A reader recently brought up the fascinating connections between Buddhist meditation and neuroscience. There has been a lot of work in the last two decades, trying to develop a scientific foundation for meditation and also teaching science a thing or two, like how meditation changes the brain. In this post I want to suggest how meditation can reduce craving, thus potentially aiding recovery, and I want to briefly describe how this might work in the brain.
Last post, I suggested that “free will” or at least deliberate choice could be facilitated by slowing, down, relaxing, seeing the bigger perspective, and…even meditating. I was following Nico Frijda’s ideas about the importance of reflectivity in overcoming impulsive action. But how on earth do you slow down, relax, and reflect (let alone meditate) when craving is erupting throughout your consciousness. The craving for drugs (or booze, or other substances and activities) can be enormously powerful. As noted recently in a response by Mike Johnson, the dACC (dorsal anterior cingulate cortex), which is the seat of deliberate self-control, can be a leaf tossed around by a cyclone when the impulse to take drugs gets too strong.
Indeed, addicts are often caught in the cross-fire between two warring brain systems. The dACC, and its connections to the (probably left) dorsolateral prefrontal cortex, try to set up a long-range forecast, a bigger picture, a more reasoned perspective, and then use that perspective to inhibit behaviours that surely lead to failure and misery. Meanwhile, connections between the ventral striatum, which is the seat of goal-seeking, and the orbitofrontal cortex, another ventral system that anticipates the pleasure and relief of taking the drug or drinking the drink, get increasingly activated by dopamine, as the possibility, no, likelihood, no, GIVE IT TO ME NOW! gets closer and closer. The craving builds on itself in a self-reinforcing feedback loop in the ventral (lower) regions of the prefrontal cortex. While efforts to control the craving activate the dorsal (upper) regions of the prefrontal cortex, trying their best to hold the feedback in check. What’s a poor brain to do?! Or in human terms, how do you slow down enough to choose tomorrow, and the day after tomorrow, instead of the few hours’ relief promised by the drug?
Research into the neuroscience of meditation often uses practiced meditators, or else they compare people following a course of meditation against those who’ve taken some other form of instruction (the control group). These people are placed in an fMRI scanner or other brain-imaging system, and their brain activity is recorded, either while they are meditating or while they are engaged in other activities (such as looking at pictures designed to induce empathy). It’s difficult to sum up this entire branch of research in a few sentences, and results are not always consistent. But one finding from several studies (here’s an example) is that meditation causes increased activation in the dACC and/or in the (left) dorsolateral prefrontal cortex—the exact regions that support insight, reflection, and long-range perspective.
So it looks like meditation builds muscle, so to speak, in brain regions that can win against impulsive (e.g., addictive) thoughts and actions. How can addicts, recovering or not, use this information to their advantage? I’m no expert on treatment and recovery. But maybe we can think of these insight-generating brain regions as muscles, that are weakened by excessive use (trying, trying, trying not to give in) and strengthened by meditation. Then meditate whenever you can! And do it even if you’re still using. In fact, do it especially if you’re still using, or if you’ve recently stopped. Try it for 5 or 10 minutes, if that’s as long as you can last, even if you’re still thinking about getting high later in the day. But do it the next day as well. And the day after that. You can learn how in twenty minutes. Or check out this link to a talk by Jon Kabat-Zinn. As I said, I’m no expert, but meditation really helped me in the weeks and months following my last relapse. A little bit of meditation, spread over days and weeks, can gradually shift the balance between brain systems that dance to the music of craving and those that turn down the volume.
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
Marc, this raises many questions for me, although not strictly in the realm of addiction.
I had to stop working as of September 2009 due to my OCD becoming severe. I live with the fear that as I live my life, I will somehow cause harm to others or render things dangerous to other people. I have become a guinea pig. I’ve tried all the medications. I tried shock therapy (surgeon Sherwin Nuland overcame OCD with shock therapy) which basically didn’t help. I tried rTMS. It made things worse. I’m trying CBT (a ‘self’ therapy) while I wait to get in to see a CBT therapist.
You mention the cingulate cortex, which I believe is implicated in OCD. And Tourette’s? I worry at times that I will impulsively blurt out an obscenity or threatening remark. Are similar areas in the brain involved in OCD and addiction? Is there a correlation between patients prone to addiction and OCD?
What you are talking about seems to have a lot to do with neuroplasticity and even CBT. You can cause electrical and chemical changes in the brain just from thinking, or meditating, or ‘cognitive’ manipulation.
I believe that my future ‘success’ (I remain positive, a positive belief system) with my crippling OCD will come about from some combination of medication (Respiradone is helping me a bit now) and cognitive work (CBT) as well as time itself allowing my brain chemistry to change and new neural pathways to develop. My doctors this summer felt that rTMS would help a new neural ‘tree’ to grow with new branches in every direction.
Marc, one of the biggest reasons I enjoy your writing is because it helps me get a vivid taste of what is going on in my brain with neurotransmitters and how they and other aspects of my brain are affected by all of the SRRIs and SNRIs and Atypical Anti-Psychotics I’m being prescribed. Not to mention getting a handle on any damage I’ve caused my psyche by consuming prescription drugs in a recreational manner — morphine, tylenol 3, Tussionex, other cough syrups, and a lot of hashish and pot over the years. Not to mention my fair share of booze.
Your book has given me a lot of food for thought as I take my healing to the next level.
Again, thank you for your book.
Dave
Hi Dave. Your comment gives me a lot of food for thought as well. Thanks for sharing this personal information with me and with other readers.
OCD is like addiction in some ways and not in others. First, the brain part that is the culprit in OCD is the striatum, but it’s thought to be a different part of the striatum, called the caudate nucleus — different, that is, from the ventral striatum, which I highlight in the book as the locus of craving. Second, it might help to differentiate impulsivity from compulsivity, or impulse from compulsion. I recently went to a neuro conference where this was a topic of debate. The contribution I liked best was by a senior neuroscientist named Trevor Robbins, at Cambridge. He said it’s simple: an impulse comes from a cue (a sensory event, an input) that you can’t inhibit, while a compulsion is an action you can’t inhibit. OCD is certainly about actions you can’t turn off. But I think addiction is more a matter of impulse, because addictive behaviours are almost always triggered by cues. These cues can be thoughts about getting hight, proximity to drugs, booze, or cigarettes, seeing or hearing from a friend you’ve gotten high with, etc, etc. The ventral striatum of the addict is highly “vulnerable” to these cues. They don’t get turned off in time, so off you go to do your thing.
Third, I think addiction can shift from an impulse to a compulsion, but that’s a topic for another blog post.
I’m glad you’re staying positive. It sounds like you’ve had a lot to deal with. And don’t worry about your OCD “spreading” or taking on different forms. That’s unlikely. Lastly, some form of mindfulness-based therapy might be worth a try. ACT (Acceptance and Commitment Therapy) is one that’s apparently had good results. It may be possible to watch rather than try to control those compulsions.
Good luck!
Marc
Got this from a friend to whom I sent your blog. …
Thanks for this … it is a topic that is close to my heart and I’ve been writing about it for years, ever since I discovered that neuroscientists had finally caught up with the Buddhists J
***********************************
Gabriella Kortsch, Ph.D., CHT
Author: Rewiring the Soul: Finding the Possible Self
Blog: http://www.RewiringtheSoul.com
After this post – your site is now added to favorites!
Good to hear!
Wow, now that makes sense. Meditation, Bhuddist chanting, those things make me feel better, reduce my anxiety. And why wouldn’t practicing those things help me learn to think differently, react differently to stimulus??? Kinda like job retraining…say from psychologist to neuroscientist….(boy, that must have been a lot of work)
Yes, it was a lot of work. But like meditation, it pulls you along. The more you do it, the better it feels. And then you start to think: hmmmm…..why was I doing all that other shit for all those years. Funny how well that analogy works!
After a lapse, I find that meditation is pretty hard for about three or four days, then it starts to make its place in your life and gets more and more….right. It really did help me to keep off drugs in the days and years following my last relapse.
Marc, I have to thank you. Your book and this blog saved my life. I do mean the blog as a whole, but I’m commenting on this post in particular because it was a turning point, an aha! moment for me.
I was drinking myself to death, spiralling out of control night after night after night. I was in harm reduction counselling by the time I came across your book — my counsellor recommended it, actually — so I’d taken some first steps, but I wasn’t doing very well at actually making changes. I’d done a bit of reading on addictions and the brain, but when I got your book I just steamed through it. Your personal story is compelling and very well told, but it was the information about the dopamine-opioid interaction that really got my attention. I got to that part of the book right around the time this post was published, and the two just clicked somehow.
It came clear to me that my cravings were just too strong — those ruts have just been carved too deep by years of travelling up and down the same circuits. I realized those pathways have to be rerouted, and that that just wasn’t going to happen as long as I kept drinking. Once I saw this, I resolved to quit altogether, started meditating again, and did quit shortly thereafter.
It’s now been two weeks and counting. I was surprised that for the first week I had almost no cravings. I’ve had a few cravings now, but I’m able to hold them off because I have a better understanding of the mechanism of the craving, which leads me to understand what I need to do to counter it. Meditation helps. So does cognitive re-training, examining values and unexamined assumptions, and so forth.
I’m grateful that you wrote the book. It made a huge difference in my life. Namaste, & blessings.
(BTW I regret having to hide behind a pseudonym for the time being. Maybe someday I’ll be ready to come out, but not yet. I need the safety of anonymity for now.)
Stories like yours make me incredibly happy that I wrote the book and that I kept it balanced between the personal and the scientific. I hoped that would be a workable, potent combination, and it sounds like it worked for you. Thank you for sharing this.
The opioid/dopamine interaction is THE driver of synaptic shaping in critical regions of the cortex (and its links to the striatum). The result, as you say, is to carve out and then streamline synaptic pathways that make the experience (substance, etc) so meaningful. Although I don’t mention this in the book, alcohol also releases lots of internal opioids. (see http://opioids.com/alcohol/index.html) And the faster you drink the more opioids you get. (In fact “normal” pleasureful experiences release internal opioids too…which is why you can get literally addicted to, say, sweets. see http://www.sciencedaily.com/releases/2007/03/070302115232.htm) That’s the pleasure part. Everything after that is just wanting to maintain the experience or get it back. That’s the craving part…hats off to dopamine.
I still have cravings sometimes. See the Toronto Life piece under the “Press” link. Knowing what they are, just sitting back and watching it happen, and then watching it fade away…. that’s how the science of mind — and a meditation approach — can really help with the path to recovery. I wish you many more days and years of peace and contentment.
Thank you, Marc. Yes, I’m watching it happen and watching it fade away, just like I do with any other thought or impulse or itch that comes up during meditation.
It also helps that there is no option. I think it was towards the end of your book that you say something about how you really do just have to say no, and say it every day. I took that to heart, and it’s made my life so much easier. The beauty of abstinence is that I’m not facing a choice every day. It’s just not going to happen, and changing my mind is not an option either. The dopamine-driven urge may be strong, but it has a short attention span, so I know all I have to do is sit it out for 15-20 minutes and it will fade. It’s getting easier …
Wonderful! Of course I know just what you mean. My “No!” had to be tacked on my wall, to remind me frequently…really just to emphasize the point. But you can do it in your own head just as well. I also resonate with the time scale you mention. When I had cravings, after a period of taking painkillers following back surgery last year, I had to do the same thing, and yes, it took about 10-20 minutes for the cravings to subside.
Sometimes it feels like you’re sitting back and watching this fleshy machine, squirting chemicals from one place to another, activating cells that activate other cells…coming around again to suck up more chemicals. But whether and how you actually engage the motor cortex (and the parts that lead up to it) remains a matter of choice. Saying No is a simple act that can be repeated as necessary. Or you can just sit and watch the craving until the activity fades, almost as a bystander. Or you can let it drive you to habitual actions, and be a slave to it, and feel like shit afterwards.
I have a lot of admiration for people who do what you’re doing and think about it and talk about it openly. And I’ve just discovered your blog. I’ll visit it today.
By the way, I recently found out that the Dutch word for “addiction” is “slavery.”