
Again, many thanks. Hope you heal fast!
Elizabeth, So glad you found comfort here. I did, too. And I continue to do so. If you want, read my Guest Memoir Immortal Pain, Loving an Addict on Marc’s Guest Memoir Page. I can tell you, my son and I have both been healing, recovering our love. Never stop believing. You are not alone.
Hi Elizabeth. I’m sorry to hear how difficult it’s been. That is a LOT of money and I recognize that every dollar has an emotional counterpart that can’t be counted. There are nonAA / nonDisease-model treatment centres, but so far they’re few and far between. I hope that our dialogue will help to change that.
Also see articles and posts by Maia Szalavitz and Stanton Peele for more inspiration. And please do consider a Guest Memoir, as suggested by Janet.
Also, if you’re still going after rehabs, you might want to look at Inside Rehab by Anne Fletcher. It’s very good. Or get in touch with me if I can help.
I’m sorry you’ve been experiencing that Elizabeth. My family did the same thing when I finally had to stop. And after throwing all that money, good after bad, we were the ones who ultimately had to figure out what worked for us, and what was going to get and keep me sober. There are some programs that take advantage of the desperation people feel at being thrown into this netherworld, by charging big bucks to basically shelter people from the world, and use free services like AA/NA meetings for treatment— under the guise of training and inuring people to what they will need to maintain sobriety when they go back to their lives.
That said, within all of this there are some extremely dedicated counselors and addiction workers…and great self-help groups. It takes work to educate oneself about the issues, who are your best allies, and what is available for treatment and the best fit for your loved one. Hang in there…
“Loneliness does not come from having no people about one, but from being unable to communicate the things that seem important to oneself, or from holding certain views which others find inadmissible.” C.G Jung
I’d like to thank all of you for your helpful feedback. I will certainly follow up on everyone’s suggestions. I agree, we can never give up hope. All the best, Elizabeth
I cant agree more with the need ” to highlight the importance of combining perspectives for newcomers — former and recovering addicts, their families, and writers, scientists, and treatment providers. Because it just isn’t done enough.” Nothing will change until that changes. And its VERY difficult to help start that process. Well done, Mark.
Can only say for now, due to time, that my thoughts parallel yours 🙂
For so many years I avoided sadness through alcohol and drugs. It’ seemed my inner afflictions were affecting my outer actions.
Today I have dealt with the past… brought closure to all, or most of my unresolved issues.
You can’t heal your wrong doings, unless you own your mistakes….
You can’t change what you don’t acknowledge.
It’s not so much what has happened to me, said to me, done to me, but how I react on it.
Sure past traumas, your environment, all have an impact on your thoughts, but it is up to you to make the best of whatever life throws you.
We as human beings are very adaptable, to our environment and can live most anywhere, like for me in jail, on the streets etc.
Our life is within our thoughts, and how we see things, if we believe “Life sucks” then it sucks for you.
Today each day is a Love and a joy of the next to come..
There seems to be sound agreement that merging approaches is important. But how do we do it without it becoming a confusing tangential mess, as ineffective as what we have now? How will people in crisis be evaluated and guided, by themselves or somebody else, in a relevant direction to the relevant tools?