Hi you people! I haven’t forgotten about you. In fact I really miss you. This blog community has been like a second family to me, and I’ve gotten a lot of warmth and a lot of learning from communicating with you.
As I mentioned last summer, I’ve moved to L.A. with my family — temporarily. And I’ve spent the last two months feverishly trying to finish my new book: The Biology of Desire: Why Addiction is Not a Disease. That’s why I haven’t been posting.
I have to get a full draft to my publishers by tomorrow, then I’ll be off traveling again (this time to South America!) for two weeks. Then I think I’ll be able to start regular posting again.
For now, I’ll copy the first few paragraphs of the book. It’s still only a draft, and the argument will be old news to those of you who have followed this blog. But it’s the best summary I can give you of what I’ve been thinking and writing about.
“Public attention has been riveted by the harm addicts cause themselves and those around them. More in the last few years than ever before. And the way we view addiction is changing, molting, and perhaps advancing at the same time. We’ve begun to separate our ideas about addiction from assumptions about moral failings. We’re less likely to dismiss addicts as simply indulgent, spineless, lacking in willpower. It becomes harder to relegate addiction to the down-and-outers, the gaunt-faced youths who shuffle toward our cars at traffic lights. We see that addiction can spring up in anyone’s backyard. It attacks our politicians, our entertainers, our relatives, and often ourselves. It’s become ubiquitous, expectable, like air pollution and cancer.
To explain addiction seems more important than ever before. And the first explanation that occurs to most people is that addiction is a disease. What else but a disease could strike anyone at any time, robbing them of their wellbeing, their self-control, and even their lives? There is indisputable evidence for physiological changes with addiction. Research over the last 20 years reveals distinct alterations in brain structure and function that parallel substance abuse. This seems to clinch the definition of addiction as a disease — a physical disease. And it gives us hope, or at least forebearance; because the notion is sensible, comforting in its own way, and part of our shared reality. If addiction is a disease, then it should have a cause, a time course, and possibly a cure, or at least agreed-on methods of treatment. Which means we can hand it over to the professionals and follow their directions.
But is addiction really a disease?
This book makes the case that addiction results from the motivated repetition of certain thoughts and behaviors until they become self-perpetuating habits. Thus, addiction develops, and it can develop quickly, through a process I call accelerated learning. A close look at the brain tells us why this occurs: because the neural circuitry of desire governs many other brain functions, so that highly attractive goals will be pursued repeatedly, and that repetition (not drugs, booze, or gambling) will change the brain’s wiring. As with other entrenched habits, this developmental process is underpinned by a neurochemical feedback loop that’s present in all normal brains but now spirals more quickly than usual because of the allure (and repeated pursuit) of particular goals. There’s mounting evidence that addiction arises from the same neural hardware that binds children to their parents and lovers to each other. And it builds on the same cognitive mechanisms that permit humans to seek goals selectively and to pursue symbols — goals that stand for something. Addiction is unquestionably destructive, yet it is also uncannily normal: an inevitable feature of the basic human design. That’s what makes it so difficult to grasp — societally, philosophically, scientifically, and clinically.
I believe that the disease idea is wrong, and that its wrongness is compounded by a biased view of the neural data — and by scientists’ habit of ignoring the personal. It’s an idea that can be replaced, not by shunning the biology of addiction but by examining it more closely, and then connecting it back to lived experience. Medical researchers are correct that the brain changes with addiction. But the way it changes has to do with learning and development — not disease. Addiction can therefore be seen as a developmental cascade, often foreshadowed by difficulties in childhood, always accelerated by the narrowing of perspective with recurrent cycles of acquisition and loss. Like other developmental outcomes, addiction isn’t easy to reverse, because it’s based on the restructuring of the brain. Like other developmental outcomes, it arises from neural plasticity, but its net effect is a reduction of further plasticity, at least for awhile. Addiction is a habit, which, like other habits, gets a major boost from the suspension of self-control. Addiction is definitely bad news for the addict and all those within range. But the severe consequences of addiction don’t make it a disease, any more than the consequences of violence make violence a disease, or the consequences of racism make racism a disease, or the folly of loving thy neighbour’s wife make infidelity a disease. What they make it is a very bad habit.
Although this book uses scientific findings to build its case, it works through the testimony of ordinary people. I relate detailed biographical narratives of five very different people, each struggling with addiction, as the scaffolding on which brain science is introduced and interpreted.Through these stories, I show what it’s like and how it feels when addiction takes hold, while explaining the neural changes underlying it. There’s no doubt that these changes mark a difficult passage in personality development. But I conclude each chapter on a positive note, following my contributors through their addictions to their growth beyond it — a phase often termed “recovery.” And I provide the neuroscientific facts and concepts to help us understand how they get there. Most addicts end up quitting: uniquely and inventively, through effort and insight. Thus quitting is best seen as further development, not recovery from a disease.”
Sayonara! More 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
” addiction results from the motivated repetition of certain thoughts and behaviors until they become self-perpetuating habits.”
This could describe anything from farming, engineering, politicians.
I think when all is said you will find it is dependent on your specific definition of “disease”.
It is not a single process, but can involves chemical, physical, social, philosophical, cultural, primitive, middle brain desires, and higher brain executive function. Some of the forms have internal chemical root issues, like some overeaters have high ghrenlin, the hunger hormone, between normal and Prader-Willie levels. Most medical systems will not fund the test. There only solution is to learn to live hungry. Now that is disease or a natural condition or just a habit? We get lumped with the overeaters or food addicts; they at least understand the issue.
Prader-Willie is a good example of a disease that went misunderstood as the “disease of over-eating.” The behavior was misinterpreted as the disease. Such is the current case of addictions. In this way, the disease was mislabeled on the behavior, which of course wasn’t the disease at all but a symptom of it. Leptin, or the lack of, is the foundation of that disease. This is where addiction has been stuck. The behaviors have been mislabeled as diseases. Addiction to alcohol, for example, has been mislabeled the disease of alcoholism. This has been done with every addictor. Thus, the diseases of addiction. Ridiculous. If one looks myopically at addictors & then concludes each addiction to whatever addictor is the disease, you”ll come to the mess we have today. But if you look at the addiction to any addictor (behavior, substance, belief, etc) as a symptom of a brain disease, things begin to fall into place. The reward cascade conflates down, for addicts, to a low functioning system, and this is the origins of the brain disease that causes the symptom of addiction. And is why addicts are constantly in the “on” position, if you will, and are inexorably seeking to raise their hypo-functioning reward cascade. The addiction(s) themselves and the habit(s) that are produced are associations, not causes. This mistake is why prevention, treatment, recovery & policies based on this misinterpretation have had little to no impact, and ultimately perpetuate the problem they’re aiming to prevent or help. In my view, it goes like this:
BRAIN DISEASE
1. Addiction(s) (symptom)
2. Decision making disasters (symptom)
3. Evaluation mistakes of self & others (symptom)
This delineation is a very important distinction from the current hi-jacked brain hypoth (HBH) that’s currently in place. Policy, prevention, treatment & recovery are all based on the wrong premise, wrong premise=wrong conclusions. The habit of putting your left sock on first every morning isn’t the same as addiction, or attempting to self regulate & increase the low-functioning reward system that we addicts are born with.
Disease – A disease is any perturbation in any physiological system of an organism which changes the function of that system and leads to negative consequences for the organism when compared to a healthy, normal, standard. Implied in this definition is that the cause of this change is outside the control of the organism; it happens to the organism. Thus, when we speak of a disease there is no blame, no recrimination, no guilt, and no stigma. Also, a behavior such as an addiction can’t be a disease, by definition. It can only be a symptom of a disease. Symptoms are inherently outward manifestations of a disease or disease process located within the body. Diseases are necessarily anchored in a bodily organ or organs through a pathophysiology such as genetic, traumatic, infectious, immune, malignant, toxic, degenerative, or others affecting parts of the body.
Hi Marcus. I agree with the details of your argument but not your overall conclusion. Granted that each addiction is not in itself a disease. Each is a variant of something more general. But why must we call that more general class of things a disease? The recurrent pursuit of a limited set of goals, poor decision making, and biased evaluations seem to me to be aspects of the human condition. In outright, long-term, end-stage addiction…true, we see these distortions in exaggerated form. But we also see them in their extreme in child abuse, racism, and certain habits of the American electorate.
I don’t think that these extremes define a disease state. Rather, I see them as extremes of the overwhelming struggle to be rational yet anxiously, desperately human. But wait, my book will make this clear. At least I hope so!
Hi Mark. I’m trying to get my mind around what you said. Also, wrestling with the feeling that I am not worthy of discussing this with you. But here goes… You said “each is a variant of something more general. But why must we call that more general class of things a disease?” If I’m understanding what you’re saying, it’s the “something” that’s “more general” that would be the (brain) disease. Specifically, the low functioning reward cascade (disease). I agree that “limited set of goals, poor decision making, and biased evaluations” are aspects of the human condition, but in the case of addictions, the cause is the diseased (limbic) brain. Like eating in the case of Prader-Willie is part of the human condition, the insatiable hunger itself is the result of the diseased brain (leptin) . A disease is any perturbation in any physiological system of an organism which changes the function of that system and leads to negative consequences for the organism when compared to a healthy, normal, standard. Simply, the reward cascade of addicts are diseased which produces the addiction(s), decision making disasters and evaluation mistakes of self & others. By comparison, they would be the equivalent of insatiable eating (symptom) in Prader-Willie.
You are VERY worthy and your arguments are sensible and clear. If it were a simple yes-or-no question, there wouldn’t be much point in writing a book about it. But without giving away my punchline, let me copy just a few points that, for me, take addiction out of the disease category. And by the way, your comparison with Prader-Willie syndrome doesn’t seem quite right. The addict’s desires are not insatiable. They’re just strong. It’s not like what happens to rats when we ablate a big hunk of their hypothalamus. Rather, the rewiring that occurs in the striatum, midbrain and prefrontal cortex involves synaptic changes that are common whenever we fall in love, whether with a sports team, a romantic partner, or our own children. They are normal developmental changes, though often they occur at an accelerated rate. And they’re reversible. But that’s a long story.
Here are a few more micro snippets:
Many of the brain changes characterizing addiction disappear when people stop using. This is true of non-substance addictions as well, so brain changes in both directions have nothing to do with substances per se.
The loss of synaptic density in certain prefrontal regions is often considered the golden proof that addiction is a disease. But all that’s going on here is pruning. Synaptic pruning is one of two primary engines of normal cortical development, and it often results in increased efficiency.
The factors that dispose people to addiction are mostly psychological, not physiological. The role of genetics has been largely overplayed, whereas the role of experience (including life events and quality of life) is often overlooked.
These psychological/environmental predictors have a lot more to do with how we experience our environments than the actual nature of those environments. But diseases are based on exposure, not experience.
The powerful attraction to addictive drugs and activities is a response to psychological suffering, including social isolation and recurring negative emotions. The “Rat Park” studies show that even rats will voluntarily withdraw from narcotics when their environments improve. As did most Vietnam vets when they got back from the war.
Pharmaceutical treatments don’t work to change addictive urges. They can ease withdrawal symptoms, but they can only suppress urges by replacing addictive chemicals with other, closely-related chemicals that can also be addictive.
(I should add here, though I haven’t yet, that we can reduce craving by blocking the activity at dopamine synapses in the striatum. But that suppresses almost all motivational activities, including the wish to engage with other people — not an ideal cure!)
In fact, treatment centers that tout a medical approach to addiction use medicines almost exclusively to ease withdrawal symptoms. And that’s only step one in overcoming addiction.
Many of those who treat addiction believe that the most effective tools are cognitive and motivational processes: e.g., determination, self-control, insight, willpower, self-acceptance. There is no disease that can be arrested through such processes.
Social processes such as support and love, and contemplative processes such as mindfulness meditation, are also considered effective. Again, we can’t cure diseases through such processes (as far as we know).
I guess I’m not that clear if you’re still thinking that I am trying to say addiction is a disease. That’s not at all what I’m trying to say. Clearly, addiction is not a disease and that’s one thing you & I definitely agree on. This study review shows the “best fit” to be genetic in regard to addiction causation. That’s more in line with my view
Genetic susceptibility to substance dependence
N Hiroi1,2 and S Agatsuma1
Molecular Psychiatry (2005) 10, 336–344
& 2005 Nature Publishing Group
But, unlike K Blums “Reward Deficiency Syndrome” which suggests its monogenetic, my understanding is that its polygenetic. K Kendler at MCV showed that the current addiction causation paradigm, the “hi-jacked brain / Gateway drug” (Alan Leshner) hypothesis is totally incorrect, and that’s been replicated. I think addiction causation is the number one problem. We must get it figured out or things will continue to devolve and the mess will continue unabated. The correct addiction causation will at least improve prevention, treatment, recovery & policy. The current hypoth has done nothing in those regards. Wrong premise = wrong conclusion.
Btw, this is the above referenced study’s results. Model 2, genetic, is said to be the “best fit.” Idk if you’re actually interested in this or not, but I’d be interested in your take on that review study…
Summary and conclusions
A majority of substance users do not develop
addiction to nicotine, alcohol, or opiates. Currently
available plasticity-based models of addiction do not
adequately account for the limited prevalence of
addiction among chronic substance users and the
presence of pre-existing, comorbid traits. The genetic model (Model 2) of addiction predicts that addiction is more likely to develop after initial substance use in individuals with genetic susceptibility, which is also associated with comorbid traits in some (Gdc), but not all cases (Gd). Model 2 highlights the need for a new direction in addiction research as well as new
treatment strategies.
Well I did think that was your point. I mean, you said what we see in addiction are the symptoms of a disease. So….I’m not clear on what the underlying disease actually is. But I’m glad we agree that addiction is NOT.
I’m not all that interested in genetic contributions. Many people do this research, but the reliability of gene interactions in complex behavior patterns is pretty low. Indeed, however, there are links, for example to impulsivity, and somebody else can study them 🙂
Instead of (mis)labelling the addiction(s) as diseases, I believe the one pathology – one disease premise. The actual disease would be the limbic brain (reward) centers of the brain are diseased, the critically low functioning reward cascade which produces the limbic wind motivation to increase this “feel ok” system. We get confused by autonomous thinking belief cortically. This is why there’s a liability to initiation (first use) and inexorably pushes people w/ the brain disease to seek out & use addictors (anything that raises this “feel ok” system – substances, behaviors, beliefs, instincts) differently than those who use addictors with normal brains.
BRAIN DISEASE
1. addiction (symptom)
2. decision making disasters (symptom)
3. Evaluation mistakes of self & others (symptom)
Addiction being just one symptom. Right now we’re stuck too myopically on this addictor & that addictor, blaming them as causing the addiction (drug war) whereas in my view they really have little to nothing to do with it. This is why ppl without the disease can use addictors with impunity while ppl with it can not. Currently, theres no cure, meditation, equine therapy, botchy ball, spa’s & the rest of the things high end rehabs offer, as well as HP nonsense, have little to do with effective treatments. Efficacy rates of rehabs show this. Neurophysiological adaptation occurs but that’s not the same as addiction. But yes, we certainly agree that addiction is NOT a disease. The current hypoth asserts that it is, and have gotten no where. We can and must do better.
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I just want to say a few words: I’ve missed you and your postings so much! So it feels good to hear from you, especially to know that there’s a new book coming out at some point. Loved the first one, keep it always nearby and almost have to read at least parts of it from time to time. So all the best from Finland!
Thank you, Laura! That is so heart-warming. I’m really touched that you feel that way, and I promise that the next book will be just as human and personal as the last one — with more general points about recovery as well — although this time I’m telling other people’s stories, not my own.
Delighted to be in touch with you again too!
Thank you, dear Marc!
Marc, this book will shift the paradigm in many ways and should be required reading for those who want to support change in those seeking help to do so. Looking forward to it……
Jan, I agree that this book and hopefully more like them will do the world a favor in creating a paradigm shift on the topic of addiction. I also believe if will provide addicts with a more direct approach in changing the behavior or habit. Very excited to get it into my hands and share with others.
Thanks, you two. I really do hope that the book will make a difference. I have a lot of neuropsychological artillery to show that “just saying no” is completely the wrong approach to recovery, as it activates brain processes that use inhibition or suppression, rather than change in perspective. Pure inhibition just facilitates ego depletion (self-control depletion) — so it is a real Achilles heel for addicts. Whereas perspective change involves other brain areas, other processes, and comes about through completely different means.
See below….
Thank you Marc! I know you are on the right line of thinking and processing in all of this. I have no doubt that the habit we create in using anything has its base in an issue we are unsure how to resolve. I also believe that abstinence gives one the space to resolve these issues. I believe you can use after this but that it is a whole new process of learning due to the post-dramatic syndrome that the using caused.
What a welcome post! Every time you post or we communicate I am re-energised to carry on!
At least I know I am not alone in this understanding of addiction. I would strongly agree with what you are saying – addiction is a natural adaptive process. Drugs may catalyse but they do not cause. Biology may increase risk, but without the circuitry for addiction we would not be human – this is part of the biological imperative, the essence of being – to desire, to attempt to resolve unmet relational needs, through whatever means possible.
Those cascades, the kindling effect, the fractals….. all discussed in your posts have really helped me develop my understanding of addictive states of being and are being used to inform treatment.
I am really looking forward to the book!
Thanks Shaun. And I’m re-energized by your energy too. We’ve known for awhile that we’re on the same relay team, and I’m looking forward to passing the baton back and forth a lot more regularly when I get through this crazy period.
There are so many examples of normal processes going haywire and becoming disorders and causing disease that I won’t bore you with any. Well, ok, so maybe one: OCD. I’m assuming that we agree that OCD is a brain disease, acquired through accelerated learning, granted, but kindled, fixed and stored intact as a behavioral pattern that can be triggered by conditioned cues and emerges automatically and autonomously.
The three stages of the addiction cycle are binge/intoxication, withdrawal/negative affect, and anticipation/obsession/craving. What makes it a disease is that the behavior itself causes the behavior, locks it in. So in OCD, the afflicted washes her hands to get rid of the germs, but because of the pathological uncertainty of the disorder, thinks, “maybe I didn’t get them all.” (Uncertainty raises motivational dopamine to impel the behavior.) The possibility of contamination leads to anxiety, leads to stress, leads to obsession, leads to washing hands. Same with addictions: the addictive behavior itself triggers the behavior. And the pattern is stored intact as we know from its reemergence intact in relapse. We’re talking about a permanently sensitized system, prone to relapse and vulnerable to other potentially addictive reinforcers.
But what about all those who have returned to social drinking? Spontaneously recovered? Either the disorder never kindled, or the amount consumed doesn’t reach the threshold for activation.
Welcome back!
Hi Nick. It’s a pleasure to see you up and at em again. I know you disagree with my treatment of this subject. And no, I don’t see OCD as a disease by the way, though it can be a very serious….well, ok, disorder.
And I’ve never agreed with your post-hoc definition: alcoholics that can return to social drinking were never REALLY alcoholics.
I just want to see if I’ve changed your mind, even by a few synapses, when/if you read the book. In any case we’ll have a lot more to talk about by then.
All the best!
Well Jeez, if I’d known that you were going to throw out three quarters of the DSM, I’d have thrown the towel in long ago.
I’d prefer to throw out 100%, but you have to start somewhere….
I agree with much of this, Nicholas; well put. Another example is delusions of reference (“they’re talking about me”).
However, you say,
//I’m assuming that we agree that OCD is a brain disease,//
No, I do not. I’m content with OCD as a “psychological disorder” as per DSM-V.
As Marc states, there is of course, an underlying biology of it, in terms of
events and characteristics of the brain and its processes. That is not sufficient for there to be a disease.
I will agree that ‘brain disease’ may be appropriate where, for example, OCD arises in connection with Alzheimer’s Disease. I prefer to stay with recognized disease entities, and a number of them can lead to OCD. Further, OCD can occur in the absence of objectively demonstrable disease, including brain disease. My opinion.
Hi NN. Of course I couldn’t agree more. I once co-authored a journal article with a guy names David Evans. It was about normative OCD-like behaviour in 3-5-year old children. Ever notice how 4 year olds get very put out by spots on the driveway, like the same stories re-read to them again and again, and pay a lot of attention to cracks on the sidewalk? So if OCD-like behaviour is normative for little kids, and non-normative for adults, it’s simply not enough to call it a brain disease. Rather — okay, I’ll go with disorder — but we might just want to call it an expression of anxiety that’s very focused on self-correction — in essence a particular cognitive style. So is racism, for example, a particular cognitive style. So is over-dependence and childish “glomming on” in adulthood. There are so many twists and turns in the trajectory of personality development. Addiction is just a particularly nasty patch on that highway.
Hi Marc…
Great to hear from you again, I always look forward to fresh new dialogue on this particular topic both from a personal perspective as well as professional.
Wether or not we consider addiction a disease, I believe there are prerequisites that pose risk for repetitive rumination leading to unwanted behaviour. Long before I developed a “drinking problem”, I developed a “thinking problem” about drinking. If thoughts can change the brain, then my brain started to change within the context of growing up in an alcoholic family. I guess you might say that once exposed to alcohol, though tobacco was actually the first drug of choice, my thinking eventually was “pathological” in nature and needless to say I didn’t like to have any delay in gratification. “I was at the center”!~ Once, in my mind, I nourished the idea of drinking, especially the fantasy that drinking would bring, it was too late…I was under the spell which lead to the physical indulging of alcohol.
In many respects, the thought and fantasy of drinking repeatedly, helped to intitate my addiction.
Though I wasn’t born an alcoholic, an alcoholic was born soon after taking the first drink. Given my thought patterns and desire for escape from choatic living at home as a young adolescent. I mean, something is wrong when you are eleven years old and you get totally wasted from alcohol and fall off a pier into the mud flats, thank God it was low tide, and despite the shame you do it again.
I intent is “Not To Blame” my family but its helpful to make sense out of what I thought was non-sense.
With a shift in my “thinking” after a number of years, I was able to take a good look at me and eventually moved myself out of the center and “Discovered” I can get help to change. For years, my thinking was just a recycling of the same old stuff leading to unwanted behaviours. In that I developed a great circle of support among my peers for drinking and drug behaviours. It was a lifestyle change. Nothing or no-thing could of helped if my thinking hadn’t changed enough for me to reach out!~
There are many influences and/or means of escape rather or not we consider them addictions such as; AOD, food, sex, money, work, gambling, technology etc…
It’s even more important to be able to rethink and imagine ways in which to transcend the light thats resonates within us all!~
HI Gary. I didn’t reply initially, probably because you posted it the day before I left for South America. But I just re-read it and I agree wholeheartedly with your portrait of addiction. In fact you flesh it out really well here. Yes, there is almost always (maybe always) a precursor in one’s family history — like you, I focus on environmental factors, because the genetic picture is still murky. And yes, there is something wrong when an 11-year-old gets trashed repeatedly. And you highlight thinking patterns, which I agree is the way in and the way out of addiction.
I don’t think that putting the picture together is akin to blaming your family. I wish people didn’t have this guilt reflex, though I suppose it shows an appropriate tendency to take responsibility for ourselves. Addicts (past or present) have to make it make sense. That is the best way to resolve and integrate all those nasty, seemingly inexplicable experiences into one story line. Thanks for your contribution!
Bravo!!!
Was just wondering about you… Thanks for the update and I’m so looking forward to the book!
Great to have you back! Quick question: What is your response to claims that addiction is a disease like mental illness is a disease? Are any of them diseases? Addiction as a disease under the umbrella of mental illness is typically the argument I hear from the “addiction is a disease”/NIDA camp.
Hi Liz. Clearly there are grey areas here. I don’t mind calling schizophrenia a disease or disorder. But I don’t want to apply that term to depression and anxiety….even when they are fairly severe. It’s a difficult definitional terrain. For example, I don’t see OCD as a disease either. Alzheimer’s? Definitely. I guess I’d say that anything that you can develop into and develop out of, using cognitive reframing, initiative, insight, etc, isn’t helped by the disease label. Rather, that label muddies the waters and can interfere with the best road forward.
Looking forward to the new book, Marc. The unambiguous title will raise some eyebrows and hopefully fire up some much needed discussions.
WOW !!! You are singing my song. Can hardly wait for more . Sure to be a very important contribution and 3 cheers to you for doing it .
MIssed these blogs too– really the only one I pay attention to ( other than my own of course ha ha )
See you soon
Always look forward to your posts, Marc. Congrats on new book. Looks like as usual you have really good insights. BTW, I live in L.A.–Sherman Oaks, actually and would love to host you and your family sometime. Let me know when available. yours truly, michael hecht (LMFT).
Great stuff Marc can’t wait to get a copy…
National Institute on drug abuse…claims…
Recant brain imaging studies have revealed an underlying disruption to brain regions that are important for the normal processes of motivation, reward and inhibitory control in addicted individuals. This provides the basis fora different view; that drug addiction is a disease of the brain, and the associated abnormal behavior is the result of dysfunction of the brain tissue, just as cardiac behavior is the result of dysfunction of brain tissue, just as cardiac insufficiency is a disease of the heart.
Dr. Nora Volkow
director (U.S.) National Institute on drug abuse…
In my view…
Once an individual becomes consumed with substance abuse, their choices are limited in that their brain has become dysfunctional and they are no longer able to make healthy decisions.
This is where I believe that people who suffer, deserve the chance to have their right for choice taken away from them, for they have a chance in coming clean and regaining their right for choice.
These individuals no longer have control over their free will and are consumed by their drug of choice.
We need to step up our efforts in helping bring more rehabilitation centers available for all those who suffer, bringing this issue to the Health Care industry and not the criminal justice system.
Treating these people with a Mental Illness and enforcing mandatory sentencing of a minimum of 3 months.
I have out lined many alternatives to this type of intervention in my book called Life in the game of Addictions. in hopes of making change in the best interest of future generations to come.
Sorry Richard, I strongly disagree with you. People in the throws of active addiction have not lost all control, they are not in denial and certainly they do not deserve to have their autonomy taken away. The level of commitment that it takes to maintain an addiction is immense. It requires effort, focus, planning etc. Yes, the drug has increased salience, and they may make ill-advised decisions, but every single person who I have worked with in the middle of active addiction who was given the right space has had a level of insight into their problems.The concept of powerlessness is a myth perpetrated by 12-step programs.
By removing autonomy, you will make the situation worse. By further stigmatising and penalising you will often increase the motivation to continue using.
What we actually need to do is to accept that drug use is almost a biological imperative in a society where people carry a sense of dislocation. We need more harm reduction services, lower barriers to entry for treatment and to fix our communities. Treatment should be based around proven interventions such as Motivational Interviewing, Community Reinforcement Approach, CBT, mindfulness and old fashioned compassion.
Well Shaun Shelly
I can only go by what I have personally gone threw, and know of many, many others that Jail has saved our lives. I’ll be it for many temporary, because jails do not have the capability at this time to address the needs of the addict.
I was the best at telling people what they wanted to hear, I was a manipulator, conner, scammer, I was in a league of all the best and could pull the wool over peoples, (counselors, psychiatrist) eyes who have not had the lived experience very easy.
Thats why I think everyone, or most everyone that is in addiction counseling have some practical experience… for they are only cheating those who need the help out of some good old fashioned “Been there, done it!!!” command of treatment.
Some 20 years ago I wish someone would have seen through me and scooped me up and through me on an island where I could have cleaned up, and came off my choice drug of intervenes use of cocaine. I had the tools put was unable to implement them under the influence.
It wasn’t till I was sentenced behind bars was I given the chance (Choice) to work what I had learned.
You make some good points,Shaun Shelly and put some good pieces together I think from what you have observed, but like a puzzle, it’s not complete till you see the big picture, and if you haven’t lived it you can’t see it.
Regards Richard
P.S Always enjoy a good debate…
Hi Richard
You may be informed by your own experience, as are many in the addiction treatment field. While this may be advantageous, it can also be a hindrance in that it causes bias – I bias that I have had to be careful to overcome.
As an example: I found that 12 step programs were helpful to me, however, as I have developed professionally I have come to learn that for some they can keep them in active addiction and be iatrogenic. They certainly have no place in the professional treatment setting.
I think that it has been well proven that confrontational approaches do not work in the addiction field, and I do and will continue do advocate for the right to autonomy.
Have a good day further!
Thanks.
https://www.facebook.com/pages/Life-in-the-game-of-Addictions/405264699595502
Like I said Shaun Shelly always enjoy a good debate, it only further helps break the stigma around addiction and mental health issuse. We may not agree on all topics or be on the same page, but we are advocating for the same book in that we all need to step up our efforts and help those who are struggling with substance abuse. I believe any input of education one hears or sees, whether forced or not, is something they may be able to use in the future when the time comes and when they are ready. Sure the short term statistics show a low return on forced rehabilitation, and I agree with much of what you say. I attached a copy of my web page above and you can also find many “Notes” on my Face Book page I have written over the years. Also if you are interested like anyone else, I could email you a copy of my book free if you are interested,
Respect Richard
Hi Richard
Yes, I too enjoy the debate and appreciate you entering into this discussion. I enjoy testing my theories and ideas in these forums, and I have often changed my opinion when presented with good evidence.
I agree that education can be stored and used at a future date, and for those who engage in non-drug related criminal activity due to their addiction I think that incarceration does provide a window of opportunity, which is more often than not missed. Certainly we should be offering better treatment options to this population.
Please send a copy of your book to me – my e-mail shaun.shelly@yahoo.com, although I will only get to it much later as I have and extensive reading list to get through before my next set of exams!
best wishes
Shaun
Hello Everyone, And thanks, Marc, for taking the time to keep us posted. Your new book is well-awaited. And your work is truly significant. Be good to yourselves… and to your brains! love always, Janet
Addiction, Choices , and consequences
August 25, 2012 at 10:14am
We all have choices in life, we can choose to hold on to Pity, resentment, sorrow, as a result of negative consequences in our life and walk around with a chip on our shoulder, or we can make the choice to deal with those issue before its to late.
My shortcomings of the past lead me to use alcohol and drugs to suppress those unhappy feelings and as a consequence became dependent on the use of them, addicted to alcohol and drugs in my everyday life.
Its the same with becoming an over eater, you become obese and as a consequence you have a heart attack, it was not your choice to have the heart attack… like the use of drugs or alcohol, it was not your choice to become addicted.
The difference being.. you still have a clear mind to loose weight and live a healthier life, unlike the drug addict or alcoholic your mind is no longer capable of making healthy choices, it becomes fogged or as some claim diseased and you loose perspective and are limited in choices.
This is at the point where you must surrender and except you are no longer in charge and get help.
For me it became one of the hardest choice in my life, having to give up my right for choice, to regain my right for choice.
I couldn’t do it, I’m stubborn and defiant, this is where many have fail and surrender to defeat and died to alcoholic or drug addict.
In my view our justice system must step up and take that right for choice away from those who have lost it, and force a mandatory sentence to rehabilitation, whether it be in or jails for those who brake the law or in drug treatment centre.
For most addicts need intervention, to have a fighting chance to make the right choice early on in life and to deal with life’s issues as they come along.
I know as a recovering addicted, while in active us, my choices where endless a constant bombardment of options from my brain to my mind on how to get my choice drug or alcohol.
It is only once we deplete all those options, dose our mind get some rest.
The options seem endless and the consequences, irrelevant or minimized.
Taking away those options for me, was a blessing in disguise, being arrested took away my choices which set me free to recover.
Today I can live life on life’s terms… becoming a productive part of society, and a part of the solutions and not the problems.
Helping others, not make the same mistakes I have, has become the greatest joy of my life..
If you need help… reach out and get that help! their is a better life waiting for you, and for those who dare to hear the truth they can reach me through facebook or my email..lifeinthegame@gmail.com
Hi Richard,
You said,
//My shortcomings of the past lead me to use alcohol and drugs to suppress those unhappy feelings and as a consequence became dependent on the use of them, addicted to alcohol and drugs in my everyday life.
Its the same with becoming an over eater, you become obese and as a consequence you have a heart attack, it was not your choice to have the heart attack… like the use of drugs or alcohol, it was not your choice to become addicted.
The difference being.. you still have a clear mind to loose weight and live a healthier life, unlike the drug addict or alcoholic your mind is no longer capable of making healthy choices, it becomes fogged or as some claim diseased and you loose perspective and are limited in choices.
This is at the point where you must surrender and except you are no longer in charge and get help. //
====
I don’t really see this contrast born out in the facts or experiences. I don’t see why clear vs. foggy separates the drug and alcohol “addicts” from others.
1) To take Marc’s case as he describes it, he became quite clear prior to, if not at his turning point. I think a number of alcoholics, e.g. Bill W in his account are ‘clear’ they have a habit that’s ruining their lives and they can’t control consumption. Supposing, however, that you are right about the substance folks, don’t you think the ‘behavioral’ (overeaters) are often ‘foggy’, e.g. in some sense realistic? Hence 2) ‘behavioral addicts’ often lack clarity and full facing of reality. Evidence in this regard: Their 12 step programs push for an admission of powerless, of unmanageability. It’s hard to imagine that there isn’t some resistance. That ‘fog’ or blindness stops them from fully realizing how bad and out of control things are–e.g. in some cases, imminence of death, just as with some drinkers.
My own position is that ‘clarity’ and some amount of ‘realism’ are found in addicts of all types, esp. those who’ve been around the block–e.g. in hospital or rehab–a few times. The problem is in acting on this awareness, and doing so steadily. In a ‘slip’ or ‘acting out’ one seeming ‘forgets’ the dire, ‘big picture.’ However here I question whether as 12S folks claim, a ‘moral defect’ is involved. I reject *both* disease and ‘character defect’ approaches in favor of a biosocial and developmental analysis.
Just one word: YES! Marc, your thinking is original … If there’s one pivotal moment from your first book that (to me) crystalizes the core of addiction, it’s your loss of existential ground when you were at boarding school and realized that absolutely no points of familiarity existed there — no bonds, no home, no sense of belonging. You write of attachment, and our biological *need* to bond … We’ll bond to someone, something, anything; the imperative to do so is inherent … I wonder if in the last analysis, our need to bond dictates most, if not all behaviour. Addiction makes so much sense to me in this context … I often think of addiction as devotion, deranged … (and in terms of etymology, the words “addiction” and “devotion” share some roots … )
You write in this post, “Addiction can therefore be seen as a developmental cascade, often foreshadowed by difficulties in childhood, always accelerated by the narrowing of perspective with recurrent cycles of acquisition and loss.” — “a developmental cascade” catches my eye — and who is free of such an event, to some extent? Such a cascade can occur at any time of life … and your later words about quitting as a conscious act of volition suggest an active, evolutionary cascade in an entirely different direction.
Really exciting stuff! You’re a pioneer, my friend, and you’ve laid a beautiful ground for this new book with your story and the most accessible writing about the neurobiology of addiction that I’ve seen.
Here’s to the evolutionary cascade! Congratulations!
Congrats on the new book. Can’t wait to read it!
Marc, I have a goofy neuro question re: a drug, and mailed it to you. Hope you don’t mind. Just heads up.
Dear Marc:
Congrats and Bravo on completing your draft. I’m sure this was/is no easy feat for you, particularly as what you have shared continues to inspire and ignite such rich dialogue.
Upon reading what you wrote, and all these thoughtful responses, I wondered about conceptualizing addiction as illness, as opposed to dis-ease. While I struggle with the thought of pinning down something like addiction with words or paradigms, there are more mainstream opinions and larger institutions that (can) play a major role in managing/treating it.
In that vein, I share a clip from your (imho 😉 wonderful interview by Allan Gregg, where you spoke about those accelerated and narrowed networks in the brains of addicts, etc. etc.
https://www.youtube.com/watch?v=Tnik-sVsGVA
Warm wishes to all,
Jasmine 😉
This is the same part of the brain where fear lives— gets processed and extinguished. Don’t mean to sound all buddhistic but isn’t there a complicated interaction with fear at work here, too. (sorry this is late. My email stopped notifying me of posts for some reason)
Matt:
What’s the problem with sounding Buddhistic? 😉 Imho, the principles of Buddhism can be so helpful and grounding for those struggling with addiction/s and/or lack of consciousness.
I continue to grapple with what seems to me like a Western appropriation of Eastern principles, especially given the differences in how such worlds are organized etc. Maybe that sounds somewhat binary, and I know some have tried to find some middle ground, with therapeutic models like DBT etc., which show great outcomes.
Thanks for the interesting response. And, Marc, hope your book is progressing nicely!
Jasmine
Hi Jasmine
Thanks for this…and you are preaching to the choir. Sorry if the qualifier “buddhistic” sounded disparaging, as it was not meant to be. You’re right, the Western appropriation of things like “mindfulness” and “meditation” has skewed their meaning, and in some cases there actual purpose. Eventually the misapprehensions and opportunists will fall away, and the “middle ground” you speak of will appear.
Marc – do you know approximately when the book will be out?
Hi Donna. I just saw this comment come in. I’m frightfully far behind. The pub date is set for late May, both in the US and Canada.