Resolving paradoxes to find the secret code of addictive behaviour

In my last post I explored the role of the default mode network in addiction. One conclusion was that addicts’ brains activate the default mode network more than the brains of nonaddicts.

This brought us to a paradox. Actually two paradoxes. (My wife hates it when I pun, but a pair o’ ducks already sounds like two… Ok, ignore that and we’ll proceed.) The default mode network (a set of 6-8 brain regions that often become synchronized) corresponds with daydreaming, nondirected thinking, going with the flow, imagining oneself in the past and/or future, etc.

Paradox 1: Isn’t it good to be in the default mode? Isn’t that the foundation of creativity or at least relaxed self-reflection? (well expressed by Persephone in a comment on the last post)

Paradox 2: Addiction is characterized by craving, which means highly focused attention on a single goal. I want to get some…..now! This focused state corresponds with an entirely different network of brain structures (including the dACC) — those involved in intense, planful activity, or homing in on a problem that needs to be resolved.

So how do we reconcile the “positives” of the default mode network, and the “negatives” of the task-focused network, in order to arrive at a coherent model of addictive behaviour?

Green field at springAnd while we consider this, let’s reflect on Shaun’s lovely metaphor, also from comments on the last post:

I have always described addictive behaviour as walking through a field of tall grass. We tread a path and we become “programmed” to walk this path. We return to this path every time we feel “lost”.

Getting lost in tall grass might correspond with the unguided thinking of the default mode. But once we’re truly lost in our fantasies, we return to a single well-worn path.cascade

My former student, Professor Rebecca Todd, suggested something similar, but in more concrete terms. Falling into an addictive act should be seen as a micro-developmental process. That means it isn’t a single event; it develops, but it develops in micro time — in seconds or minutes. Duh. Why didn’t I think of that? Almost every emotional phenomenon is best seen as a micro-developmental process — a cascade (love that word) that takes a few seconds, minutes, or even hours to unfold. Thank you, Rebecca! (I like to think I taught her to be brilliant, but maybe she just came that way.)

So here’s the beginning of a micro-developmental model that puts these ideas together:

daydreamingStep 1: fantasizing. You are in the default mode. Your thoughts are running wild and free.

Step 2: Impulse. This is exactly the state from which impulsive behaviour can easily spring. Because it’s…thoughtless. Free-floating fantasies lead to images of drugs, booze, sex, food, or whatever it is that attracts you. And off you go!

Scientists have very good evidence of the link between impulsivity and drug-taking. The following is from an article by Dalley, Everitt, and Robbins, 2011:

Impulsivity is the tendency to act prematurely without foresight…. One form of impulsivity depends on the temporal discounting of reward [which means going after immediate rewards, even at the expense of long-term consequences], another on….response disinhibition [what it sounds like: just do it!]. Impulsivity is commonly associated with addiction to drugs from different pharmacological classes…

climbingwallStep 3: Focused attention driven by desire. The third step is that tightly focused preoccupation with the soon-to-be (I hope, I wish) reward. Now brain activation patterns have switched over completely, from the nondirected to the directed, from the default mode to the highly-focused, task-oriented mode (which, in the case of addiction, must include hyperactivation of the nucleus accumbens / ventral striatum, spiking on dopamine). Now all your energies are directed at solving the problem: getting it and doing it — plus subsidiary problems like paying for it, lying about, and hiding it.

I believe there is a fourth step, compulsion, which is not the same thing as impulse (though they are related). More about that next post.  I also believe there are different strategies for trying to stop the cascade, depending on which step you’re in. I’d love to hear your ideas about that.

 

BhagavanDasFinally, here’s Bhagavan Das, that wise / spiritual / contemplative / meditative dude with a huge beard, talking to us from a recent documentary:

You’ve got to realize one thing: you need to tame your wild and crazy mind. Your mind has a very very bad habit, which we call self-cherishing.

That may be where all the trouble starts: the free-ranging fantasies of the default mode converge on the wish to improve the way you feel.

 

 

 

 

 

 

 

76 thoughts on “Resolving paradoxes to find the secret code of addictive behaviour

  1. Alese January 30, 2013 at 7:19 am #

    VERY cool ideas. Lots to digest here. But one thought that immediately came to mind: Wouldn’t this model be so “easy” (in the sense that it is actually doable) to test through a fairly straightforward fMRI study? It would be fascinating to watch this microdevelopmental process unfold and gauge the action tendencies that are elicited whilst moving from the default mode to the focused attention mode…

    • Marc February 4, 2013 at 5:24 pm #

      Yes, Alese, I think it would. I guess you would need some kind of self-reporting to be recorded in parallel with the brain-scan information. Or maybe you could measure the shift to impulsivity in a different way. Some recent researchers in the addiction field (e.g., Reinout Wiers) use a “joystick” to estimate subconscious motives. When you pull on it (harder, faster) you are trying to pull something toward you. When you push it, you’re trying to shove the thing away from you.

      If there are images of drugs or booze or sex on the screen, while you’re acting on the joystick, then you could look at the correlation between network switching in the brain and motive switching in the mind. This is quite a new line of research methodology, but it may be well suited to test my new model.

  2. Persephone January 30, 2013 at 12:39 pm #

    Very interesting, and thank you for the complimentary mention as well. I can only speak from personal experience re: the cascade and how to stop it, but that experience is also one by which I have rather ceased to have the “cascade effect” at all. I think part of the answer lies in your identity, in how you view yourself. If you are able to build up a self image that is counter to the impulse driven/instant gratification part of your brain (at least as it relates to substance abuse) that new self can outweigh what you can learn to see as a rather small instant reward. In my case, I like to function well and to be on top of things. I see myself as strong and willing to work for the goals I set. Many of these are physical (as I mentioned in the comment you linked to), so any instant gratification via use of a substance inevitably makes me weaker or at the least muddle-headed, so it’s not worth the risk to me.

    I think this is why it is sometimes harder to quit smoking cigarettes than mind altering substances, also. If you go ahead and take a drink or use, you have the instant gratification (though I no longer find it gratifying, and associate it with being out of control, which is not a feeling I like whatsoever!) but you also have the instant consequence of being mentally altered. You might do or say something that reflects your messed up state. If you break down and smoke a cigarette, on the other hand, you’re not drunk or high…..the consequences seem distant and the risk seems quite far in the future.

    For me the switch from addict to non-addict was almost overnight, and was strongly connected (if not caused by) this sense of self, or coming into that sense of self. I had long wanted to not be the kind of person that anything could have such control over (i.e. the craving-to-compulsion aspect, or cascade, you write of). I really kind of used the default mode to construct that person I wanted to be, but as with most of my default mode thinking (I’ve been involved in the creative arts since I was very young), it leads to action of some sort. Instead of writing a song or short story in this case, I rewrote who I was, and then focused on becoming this person, no matter how many times I was told I couldn’t ever become more than an “addict in recovery”. I believed myself instead, and believed in myself, and that self doesn’t fall prey to the problems that the old self did.

    Or, to paraphrase Glinda the Good Witch, I had the power all along. And so do we all;)

    • Shaun Shelly January 31, 2013 at 6:14 am #

      Persephone, what you say makes a lot of sense. I made this comment the other day: “Not using drugs is no longer a choice I make, it is a function of who I’ve become.”

      In a previous post Marc describes his own recovery: https://www.memoirsofanaddictedbrain.com/connect/how-i-quit-at-least-how-i-think-i-quit/

      and I have commented there on the addict deciding that they “want” something new, and that is often enough to jump start recovery, and although the results may take some time, the fundamental shift has occurred.

    • Elizabeth February 1, 2013 at 9:05 am #

      I wish I was on reddit so I could just “upvote” this post. You do such a great job of highlighting the importance of “coming to a sense of self.” I hope to use this in the future when I begin group facilitation!

    • Marc February 4, 2013 at 5:17 pm #

      Persephone: No doubt revising your self-image radically changes what goes on in your default mode cognition. Even if you still have drug fantasies, you can more easily dismiss them as daydreams, rather than Should I? Could I?

      But building a new self-image takes a lot of work. True, the creative spark for what to create and how to create it might emerge from default mode thinking. But then actualizing it, standing it up on the table (like that house of cards my grandmother taught me to build), and reinforcing it, especially when a strong wind comes along — well I think that is very task-focused, effortful, choice-full.

      The task-focused network gets a bad name because it’s associated with, um, tasks. But all it really means is being present, focused, and directed — which is the basic condition for something resembling free will.

      • Persephone February 5, 2013 at 8:44 pm #

        I was remarkably lucky in that regard, Marc, and I do honestly consider it to have been lucky. I had a complete break from my addicted self in some ways, so it wasn’t the hard work for me that it can be for others. I had several seizures during the process of getting clean, and had severe memory problems that persisted for 6-8 months. I couldn’t remember, for a time, much of my addicted self at all, and short term was sketchy for about 6 months. I remembered rehab, a bit that followed, a few more seizures and then some more that I remember little of. Some friends suggested I watch the film, “Memento”, so I bought it but couldn’t ever remember to watch the damned thing (I finally did last month)!

        When you speak of actualizing it, of holding on when a strong wind came along, that would’ve been rather hard before the seizures. But in the period after it, all I had whatsoever was this weird, detached set of memories and sense of self, which was itself life (in a sense), so it was all I had to hold on in a strong wind anyway. That and a notebook detailing everything as it happened, headed with the words (as I believe you say you wrote as well), “never again” and the very strong desire to stay alive and become strong. I remembered enough (I remembered rehab and withdrawing, for example) to know I was not ever going backwards.

        All is well now, but I guess what I had in my default mode at that point to work with was stuff that was buried rather deep, and mostly pleasant; but more to the point, it wasn’t much to do with the addicted self I had been. I remember now that I had once had those drug fantasies you refer to (and they did keep me in a state of constant relapse, too!), but at the time, it was as if I had been rebooted. I normally don’t share too much of that, but as you suggested I should, I decided to go ahead and do it, despite it perhaps making me look very, very strange.

        I might just add that once the memory problems stopped, I did remember a bit of the bad stuff but felt like I should just go on with the “rewrite”, as it were. One lucky aspect of the “reboot”, however, is that I can’t stand boredom and do tend to like “tasks”. I couldn’t stand the thought of wallowing in it, in any case, and figured there was nothing to do but keep moving forward. There’s a potential lifetime of wallowing back there, after all, which I’m sure most here can identify with.

        So, I guess that makes me the neurological oddball of the group here then, doesn’t it? After sharing that, any jokes will be much appreciated!

        • Marc February 6, 2013 at 3:56 pm #

          Sometimes a single case history is worth 10,000 controlled experiments. In fact, most of the really great discoveries in physics come from single, oddball studies rather than lengthy, incremental research programs.

          Maybe you’re the one. Your strange history points unmistakably to the role of memory in maintaining an addictive self-image and its relation to a set of self-destructive habits. Perhaps that in itself is not surprising, but we have to wonder what kind of memory keeps us being addicts day after day, month after month.

          It’s interesting to note that one of the few SUBcortical anchor-points of the default mode network is the hippocampus — which supports the capacity to acquire memories and facilitate their consolidation in long-term storage. Not the amygdala, but the hippocampus. If your memory lapses were of the sort portrayed on Memento — actual loss of memory for events or episodes, well that’s the domain of the hippocampus, not the amygdala. In other words, your strange history could shine light on the missing link between addictive rumination and active addiction — at the brain level. Pretty cool!

          More later…

          • Persephone February 6, 2013 at 4:13 pm #

            More later? You’re leaving me hanging after that?

            LOL….just kidding.

          • Persephone February 6, 2013 at 5:33 pm #

            Oh, my response got swallowed up somewhere……anyway, I refuse to have my brain sound that interesting! That makes it seems like I’m the Phineas Gage of addiction research. It wasn’t as bad as Memento, true, (I only got one tattoo of ancient text I was afraid I’d forget and then didn’t remember having done it–hence the friends’ jokes about the film). But that in itself does, well, yes, there are gaping holes and everything starts back up with the start of the seizures, oddly enough, in terms of long term (which was in rehab, so I remember all of that perfectly).

            But no one wants to talk about me, most of all me, so what is the importance of the hippocampus alone in this scenario, or in all of our scenarios? What is the role of hippocampus vs. amygdala in terms of this type of memory formation and breaks in it–or continuances? I’m going back to reread older posts and parts of your book, but can you perhaps throw out a link for someone who isn’t as inclined with the neuroscientific particulars? (Funny how the need for instant gratification rears its ugly head again now!) If it is already there and I just forgot it, well, I’ll leave it to you to make the joke.

            • Elizabeth February 6, 2013 at 9:40 pm #

              The hippocampus is actually quite involved in our memory of contexts associated with drug cravings. There’s also a big role for this one area, the ventral subiculum, in regulating dopamine levels in the Nucleus Accumbens. That same region is also implicated in the high subcortical DA seen in schizophrenia.

              The hippocampus does SO MUCH! I wish I knew more….

              • Persephone February 6, 2013 at 9:57 pm #

                Well, that much I do know, but how it all works together and what Marc was referring to, I’m absolutely sure I don’t know. I understand that they work together, and how damage to the hippocampus relates to my own sad brain, but to make a broader point I’m quite lost and would just make myself look foolish. OK, I was going to say something, but think I’ll wait for Marc to speak first.

                • Elizabeth February 6, 2013 at 10:07 pm #

                  Honestly, I think I get lost in all this research as well….and it’s my job to study this stuff! Ahh!

                  Don’t feel afraid to talk; I usually find your posts quite fascinating and insightful!

                  • Persephone February 6, 2013 at 10:42 pm #

                    You work in this field? That must be interesting!

                    Thanks, I’m just pretty sure my comments will drop in quality in this area….though I am interested.

                    • Elizabeth February 7, 2013 at 8:35 am #

                      Haha, yep! I’m a PhD student studying addictions neuroscience…or myself, lol.

              • Marc February 7, 2013 at 10:58 am #

                Thanks, Elizabeth. But you know a lot. The connection to the Nucleus Accumbens (NAcc) is a crucial datum, isn’t it. The NAcc is considered by most addiction neuroscientists to be critical for addiction, because it mediates desire, attraction, or what I call forward-thrust. It seems to be highly active in craving — thus the hallmark of true addiction.

                I was going to point out that the contextual/episodic nature of hippocampal memory is pretty much the right “setting” for default mode cognition. And it is notable that it’s NOT the amygdala, the arbiter of emotional memory, that’s important here. The default mode network (DMN) does not seem to be related to high levels of emotion, or else it would be the amygdala, not the hippocampus, that resonates with it.

                To me, this furthers the argument for STAGES of addictive action. First you are daydreaming, you are somewhat detached, and your fantasies are pretty much at the fringe of consciousness. Then, once craving sets in, everything switches. You turn off the DMN, you turn on the task-focused network, emotional intensity goes up, and I’d guess that the amygdala becomes much more involved than the hippocampus in your (now almost fevered) cognitive state.

                • Elizabeth February 7, 2013 at 8:24 pm #

                  If you guys are ever interested, Anthony Grace at Pitt has some amazing reviews of the interplay between the PFC, hippocampus, and ventral striatum. I find his stuff to be incredibly easy to read. Most of it is in relation to schizophrenia, but there are certainly some commonalities between schiz/addiction. After all, one of the models used for schizophrenia is amphetamine-induced sensitization!

                • Persephone February 10, 2013 at 11:19 pm #

                  Not that this is terribly important, but I have been out for 2 weeks with the flu, and therefore not going about my normal task-oriented routine. To make matters worse, I have been reading a book about rehabs (it’s a good book, but to read while ill for the first time since, well, rehab, and while not feeling mentally on top of things was starting to get a bit jarring…) and my DMN has been in overdrive. After 2 weeks, it was starting to be a BAD overdrive, and I was finally getting panicky over it tonight…..

                  Until the moment I logged in and realized I wasn’t as up on my assignments as I thought I was, and have an exercise due tomorrow and an assignment this week. I cannot even explain the relief I just got over getting my books and notebooks out, and setting my mind to these tasks. Obviously the previous issue was light, but still a craving issue, that I was starting to obsess over going out and smoking cigarettes (which I have forbidden myself to do, almost entirely, but on enough steroids for the bronchial tubes suddenly seemed a GRAND idea.), which hardly compares to something like heroin. But I even went and bought some. And smoked a few.

                  I must admit, I thought it would be the other way around, though my understanding of neuroscience is obviously pathetic, in terms of the amygdala. It seems emotional IN the DMN, yet calm and unemotional in the task I have at hand. (Though also emotion turned on when deciding to go buy the smokes, correct?)

                  Apologies, while what I’m working on would strike most as very dull, it is utterly comforting to me compared to trying to understand certain aspects of neuroscience (but don’t think for a minute that I’m knocking it!), and this is my sad hope that it will be explained to me in ways I will better understand by supplying a goofy (yet completely true) anecdote of my evening.

                  Well, that, and I just had to share how fulfilled and happy my mind felt the second I went into “task” mode.

                  • Marc February 12, 2013 at 12:07 pm #

                    Hi Persephone. That sounds like a pretty nasty turn in an already uncomfortable state. So what about the default mode network (DMN)? …let’s not worry about the neurobiology for now. It’s just a state of daydreaming, free-floating images, memories arising and fading… Until that one particular memory gets stuck and starts to grow on itself. Sort of like a cancer in fast motion.

                    I don’t know the exact moment when daydreaming turns to craving. As stated previously, it’s a cascade… I would imagine a scale of minutes. Maybe even seconds when your addiction is highly “active.”

                    But of course you are not the addict you used to be. So you kept tossing in the surf of increasingly worrisome daydreams. And then came nudge from the outside world: Get that assignment done! Now!

                    That’s clearly a great way out. A lesson for all of us. A fire escape, descending back down to the real world when the imagery starts to heat up.

                    Freedom in action. Right?

                    • Persephone February 12, 2013 at 7:45 pm #

                      Well, as odd as it might be for me now, I do finally want to worry about the neurobiology! I get what you’re saying, however, thanks. I live on daydreaming and tasks equally, I think, and getting them out of balance is never good for me. But then, the flu isn’t that good for anyone.

                      I always perhaps dreaded this aspect of it (or perhaps just remember it better) less than the don’t want to get (be) high/can’t face withdrawals side of things, and that’s a whole other side of things, and eventually, hopefully, a post.

  3. Alese January 31, 2013 at 5:15 am #

    So well said, Persephone: “Instead of writing a song or short story in this case, I rewrote who I was…”

    And completely consistent with your account, Persephone, check out this article:
    http://intl-pss.sagepub.com/content/21/11/1686.full

    To summarize: These set of studies show that only people who BELIEVE that willpower is a limited resource actually feel depleted of that willpower when stressed. Those who don’t hold this belief, DON’T feel depleted of willpower. So it modifies the basic idea that willpower is inevitably, and for all, a limited resource and that if you deplete that resource (for example, with craving cues, or with other stressful contexts), you inevitably lose your ability to inhibit impulses.

    The cascade never starts if you don’t identify yourself as one who is inevitably and for always drawn to the rapids.

    On the other hand, I have no idea how one actually changes that identity. I mean the nuts and bolts of it all. I like the poetic descriptions, but I’m still not sure how it actually WORKS. It’s why Marc’s tale of finally kicking his addiction, in the book, remains so elusive. I get the description, I even buy the explanation, I just really don’t get the prescription, the recipe, and why it works sometimes, for some people, and not for others…

    • Persephone January 31, 2013 at 9:36 am #

      Shaun and Alese, thanks, I’ve often wondered the same things about Marc’s story as well in terms of it being one of the first that mirrored mine (the recovering aspect), There are two very powerful but common threads there, willpower and rage (as Marc put it). Perhaps that amount of rage can override the almost passive ride we are on when stuck in a cycle of compulsion. At least, that’s how I had been viewing my addiction.

      I wish I could give you a better description, Alese, or rather prescription! I get a bit lost with the neuroscience, honestly, and so I cannot describe it in that sense…..I know part of it dealt (for me) with switching the idea of control from something outside of myself to completely within myself. Not caring if people thought I was a fuck-up, just going where my brain was telling me to go and trusting myself. But all I can really tell you is that I knew it was all over and that I was very different. It took time for people around me to realize this, obviously, but they did.

      I have heard of this many times, but haven’t studied it much myself, so I had to grab a link without going through most of them, but in terms of mind/body control I think this speaks volumes: http://news.harvard.edu/gazette/2002/04.18/09-tummo.html

      “In a monastery in northern India, thinly clad Tibetan monks sat quietly in a room where the temperature was a chilly 40 degrees Fahrenheit. Using a yoga technique known as g Tum-mo, they entered a state of deep meditation. Other monks soaked 3-by-6-foot sheets in cold water (49 degrees) and placed them over the meditators’ shoulders. For untrained people, such frigid wrappings would produce uncontrolled shivering.

      If body temperatures continue to drop under these conditions, death can result. But it was not long before steam began rising from the sheets. As a result of body heat produced by the monks during meditation, the sheets dried in about an hour…..” (more at the link)

      If this is possible for humans to do, I figured becoming someone who isn’t addicted to drugs anymore couldn’t be too difficult by comparison.

    • Marc February 7, 2013 at 11:19 am #

      Very interesting article, Alese. But I only half buy it. These investigators show that ego fatigue is reduced by your sense of having self-control….but then I’d ask, where do you get that sense of confidence in your own willpower, except through holding out against ego fatigue? So there’s a circular process here. As your willpower starts to erode, so does your belief in its capacity. You start to sense that you are losing the battle against your impulses. I think that this gradation can be seen both within individuals and between individuals, and that’s consistent with the results of this study. It may start off as a “state” but end up as a “trait” once you become a serious addict.

      Here’s another layer: as your resolve starts to crumble, you now have to resist the impulse to use/smoke/drink/eat, but you also have to resist the impulse to give up control. These are not the same thing. One is a reflection on the inevitability of your actions; the other is a reflection on the inevitability of becoming a different kind of person — a loser! — even if only for a little while.

      Moreover, when you have to HOLD ON to the state of holding on, as well as keep your hand out of the cookie jar, you are clearly working harder at inhibitory control. Working hard at self-control is exactly what eats away at the capacity for self-control, according to the ego fatigue model. So it’s not so surprising that you are, by now, a lot closer to losing the battle with ego fatigue!

      You become like Atlas, holding the world on your shoulders, but you are now holding a world that includes a smaller Atlas holding a smaller world that includes an even smaller Atlas….etc. Infinite regress. Loss of control can be like losing everything at once, including the determination and the ability — even the reason — you had for holding on.

  4. Carolyn Kay January 31, 2013 at 6:23 am #

    LiveScience:

    Brain Circuitry Behind Cigarette Cravings Revealed

    Addiction to cigarettes and other drugs may result from abnormal wiring in the brain’s frontal cortex, an area critical for self-control, a new study finds…

    When participants watched … smoking videos, their brains showed increased activity in the medial orbitofrontal cortex, a brain area that assigns value to a behavior. When the cigarettes were available immediately as opposed to hours later, smokers reported greater cravings and their brains showed more activity in the dorsolateral prefrontal cortex. The researchers hypothesize that this area modulates value. In other words, it can turns up or down the “value level” of cigarettes (or other rewards) in the first area, the medial orbitofrontal cortex. The results show that addiction involves a brain circuit important for self-control and decision-making.

    Prior to some of the scans, study participants were exposed to transcranial magnetic stimulation, or TMS. This non-invasive method excites or blocks neural activity by inducing weak electrical currents in a particular region of the brain. When the dorsolateral prefrontal cortex was deactivated using TMS, there was no difference in brain activity between those who watched the smoking clips and those who watched neutral videos; those two groups also reported similarly low cravings for cigarettes.

    The blocking of this brain region cut off the link between craving and awareness of cigarette availability, suggesting that suppressing the area could reduce cravings brought on by impending access to the drug.

    http://www.livescience.com/26648-cigarette-craving-self-control.html

    • kevin cody February 1, 2013 at 4:36 pm #

      now i want a cigarette. argh?!

      • Persephone February 6, 2013 at 7:33 pm #

        Ack….me too….and something intelligent to say. Blurg.

    • Marc February 6, 2013 at 4:06 pm #

      The orbitofrontal cortex is a critical player in my (and others’) brain model of addiction. This is the part of the prefrontal cortex that is most closely connected to the nucleus accumbens (NAcc, or ventral striatum). And yes, it tunes itself to represent VALUE, but it seems that it does so in the context of availability.

      I think that the NAcc must activate the orbitofrontal cortex when there’s a hope in hell of getting the goods (e.g., cigarettes) now rather than later. Then the orbitofrontal cortex (OFC) lights up with with value of the thing: oh yes, we like that! That’s what we want! It feels so warm and good and right, and it’s just the thing we need!

      All this action can lead “upward” to cognitive control, or it can be disrupted by TMS, so that you don’t need cognitive control — but those possibilities aren’t so easy to put into effect during the uncontrolled momentum of day-to-day life.

      Thank you for bringing this study to our attention, Carolyn. It seems important!

      • Carolyn Kay February 6, 2013 at 4:29 pm #

        And TMS is noninvasive. It doesn’t take invasive deep brain stimulation to get this effect.

        Not sure if (also noninvasive) transcranial LED-based light therapy has the same effect, but it’s being used for improving cognition in the case of brain injuries. (http://bit.ly/14EDZIp)

  5. Shaun Shelly January 31, 2013 at 6:48 am #

    Marc, this also ties in with the dual process models which I briefly describe in my newletter:
    http://addictioncapetown.blogspot.com/2013/01/addiction-information-january-newsletter.html

    Also this fits in with the Salience Attribution and impaired inhibition models: The acute reinforcement of the “worn and tested path” being a part of the increased Salience Attribution. The impaired inhibition being the cascade part. The anhedonic state of withdrawal being the perfect ground for default mode to flourish. And with the increased salience, we repeat the cycle.

    The big problem is that as addicts we have made the drugs an end in themselves. We have forgotten, or never found out, what it is that we actually want.

    As far as resolving the paradox is concerned, perhaps the paradox is the answer in itself. Our very Greek minds want nice mutually exclusive answers. We should maybe embrace a more Hebraic or Eastern mindset that says “Both, plus more”. Balance is, possibly, better created by my being prepared to embrace both ends of the see-saw, rather than by neatly standing in the middle!

    • Marc February 7, 2013 at 4:31 pm #

      I think we see many of these features in the same way, Shaun. In addiction, there are paradoxes piled on paradoxes. But I sometimes wonder if one of the most bizarre paradoxes is that the addictive goal — the drug or drink — really does replace the thing that we wanted most. Warmth, connection, safety….all so complicated, so difficult to control — some kind of purgatory compared to the sheer end-of-the-world salvation of the addictive act, which takes us straight to hell but passes by heaven en route.

      I’m being a bit poetic, but I really mean it. I wonder if the craving for the high actually replaces the wish for the goal that it originally stood in place of. I think it may have that power — and that is a really scary thing.

      • Shaun Shelly February 8, 2013 at 4:17 am #

        It may be poetic, but spot on! Marc, that is put in a way that really captures the essence of addiction. I will be borrowing this (with credits of course!) This is also perhaps why so many people get sucked into the faith based thing. I have just written an article about this: http://addictioncapetown.blogspot.com/2013/02/faith-based-rehabs-what-in-gods-name-is.html

        • Marc February 14, 2013 at 2:27 am #

          Thanks for the link, Shaun. I read the article and I think (speaking of allowing paradoxes to remain unresolved) you did a good job of pointing out some of the benefits of religious thoughts and feelings, while clearly showing where charlatanism and plain false advertising takes its toll in addiction treatment. Not to mention preying on the vulnerable.

          The only thing I took exception to was calling meditation a religious ritual. I don’t think so. I know a lot of good atheists who find an inner truth and outward clarity through meditation. Then, speaking of paradoxes, is Buddhism even a religion? Not in the normal sense, I’d say.

  6. Elizabeth January 31, 2013 at 8:47 am #

    Interesting, but I do feel like a step is missing. In between “fantasizing”, where thoughts are running free, and the “impulse”, shouldn’t there be some sense of losing executive control? I would think that it is fine to have thoughts run free and unfocused during periods of low stress. This could be conducive to creativity or help an individual develop a new way of thinking of himself/herself. It seems to me that environmental stress or threats to the self would induce the “narrowing” of thought that would propel someone toward the old “tried and true” path of the addictive behavior. At this point, returning to the default mode and reducing the stress response (meditation here?) would enable the individual to disengage from that impulsive behavior.

    I find this “default mode” stuff terribly interesting and confusing to reconcile….keep talking, guys!

    • Shaun Shelly February 1, 2013 at 3:30 am #

      Elizabeth, you are of course right, there is a loss of executive function. This is, however, more of a background process that happens over a period of time as feedback from the PFC becomes less salient.

      Your comment about periods of “low stress” is also true, as Berridge has so beautifully shown with his experiments, the once addicted will forever be susceptible in times of stress. This is why in-patient treatment is sometimes needed, to remove the individual from the “stress” of the using environment and give them a chance to develop new neural pathways.

      The good news is that if we, as Persephone so nicely put it, rewrite ourselves, then we can reprogram our default mode, and although the shadow of the previous self will always be there, and could be returned to, our recovery becomes a function of who we have become, not who we once were.

      • Elizabeth February 1, 2013 at 9:02 am #

        Hmmm, interesting. So, the “default mode” in addicts is akin to some of the Dalley et al. (Robbins & Everitt group) description of the transition from impulsivity to compulsivity? The cues have over-attributed salience, making them still “wanted”, but without regard to what they signify. I think I remember some stuff about how the orbitofrontal cortex, which is involved in signaling the reward value of an object, may no longer be as involved in cue-evoked drug seeking once there is a transition to habitual drug-seeking. So, by changing the over-attribution of these cues as we reform ourselves, we can weaken their power over our behavior? I agree that this is where mindfulness can be an amazing intervention strategy. From my experience, becoming “mindful” of engaging with my habit did not alter my behavior immediately, but I became more and more aware of the actions and outcomes of the behavior over time. Now I am at the point where I can see a “cue” to engage in my addictive behaviors and decide whether the outcome is worth it or not. Fortunately, choosing not to engage is the norm now :).

        • Shaun Shelly February 1, 2013 at 10:07 am #

          Yes! In addiction “wanting” is more important than “liking”. Marc I know we on the same page with this!

          I have just this minute finished talking to a patient where we have been discussing how when he is in a state of chaos (usually as the result of a relapse) his behaviour becomes focused and driven – using ceases to become an option. He is hyper-aware of every decision and move he makes. As soon as life is back on track, his behaviour becomes less “mindful”. This is , paradoxically, his “lost” state. Suddenly he finds himself attributing undue importance to his drug (salience attribution) and he slips into using mode.

          Through a gradual awareness of his process he is beginning to form new paths, to become more aware of his default state and his “pre-programmed” or learned responses, thus interrupt the cascade.

          Certainly a lot here, and I look forward to Marc’s next post on compulsion and impulse, which I trying hard not to preempt!

          • Marc February 7, 2013 at 4:50 pm #

            Coming up, Shean. I love your comments, but I think that the extra salience you and Elizabeth are discussing is the tinderbox-trigger for impulse, not compulsion. I think that compulsion doesn’t care at all about cues, salient or not. Compulsion only cares about completing the action sequence. Just get it over with, to relieve the tension, to sop up the anxiety…..

            I will do a new post on this within the next couple of days.

            • Shaun Shelly February 8, 2013 at 4:23 am #

              Will look into this some more and look forward to your next post. Your response to my previous comment will certainly make quote of the month in my next newsletter!

              • Marc February 9, 2013 at 12:24 pm #

                Thanks, man. Actually, I’m an idiot. Compulsion does care about cues. It is triggered by cues. I should have been more careful in expressing the above

                What I should have said is that compulsion, once cued, has a great deal of information build into the response sequence. So once it’s triggered it’s very automatic. I’m reading and thinking about this now and will come up with something coherent next post.

    • Persephone February 6, 2013 at 7:39 pm #

      Elizabeth, your comment (especially about stress or threats) made me wonder about the role of increased adrenaline production that I may have heard of either correctly or incorrectly from sources during the withdrawal stage. I don’t know if the adrenaline spikes prior to that in other times of active addiction, but could that play a role in the missing step you’re talking about (and that I’m sure we’ve all considered at those times)?

      I don’t know the neurochemistry of it, but it surely does more than just ramp up the body…..thoughts?

      • Elizabeth February 6, 2013 at 9:35 pm #

        There is definitely some literature out there about the increased activity of stress circuits in addiction, especially those that have progressed to the “compulsive” stage (George Koob is a big proponent of this in his “homeostatic hedonic dysregulation” model). Some of the stress researchers at Yale (Amy Arnsten and Rajita Sinha) have been looking at how heightened stress responses compromise prefrontal cortex/executive control functioning and indeed the noradrenergic system is involved here. There are proposals that are working on drugs that target one of those specific receptors that is activated when there is a flood of noradrenaline to the PFC, which can limit cognitive flexibility.

        I think I’m basically just affirming that, yes, rather than just ramping up the body, a flood of noradrenaline can impair cognitive flexibility; thus narrowing the range of possible behaviors down to a few, ingrained habits. At least that’s my interpretation of the evidence :).

        • Marc February 14, 2013 at 4:36 pm #

          Also, many of the drugs that are used to ease withdrawal symptoms and suppress further cravings are GABA enhancers. GABA is the chief inhibitory neurotransmitter. All the benzodiazepines (including Valium, etc) as well as baclofen, the subject of current controversy, increase GABA, which in turn decreases excitatory activity/stress reactivity in the brain (e.g., by decreasing norepinephrine / noradrenaline) and the body. In my book, I explore the “antireward” perspective on withdrawal symptoms. Doesn’t take much imagination to get where that term came from.

    • Marc February 7, 2013 at 11:28 am #

      Elizabeth, you hit the nail on the head, in your Jan. 31 comment, concerning the intrusion of executive control. And I really like Shaun’s response, which should be above this one. But here’s another angle. We’re talking about using self-control, and how it dissipates with ego fatigue, right? So…

      The sense of losing self-control that you describe is exactly equivalent to the experience of ego fatigue, discussed above. You are starting to cave in. But I don’t think this happens so early in the sequence. I think that the order should go like this:

      1. free-floating fantasy in the default mode
      2. thoughts of addictive behaviour becoming more focal
      3. experience of craving starts up, an you switch OUT of the default mode
      4. only at this step would you start intentionally trying to brake, trying to inhibit the downhill slide, by using your executive control
      5. and only after a few seconds or minutes of this do you start to perceive that you’re losing the battle, and that your executive control is getting used up as the impulse grows stronger and stronger

      So yes, that step needs to be there, but I don’t think it comes up until things get pretty heated and steam is coming out of your ears. Or, in a nutshell, it’s not until you become really conscious of “I think I’m about to fuck up” that you start jamming on the brakes….and realize that you forgot to put on snow tires.

      • Shaun Shelly February 8, 2013 at 4:29 am #

        Marc, very true. I always say to my guys that fighting using at the point of using, at that moment of conscious choice, is almost too late. At that point most addicts in early recovery don’t have the strength of executive decision making to stop the bus, so to speak. The decision has been made, in spite of our best efforts to stop the corresponding action.

        I remember being fascinated by this story: http://exploringthemind.com/the-mind/brain-scans-can-reveal-your-decisions-7-seconds-before-you-decide

        and wonder if this has bearing on addiction?

        • Marc February 14, 2013 at 4:42 pm #

          I think there is a connection, but we don’t want to be too fussy regarding the time scale. Yes, your brain begins to make decisions before you are consciously aware of them. But as well, cascades of intentionality can begin seconds, minutes, even hours before we become aware of them.

          It’s an eerie perspective, because it leaves us wondering if there is anything approaching “free will”. See my post from last year for more details: https://www.memoirsofanaddictedbrain.com/connect/not-quite-free-will/

  7. Janet January 31, 2013 at 9:44 am #

    I’m addicted to daydreaming. I wander peacefully around in my own brain and try on ideas and think about stuff and let things flow around. It is a safe place. My thoughts don’t cascade off the edge. They pool around and there is resolution and comfort. In “real” life I have the cascade, or even the tsunami, of worry and crazy thinking that can drive me to an unhealthy place. Maybe my “daydreaming” is really a kind of meditation, but it is good for me. Even if I am “daydreaming” about things that are difficult or unpleasant.
    Thank you for listening. I love this blog and your amazing voices and brilliance. I am always learning and that keeps me alive. I am the mother of an addict. I have watched him go over the cliff so many times in all the ways you all describe. Thank you again for letting me come here and be a part of this incredible, inspiring conversation.

  8. nicolas ruf January 31, 2013 at 10:05 am #

    Dear Persephone, I can never tell if you’re writing from hell or earth; maybe halfway between? Did you ever see the movie ‘The Talented Mr Ripley?” In it the title character takes on a phony identity so he can be one of the jet-setters. At one point he says, “It’s better to be a fake somebody than a real nobody.” Be careful. Love, Nick

    More generally, Bhagavan Das’s point, as I understand it, is about ego, The self-will whose motto is “me, mine, more,” and for which there can never be enough whether it be booze, drugs, sex, money, praise, love. Isn’t the paradox that the ‘proper’ use of free will is to give it over? Just not to members of the above list because that way leads to . . . .

    • Persephone February 1, 2013 at 12:45 pm #

      Nicolas, that was quite an esoteric reply. Despite my name here, however, I do not believe in hell except that it surely was what I experienced. I’m afraid my memory of that film is rather poor, but I do remember that the character did not do what I myself am talking about. He was, as you point out, “phony”, and his true self was just beneath the surface and poorly masked.

      I’m speaking of something more akin to (I hate to use the term, as I’m no expert in psychology) self-actualization, as I understand it. Becoming the self that was subverted by addiction instead of staying the person trapped or defined by the period of addiction. Personal empowerment and the like, which is rather different from creating a “phony” identity, but rather becoming the true self based on goals previously not acted or worked on.

      • kevin cody February 1, 2013 at 5:25 pm #

        self-actualization=awakening
        ?

    • kevin cody February 1, 2013 at 4:47 pm #

      ego |ˈēgō|
      noun ( pl. egos)
      a person’s sense of self-esteem or self-importance : a boost to my ego.
      • Psychoanalysis the part of the mind that mediates between the conscious and the unconscious and is responsible for reality testing and a sense of personal identity. Compare with id and superego .
      • an overly high opinion of oneself : some major players with really big egos.
      • Philosophy (in metaphysics) a conscious thinking subject.

      Note: I am not a linguistics xpert. But the definition doesn;t seem to fit the paragraph? I have a otc cold medicine thing today-so please clarify if you can find time. Seems to me ego is the mediator, and id/super ego is to what you refer?

      • nicolas ruf February 2, 2013 at 9:35 am #

        Kevin, I didn’t use ‘ego’ in the Freudian sense, but in the sense of of a persona, what T.S. Eliot described as ‘preparing a face to meet the faces that you meet.’ Some explanation of how I was using it is also in the paragraph itself.
        Persephone, Exactly. It’s that real self or actualized self, or as Kevin puts it the ‘awakened’ self. Many people who have been troubled by alcohol/other drug problems have described themselves as ‘chameleons,’ able to assume an identity to fit in or to get what they want. Whether it’s a risk factor for or a construct of addiction I don’t know, but it’s related to the cliche ‘when you start using you stop growing.’

        • Persephone February 2, 2013 at 10:59 am #

          Nicolas, I do remember that in rehab, them asking us if we viewed ourselves as chameleons (it was always like unofficial research was being done), and most people almost competing for the award of being most chameleon-like.

          One thing I’ve noticed about the chameleon type of personality is that whether addict or not, it’s not uncommon among victims of emotional abuse. Especially if the abuse is manipulative and of a controlling nature. People subjected to that must become “chameleons” to survive, and are also being constantly subjected to their sense of self being defined by another person/people. I’ve often wondered if that accounts for the high number of addicts described as such, as many addicts are also victims of emotional (and other forms of) abuse.

          I don’t know if that could partly account for your observation or not, it just started making sense to me the further away from the experience I got.

    • Marc February 9, 2013 at 12:30 pm #

      Yes, Nicolas, that’s exactly what he means. I took “self-cherishing” a bit out of context, because Bhagavan Das talks about it as a very active pursuit.

      Still the default mode network really is about the self — what else would it care about? So “self-cherishing” seemed a good way to capture the preoccupation we have with ourselves both while daydreaming and when caught up in the frenzied pursuit of addictive substances. We imagine ourselves, we find the hole in ourselves, and then we try like crazy to fill it.

  9. Chris January 31, 2013 at 11:55 pm #

    Not quite a year and a half ago, a pair of consecutive posts in this blog woke me up to the possibility there was a way to avoid getting my mental wheels stuck in the ruts that years of addiction had worn into place. I had accumulated about six months of abstinent time at that point. Mentally and emotionally, I was in a bad place, exhausted from the strain of resisting the urge to use. The ideas from those posts, as well as some things I read elsewhere, helped me find a path through that time.

    From the first of those posts, Not quite free will:

    These results suggest that the moment of choice is not free at all. It is already determined by events in the brain. The debate between free will and “determinism” has gone on for years (in fact it started way back in the 18th century, with philosopher David Hume). But the science that shows us the nature of determinism has become more and more sophisticated. Now it is hard to refute the idea that choice is a moment in a stream of biological events. It is never entirely “free”.

    And from the second, Building brain muscle with meditation:

    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.

    Over the three months following those posts, I was gradually able to move from being overwhelmed and exhausted by urges and addictive thoughts, to being able to observe them as they arose in my awareness then release them into the unending stream of all the rest of the thoughts that also flow through my awareness. Like leaves on the surface of a stream, they would come and go. That point in time marks (for me) the transition from the feeling that using was something I wanted very badly but couldn’t have anymore, to being something I used to be compelled to do no matter what but no longer had to do. It was the beginning of freedom.

    This discussion, with the implication the default network is the path by which those aspects of addiction that seem to be stronger than free will arise, brought to mind those posts from the early days of this blog … free will, the antithesis of free will, compulsive thoughts and behaviors, meditation, reflection, a broader perspective, deliberate thoughts and behaviors. It’s like deja vu all over again. 😉

    • Janet February 1, 2013 at 9:29 am #

      This piece itself was like a meditation. Absolutely beautiful.

    • Spike February 4, 2013 at 1:57 am #

      Very helpful Chris.
      I have been struggling this week with stopping myself going into a cascade of sexual acting out. Once I take the first small minor step it is usually only a matter of time before I reach a full blown acting out episode. Which is usually visiting a sex worker.
      I am a great believer in using mindfulness before I get to that initial first step, but once I have gone past that first step and the urge and impulse is very strong to proceed on the journey ,I find it by hard to use mindfullness.
      So i would be interested to know what type of meditation you use to help you build your brain muscle.
      As you said , the struggle is so exhausting.

      • Chris February 4, 2013 at 11:52 am #

        I am no guru, Spike. But … [deep breath] … I can share what has worked for me. Maybe that helps you find your own path; maybe it doesn’t. I hope it’s the former.

        First, you have my utmost compassion. The path I found out of addiction includes abstinence. As difficult as that is, at least drugs and alcohol aren’t basic life necessities. People in recovery from sex addictions or food addictions amaze me; ultimately their recovery involves some sort of accommodation with that to which they are addicted. Abstinence is not always an option.

        The video Marc linked to in the Building brain muscle with meditation post I linked to above was helpful. It was a lecture on meditation at the Google campus given by Jon Kabat-Zinn, which included a twenty-minute guided meditation. That led me to recordings of other videos by Dr. Kabat-Zinn and eventually to a book he coauthored, The Mindful Way through Depression (since I struggle with it). The book includes a CD of guided meditations narrated by Dr. Kabat-Zinn. That’s pretty much the extent of my practice, a different meditation for 20 to 30 minutes most mornings. When I’m regular about this, my mind and reactions are less chaotic; I’m able to look before I leap, to steer around the rut rather than into it. When I get out of the routine, I suffer.

        My take is that these meditations are derived from the vipassana tradition. That said, I could be wrong. Perhaps that’s where my practice will eventually lead. Perhaps not.

        I’ve tried a couple of meditation classes locally. They seem to invariably include chanting. My skepticism inevitably gets in the way of whatever benefit those types of classes might provide. I cannot bring myself to chant the name of some Hindu deity (or of any deity for that matter) … ymmv.

        Best wishes. I know how difficult it is, but try not to beat yourself up when you slip. Keep pursuing your goal of recovery. I’ve heard it said the definition of insanity is doing the same thing over and over again while expecting different results. I never agreed; it always sounded more like perseverance than insanity to me. My experience has been that refusal to surrender and continued practice does lead to different results.

        • Spike February 4, 2013 at 5:13 pm #

          Many thanks Chris , very helpful, I will have a look at what you suggested.
          Cheers spike

          • kevin cody February 7, 2013 at 1:56 pm #

            I found this information/audiobook on a kickasrsetorrent (hint) site a few months back, Spike.
            I don’t have much money thanks to the scarlet letter of felony addiction due to my own actions, of course.

            But i do have an idea that if copyrights were so moral why didn’t einstein patent his? or franklin…

            I know i am wrong.

        • Marc February 12, 2013 at 12:34 pm #

          Thanks for these wise words, Chris, and for these links to Kabat-Zinn’s stuff. By the way, if others are reading this, Kabat-Zinn is no robed guru, despite the name. He’s a meat-and-potatoes American who has developed techniques for mindfulness that are accessible and attractive to most of us Western types.

          I say this partly because I understand your aversion to chanting. I tried it when I was in my 20s, like a good hippie, but I never got too far with it either.

          Just plain old meditation seems to work just fine. You get comfortable, you close your eyes, you might focus on your breath, in and out, in and out — that helps give you that mental clarity — and then you watch your thoughts and especially your feelings, as they come and go. That’s the basic technique. It’s simple!

          Spike, I also admire your guts and cringe at how hard it can be. As Chris says, keep trying. It gets easier.

    • Marc February 12, 2013 at 12:25 pm #

      Chris, reading your words above (I know there will be many intermediary comments) bring me this jolt of warmth and gratitude. The thought that I could be lucky enough to be at the intersection of these themes, these conceptual streams, and be able to juxtapose them in my writing, and that you — someone I don’t know but feel I do — could read them and work with them and use them to get better… Wow! Thanks for letting me know.

      That meditative perspective is exactly, exactly, what helped me during the months after I quit. It became a new home, so that I started to really believe that I no longer needed that other home. Just as you say. It’s like a hut overlooking a stream, on which you see the leaves floating by and you let them float away.

      I should have used the word “compulsion” rather than “impulse” in those posts. I’m learning as I go along. That’s why it’s so exhausting, isn’t it? Because you have to fight off, not only the images, but also the “action motor” already whirring in your brain, desperately trying to engage your gears and drive you back to that dark place.

      I want to say congratulations. But it’s weird to congratulate someone for just being aware. Well, congratulations anyway!

      • Chris February 12, 2013 at 1:59 pm #

        Marc, I am fond of Kabat-Zinn’s description of meditation in that talk at Google you linked to so long ago, “… meditation is the act of falling awake.”

        By the way, nothing weird about it … after so many years of successfully avoiding awareness, I will cheerfully accept congratulations for finally waking up. Thank you.

        • Marc February 14, 2013 at 12:40 pm #

          That’s a good point!

  10. kevin cody February 1, 2013 at 4:50 pm #

    I think it was “In the Realm of Hungry Ghosts” by Gabor Mate which said it may be more accurate to describe it as “free won’t.”

    • Marc February 14, 2013 at 4:44 pm #

      That’s a great phrase! No idea where it came from, but I like it.

  11. kevin cody February 7, 2013 at 1:49 pm #

    Hey Doc, I was wondering after reading this paradox article, which i have now read a few times and sent to myself to re-read wit when the electrical storm of craving hits my brain (maybe more like the peak of obsession before to stem the tide of compulsion) if there is any definitive evidence that as the reference states (http://www.expaa.org/apps/forums/topics/show/8456613-occupy-aa-do-it-it-s-fun-?page=last, from the Dr Cain Post Artcile, 1963)

    “Actually, there is no scientific evidence that alcoholism is an incurable, physical disease. ”

    I find no answers from Professor Google.

    Also, I was sondering what you, Marc, and others here might think of the ye olde Post article? Is this a rehash? maybe someone can point me in a direction here, because it seems a very good interesting article, though outdated

    • kevin cody February 7, 2013 at 1:58 pm #

      Sorry if i am outta bounds but, i have day of and no wish to give into the bad wiring/storm.

      • Marc February 12, 2013 at 12:39 pm #

        You’re not out of bounds. People in this community get it.

        I’ll get back to you on your previous comment in a day or two.

        Meanwhile, carry an umbrella, but avoid tall structures (unless they include lightning rods).

    • Marc February 14, 2013 at 4:53 pm #

      Hi Kevin. The big debate about whether alcoholism and drug addiction are physical diseases still goes on. Does alcohol change the brain? Of course it does, but so does falling in love or learning to play the cello. My own stance has been to rebut the disease model. I’ve done this in many previous posts, plus a recent post on Psychology Today — http://www.psychologytoday.com/blog/addicted-brains/201301/does-12-step-treatment-work-inducing-ptsd . You might want to check out that one, even though it’s a rehash of something I wrote on this blog, simply because it got upwards of 150 comments, and they include a lot of information and controversy about what alcoholism really is: disease or not. I learned a lot from these comments.

      On the other hand, you don’t want to spend all your energies trying to resolve a definitional debate. Definitions are often just matters of perspective.

      So, sure, read some more, but then I suggest you go with your own intuitions and stop worrying about what the experts have to say.

  12. Persephone February 9, 2013 at 4:20 pm #

    I wanted to share a quote, and thought this the best place to do so, considering the nature of the discussion and Dr. Lewis’ expertise. This is from the introduction to a new book I just received in the mail on the rehab industry:

    “Most scientists agree that the genetic, brain, and behavioral changes associated with addiction to not appear to be completely reversible–like other chronic illnesses, most cases of severe addiction can be managed, but not cured, with continuing care.” (….)
    -A. Thomas McLellan, PhD, CEO and Cofounder, Treatment Research Institute, Philadelphia.

    Would anyone like to share thoughts on this (though I am not trying to start a fight or drag Dr. McLellan into anything if he is connected to you, Marc)? I am aware of quotes to the contrary on Marc’s part in terms of the brain, obviously, but was surprised to see this stated so emphatically in a book I’ve been looking forward to.

    Thanks everyone! I know we’re all at different stages in terms of this, but in terms of discussing the brain (and I’m not sure where the “genetics” is supposed to play in here particularly either…), this thread seems to be the right place to put this, though slightly off topic.

    • Shaun Shelly February 10, 2013 at 2:49 pm #

      Hi Persephone, Let me explain my understanding of this: I to see the path to addiction as a slope. Things like genetics, early attachment, underlying conditions etc tilt this slope either towards or away from addiction. Recent studies would include in this “predisposition” neuro-biology, such as the size of the PFC. So some of us start with this slope tilted, to some or other degree, more towards addiction.

      Once we add micro and macro system factors, such as family of origin and societal view of drugs, we either add weight to our move towards addiction, or add resistance which protects us from this slide.

      If we now add drugs into this mix, and we are already tilted towards addiction, and we have the macro and micro system momentum, we can begin to see that the slide towards addiction is almost inevitable in some cases.

      When we start using drugs we move along this slippery slope, and as we do so we start experiencing behavioral changes, and underlying these are neurological changes, the plasticty Marc often talks about, changes in gene expression. (I personally believe that at some point we move from abuser to addicted because of these changes, and that one day we will be able to identify certain biological markers to indicate this change)

      So now we are addicted and significant changes have taken place – I won’t go into all this now – and now we “get clean” or start recovering. Do we ever get back to our original pre-drug “settings”? Probably not. Most of us already had the slope tilted towards addiction within our first few years, and it will forever remain so, but now that we have actually been “addicted” there will be more of an angle to that slope. Berridge and Robinson have described long-term, possibly life-long, sensitization to cues: drug cues in the PFC, Cue Primed (people, places, things) in the Basolateral Amygdala and Stressed Primed in the Extended Amygdala.

      As an example we see life-long changes in the cellular structure of alcoholics, that will forever make them more susceptible to alcohol.

      What does this all mean? Does it mean that we are forever doomed? No. I actually think that it provides us with a rather unique opportunity. Unlike most other people we get a chance to examine who we are at the very core, and take that opportunity to create new neural pathways. We learn a new way to live and look at the world. As they say, recovery is not for sissies!

      I was clean for over 11000 days before I touched my first drug, but my rapid decline into full-blown addiction gave me the opportunity to face my “slope” and deal with the issues that created this decline. Using drugs is no longer an option for me, not because of some complex choice, but because of who I have become.

      Behaviorally and cognitively am now further away from using than I have ever been.

      Hope this answer gives you some peace.

      • Marc February 14, 2013 at 5:06 pm #

        What a great answer, Shaun. My response (below? above?) was rather grumpy and curt. You have fleshed out the territory beautifully.

        Indeed, whether the brain changes is not the issue. The brain is always changing — a reflection of the changing slope you describe.

        The point you make so well is that brain change in itself is not definitive. It doesn’t allow us to proclaim anything. Rather, it’s a marker of a process, a clue, that points toward our true, fluid, ongoing biology, permitting us to see ourselves in perspective. An invitation to take stock of who we are, where we’ve been, and where we’re going.

    • Marc February 14, 2013 at 4:59 pm #

      Brain changes are never completely reversible. The brain — like other complex systems — can’t go backward in time. Neither can your pancreas or skin or your liver or your colon, I’d imagine, though diseases associated with these organs can indeed be cured.

      In a nutshell, Persephone, I think this is just a lot of hot air. People make statements that sound incredibly profound until you really think about them. No, brain changes are not reversible. But the brain continues to change, profoundly, so the claim itself is both irrelevant and misleading, in my view.

      • Persephone February 14, 2013 at 5:14 pm #

        Thanks, both of you, that’s rather what I had thought on it all, regardless of the plasticity issues. Or, as Marc points out so often other than just above, we keep developing by learning and that changes how you operate on a neuro-level also.

        It was just an odd quote to come across, especially in a (good) book that deals quite a bit with success in terms of addiction.

  13. Carolyn Kay February 10, 2013 at 8:08 am #

    Science Daily:

    Turning Repulsive Feelings Into Desires

    Hunger, thirst, stress and drugs can create a change in the brain that transforms a repulsive feeling into a strong positive “wanting,” a new University of Michigan study indicates…

    Researchers studied how rats responded to metal objects that represented either pleasant sugar or disgustingly intense Dead Sea saltiness. The rats quickly learned to jump on and nibble the sweetness cue, but turned away from and avoided the saltiness cue.

    But one day the rats suddenly woke up in a new state of sodium appetite induced by drugs given the night before. On their first re-encounter with the saltiness cue in the new appetite state, their brain systems became activated and the rats instantly jumped on and nibbled the saltiness cue as though it were the sugar cue.
    “The cue becomes avidly ‘wanted’ despite knowledge the salt always tasted disgusting,” [researcher Mike] Robinson said.

    http://www.sciencedaily.com/releases/2013/02/130206162127.htm

    • Marc March 6, 2013 at 12:31 pm #

      This reminds me of my relationship with scotch, I must admit.

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