Teeter-totters go through a tipping point when no one is in control
There is something terribly interesting about the moment of giving in. That moment when the teeter-totter crosses that invisible threshold, when the momentum shifts, when you know you’re going to do it, despite the hours of telling yourself you won’t. It’s a very distinct feeling, says a recent reader. It’s a lot different from thinking about getting high. It’s not thinking at all, really. It’s not imagining what it will be like. Rather, it’s a feeling of free fall, a release from the incessant gravity of your own rule book. It’s a massive change: from control to freedom, from responsibility to neglect, from wisdom to foolishness, from security to doom — all at the same time.
We’ve just come through the holiday season, most of us intact, I hope. And yet many of us may have slipped in one way or another. If you’re a recovering alcoholic, you may have buckled and started drinking. Maybe for a night, maybe for a week, or maybe you’re still drinking. If you’re a chipper (a sometimes addict), maybe you chipped at something a lot bigger and a lot more dangerous than you thought you would. If you live on the clean side of the line of self-indulgence for most of the days of your life, maybe you crossed the line — for an hour, a night, or a week — with a bottle, with your neighbour’s spouse, with a reckless ride through the dark side of the internet… What I’m interested in is that moment when you actually cross the line. When it’s no longer a choice that you continue to make or that you’re always about to make, but a choice (if you still want to call it that) you’ve already made. That’s when the free-fall starts…that pitch away from your centre of gravity to a new orbit, a new star, much brighter in that moment than the dull planet you’ve been calling home.
Sometimes the moment of giving in is barely conscious, and sometimes it comes long before there’s a full recognition that you’ve already changed orbits, irrevocably, and the crash landing is coming next. Just the other night I read of the “fall” of a reader/fellow blogger whom I respect very much. She’s a recovering alcoholic who gave in to a couple of drinks, and she wrote about it before, during, and after crossing the line. In one post she describes the moment when (I’d say) her intention shifted trajectories, though that moment was still embedded in the chatter of a familiar self-dialogue:
Today I was at the market and managed to talk myself into buying wine — for taking to a friend’s house for dinner tonight, of course, but the truth is we don’t have to take wine. We’re bringing other things, so wine is probably a bit too much. But I talked myself into buying it anyway, “just in case”. Just in case WHAT, I now ask myself. I tell myself, you know. Who are you trying to kid, you know exactly just in case WHAT. What was I thinking? Ohhhh, I’m so far out on the limb I’m not sure I can get back.
At a certain point she warned herself, “One sip is too many…the dangers are huge…but the desire is chipping away at my resolve.”
Once you’ve said that to yourself, it’s pretty much game over.
In my years of addiction, I told myself many many times that my resolve was weakening. Like that terrible weekend in Thunder Bay when it became inevitable that I would steal more drugs. I had lost the belief that I was capable of self-control. And I was so fed up with the whole process that I took absurd chances that night and managed, finally, to get caught in the act and carted off to jail. To say “my resolve is weakening” is code for “I can’t stop myself anymore.”
But luckily, this blogger — someone I now consider a friend even though we’ve never met — stopped herself, just an hour or two later. Check out her second post. It’s a happy ending. Relapse is part of recovery, so they say.
Where am I going with this? I want to spend the next couple of posts thinking about loss of control – a major theme in the psychology and neuroscience of addiction. Psychologists have been studying a phenomenon known as “ego fatigue” for roughly ten years. That’s when you’ve been trying to suppress or inhibit an impulse continuously, for an hour or more, and the result is a breakdown in the self-regulatory function – which we think is housed in the anterior cingulate cortex (ACC: see my book for details). After excessive use (think of a car that’s been going uphill in first gear for an hour), that part of the brain literally runs out of its fuel supply (glutamate and/or GABA), and like an over-used muscle it just caves in. Recovering addicts have the unfortunate mission of maintaining active, effortful – sometimes tremendously effortful — self-control. Not just for an hour but for a day, several days, a week, maybe a month or more. Our neural machinery wasn’t made to take that kind of strain.
But that first pivotal moment of giving in doesn’t just feel like a branch breaking under too much weight. There is also excitement, tingling anticipation, hope, freedom, relief — and something a lot like pride — for some of us — a sense of triumph, just for that brief window of time. Now you are no longer ensnared in a tug-of-war between two ideal selves. Now you are wholly and completely you. Or so it seems.
In my next post I’ll get into some details, looking at people’s experience of the loss of control and the brain processes behind those experiences. Stay tuned.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
Whoa…this hits home on a number of levels. Last night I felt that loss of control. After the bottle of wine my wife and I shared we got into the rum and polished off most of the bottle. I often wonder if I’m an alcoholic or not but on nights like last night I really think that I am. I can go days without drinking at all or my wife and I will share a bottle of wine together at dinner and afterwards without going any further. But last night (and many more in my life) I did exactly as you describe here. I get to a point then just say ‘fuck it’ I’m getting that one more glass, then it turns out to be three or four more glasses. I don’t pass out anymore from drinking. I stopped doing that years ago but I can feel myself going there, losing control. I may be killing myself, but when I hit that moment you describe here I just don’t give a shit. I lost a kidney to cancer ten years ago. You’d think I’d learn from that and stop drinking altogether. I might have, but my wife and I drink together and we like it! I like (love) the feeling of losing control.
Now to another level. I’m a sociologist. The topic in sociology that has consumed me for many years is the ‘dance’ we do between self-aggrandizement or individuation and self-effacement or full immersion in the group and denial of ‘ego.’ I could go on and on about this, but essentially it boils down to the fact that we are completely dependent on our ‘societies’ (meaning any size and configuration of a number of people, some we know personally and some we don’t) for life. Our societies set out the moral rules for acceptable behaviour and we must respect those rules or suffer the consequences, but we also need to develop ourselves as individuals, if for no other reason than to attract a mate in a very competitive sexual marketplace. So we’re caught in a contradiction. We need to be individuals but we also need to be fully responsible members of our ‘collectivities.’ Losing control, as you describe it, is tipping the scale over to the individuation end of the spectrum. We say “Fuck it…I don’t care about social responsibility or being a good moral person, I jut want to surrender to this feeling of ego annihilation.” Addiction, in my mind, then, is extreme self-expression and a turning away from our moral worlds.
I am most interested in your observations about Society. In ancient kingships only the monarch was truly sovereign able to do as he chose for the period of his rein. We know a lot about this due to the reports of explorers who encountered and still encounter populations at different developmental stages.
Also many religions suggest a similar account of an all powerful superior reflecting this notion of life on Earth being a derivation from a divine realm ordered in much the same way as a hierarchy of ascending power to the supreme authority.
Naturally all members of these societies were individuals in some limited sense though almost every detail of your life was indicated to you such as in arranged marriages.
In our society the expectation for the “individual” is increasingly magnified reversing the earlier priority of individual subordination to the community. This is especially true in the “new economy” where all are expected to be fully powered up creative entrepreneurs. This is truly collective insanity.
I really have to wonder if more than 5% of the population is capable of sustaining this degree of individuality even if it were a good and necessary thing.
I think you state it well. A really “free” person does exactly what they like whenever they feel an impulse and there is no better way to show that then in tossing “control” out the window by getting intoxicated and engaging in antisocial behavior ruining your mind, marriage, crashing cars and stealing drugs. After all in the state of nature all are completely free though it turns out to be the war of all against all (Hobbes?).
It must be admitted though that one can be “King of the Jungle” if only for a day.
Similarly a person often wants to take a chance of mating with a rule breaker so as to obtain a social position above what good order might indicate. One might marry a drunken band member with the hope that they “might make it” elevating one to the near aristocracy.
So we see all our modestly talented young men throwing away all the financial potential of their early years on dining, drugs, travel and all the disposable forms of consumption that one might be a player and worth a chance.
This works about once in every hundred thousand shots but for most we wind up broke and sodden confronting early middle age and often health is diminished as well. By then the pathways to addiction to one degree or another are completely worn in.
Thanks for an extremely honest comment. First of all, I have very similar experiences with alcohol. My wife and I keep talking about going without, but at the end of the work day we hardly even hesitate on that trip to the booze shelf. I pour her a martini and I have a scotch. And then….we might stop after another glass of wine, but we might go on for a few hours. Like you and so many others, I really like the feeling. But it gets old pretty fast. Alcohol releases endogenous opioids, but only in the first half hour or so. After that…..it’s mostly just a suppressant. And yet….we keep chasing the best moments of the high, hoping to fetch a few more before the night is done.
I totally agree about giving up control as a form of independence. Well, maybe it’s an analog of independence. But as I say in my post, there is this moment of pride or triumph or something, when you say “fuck you” to the norms you’re supposed to follow. You dash out on your own trajectory, leaving “the group” (or its representative in your superego) eating your dust, and what I describe above as “free fall” really does feel like freedom.
In my book, I trace my addiction to the point where self-directed anger (and relentless efforts to stay in control) were completely transformed into a triumphant “fuck you” directed at the rest of the world. This was an extreme, and I think most of us don’t go that far. But like you, many of us get a heady taste of freedom when we give in to the impulse. I think this is exactly where we need to turn the microscope and watch what’s happening. So I’m going to be posting about, not only ego fatigue, but about the headlong rush of an alternative self that seems to be released when we get to the pivot point.
Hi Marc:
I started a re read on the book having moved so much in my thinking I have to go back to the “start”. 🙂
One view is that we are not necessarily naturally inclined to do the things we do. I keep an image of an indifferent earth which tolerates us in a band that we can inhabit and survive in but which is not “designed” for us. Society is a social/human institution which is kind of a pack or herd. In the State of Nature it is the only means to survive and get a chance at meeting your needs more regularly. This does not mean it is comfortable though… simply a lot less abrasive then the exterior experience which is even more nasty, brutish and short.
If you are the KING in an absolute theocratic monarchy organized on a Fertility Religion basis it would probably be pretty OK with lyre players and cup bearers on hand!
Note how you state “alcohol releases endogenous opioids” Is there any research on mild “substances” that would be designed to simply elicit that effect.
All these natural substances are really Stone Age adaptations embedded in the Culture but which have very broad effects not being designed. Alcohol is simply yeast urine after all. If you drank 50% reindeer urine you might have all sorts of good and bad effects too- not trying to be rude here or scatological here but you get my point – there would likely be a range of effects some of which were sought and others not so.
Hi Mike. Your comments on the place of man in nature, on less developed societies, monarchies — with lyre players on hand — are all extremely erudite and also fun to read. That’s a good combination! What can I say? It’s true, our comfort zone within Nature has been hacked out of the jungle of evolution and competition. It wasn’t designed for us — far from it — and in fact we were designed for it. Which isn’t to say that it’s all that comfortable. It’s not. Most of the faces I’m used to seeing in my day-to-day life, especially when I still lived in Toronto, were not very happy faces. Here in the Netherlands, things are a bit more upbeat for some reason. And it’s not because everyone’s smoking pot, as some people imagine. So getting along with fellow members of the herd isn’t easy, especially when we’re all competing for the same blades of grass. The horrid side of natural selection is that there have to be more individuals than resources if a species is to evolve. Without that “adaptive pressure” selection just doesn’t happen. It doesn’t need to.
Sorry to say, but I know of no other way to get an opioid rush than to drink alcohol pretty quickly. Martinis are useful for that. The joggers’ high sounds like BS to me, though some swear by it. The only thing I ever got from jogging is very tired. Oh, you can also get an opioid rush from taking opiates of course, but that’s such a lot of trouble. I get most of my opioids these days from hugs. Sounds cheesy, I know, but my five-year-old twins are really good huggers and that does it for me. So does booze, but I don’t feel nearly as good afterward.
You and I are “old” so we do not want over commitments as much however there does seem to be an opportunity for “Marc Lewis Biotechnology LLC” to research this wedge issue regarding the peculiarities of alcohol. Alcohol is also a kind of retro anti-freeze used in radiators until ethylene glycol was introduced also a sweet poison. It is used to upgrade poor wine and is known for its intoxicating effect and brutal hangovers as well.
There is some pivot knowledge hiding here. If it is accepted that the brain is very porous to biochemical hacking and this is going to be very difficult to restrain especially across a population the idea of a nasal inhaler loaded with the least noxious compound that can designed is very interesting.
I understand that olfactory circuitry is the only unfiltered access to the brain not sure about that but if correct that would be “the route”.
Can’t wait! In my own experience, the one who Tries Very Hard To Resist is NOT the one who picks up the bottle and goes for it. It really does feel like an alter-ego!
When I was a serious druggie I had (at least) two very distinct personalities. One time (and this isn’t in the book), I actually excused myself from a group therapy session. It happened to be in a medical building. I went to an office on another floor, somehow unlocked the door and stole some drugs. I swallowed them quickly and went right back to therapy. I still remember the tremendous freedom I felt breaking away from the rather stifling, boring, predictable, pathetic issues we were all supposed to be talking about, and running completely wild. I became whole, in a sense, but it wasn’t the same “I”.
Ha! Chalk me up for also having gotten a wee illicit buzz on during therapy groups {in my case it was methadone I pilfered from the center and I conveniently submitted my urine drug screen early telling them “I know how rushed you get after group.”and continuing to participate with a bit of a smug smile and a side-order of guilty ‘I hope I don’t get found out.”
Sheesh. The addict brain is quite the untrained beast.
One point about the ACC is that you can buy glutamine at a nutritional supplement store and I am currently consuming about 12 grams a day of that. I am not a dietary extremist but I am interested in the research that indicates some people are not able to process adequate supplies of a given nutrient for some specific reason. A good example is Vitamin D3 for which nearly everyone is deficient in the Northern Hemisphere and which certain people are impaired genetically and unable to process more than a small % of what they are receiving.
GABA might also be available too.
This is a part of the pivot point to which you refer if the ACC comes to the match depleted of fuel.
A similar sort of event takes place in the transition from a mixed state of depression which is very uncomfortable to say the least and an “upgrade” to BP2. Personally, I mostly took psychedelics and/or stimulants. And really a meth/acid rush is a lot like Hypomania up until the point where the hallucinations start. Likely you know this.
I am wondering if you have looked into the reversibility of the pivot point here?
Could we say that the suffering abstainer is in a “mixed state depression” as to how they perceive it themselves and reaching for that substance is a moment of hypomanic relief?
Hopefully BP is okay to mention here as substance abuse is so common with this as well as all out addiction.
It is such a relief when that “all natural organic mania” kicks in on its own. Mind you I am reformed now understanding that crushing depression is determined as the price for that joy.
Right on. There’s a lot of overlap between your comment and Roger’s (above). Yes, I would say that the pivot point does feel like the jump to mania — at least that’s what it feels like, though the neural underpinnings are probably different.
I’d characterize the pre-pivot state not so much as depression as anxiety. You feel the pull, you feel the struggle, you have to apply real effort to continue to avert what you recognize as a danger to yourself, and of course you feel the hot wind of the future on your neck: you begin to anticipate failure, and the whole fall from grace thing, even as you try to fight it off. So I’d say anxiety. (which has a lot of overlap with depression, granted) And then….free fall. Relief. By the way, relief comes in many flavours: you not only get freed up from your own tight reins, but you also get to have the thing you really want. The relief is partly just getting what was previously denied.
I’m no expert on the supplements you mention, but my understanding is that glutamate taken orally doesn’t make it to the brain, or at least not much of it and not very rapidly. On the other hand, there’s good evidence from Baumeister’s group that eating glucose does counteract ego fatigue. I find this hard to fathom, and so do others, so we’ll have to take a good look at this research and figure out how to interpret it.
SUGAR? That’s amazing. Chocolate chip cookies, here I come!
On another note, I totally relate to the pre-pivot state being anxiety. I call it the “bitching hour”, when I can’t sit still, and I gotta have a drink, gotta have a drink, gotta have a drink. The depression kicks in later on — well, it used to, anyway, when I was drinking, and depression would come hand-in-hand with “fuckyouall”, when I faced the sense of failure at the same time as the anticipation of getting that drink. Now, I’m still figuring out what else to do. I’m not ruling out chocolate.
Interestingly, this bitching hour for me happens at the same time as the bitching hour for kids. We’ve all seen that one, especially if there’s more than one kid involved. It’s that hour or two just before supper, soon after they get home from school, when they’re all hyper and hungry, and if there’s more than one of them, they’re usually fighting and if not, they’re oppositional. Wait, did I say hungry? As in low blood sugar?
Could there be a connection? Could the cravings at that time of day be more than just habit and cues? Could the craving really be for food and/or sugar?
I don’t know the answer to that. I’ll have to look at the research again. The breakdown of inhibitory control, known as ego fatigue, could be expressed in all sorts of ways. Subjects in these experiments often fail, not just at self-control but also at solving puzzles. You basically lose some of the capacity to control and direct your thinking. But I don’t know if the fuck-it moment (we all seem to be happy with that expression) that leads to substance use has much to do with low blood sugar. I doubt it. But I’ll find out.
By the way, the one form of depression I’ve encountered in the pre-fuckit state falls into the category of “learned helplessness”: I’m damned if I do (use) and damned if I don’t. I’m damned if I don’t because I’ll miss it so much (so I believe), and we all know very well why I’m damned if I do.
Holy hecks! This post just landed in the middle of a curriculum and training I teach trying to explain to lay (non-addicted) folk who work in social services (drug courts, child welfare, etc.) how the addict brain works! I rely heavily on explaining the various neurotransmitters and how they factor into what the addict is looking for and why that sometimes compromises so many other priorities in life; employment, health, caring for children.
This post just nailed they part that I’ve been noodling on myself. I get the brain science of the active addict, and I have a good foundation of understanding of how the newly recovering brain compensates and attempts to “find normal” after binge or chronic use. But I’ve been considering that long-term recovery brain and why it sometimes locks and loads on a maladaptive thought or trait and then just won’t let go until it drags the addict to the loony bin or the treatment center.
I’m going to have to read more of your stuff because you seen to get why that’s happening! I bet you have other remarkable insight as well. Thanks for your post.
What a nice message. Thanks. Yes, the problem of long-term relapse, or psychological addiction, or whatever you want to call it is really at the centre of my interest. If you read my book (see home page) you’ll see that I spent many years trying to quit. Sometimes it would last a week, sometimes a month, and sometimes more like 4 or 5 months. After such long periods, your brain is functioning pretty normally in almost all respects. At least that’s the case with opiate use, though other drugs have very long-lasting after-effects.
So why does it happen?!
I think it’s a complicated picture. Sometimes a single slip, because you’ve stopped lecturing yourself about it, begins the snowball effect that people talk about. But there’s more to it. The feeling of the drug becomes deeply interpenetrated with synaptic networks (probably in the orbitofrontal cortex and other places, maybe the insula, maybe the amygdala) that represent meaning. The meaning in this case being “this is what I need” or “this takes care of me” or “now I’m complete again”….stuff like that. These scripts or whatever you want to call them may in themselves overlap with very primitive associations of being taken care of by a parent.
I’m still looking into all this, and I think my next book or two will focus on other people’s addictions, again using neuroscience and psychology to help understand what’s going on.
“Now I am complete again.”
That is what is in my mind the moment the mood-altering vehicle takes hold. Drugs…sex…chocolate. First there is that unbearable anxiety in which builds my desire to use ‘just to quiet the constant yammering” inside my head…then the use and the big-bang followed by an interior exhalation relaxing into a feeling {although both erroneous and temporary) of being complete and at home.
Interesting that Marc equated that feeling with being cared for with parental attunement and protection. I have an ACE (adverse Childhood Effects) score of 8, so I’ve never even considered comfort I get from that my drug use like it feels to be protected by parents. Having read that though I can say that when I think of my own romanticized feeling of how parents should be THAT does harbor many similarities to that ‘relaxing kitty-cat’ feeling I get when the opiates kick in.
The exhale — the relaxing feeling of giving in — I think it’s mostly the release of pressure. You were on this knife-edge of indecision, fighting furiously to tip to the right even though you were listing to the left. And then…..after hours or days….you topple. And then the tension is just plain gone.
Also the yammering you refer to is not without its malevolent barbs, harsh criticisms, judgmental scoldings: How could you? Why would you? What kind of a person….? etc. etc. etc. Once we go over the edge that voice just goes “mmmpfff” like a sock was stuck in its mouth. The rest of the crowd we keep in our heads is a lot more friendly.
Glucose:
As you know the brain is 3.5 lbs? (maybe) but consumes about 20% of the metabolic output and all it burns is glucose for energy- this is one of my massive tricks- sugar consumption usually in the form of maltodextrin which is not as hot on the glycemic hit parade. Dextrose is good too as diabetics know and you can get dex candies. Sucrose and fructose are too difficult to digest and subject to in vivo fermentation though not as strongly fermented as lactose.
Nutrition cranks have beaten down sugar too much because people consume WAY too much at one time spiking and crashing blood sugar.
Alcohol and alcoholic drinks are sugary after all with the dryness coming from tartrates as I recall… alcohol is a kind of sugar water- wine, beer…I am sure this is a big part of its appeal as it goes straight to the liver + right into the blood+ right to the CNS Kayoing the neo cortex on the way by.
Why not try this: Get some of that edible diabetic Dex candy and eat one every hour then one every 1/2 hour. Better than a glucose/saline drip or nearly so. Carbos are only 4 cal/gram so there is no possibility of blowing your blood sugar out the window though a baseline reading might be good.
The goal is to insure that the brain is always seeing glucose molecules so it does not get anxious. It is looking for lipids and glucose primarily.
I have experimented with this for many years and the idea IMHO of eating 3 large piles of food/day at fixed points is a convention that should be looked at. Hard training competitive athletes usually do not do this which is where I adopted the idea initially.
Yes, the brain runs on glucose, but I assume that glucose is also the raw material out of which it builds glutamate and GABA for synaptic transmission. You seem to know a lot about this stuff, so please tell me if you think this is correct. My sense of ego fatigue is that it depends on transmission in specific areas, like the ACC, rather than on an overall level of metabolism.
Also, my understanding was that the brain uses up over 50% of the calories we ingest, not 20%. What’s your take?
Glutamate is synthesized from glutamine so while you cannot cross the blood brain barrier with glutamate you can cross glutamine which is also utilized in the guts. Communication about status with the vagus. See a really good illustration of the intestines which are VERY deeply penetrated by neural tissue, I consider it remarkable and a personal revelation as to the mechanics here.
If a person is healthy they might be able to generate about 100 watts of electrical power functioning nominally and awake. A Heavyweight on the National Rowing Team can hit 4-500 watts, for example.
For our average person we see about 20-25 watts being drawn by the brain when it is functioning nominally. (broad median here).
This is a VERY expensive load on the metabolic fusebox and it has a priority. Calorie intake/ metabolic efficiency = roughly equals total watts available. This output can be leveraged to deliver force/distance through biomechanics and delivered to the brain.
Nutritional deficiency/metabolic failure delivered immediately to the brain as news to order progressive brownouts across the system.
Please note the correlation (not causation nec) between psychosis and what is called “metabolic syndrome”.
Not all that is caused as a side effect of Olanzapine or other.
This is a worthy area of research to chain grad students to. It will make them and their institutions very wealthy.
Insanity/Obesity/Metabolic Syndrome/ Vagus- Brain circuit to primitive brain areas
Thanks, Mike. You do know your stuff. But glutamate is synthesized from glutamine AND glucose metabolites. Then GABA is synthesized from glutamate.
I love your description of how the brain shuts down. Whether it uses 20% or 50% of caloric intake, that’s a hell of a lot for a 3-pound organ. At about 2:30 PM I could not listen to one more boring word of academese, and I believe my eyes actually rolled up in my head — which was an easy way to chase off a new graduate student.
Right:
I usually follow a 3 to 1 rule with glutamine- 30 grams of dextrose, maltodextrin + 10 grams of glutamine and this will give you the glucose also needed in the brain.
Glucose powder is not widely available, here anyway, just appearing in buckets as a syrup. Often found in premium lollipops though which shows Kojak did know some stuff.
Try the dextrose tablets but do not wait until you flatline as there is a lag ;-).
The brain is very odd in that it sits there in near total darkness looking at interpretations of exterior data which must be profoundly baffling to it at times but it knows one thing!
Find ways through direct behavior to move brain chemistry into more comfortable directions. Only real goal or the first one in any case. A hot tired, itchy scratchy brain can get pretty frustrated and irritable.
Since you are talking here about glutamate and GABA, this seems like the right place to ask: What do you think about this approach
http://www.olivierameisen.com/faq
And how does it fit in with the discussion here?
Hi Jeannie,
I just did a brief scan of the literature. Baclofen does not seem to be generally recommended for treatment of addiction, though different things work for different people, and there is some indication that it can work against alcohol addiction. Your link is to an interview with someone who extols its virtues because it worked for him. Such anecdotal accounts are useful, but once people start saying that this is THE wonder drug and everyone should try it…that’s when I start losing interest. If anything was THAT reliable, it would certainly be in the spotlight more than it is. This drug seems to be a tranquilizer with some interesting side effects. That said, I don’t oppose trying anything (that won’t harm you) if you think it can help.
Best,
Marc
Oh, and as for the enteric nervous system, the gut brain, yes, I believe it has about as many neurons as the forebrain. Which is completely amazing news, and should get us to eat better.
http://www.npr.org/blogs/health/2012/01/31/146096540/i-wanted-to-live-new-depression-drugs-offer-hope-for-toughest-cases
Listening to NPR yesterday (Tuesday, January 31, 2012) I caught one part of a series they are running on depression and the drugs used to treat it. Tuesday’s story featured drugs that tweak the glutamate system–ketamine, riluzole, and scopolomine–and are effectively treating depression in patients who were not responding favorably to drugs that affect the serotonin, norepinephrine, and dopamine pathways. Apparently drug companies are looking into newer and more targeted drug therapies that address the glutamate system for the treatment of depression.
Anyway, as an alcoholic in recovery who is intimately familiar with “ego fatigue” vis a vis the war between the part of my brain that resists the first drink and the part that really, really wants it, the NPR story reminded me of this discussion and made me wonder … would such drugs bolster the self-regulatory function in the ACC during those first few months of abstention when an addict in recovery is so precariously balanced on the tipping point? Making it past six months was a key in that internal war for me (and I should thank you Marc for your post–October 25, 2011, Building Brain Muscle with Meditation–on meditation practice as a tool to strengthen self-regulation, because it helped … a lot), but an alarming number of addicts and alcoholics never abstain long enough for their internal NO to get stronger than their internal YES.
Hi Chris. Sorry for the delay. You have brought up a really interesting topic and asked a very relevant question. I just read the article you linked to. Here’s the story as I see it.
NMDA-antagonists like ketamine break up habitual patterns of cortical activity. NMDA is a receptor type that reacts to glutamate. So it is a gateway for glutamate transmission. Glutamate is the fundamental neurotransmitter that sends messages from one neuron to the next in the cortex. That chain of activation falls into patterns, and those patterns turn into habits as the synapses get strengthened or weakened through repeated experience.
So….depression is a habit. It’s a way of viewing yourself and the world. It’s like a traffic route that you take every day. Ketamine type drugs break up the organization of the whole system by reducing the glutamate flow along the major traffic routes. And that’s how people get high on it. Check out my post on November 21. Breaking up cognitive habits is radical. Now reality can be seen in any number of new ways. That disorganization can feel like freedom, or like an escape from normal perception. But at its extreme, the ketamine experience can be scary and it can be dangerous. Some people get a long way from “normal” perception. And they may not come back for a long time. That’s partly why ketamine is used in experiments to simulate schizophrenia.
So I can see how NMDA-antagonists like ketamine can break up habits like depression. But I don’t think they would help build “muscle” in your ACC and protect you against ego depletion. In fact, probably the opposite. Self-control is also a “habit” and the ACC is a cortical structure. It communicates with other regions all over the cortex — through glutamate. So the ketamine could easily change the mechanism and the motive of self-control. That could be a disaster.
I suppose it could break up other cortical habits — negative ones like the self-annihilation urge that can go with alcohol use. Or simply an underlying depression. But it would be a crap-shoot. So if you’re doing okay right now, stick with it. Especially given your success with meditation! Meditation seems the best way to make self-control an extension of your own will, a choice rather than a necessity. It also makes “normal” life more vivid and more comfortable, both, so changing it becomes less attractive.
Good luck, and please feel free to bring up any related issues!
Check out this paper, Marc. It’s about how general processes of disinhibition produce different sorts of behaviour — alcohol is dealt with. They use Gray’s model of Behavioural activation/inhibition in interesting ways. But what I most like about it is the way these ideas of inhibition and control relate to feelings of power (directly applicable to your last point about the feeling of “triumph” when you finally become disinhibited).
Jacob B. Hirsh, Adam D. Galinsky, and Chen-Bo Zhong
Drunk, Powerful, and in the Dark: How General Processes of Disinhibition Produce Both Prosocial and Antisocial Behavior
Perspectives on Psychological Science September 2011 6: 415-427, doi:10.1177/1745691611416992
Thanks, Alese. This looks really important, and I’ll definitely get to it soon. Disinhibition in adolescence may be a classic (and normative) case of the triumph or sense of power that comes from disinhibition. Just another brick in the wall? Or Power to the People!
Wow, this is it, isn’t it, the key, the crux of the matter, an explanation of the pathway to continued, long term recovery.
How many times have I heard someone describe their relapse as an almost “out-of-body” experiance. “I was driving along, and “my car” turned into the liquor store parking lot…..” They were simply “out of fuel”, unable to resist the impulse any longer, perhaps obsessing for a long period of time at an almost subconsious level, in first gear, so to speak.
It’s just so completely crystal clear to me now. How can I apply this to my own recovery? Never let that obsessive thinking simmer at that subconsious level, drag it up into the light and deal with it. How do I turn that kind of thinking off, before I run out of fuel? AA literature is full of methods do do just this, “Let go and let God” for example, or Prayer and Meditation (effective even for atheists).
Why does recovery seem easier after a period of time? Perhaps because there is a capacity to increase the amount of Glutamine or GABA, or to process it more efficiently, like a form of exercise, or a reversal of that perverted learning, that Marc describes in his book. And why does that obsessive thinking return so vengfully after relapse? Perhaps a form of “rebound” effect, like many pharmaceutical treatments.
Some 70 years ago, the AA Big Book was written, and it describes recovering alcoholics development of a craving for sweet food, chocolate for example. Perhaps there is something to the Baumeisters glucose theory.
Marc, you describe the feelings associated with these mechanisms in a manner that is so very easy for me to relate to, I cannot wait for your next post. You are supercharging my recovery, like a race car, rather than the old Dodge that I felt like before.
Thanks Brother
Peter
Hey Peter, I had the same experience when I read Marc’s book. I was gobsmacked when I got to the part where he explains the dopamine-opioid-craving connections, and that got me, as you say, supercharged. Much gratitude!
And hang in there — you’re not alone!
Do try dextrose tablets available in any pharmacy. If you believe it is functioning for you maltodextrin is very cheap and only about 60% as sweet tasting as sucrose so it is not sickly sticky tasting.
You really need to limit the quantity of sugars you consume at any given time.
I will take it all at once and save the hassle is not good.
There is a massive amount of CNS tissue in your guts, about the same volume as an entire cat brain and this plexus communicates with HQ in your head through the Vagus nerve.
Interestingly depression is treated by electrically stimulating the Vagus- hmmm- the brain is in a 2 way communication here assaying the state of nutrition and it is very easy to spark the starvation metabolic reflex.
Man, that is music to my ears. I never really thought, when I wrote the book, that it would be of much help to other ex/recovering/half-recovering/recovered addicts. So it is just so good to hear that it can have this effect. I’ve been thinking a lot about my next book, and I’m thinking now of a detailed “biography” of a friend of mine who met an untimely death after years of serious addiction. If I can figure out just how that worked with him, maybe that will be helpful to others as well.
Indeed the simmering process is deadly. It really is the last phase before going over the cliff, or maybe by the time you’re simmering you’re already going over. I think that The Bus Driver’s comments, here and especially on her own blog (http://drivingmyownbus.wordpress.com/), suggest some very insightful ways to talk to yourself in such a way as to to avoid the simmering, so that you stop before the simmering starts.
Ego fatigue is real. It’s been experimentally validated over and over. I’m going to start my own research on its neural basis in the next few months. But from a practical point of view, I think we have to see the threshold crossing as more than just a muscle giving out. There’s a lot of attractive stuff on the other side. Which makes me think that ego fatigue actually starts to enlist thoughts about giving in, about the relief of it, about excuses for doing so…maybe that’s when the car drives you into the liquor store. You pick up other signals, so to speak, when the signals of self-control start to fade to static. This really will be the topic of my next post.
As to why recovery gets easier over time? That’s a big question. Perhaps we learn to shift the trajectory of our own thinking before it starts to indulge in fantasies of getting loaded. Just like we learn alternate traffic routes to avoid traffic problems. Also the synapses that represent the wonderfulness and meaningfulness of the drug/booze experience really do start to lose power WHEN you activate other synaptic pathways that represent other ways of feeling good. Synapses are little gaps between neurons, and with disuse the gaps get wider, so your neurotransmitters don’t get across them as quickly or easily. They may never go away completely, but they really DO get weaker. And the trick is to find those alternate routes and stick to them, strengthen them, to help the others weaken.
More to come, but thanks for your comments, and GOOD LUCK to you! (yes, I believe in luck a bit too)
Hi:
Gluta-mine is the supplement not glutamate and the idea is you are feeding the precursor so that your body may synthesize more glutamate if it is less efficient at producing it. Many doctors insist that a balanced diet “should provide..” but this is simply an assertion. The question should be how does “Patient Fred” process some needed substrate. If you are deficient in processing requirements you are going to have a lot of head problems. How can we say ( yet ) that a given subject in particular IS meeting specification for the full range of required compounds? We can think about iron deposits in the brain generated by hemochromatosis or some degree of demyelination due to inadequate D3 processing or a situation with respect to the thyroid and so forth.
One of the things I seem to see is that the CNS has a restricted number of pathways that are multi purpose and we rely on interpreters to tell us what it is we are feeling or need. Various “perversions” ( no offence intended ) involve redirections of this sort.
As I am re -reading your book chapters in reverse order I have focused more on your relationships and outlook such as your feelings as you first drew the “NO” mandala and it does sound an awful lot like “Agitated Depression” to me from my personal not clinical experience but then I have had a lot of trouble with that and have looked to substances for relief. So I am not trying to carry coal to Newcastle here but I would say my ground state was agitated explosive depression similar to the sort of PTSD reported by Dr. Shay in “Achilles in Vietnam”- interesting history for Dr. Shay too. From agitated depression I could clinical or rise to mania then cross back like a figure 8 through this turf.
For certain, there are no side effects to glutamine in small quantities though it might support mania slightly. You have a massive concept with this notion of “depletion” in the ACC leading to an exacerbation in more than one direction. A BP 2 struggles massively not to fall either way with no leverage point and you float free then away.
Thanks for the dietary advice for readers, and I agree that treating our chemical deficiencies is a hugely important and hugely individual enterprise.
As to whether anxiety or “agitated depression” precedes the jumping-off point, I believe that varies from individual to individual as well. And I don’t think there’s any solid demarcation point between them anyway. After all, antidepressants (SSRI’s) are useful for both.
No offence taken. I did a lot of things that were undoubtedly perverse. Addicts often do, and that’s the main problem.
There’s another paper just published in some big-super-science journal with Baumeister as second author that I can’t find right now but wanted to just mention. They find that we feel “desire” 70% of our waking life. We try to resist that “desire” at least half of that time. And one of the upshots is that resistance is SOMETIMES futile. The best defense? Stay away from the temptation in the first place. Seems so freaking obvious. But their point was that people who resist what they most NEED to resist (based on their own reports) often fail when they try hard. But if they don’t have to try (i.e., if they avoid situations in which they crave/desire in the first place) they do a whole lot better (according to their own reports of doing well). So I think the main point was that if you put yourself in the conditions under which you are testing and straining and pushing your ego control, you’re bound to get depleted. You’ll cave eventually. The trick is not to try… and therefore not to fail.
And on a completely different note, any comments on this, Prof. Lewis?
http://www.npr.org/blogs/health/2012/01/24/145731952/your-brain-on-psilocybin-might-be-less-depressed?sc=fb&cc=fp
Wow, that article seems to capture so much that’s important for the readers of this blog. And I really do believe that little spurts of desire are almost like the cement that connects the elements of our fantasy life. So 70% doesn’t sound too far off. Your advice is excellent, and I’ll try to incorporate it in future posts.
As for psilocybin, I’m a bit tired now, but I’ll try some tomorrow once the kids are in school. It’s been a while.
BaHahahaha, Bust my gut; try some once the kids are in school. Might be Ok if you can just get the ED50 right. My problem was that I usually took something closer to the LD50…….
Marc, this is awesome, your book and blogs really speak to me. After 20 plus years of heroin (among other drugs), I went back to school and became a substance abuse counselor. In my counseling, groups, and didactic lectures, I spend a lot of time calling attention to the neuroscience of addiction. Your book and blogs have greatly helped me fine tune that effort. I often speak about this pivot point. I explain my own experience of that place as feeling like I was being held under water. Eventually I had to come up for air, and that meant using. I would justify it by saying I’d get get to sobriety tomorrow, but I just had to take a break today. I just wanted the argument in my head to stop for a while, I just wanted to sleep normal for a day, and stop the anxiety. I never realized that taking that breather would ensure that I would remain in that suffocating cycle. Your writings have really helped me communicate this whole process.
Hi Eric. Sorry for the late response, but it’s harder to find and reply to posts that aren’t recent. Anyway, I’m delighted that the book resonates with your own experience and helps you to think about the neurobiology of addiction. I remember the suffocating feeling very very well. I could not shake it. Actually, for me it was more like a feeling of being strangled (very close). The dialogue in my head was so intense and inescapable…until I took the plunge each time. I think that was a major component in the string of relapses that characterized my addiction.
Anyway, good to “meet” a fellow traveller — junkie turned counselor. I think there’s a lot of work for people like us!!