Revisiting addiction…and the sticky synapses you’re up against

My recovery is going well. The pain is nearly gone, so all I have to do right now, besides a fair bit of physio, is get off the damn painkillers.

The post-op pain was bad for about two weeks, so, given the tolerance I’d already built up before the surgery, my dose of oxycodone was about 100 mg per day, spiced up with a side of morphine while I was still in the hospital. There wasn’t much follow-up care. Okay, I got a call from the ward doctor about a week after the operation to make sure I wasn’t paralyzed from the neck down, and I’ll see the surgeon for a check-up in another month. The health-care system here is a bit spotty when it comes to individualized care. My family doc couldn’t even remember what was wrong with me, five days after I left the hospital. It was a herniated disk, right? Um, no, wrong. It was a stenosis, which means extra bone growth impinging on the spinal cord, and the solution was to take out the trash and then fuse three verterbrae. A pretty hefty operation. So, not having a clue as to the specifics, he simply asked how much pain medication (oxycodone) I needed and gave it to me.

But now comes the delicate matter of getting off the oxys — delicate because I lived (and came close to dying a few times) for these very drugs (or their cousins) a mere 33 years ago. So where am I at now? Should I have shaken my head, with a manly chuckle, and Just Said No? A lot of ex-addicts find this decision more agonizing than the pain. Check out some of the comments to my last two posts. They ask themselves: Is the pain relief worth the chance of going back to that terrible place?

blueboxLast week my post highlighted the glories of self-programming — both as a principle and as a concrete solution to an existential problem. I still think it’s a big part of the answer. But, as some of you cautioned me, the dividers in a pillbox are not exactly bullet proof. So I sometimes found myself taking a couple of Thursday’s supply on Wednesday, and compensating by borrowing from Saturday to Friday, and so forth. Why? Because I still like the feeling. Because the line between pain relief and the soothing calmness provided by opiates is impossible (at least for me) to pinpoint. In fact it’s not a line at all. It’s a space, a zone. And my self-control is good…but it’s not perfect.

So I took self-programming a step further. My agreement with my doctor about a weekly reduction (20 mg per week — about the fastest you can go and still avoid withdrawal symptoms) was already signed and sealed. (And by the way, that plan came from me, not him.) But for the day-to-day, I handed my neatly organized pillbox to Isabel and said, please give me the daily amount, as indicated, and put the rest away somewhere. I cleverly set up a system in which I have no control, and I did it as the ultimate expression of self-control.

Suggestion: if you don’t have a partner handy, use a friend, or maybe just ask your pharmacist, if it’s someone you know and trust. If you were creative enough to be a successful addict, then this is not going to be so difficult.

But why? Why should this attraction, this conflict, come back and haunt me now — so many  years later? The answer, of course, is to be found in the brain. When I teach about addiction, whether to my university classes or on lecture tours, I repeatedly pound in the critical fact that physical addiction and psychological addiction are two different animals. And yet psychological addiction is obviously physical, in the sense that it stems from synapse firingchanges in bodily structures — namely, synapses — the connections between neurons. Synapses in the amygdala, the striatum (nucleus accumbens), and the cortex blossom in new places or just get stronger — more easily passing electrochemical energy from one set of neurons to another — as we become increasingly drawn to a drug (e.g., oxycodone, crack, booze), an activity (e.g., gambling, football, playing the guitar), or a person. So what happens to synapses that are left “unused” for 20 or 30 years? There are two answers to that question.

1. They are not left unused. You know those dreams you wake up from in a sweat, all those years after giving up smack or Andrea or whatever/whoever it was? Or the images in your mind when you read that article about the scourge of methamphetamine use in Kansas? You just gave those synapses a very thorough workout. And that’s what helps them grow stronger.


dandelions2. Just as with PTSD, there are synapses that “contain information” that is just too emotionally loaded to ever disappear completely. Strong emotion builds strong synapses. By sending floods of dopamine, norepinephrine and other neuromodulators to brain regions at the crossroads of emotion and imagery, the initial experience (especially when repeated) provides a sort of super-fertilizer for synapse growth. Like the patch of weeds that sprang out of that spot where you accidentally spilled fertilizer last season, those synapses may be essentially indestructible.

There are other variants to these answers. But you get the general idea. Development is not a two-way street. You can’t ever go in reverse. Which is why “recovery” is not about deleting addictive impulses or images. It’s about saying “No.” And saying it often enough. And then building new synaptic pathways from that point onward — and maybe big axonconnecting those up to other pathways that went dormant for a while — pathways that are also supercharged by emotions, but, in this case, emotions about nurturing yourself and others, loving and forgiving yourself (and others), and keeping yourself out of harm’s way. That’s how you change the meaning of the addictive impulse, you change its context, you change the value that getting some has for you. But as with other developmental landmarks, you can’t just erase it.



71 thoughts on “Revisiting addiction…and the sticky synapses you’re up against

  1. shaun shelly May 13, 2014 at 4:36 am #

    Hey Marc

    This perfectly explains my experience of recovery. I have been having long discussions with some very disease model orientated people, and they are saying that this is proof of an underlying disease. Of course it is not. It is the human condition.

    We can never completely eradicate our memories – the other day I was taken back to my childhood by a seemingly innocuous cue – much like the drug cues that seem to be present (although less frequently).

    I remember some discussion at Mind Life about learning to embrace cravings – HH described this as a kind of higher grade concept! Indeed it is certainly true that we that have had these strong and reinforcing solutions (the drugs) imprinted in our brain need to recognise this and find alternative paths – and as you say reinforce these new paths with emotion.

    I was shocked the other day to find myself actually being able to describe a multitude of emotions I was feeling in a particularly emotionally charged situation – in the past this would have been a perfect drug cue! Indeed, I was even able to recognise this and accept it non-judgmentally! So many treatment approaches teach us to ignore or avoid the feelings, which to me is not helpful – it is better to recognise and contextualize!

    Anyway, I am rambling and repeating what you have already so eloquently stated!

    • Marc May 13, 2014 at 4:58 am #

      Thank you for sharing this Shaun. Whatever gets repeated gets stronger, right? What fires together wires together. So what could be more important than reinforcing this message and getting it out there. Or, I should say, getting it in there. Into the actual, miserable and confusing internal worlds of people struggling to keep their addiction behind them.

      That’s where people like you come in: therapists who have not only been there, but who have thought about it deeply and come to understand it. That’s the bottleneck between knowledge and experience, right? So when the therapist can feel it and formulate it, both, and then express it, you actually create room for those new avenues of synaptic growth. And that’s where self-knowledge and self-forgiveness come together, and blow a hole in the wall of addiction.

  2. Carolyn Kay May 13, 2014 at 6:11 am #

    I’m glad you gave someone else the control over your meds. The few times doctors have suggested painkillers to me since I got sober, I told them I’d agree only if they administered the painkillers and didn’t put any in my hands. I know I can’t be trusted.

    • Marc May 15, 2014 at 3:42 am #

      You know that expression: Possession is nine-tenths of the law. It’s pretty much like that.

  3. Kathleen May 13, 2014 at 8:44 am #

    I totally feel for you. I think you are doing all the “right things” Asking for help is hard, but huge! I have seen this before through nursing and the program, most people don’t have the knowledge or the willpower that you do, which is too bad. I try to be a resource and advocate for patients when I can, but the Doc’s don’t always listen to the nurses!
    Writing about it seems therapeutic, keep it up!

    • Marc May 15, 2014 at 3:50 am #

      So nice to hear from you! Have we changed places?!

      Yes, writing about it IS therapeutic. It’s therapeutic partly because it keeps asking you to be honest, with yourself and often with others. That’s necessary for me to be the least bit centered, which is necessary for every other good thing.

  4. William Abbott May 13, 2014 at 9:29 am #

    Spinal fusion is a very hefty operation indeed especially if the bone for the grafting is taken from the hip. So big time pain. But it can be managed , even in a former opiate addict without re-addiction if very carefully managed by one who knows how to do it . Sounds like that was lacking there—not that its a lot better in the USA.
    We don’t know near enough about neuroplasticity – but some years ago it was explained to me by a cell/molecular biologist friend of mine working in the field, that the rewired addicted brain again gets rewired in recovery more along “ normal “ pathways over time. This is measured in years and why many addictionologists are looking at recovery in 5 year terms , just as is done for cancer . The long term relapse rate curve doesn’t flatten out til 4-5 years of abstinence .
    The still sketchy evidence at the cellular level however shows that the old wiring pathways and connections ( synapses) at the molecular level have “ memory” . That is , in the presence of re-exposure , the old “ addicted” system is reactivated – not rewiring anew . Sounds reasonable to me since most having relapse reporting getting into trouble faster and deeper than the first time—the old slippery slope being very slippery indeed . Kind of like my driveway on an icy day.
    Be interested in Marc’s ideas on this as I wish him all the good wishes available as he again successfully “ rewires”
    Bill Abbott

    • Marc May 15, 2014 at 3:57 am #

      Thanks, Bill. Your description is completely in synch with mine (in the post). You can’t delete those hearty synaptic pathways — well, certainly not very quickly. So you build around them. That’s just what you have to do.

      Thanks for the added info. The timeline you suggest for change in the relapse rate is important: Ok, years. But look at the findings I published last post. They show (if replicated) that you can grow new circuits in regions responsible for self-control in a matter of months, and those can keep on growing until they exceed the population base rate at less than a year. We need to know more about that side of the story so that we can shore up our addicts during those 4-5 years you mention.

      • William Abbott May 15, 2014 at 11:58 am #

        WOW Marc and thanks so much

        I somehow missed that previous one and reading it and the source paper brings a smile.

        The long term relapse data I cited is for alcohol and is epidemiologic , not neuroscience . Hence likeley with broad standard errors . Thus on the low end folks with the reinforced new ” habit” being more resistant than those not . .

        Hopefully you can add some info here but it sure would be good if we had data that showed this and even in the nirvana state , a way to tell how strong your resisters were vs the old pathways if re exposure occurs

        Practically speaking I like two concepts from Smart Recovery. Be aware you remain vulnerable and hence stay vigilant

        And remember the three P’s plus one I added.. Patience, Practice, and Persistence plus Planning !!


        • Marc May 16, 2014 at 1:45 am #

          It’s true, these are really two radically different kinds of data. I guess the neuro data speaks to potential and the epidemiological data speaks to real life — as much as population means actually tell us anything. But notice that the regression line comes mostly from cocaine, and the scatter is enormous. As you say, there is tremendous individual variability, and that’s what BOTH these statistics tend to obscure. Oh, and there are only three observations re alcohol. Though they fit the regression line, that’s hardly a reliable estimate…

          How to plumb that variability? That’s a really big question. The answers would suggest not only who needs more help but who needs what kind of help.

          Working on it!


          • William Abbott May 16, 2014 at 9:01 am #

            Nose to the ole grindstone my friend !!

            Eyes on STockholm


      • Matt May 16, 2014 at 2:07 pm #

        I think it depends on a number of things, but just like the old joke about “How do you get to Carnegie Hall”. Practice, practice, practice…

    • Matt May 16, 2014 at 2:20 pm #

      I’d love to know the protocol you describe for the management of surgical pain in former— or current addicts, for that matter. In my experience as a patient, there didn’t ever seem to be a clear cut procedure…and there have been times when I was lying in the recovery room with breakthrough pain. And I was still in the hospital at that point….

      • William Abbott May 17, 2014 at 6:00 pm #

        Discussion of specifics of medical ,management in a forum like this is not appropriate- sorry

        And it is highly specific to the patient and the type of procedure he has had

        • Matt May 17, 2014 at 9:19 pm #

          Then don’t discuss it. I was responding to you….

  5. China Krys Darrington May 13, 2014 at 9:44 am #

    Hi Marc, Glad you are recovering from the fusion. I had, what sounds to be, a very similar surgery in 2008. It was “successful” and I’m very glad I had it done. I remember that pain. I remember liking the morphine-based drugs. I remember being focused on getting off them so I wouldn’t “cross-the-line” again. And I remember that my worried were greater than the pull of addiction. I was *very* grateful for that! I have lots of good stuff in my life now. Stuff I wouldn’t get to do if I was sitting drooling into oblivion on the sofa. I think the balance of good stuff vs. stuff-to-run-from is weighted on the positive side of things. Hope you get to find the same thing and I think giving your pills to your partner was a wise thing too. I have way too much rationalization and justification going on in my head to trust myself! Good luck with the rest of your recovery and DO THE PHYSIO!!! That helped so. so. so. much!

    • Cheryl May 13, 2014 at 11:16 am #

      China, I think what you mentioned about the “good stuff” pull is the biggest and best as far as a bullet proof vest. It is what keeps people moving forward in all cases. Developing the good stuff is a worthwhile effort to practice for so many reasons.

    • Marc May 15, 2014 at 4:03 am #

      Hey China. Thanks for that. Yes, it sounds like we’ve been through very similar experiences. I’m really glad to hear about the balance in favor of good things in your life. I sensed that when we met. Frankly, I’ve been pretty up and down these days, living in a foreign country that refuses to ever feel like home, and wondering just where my career is going. Yet there’s a lot that’s good. And I try to keep topping it up. Being out of pain is big plus. I’m just about to start up yoga again. And I’m sitting here typing, telling myself that my head is a kite and my spine is its tail. And it’s working.

      • China Krys Darrington May 15, 2014 at 8:46 am #

        Yoga is awesome. Gentle. Do what you can. All that good stuff. I have up and down days too. I think we all do. Hang in there. And yes, pain sucks.

  6. Dirk+Hanson May 13, 2014 at 11:33 am #

    If I didn’t know better, I’d say that the experience of addiction changes how your brain works. 😉

  7. John Becker May 13, 2014 at 3:39 pm #

    The seed of a bamboo tree lays dormant, just a seed, in some sub-species for five years, in others longer, in fact, in one, for a hundred and thirty-five years. And then, that seed germinates and a few weeks later you’ve got a fifty-foot tree. No plant grows faster. This is nothing compared to the rate at which human beings can change. My addictions can lie dormant, like a seed, but they can grow like a god-dammed thunderstorm.

    • NN May 15, 2014 at 2:01 am #

      When someone does something surprising, it’s tempting and often plausible
      to say, “the seeds of this act” were there long before. The serial killer is
      found to have tortured animals as a child. Or, we say, ‘the person appeared
      normal’ but wasn’t, as shown by his weird eruption in his 30s.

      When a recovered person, after 20 years, goes into serious relapse, one
      can as well say, ‘he was carrying the seed,’ and that’s like a bamboo seed
      or a rat or ancient seed caught in ice. It’s to be noted that this analysis
      is NOT, as I’ve illustrated above, peculiarly apt for the *recovered person*:
      it has general applicability.

      Further, note that ‘he had the seed’ is usually applied post hoc; after the strange event or relapse in recovery. Question: Is there any way, beforehand
      to say, “He or she bears the seed”? How about when nothing happens.
      Marc reaches 100, passes on, and never relapses. Of course then you say,
      “Well, he still had the seed in 2014, but it never sprouted.”

      This is equivalent to saying “Everyone who’s an addict has the seed.” However it’s to be noted that this might serve as a therapist’s rule of thumb, but it’s not a scientific or scientifically valid statement. For when I ask about evidence you say, “Many have relapses. Clearly they have the seed.”
      “What about the others?”
      “Well, they have the seed, but it’s never sprouted.”

      • Marc May 15, 2014 at 4:47 am #

        I see your point, NN. And maybe John will have more to say. But when you describe this as a post-hoc (and therefore invalid) argument, about causality, you are taking it deep into the corridors of scientific reasoning. But I’m not sure that’s where it belongs. It’s an analogy, it’s poetry, it rings true. That’s the beauty of it.

        Still, I’ll give you one thing: We do need to be vigilant about the soothing false logic of cause-effect thinking when we try to understand addiction. I’d say one reason for that is because, unlike the bamboo shoot, there are many causes working together to get you into full-blown addiction in the first place. As far as “re-addiction” (or relapse?), it’s still partly mysterious. It feels like that old thing again. And it is, partly. But as you’ve told me on the side, it’s not quite the same thing because you are/I am a different person now. That changes things.

        • Marc May 15, 2014 at 4:49 am #

          Come to think of it, bamboo shoots also grow in a complex universe where many causes interact. Otherwise, every seed would produce a tree, and it never works like that.

    • Marc May 15, 2014 at 4:20 am #

      Jeez John. You get it across so powerfully. I’ll be in Toronto again in August. Let’s meet up.

      Your words bring me straight back to your memoir. It’s about the god-damned thunderstorm… You sense it even when it’s way off at the horizon, just by the way the air changes and that almost subsonic rumble that you wish you hadn’t heard.

  8. Peter Sheath May 14, 2014 at 5:53 am #

    Hi Marc
    Glad to know your on the mend, loving kindness being sent your way. This is a timely post, I’m doing a series of talks in a local prison about medication and recovery and I’ve taken the liberty of using your blog to illustrate, much like the bamboo seed anology above, that addiction can lie dormant, almost like a sleeping rat. Trouble is it prowls about in your dreams and the slightest hint of an opiate aroma can wake him with a vengeance. I’ve said that the 12 step fellowships do give some guidelines along the lines of we aren’t medically trained so basically it’s between you and your Doctor.
    For me, and this is what I’ve put in my talk, this relies heavily on three major assumptions;
    1. Does the medic know enough about addiction that will help them negotiate a treatment package?
    2. Are you confident enough in your recovery that you won’t start to exaggerate your symptoms or throw a couple of other none existent ones in?
    3. Are you confident enough in your recovery that the bag of meds you are walking out with won’t become your new drug of choice?
    It’s a difficult, and probably a dilemma we will all face at some time. I see it at it’s most basic as choice and boundaries. You can opt out at any time, but if you do opt in get as many boundaries in place as quick as you can.
    Namaste my friend

    • Marc May 15, 2014 at 4:36 am #

      Got the loving-kindness, Peter. Feels good!

      As Bill Abbott and Kathleen mention above, the doctors are not too swift about these too-well-oiled hinges. They often stint when there’s no need and then dole it out when that’s NOT what you need. Still, I guess we’re all trying to do our best.

      That’s in response to your #1 above. As far as #2, it can be really hard to be that honest with yourself. While I was still in hospital, I pretty much sat up and begged for my next shot of morphine. In my most pathetic Dutch. This was on top of the oxys, but it was still just 24 hours post-op. So, of course I told myself, you DESERVE this man. There is nothing manipulative about it. But then I wondered, and I still do, was it really THAT bad? As to your third point, I wonder about that too. They wanted me to take lots of diazepam, to relax all those freaked-out muscles. But the fact is, I don’t like diazepam. I don’t like the feeling. But I could see that balance shifting with a bit more practice. I could get to like a lot of things.

      Anyway, that phase is over. Back to life. And friendly boundaries — my boundaries.

      I’m honoured for you to use my post for your talks to inmates. I pretty much wrote it because I don’t want to be on any pedestal and we can benefit a lot from sharing our struggles. I know I don’t have to tell you that.

      I’ll be in touch soon… Namaste to you.

    • William Abbott May 15, 2014 at 11:49 am #

      This is very timely and exactly what the ex addict needs to know. and especially question # 1. Ask your doctor if he knows how to treat pain in an ex opiate addict , and if he says no ask him to get help from one who does !!.. If he blows it off, think of being insistent or getting a new doc. There are pain experts as well as addictionologists who can handle this

    • Ania May 17, 2014 at 5:16 am #

      Something I realized relating to your post is that I believe going to AA or NA or any kind of group therapy we are told that addiction is a disease and it is incurable and there is no just one cause. Not knowing or trusting the doctor, always told the same thing by many, many different addiction specialists. Suffering from addiction myself and doing these things because I was told to by my counselors and addiction psychiatrists I too fell into that kind of thinking that I do not have control, I have a disease, and I will forever be an addict and struggle with this. But what I discovered is that it does not have to be this way. I do not believe in AA and NA and the 12 steps. When I was going to AA meetings, yes I felt “safe” and I wasn’t (struggling) alone but that’s all we do and discuss, how we struggle, how we can’t seem to get rid of the cravings, and we’re unable to do b/c we do not enjoy what we do b/c we crave the drugs to make us feel good and we don’t know why. So after years of struggling I finally realized that I HAVE to be around non-addicts that are intelligent, hard workers, and know what they’re doing and are happy and positive b/c at this point I tried EVERYTHING. Did just that but still struggled. Then I finally found out “why”. Then first step was become mentally stable by using food and supplements along with herbs if needed that the body does need. We’re not depressed and anxious b/c our body lacks Zoloft or Buspar but our body lacks the proper nutrients and b/c of the mind-altering chemicals it is unbalanced. Then after a couple weeks began feeling so good b/c I finally knew why and I was able to really focus on my studies and school and finally do and was becoming one of the happy, positive, workaholic types. Since addicts naturally have addictive personalities can you imagine what would happen if addicts began to get it and began to love to learn and work hard b/c this is what makes them feel good now. And b/c it makes them feel good they want and have to keep doing and pushing to achieve great success, an alcoholic or drug addict turned into workaholic what that would be like??? So ever since then, which was 15months ago instead of craving opiates and alcohol those cravings have turned into passion, drive, and ambition b/c I finally understand what is going on, what the drugs do to us and I understand the meaning of life, you just have to know why, why, why. To do and keep doing the things that make us happy. Whenever I get stressed(it is a lot) BUT it’s that positive stress that makes you feel so passionate and driven towards what you’re doing that you have to keep going and do the best damn job you can and most importantly learn, learn, and learn, knowledge really is power. And always surround yourself with strong, successful, extremely educated, and positive people. Now when I go to meetings (AA and NA) for research purposes, I just feel the pain, anxiety, stress, and suffering that these people are going through and it makes me so sad b/c life doesn’t have to be this way:(

      • Matt May 17, 2014 at 7:52 am #

        Yes. I totally agree. Turning the disease of “more” as they say in NA and AA to a positive, focused direction. But this can have pitfalls for people with stronger obsessive tendencies like perfectionism. And (big surprise) addicts are usually members of this population. I think the most important thing, which you seem to have mastered, is balance. People can become obsessive or “addicted ” to all kinds of behaviors, activities, and substances. It’s finding that balance within the context of your own life that is the journey.

        And actually the gift of addiction for those of us who make it out the other side. We’ve see that obsessiveness up close and personal in a way that “normies” rarely ever do.

        • Ania May 17, 2014 at 1:33 pm #

          Exactly, balance is the hardest but once you know how to (and why)and the keys to having a balanced life, the possibilities are endless. Keep going and just never ever give up, look at the glass as half full rather than half empty and have that want to learn! But when we are struggling to stay clean our emotions are so out of control and that gets to us. It is an amazing feeling and rush I get, which is of course what would keep a person going and craving more (not drugs, but learning and doing). But then again, what about the people that never really realize why, what, and how, just the what and how that we are taught. This is the problem and after doing and not knowing exactly why a person becomes bored and that means relapse is just around the corner.

          • Matt May 17, 2014 at 1:57 pm #

            That’s why most people recommend keeping busy and distracted in early recovery, because boredom can be your worst enemy. You might not be in a condition to understand the “why.” It can also keep you moving, and trying things you might not have even thought of, or been able to do while using. You fill up the time using once occupied. And it’s harder to hit a moving target, right?

            • Ania May 17, 2014 at 2:11 pm #

              Right, but after years of the same routine and the antidepressants, non-addictive anti-anxiety meds had actually made me emotionless and didn’t have that positive energy and this is b/c chemicals on top of chemicals with side effects but you might think that’s just how you are sober. So I found this so very crucial, first step-mental stability through things YOUR body needs. Drugs and alcohol deplete of vitamins, minerals, and vital nutrients. You do that and you will then see the difference, I know I’m not a doctor but it’s something I learned that fascinates me now. Also a clean diet with complex carbs and protein. Keep that blood sugar stable and get that fuel from foods, herbs, and spices, it really makes a difference therefore you’re positive and can be more creative, does this makes sense or am I a nut?lol

              • Matt May 17, 2014 at 7:54 pm #

                I think it makes a lot of sense…good diet and exercise are two areas that help balance your body chemistry. Keeping your blood sugar stable is important b/c it was on such a roller coaster while drinking. For me, getting the depression treated adequately was key. It’s like what you describe about your overmedication experience. I thought my new sober was the feeling I had when clinically depressed. Who wants to live like that?

                • Ania May 18, 2014 at 8:20 am #

                  And when we go see an addiction MD that is what they give us. Not all, but the ones I had seen and assigned to me, and addicts that I knew, go by protocol. We want help but we are given and told to do things just to mask the addiction and cravings. And it is so tricky to really get through to an addict. You say “Well you have to do and keep busy” but what do we do?! haha, we’ve been living under a rock and are uneducated. I’m just speaking from experience and what I’ve seen in friends that were addicts too.

                  • Matt May 18, 2014 at 9:05 am #

                    You just identified two giant holes in treatment: identifying the “type” of addict, and what they can do in recovery that gives their lives meaning. In other words, their motivation to quit the addiction, and the motivation to move on. Check out the Self-Determination Theory website. They’ve looked at this in depth and they say to maintain motivation, we need three things: a feeling of autonomy, competence and relatedness. What do you think would be important to help the addicts you’re talking about?

                • Ania May 18, 2014 at 8:41 am #

                  Also, then we don’t know what to do and become bored and stressed and crave so we go back to using b/c that is why we began in the first place. Being undereducated and not seeing a point to waste another 4 years in college or going to college and not really learning what is beyond that in the text book. I go to a community college and my God, the younger teachers just go by what and how and so do many students, no wonder so many kids get bored and don’t like school b/c we don’t get it and when we do get it then learning is so much fun. That’s how I was and the addicts I hung out with.

                  • Matt May 18, 2014 at 9:07 am #

                    (see above)

                    • Ania May 18, 2014 at 10:10 am #

                      Just out of curiosity are you an medical doctor, psychologist, or a counselor? Oh wow, I never heard of the website, thank you!! and I definitely agree, we need those 3 things but we first need to teach these kind of addicts this but after getting them mentally stable in my opinion and experience. I’ve actually been working on a research paper for the past year about how to really get through to these kind of addicts, from my personal experience. I’ll go read the website now.

    • Ania May 17, 2014 at 1:56 pm #

      When we go to 12step meetings and so on we are just told that addiction is an incurable disease and there is not just one cause. But why isn’t anyone telling us the proper steps and just putting us on more chemicals such as antidepressants, and sending us off to counseling and meetings? I used to go to meetings and thought they helped but it was b/c I wasn’t alone and felt safe but it didn’t rid me of anxiety, depression, and cravings. I go back there for research purposes and I feel the depression, anxiety, and suffering. But why does it have to be like this?! Many using the 12 steps just replace drugs with God thinking that just praying will help guide them. Never did I think I would get to this point (b/c yes I was a horrid horrid compulsive addict, drank OFF when I was withdrawing once) So if I can do it many people can. Addiction in a way is a symptom of an underlying cause, chemical imbalance, a bored mind b/c we just do what we’re told without going deeper so we party b/c that’s what makes us feel good, and family dysfunction; abuse, neglect, addicted parents. It is sad and something needs to change. We’re depressed b/c we’re not doing but we’re not doing b/c we’re depressed…and lost.

      • Matt May 18, 2014 at 11:10 am #

        (to the comment above this with no reply button??)

        I’m none of those— I’m like you. I just have a boatload of experience with addiction which I’d just as soon have avoided. But I didn’t so I try to use it to help others. I’m a facilitator for SMART Recovery and also run a hybrid 12-Step/Meditation meeting that is inclusive of all addictive behaviors. I think your research is really important and would love to hear about the results. Also, check out the work of Sarah Bowen at the Univ of Washington. She works on Mindfulness-Based Relapse Prevention and methods for addicts to figure out their Individual Relapse Signature (IRS) to help manage recovery more successfully. Sounds like what you are looking at. Anybody else have suggestions for things Ania could be looking at?

        • Ania May 18, 2014 at 12:37 pm #

          Also posted a comment/question at the bottom, I think it’s the last one if you haven’t seen it. Just curious about other’s thoughts, ideas, opinions, ect; Thank you so much for the info! I am ALWAYS looking and researching for more and more, since I’m not even in Med school or close to, yet:)

  9. Denise May 14, 2014 at 10:10 am #

    Marc, I so totally relate. Two blogs ago I had shared that I had (elective) surgery and opted for dealing with post-op pain without opiates. During the first 10 days, of course, I regretted that choice, as I was extremely uncomfortable, both physically and mentally. Now, three weeks post surgery, I am extremely glad I followed that course (as I had a choice given that the pain was not excruciating). I know that had I given in to taking the opiates right now I’d be loathe to give them up… not for the relief of physical pain but for the soothing of emotional pain: anxiety, doubt, sadness, etc. What you referred to as “soothing calmness” is the draw: the matter of the synapses aside, once I get a taste of something that feels so good, why in the world should I want to let it go?? Ironically, when I was bitching to my husband about how shitty I felt, he said, “If you feel you must get them (the painkillers) give them to me. I’ll hold them, that way you won’t be able to abuse them.” It makes a lot of sense. But again, there is nothing wrong with us for wanting something that feels good. After all, we are human. I’m wishing the best for you in your process.

    • Marc May 17, 2014 at 3:12 am #

      Hi Denise. I think your decision was thoughtful, wise, and brave. Yet we sometimes miss the simplest solutions — and husbands and wives have to be good for something.

      I must admit that I didn’t think the whole tapering business would be this difficult. Which makes me smile. After 5 years of researching everything about addiction, writing one book and nearly completing another on the subject, recounting my own addiction in great detail, and talking with hundreds of mostly ex or recovering addicts, sometimes for hours….I SHOULD HAVE KNOWN!

      But you are quite right about the self-blame that is almost as habitual as the desire to refresh the “warmth”. We all got to our addictions along pathways that we did not design or initiate. In a very real sense, we are blameless. But of course that doesn’t mean we want to live with the resulting misery.

  10. Matt May 15, 2014 at 6:35 am #

    Hi Marc

    I’m happy you decided to enlist Isabel’s help in managing your meds. In the long term, it can erode a relationship. But in this situation, I believe it can make the bond grow stronger: her having access to a personal demon of yours whose usual MO is to try to hide. It also helps for you to see the potential for disaster, when you look into her eyes as she gives you your daily allotment. It keeps you honest— with her and yourself.

    • Matt May 15, 2014 at 6:48 am #

      When you can see the imperfection in your self-control, it’s time to hand it over, as you say— the ultimate form of self-control, admitting yours (at least in this instance) has become a problem.

      • Marc May 17, 2014 at 3:19 am #

        Yes, I quite like that. It’s a bit like a Zen koan. It’s got this cool built-in paradox: achieving self-control by giving it away. I wonder if this is related to the AA insistence on surrendering your power to a higher authority. Certainly seems to ring true.

        • Matt May 17, 2014 at 6:10 am #

          It’s true. And there gets to be so much quibbling over semantics about this in recovery programs, it’s a freaking distraction. People find the notion of “powerlessness” so offensive. Of course, no one is truly powerless. That’s ridiculous. All powerlessness means is that one accepts the fact that they have a problem. Then they have a choice. (SMART’s big rallying cry). Acceptance of the problem (powerlessness) and choice are not antithetical. They’re sequential.

          • Marc May 17, 2014 at 5:54 pm #

            Yes, I can see how they are sequential. Of course they are. And I understand the aversion to powerlessness, especially when it’s presented dogmatically. To be coerced into giving your power away….well that just doesn’t ring true. I guess it’s issues like that, and the multiple meanings of “choice”, that are responsible for the semantic confusion.

  11. Richard Henry May 16, 2014 at 1:31 pm #

    Too many people are stuck on this abstinence free program of recovery and it puts harm on to those who can and do use on occasion. I believe after having some time clean and finding the answers to which brought you to your addiction and bring closure to those issues you… well I must say “NOT MOST” can go back to the beginning as I say, and start all over as a recreational user. Harm reduction is key for many, total abstinence is not the only road to recovery, and a one shoe fits all recovery program will never work. Each person in my view has his or her own recovery process, mind you AA has some good steps in reaching your goals its not the only way, and dose not suit everyone.

    • Richard Henry May 16, 2014 at 1:46 pm #

      Richard Henry I do have a drink on rare occasions, and the risk of abusing alcohol again in my life, is very minimal. Other substances may not be that easy and for everyone sake of fear and disappointment they are best left alone… I love my life today and if total abstinence is what it takes to keep that confidence and support from others, then thats what I will do…

      • Richard Henry May 18, 2014 at 7:30 pm #

        It sure does make a total abstinence life is a whole lot easier and I respect your opinion on these matters, and yes for me as well. My two youngest girls 19 and 21 were devastated that I used on occasion and thought being clean and sober was total abstinence. Even if I have a beer on occasion with my son, like every 3 or 4 months seems to hard for them to except, and with the past trauma they have experience with drugs and alcohol, I get it. I do believe that total abstinence is the way to go, a better life, clear thinking without any outside influences. Sometimes my fight is on behalf of others, and I like a good debate and brain storming is my addiction today…hahaha… So many years I was starving for knowledge today i’m an information funatic.. P.S I liked how you said you probably could go back to casual using but what would be the point, it would take too much work for the gain, For what? To prove a point”… I am much happier today, then anytime in the past when using…
        At the end of the day, no matter how you get there. TOTAL ABSTINENCE IS THE ULTIMATE GOAL” in my view… You know Marc I could go on and on, just one more thing if a person dose not find the underlying issues and has to live in torment sober, is that really a desire either? just to be clean and sober? being clean is not the end but just the beginning…
        Respect Marc

    • Matt May 16, 2014 at 4:34 pm #

      There’s that old saying: you can’t turn a pickle back into a cucumber. If I wanted to moderate my use now, I might be able to— but I don’t want to. Why would I want to go back there? Irrespective of neural networks, etc it holds no appeal to me. It would be just as much, if not more freaking work, than it took to maintain my addiction. Life is too short. Abstinence is not the ONLY cure, it’s just easier. And it keeps all that vinegary pickle juice out of my ears.

      That said, I totally agree with you. There is no one size fits all in recovery…It’s way too complicated for that.

    • Marc May 17, 2014 at 3:24 am #

      I think most of the readers and I also agree that one shoe does not fit all. But my recent experience of going back on and now getting off of narcotics for pain relief highlights the value of total abstinence. I have not found this to be easy or fun. I won’t open up that whole can of worms about harm reduction again, but sometimes total abstinence just makes life a lot simpler. Which is precisely what Matt is saying (above).

  12. Ania May 17, 2014 at 9:45 am #

    Just out of curiosity, since you are tapering off of the opiates do you pay attention to diet? Eating clean when you can and getting specific nutrients the body NEEDS? And/or take supplements? In order to counteract the drug tapering minor withdrawal? Vitamin’s and minerals and 5-HTP? amino acids, EFA’s or herbs such as St. Johns Wort. Ginseng, Ashwahgandha, Passionflower, Ginger, Cayenne supplements (for endorphins and blood circulation, helps me a lot during winter), Garlic, and/or Dr. Bachs Flower tinctures? Balance of complex carbs and protein for stable blood sugar and sustained energy. Intense exercise and yoga (amazing for opiate addicts!) I found this to be the most effective way that worked long term and currently tapering off of Suboxone. I know this is about tapering off after few weeks of use but that can be tough too, right? b/c of what happens to brain chemistry. It’s insane how different we think when we’re positive vs. negative b/c just like drugs our emotions overpower critical, and creative thinking, right? So why not balance that with this kind of simple all natural method that your body and mind really need without any negative side effects and sustained energy? I am just very curious because I rarely see this kind of way in others who are trying to stay clean or tapering off and struggling or being promoted by addictions specialists for long term recovery and over all well being. What do you think about this? Thanks and good luck:)

    • Marc May 22, 2014 at 8:01 am #

      HI Ania, Frankly I don’t pay much attention to diet — ever. But my habits seem to be in the right ballpark. I do notice how subtleties of mood can be sensitive to a whole host of things, from the weather to, well, diet I suppose. I’ll try to steer myself toward some of the nutrients you mention. Garlic — no problem. Love it.All those herbs and stuff. I don’t know. I’m a pretty old dog.

      But things are going well. I’m nearly at the end of my tapering regime, and my mood is reasonable. Thanks for these valuable suggestions, and I’m sure that for a lot of younger dogs they can be of immediate value.

  13. NN May 17, 2014 at 10:27 am #

    Of course we make quantitative cut offs all the time. We allow ourselves some
    ice cream, but don’t eat a gallon. I’m not so sure about potato chips! (Some
    foods, perhaps like some drugs, are designed to be ‘hard to stop’ I think!).

    We allow *some* television on an evening where there is some work, and
    hardly any–just the news– when there’s a pile of work to do.

    But for a given substance or activity, *SOME* people seems to have lost
    the ability, to stop eating ice cream or stop playing video game.

    The intervenors then say, you must have the rule “NO ice cream” etc. The qualitative criterion is somehow easier. For one thing, “NO ice cream is kept
    in the house” hence the problem of stopping after a bowl does not arise. Life is simpler.

    I’m all for ‘qualitative’ rules; ‘yes’ to “no amphetamines or derivatives.”

    Some people like the ‘black and white’ since it makes the behavior into a moral issue. “No ice cream” is like “No cheating on your spouse.” But–going back
    to the Oxford movement, “No lying” is a bit trickier. “No lying to your spouse about sexual contacts with outside parties” is practicable, but “No lying to anyone, ever” is probably not.

    But some things like food seem awfully hard to deal with with only qualitative rules.
    IF you have a food problem, you probably will have to deal with *amounts* of
    the allowed foods. I see no other way.

    I’m going to go on a limb here, having just had lung and rib surgery: for severe pain, the morphine related drugs are in order. Even the former addict (I’m not one, to opiates, downers or uppers or booze) needs, even requires them. This is not simply
    for comfort. You simply cannot breathe if there is too much pain in the lungs and ribs. Relief of pain allows the body to undertake other processes and heal.

    Just some thoughts out of my experience. And yes, I’m tapering–down to zero on the major drugs.

  14. Peter Sheath May 20, 2014 at 2:33 am #

    Hi Marc
    The talk went really well. I had over 150 people in the audience, most of them inmates, and the attention they gave was nothing short of amazing. These were all guys doing pretty long sentences and afterwards one of the prison officers came up to me and said that in over twenty years he had never seen them so engrossed and well behaved. I talked quite a bit about how chemicals work in the brain and how the brain becomes attached to them, a lot of that was straight out of your book. They asked lots of really meaningful questions and lots of them came up to me afterwards to talk and ask questions they couldn’t ask in front of the group. It was a great day

    • Marc May 21, 2014 at 3:47 am #

      Wonderful to hear!!! Peter, tell me if you want me to send you Powerpoint slides for other talks of this nature. I’ve got lots….and they’re just sitting in my computer, dormant. You could pick and choose. And some of them show brain processes underlying addiction in very accessible format.

      I love the work you’re doing. I wonder if we can get you on tour. In fact, you and I should tour together. I’ll be Punch and you be Judy. Okay, I’ll be Judy if I get to go first.

  15. Ron Freilich May 23, 2014 at 3:28 pm #

    Just how substance or experientially specific are these sticky synapses? Do they vary in quality with respect to the class of substance on a neurobiological level? Its always fascinated me that while some claim to be addicted to everything.. others such as myself seem to have found one magical substance.. That said.. how can we accurately define relapse?.. as certain schools of thought would even include enabling behaviors far in advance of the partaking of ANY mood altering substance..not just the problematic ones. I guess it depends on how broadly one chooses to define the concept of addiction on both a personal and dogmatic level.

    As for me.. dont drink the koolaid.. and know thine enemy!

    • Marc May 26, 2014 at 8:11 am #

      Good questions! And good answers. Know thine enemy. For many of us, booze is not our drug of choice, and the sticky synapses aren’t “about” booze. But drinking, sparks other connections, reduces the capacity for judgment and forbearance, and thus acts as a tributary back to the main channel. And for others, “getting high” really is a broad category of things, and anything that promises to land you somewhere in that swampy domain of “not-self” is tempting and attractive. While for others, it’s just got be meth, or opiates, or synthetic opiates, or whatever. Nothing else ignites the engine.

      Know thine koolaid.

  16. morgan machen May 23, 2014 at 9:46 pm #

    I’d like to share an excerpt from an article I read on cannabinoids that proposed a potential treatment for heroin addiction through the use of CBD:

    The issue of cannabis addiction remains controversial. Some benefit of oral THC has been noted in cannabis withdrawal (Hart et al., 2002; Haney et al., 2004). More intriguing, perhaps, are claims of improvement on other substance dependencies, particularly cocaine (Labigalini et al., 1999; Dreher, 2002). The situation with CBD is yet more promising. CBD and THC at doses of 4 mg·kg−1 i.p. potentiated extinction of cocaine- and amphetamine-induced conditioned place preference in rats, and CBD produced no hedonic effects of its own (Parker et al., 2004). CBD 5 mg·kg−1·d−1 in rats attenuated heroin-seeking behaviour by conditioned stimuli, even after a lapse of 2 weeks (Ren et al., 2009). A suggested mechanism of CBD relates to its ability to reverse changes in α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate glutamate and CB1 receptor expression in the nucleus accumbens induced by heroin. The authors proposed CBD as a treatment for heroin craving and addiction relapse.

    • Marc May 26, 2014 at 8:39 am #

      I’m not up on the chemistry, but changing the receptor environment in the nucleus accumbens is clearly a goal for many agents being studied to counteract addiction, especially through the reduction of craving. I hope to post a guest post shortly that deals with the effects of ibogaine — a natural substance that’s been around for centuries, possibly millenia, in Africa. And which is rumored to abolish opiate addiction in a single trial, withdrawal symptoms and all.

      I sometimes wonder at the ethos that guides the development of synthetic “anti-addictive” agents. How important, or is it possibly counterproductive, to try to remove the hedonic properties of these drugs before letting them loose on the poor, unsuspecting addict? People who have used ayahuasca to fight addiction are very emphatic that what you FEEL is a central aspect of its therapeutic value. Imagine if pharma labs were working toward an antidepressant that does not, in any way, make you feel happier.

  17. morgan machen May 23, 2014 at 9:51 pm #

    I neglected to include the entire paragraph on CBD:
    A recent study demonstrated the fascinating result that patients with damage to the insula due to cerebrovascular accident were able to quit tobacco smoking without relapse or urges (Naqvi et al., 2007), highlighting this structure as a critical neural centre mediating addiction to nicotine. Further study has confirmed the role of the insula in cocaine, alcohol and heroin addiction (Naqvi and Bechara, 2009; Naqvi and Bechara, 2010). In a provocative parallel, CBD 600 mg p.o. was demonstrated to deactivate functional magnetic resonance imaging (fMRI) activity in human volunteers in the left insula versus placebo (P < 0.01) without accompanying sedation or psychoactive changes (Borgwardt et al., 2008), suggesting the possibility that CBD could act as a pharmaceutical surrogate for insular damage in exerting an anti-addiction therapeutic benefit. Human studies have recently demonstrated that human volunteers smoking cannabis with higher CBD content reduced their liking for drug-related stimuli, including food (Morgan et al., 2010a). The authors posited that CBD can modulate reinforcing properties of drugs of abuse, and help in training to reduce relapse to alcoholism. A single case report of a successful withdrawal from cannabis dependency utilizing pure CBD treatment was recently published (Crippa et al., 2010).

    • Marc May 26, 2014 at 8:47 am #

      Ah, the insula. For the non-neuroscientist, the insula is a region just behind the prefrontal cortex, sort of wedged inside the temporal lobes, that registers how things feel. Everything from muscle movement to tactile information to empathy to fatigue to getting high includes a critical feeling component, and the insula seems to be the brain region that gathers this information from the body and releases it to the cortex.

      But, maybe unfortunately, I’m told that the insula lights up in fMRI (scanning) studies pretty much whenever a stimulus has emotional or motivating properties. In other words, whenever you feel stuff. Which makes it too vague to be a marker of anything specific.

  18. Paige Hawin May 27, 2014 at 10:35 am #

    A really great post Marc and I admire the way you have chosen to handle the situation by having your intake monitored. It’s a brave and responsible step. Whilst 33 years may seem like a lifetime ago, the memories can be a very easy trigger. I think the medication is integral to your recovery. Their purpose is to offer you pain relief for a while and nothing more and you are making sure it is for that purpose. I think you hit the nail on the head with this comment: “Which is why “recovery” is not about deleting addictive impulses or images. It’s about saying “No.” I always wondered how much of our brain plays in the process of addiction. Is physical addiction and psychological addiction inherently linked?

    • Marc May 28, 2014 at 5:25 am #

      Hi Paige. Thanks, I’m doing what I can. Yes, physical and psychological addiction are linked. But they’re not the same. Some drugs, like cocaine, have no physical addiction, but they can still be highly addictive psychologically — obviously. And physical addiction certainly adds a great burden to one’s psych addiction…. Makes it that much harder to stop thinking about it!

      And even psychological addiction results from brain change — so everything is physical in a sense.

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