Several posts ago I started a discussion of “the pivot point” — the moment when we give in to our cravings and dive for the drugs or the booze. I emphasized a few things about this event, many of which resonated with readers’ experiences — in fact many of which came from readers:
-it can begin with a change in your internal dialogue, like my humming to myself in the rat lab, when you already know, without full consciousness, that you’re going to do it
-at the final moment, it feels like you are throwing off control, not just surrender but also triumph
-there is often a feeling of great relief, abandon, or escape from suffocating self-control — one reader called it the sense of free fall
We then discussed the pivot point in more detail, getting into the psychology of ego fatigue and the underlying brain dynamics: the weakening of the will as the anterior cingulate cortex (ACC) runs out of fuel, and the final snapping of the branch. The dialogue concluded with the notion of an 11th commandment: Avoid Temptation. Because you can’t inhibit your impulses, actively, for a very long time. Your brain can’t take the strain.
In this post I want to go a step further and explore the relief that comes at the pivot point. There is still an untapped mystery here. Sure, you’ve been craving, and now you allow yourself to get the thing you’ve been craving. Dopamine feels like desperate desire when the goal is out of reach. But it feels like a headlong rush when you’re suddenly “allowed” to go get it. That’s a part of the relief.
Yet there’s a lot more to it. During periods of self-restraint, there can be an ongoing struggle that often takes the form of an internal dialogue: Don’t do it. No, just stop. But it would be so nice… Stop thinking about it. But I want… Shut up! Just stop! And it can get quite a bit more vicious than that: Stop, you self-indulgent baby. But it’s just one last time. That’s what you always say, you hopeless cretin. So? Everyone’s got their problems. You don’t deserve sympathy. But I’m so depressed… No wonder you disgust people. Etc, etc. If you’ve ever heard a (usually unspoken) dialogue like this, going on in your head, then you’ve probably gotten to the point of saying “Fuck it.” And you know that the relief you get is not only from the drug/drink, or the anticipation of the drug/drink. It’s also the blissful shutting off of that nasty voice of self-rebuke.
Think about it this way: When are you more likely to yell at your kid? When she is playing safely in the playground, or when she’s wandering out into the street? When your kid is approaching an oncoming truck, or a cliff edge, is when you lose it and scream: Stop! Go back! I told you NEVER to do that!
So what’s going on in the brain during this state? Picture your ACC, sitting near the top of the brain, trying to keep control, but finding it slipping, slipping. Two floors down there’s the amygdala, the organ of emotional colouring. As your ACC starts losing it, your amygdala begins to panic. Not only because of the longterm suffering you’re about to contract, but also because the internal “parent-like” voice is getting more and more harsh, nasty, and punitive.
With the ACC losing control and the amygdala responding with waves of anxiety, the two voices in your head, the childish self and the scolding parent, become more desperate, and more desperately at odds with each other. There is no consensus on where internal voices are generated in the brain, but we do know that anger is associated with the left prefrontal cortex (PFC) and fear with the right. The left PFC, being involved in planning, logic, and making sense, has also been associated with moral judgment. The right PFC is more “childish” — it develops rapidly in infancy, before the left — and it’s more closely connected with raw emotion. In fact, some neuroscientists claim that an important job of the left PFC is to regulate the right. That often means inhibiting impulses. So now you’re losing control, the amygdala is blaring anxiety, and the “childish” right hemisphere is being suffocated by the moral authority of the left. This is no picnic. It’s a major family argument in the privacy of your own brain!
And then comes the pivot point. The ACC is finally too “fatigued” to keep controlling impulses. So here’s what I think happens next:
Without the ACC to help keep the ship on course, the left-based punitive “voice” loses its authority. The right PFC is suddenly free to take the emotional path of least resistance. Left-hemisphere reasoning now switches over to become allied with its old friend, the ventral striatum (the engine of goal-pursuit), which has silently toppled the ACC in terms of cortical supremacy. In fact the whole frontal brain becomes unified behind one exalted goal: LET’S GET HIGH. And the left PFC does its part by planning (its specialty) — how to get it, how to pay for it, how to hide it. The amygdala is suddenly passing along waves of excitement rather than anxiety, and you are cruising, rudderless, in a tide of pure intention.
This kind of brain modelling needs to be verified by research, and we’re just starting to acquire the tools to go there. For example, recent research (in a related model) shows that, when the inner voice of restraint is coming from brain regions that represent other people (not oneself), we stop listening, and we stop acting responsibly.
So there it is: a (speculative) brain-based model of the relief that comes from escaping self-restraint. But I’m not recommending it! (Don’t try this at home, kids.) That relief is real, both psychologically and neurologically, but it is a temporary flash of positive emotion at the start of a long dive into negative emotion. This is part of the siren song, the fool’s gold, of substance use. It doesn’t last long, and it leaves you empty and gasping when it’s gone.
I know this post is a little dense. I wanted to get these ideas down before leaving for the US book tour — in less than two days. But please post your comments or questions, I’ll check in while I’m on the road, and I hope to unpack some of these themes in the near future.
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
interesting. surely the ’11th commandment: avoid temptation’ would say if you are beginning to feel that way just do not go to the lab. do not go physically near a possible source of failure?
secondly maybe there is an issue with reality of expectation post-stopping; the right mind set may be not to expect everything to be fine, but to expect recovery to be a long, long road with continual risk and some discomfort, and requiring vigilance (one of many great points made in this post http://www.spiritualriver.com/51-things-you-should-know-about-addiction-recovery/comment-page-1/#comment-162189)
It certainly is important to not let yourself get too cocky. I’ve never heard of anyone successful in recovery say “hey, this is easy!”
Marc I’d love to see you write on prevention. If we have these weaknesses, how do we parent and help and manage our children’s lives so that they don’t go the same way?
See the mental illness Prevention section here… http://en.wikipedia.org/wiki/Mental_Illness#Prevention
Very best
John
I think we could do with a nuturing parent on our side. Those critical voices came from somewhere, for me..it began with my mother!
I can relate to that desire to ‘win’ over the ‘don’t do it’ warnings. I win at my own peril however.
It is still my mother I’m at war with. I need to treat myself as I do my own children. They are both now adults, I listen and trust them to make their own way in this world.
This is where it gets fascinating. I don’t think the voices are copies of parental voices. I do think that parental voices act as seeds. But the voices in our heads seem to grow and attain their own personality — a personality that only partly resembles one or both parents.
When my daughter was in the bath at age 3, I was amazed to see her arranging her dinosaurs, on the rim of the tub, into a family and an outcast. The isolated one was told by the others: You can’t be with us because you’re too greedy. You won’t get any food, and you need to stay by yourself. She has NEVER been spoken to that way, so where did that voice come from?
I think that this incipient voice became a part of her own internal dialogue, and the finger of accusation went from a plastic toy to her own being. This is, I believe, how internal voices grow. They become internalized or interiorized with development (Vygotsky), but they start out as utterances made toward animals, dolls, or whatever. So the voices start off as “practice scripts” which then get moulded and shaped, not only modeled after a parent, but also growing and taking on their own style and content. These voices are, after all, parts of ourselves.
When I first identified my own internal voices, they seemed to come from my mother too. But after a while, I realized that I was their real author, and my mother was more like a personal trainer.
Congratulations on your U.S Tour Marc!
I have become an information fanatic, with addictions being my primary focus. This post was right up my ally in filling the need. Its hard for me to simplify things, put you make it easy for me in seeing things more clearly, your are for me what I hope to be for other addicts in my book, A vision of understanding. For many feal whats going on, but don’t know why. Knowing is half the battle!
Thanks again Marc! keep them coming..
Reg; Richard Henry
Thanks, Richard. I’ll try…
I’m glad that you’ve decided to model out the tipping point. I recall the conversations that were had where we tried to narrow in on this phenomena.
As for the endurance of the ACC, do you think that there are ways in developing that voice? For me, when I first turned to drugs, there was no voice. I was free to start having fun with my life, as a 22 year old, this is just what people my age enjoyed doing. Being stupid and what not. But then after some time I had my fun and had to stop using as much as I was. During times of temptation, I would hear the voice in my head that was telling me to avoid using, at least until my daily responsibilities were taken care of.
This voice took the shape of that of my father’s. It was stern, but mostly, I was obedient. It was a very strange feeling to not only hear my father’s voice telling me to avoid temptation, but my reaction, as if he were actually there to tell me this.
For anyone else, whose voice, or what kind of authority do you use on yourself when avoiding temptation? And Marc, could the amount of authority contained within the voice reflect the power of your ACC? And vice versa, would strengthening your ACC result in a more authoritative voice?
These are difficult questions, Daniel. Could the strength of the ACC be reflected in the authority of an inner voice? I don’t think inner voices RESIDE in the ACC. The ACC is more like a neural module that DOES self-monitoring and selection. I supposed it could be used for good or evil, so to speak. I mean you can also “select” things that will hurt yourself or others. But the ACC is connected to many, many other regions. It’s connected down to the amygdala, where it helps regulate emotion. And it’s connected up to the lateral PFC, which holds information in mind. Meanwhile, the lateral PFC gets its information from other neural sources. So the whole thing is pretty complicated.
I’d say that internal voices are generated by networks that include several of these regions. The authority of the voice may reflect the COHERENCE or COHESIVENESS of a particular network. Networks of regions that are more weakly linked may not have as much control or authority, whereas those that are tightly linked may have more independence and seeming authority. There’s also the nature of the internal dialogue to consider. Do different networks represent different “selves”? I think they might. In which case, the interaction or “dialogue” between them would be important. So, take a listen, and sense how “you” are reacting to that internal fatherly voice. You might find that the authority of the voice resides in your willingness to listen.
Well that’s an interesting final point. What about the willingness to listen? Is it a poor cohesion in networks involved in willpower that break down? Or is this the dACC growing tired? I would imagine a combination of both, plus a few other factors. In your book, it was stated that religion, or some other abstract grounding, could aid the dACC from subjecting you to ego fatigue. But, and pardon the chicken/egg speak, but do these abstract bases take the load off the dACC, or is it when the ego is fatigued that it falls on these bases for a final hope?
As a child, one does not give into temptation not because they see the dangers in it directly, but rather because their parents told them so. So in a tempting moment, does the child contemplate to the point or exhaustion and then take their parents advise? Or does the child simply respect their parents wishes and move on? I think that the later is true. Which is to say that it is on the ownership of these abstract bases to prevent you from having to fight off these temptations.
But the topic is a willingness to listen, and all we’ve talked about is establishing different authorities to listen to. Do you have a neurological opinion on listening to your internal dialogue?
More tough questions. But first, I agree. It it the abstract bases, as you call them, that come first. Whether it’s a religion, a philosophy, a change in self-definition, or even the insistence of a spouse (or, as you say, initially, a parent — not so abstract). First you willingly participate in that dialogue, and shift attention away from the drug-goal. This takes the pressure off the dACC, so you don’t have to go through too much ego fatigue. You are literally switching attention away from “the prize”, much like the kids who looked away from the marshmallow. Then you do not need to fight the urge minute by minute, your dACC can rest and recuperate, and then you can use it again, the next time you need it.
The tough part is modelling how it is we “listen” to the internal voice. In a word, I would say that the auditory cortex (temporal lobe) decodes fragments of words, if there are internal (unspoken) words, but the orbitofrontal cortex (OFC) decodes the intent of the internal voice. The OFC “gets” whether the voice is harsh, judgemental, ridiculing, scornful, or…..when we’re lucky, sympathetic or empathic.
The biggest mystery, to me, is how we go about “being” the voice and then alternately “hearing” the voice. I think our subjective experience is more of the hearer, the listener, or perhaps the victim, the scolded child. Yet sometimes we can catch ourselves in the act of BEING the harsh, judgmental parent….that is, until we reach the pivot point.
This blog post rings so true for me. I am always amazed how the pivot point for me is in the purchase of the alcohol, as much or more than the drinking of the alcohol.
Yup. After taking that first big step, the rest is pretty much anticlimactic!
http://www.charlierose.com/view/interview/12185
Here is an interview with Dan Kahneman who has written Thinking Fast Thinking Slow.
This guy is a leading decision making psychologist and elements of the left right PFC, rational vs. intuitional decision making.
I will read this book but he is definitely edging into a familiar area as to issues raised in Memoirs of an… and in this blog especially, it seems to me, on this pivot point concept.
It’s on my list, Mike. Kahneman was a pioneer. Worked with a guy named Tversky who I think got the Nobel prize. One of the main points made by these two is that thinking is often not rational, that it is biased and distorted by contexts, and that norms are more important than logic when it comes to making decisions.
Obsessing about (drug of choice) is a lot of work. It takes a lot of energy, like running a marathon. I run and run until I just can’t put one foot in front of the other anymore, so I have to stop…….that’s relief…whew. But do I feel good?? Hell no, my muscles, my bones ache…..why does that seem to feel good??
So what is relief? People say that smoking “relaxes” them. From what? Pending symptoms of withdrawl, and the anxiety, adrenaline, muscle tension, rapid heart rate etc that follows?
Isn’t this just what meditation does for me! It removes the tension, the anxiety. It deeply relaxes me. Keeps me walking.
There’s a lot of stuff in this post…..really got me thinking now. Think I’ll meditate on it a while…..
Peter
I also find meditation to be a vey welcome relief to the efforts and anxieties of thinking. The problem is that meditation doesn’t attract us the way drugs and booze do. It doesn’t offer big rewards, at least not until you’re right in the middle of it. The relief provide by meditation always comes to me as a bit of a shock. Oh yeah, this place…I really like being in this place….I want to come back here again.
What’s interesting regarding the so-called pivot point is the connection to the weakening resolve i read about in a review of the book. (i still need to read the book). I know the pivot point all too well. I am a heroin addict and on certain days that I am resolved not to use (physical withdrawal is not an issue for me b/c I am in a methadone maintenance program) I will be doing fine, and any random thing…a phrase I read….a snippet of a song..etc etc..it doesn’t have to have anything to do with drugs…will cause me to instantly decide to go cop, and as soon as I decide to go cop, I am rewarded with a great sense of joy splashing down all over my brain. These split second triggers are inevitable and I’m not sure that I will ever overcome them.
There are many of us in this blog/community that resonate strongly with what you describe: whether it’s drug or drink, past or present, many of us have been there and many of us keep going back. It is almost like a “singularity” — a black hole in astrophysics or cosmology — or, to use a much more mundane metaphor, a bottleneck through which we squeeze on our way from the sane and predictable world of rational action to the sudden sleigh-ride down that slippery slope of drug seeking.
What makes this pivot point so fascinating is that it represents weakness, failure, even doom, when regarded from a slight distance, or from the day after, or the day before. But at the moment there is triumph, sometimes joy, or peace, and even a strange kind of courage: yes, I’m really going to do this, and damn the torpedoes! Damn the internal voices that have blocked me until now!
As you say, the slide starts with a cue. It does not bubble up from nowhere, or go off at a set time like an alarm clock. Rather, something in your perceptions or thoughts makes the connection, and then a bridge of electricity arcs between your cingulate and your striatum, the conscious and unconscious poles of willful action. That current now recruits the circuits of appraisal, planning, and action preparation in a rapid cascade…to do its bidding, to get there.
I think that “will” may arise well after the cascade begins. The will is sometimes thought to have its epicentre in the supplementary motor area — a region above the cingulate, activated by the cingulate, that generates global motor plans before they are articulated into actions by the motor cortex. First comes the trigger, the connection, then the appraisal, the emotional rush, and the launching of an action tendency. Then, before long, “you” are on board, and like God’s optimistic pronouncement in the act of creation, you tell yourself “this is good!”
Cin, hang in there. What you are describing is very usual for MAT (medication assisted treatment). Especially with Methadone. One thing I found fascination with regard to methadone is that it has a much long half-life than heroin. So if you think of a bell curve heroin has a “high-high” but the start-end is short. Methadone has a much lower “high-high” but the duration of that start-end is longer…like 29-days long.
I think that the short-but-dramatic bell curve of heroin may make our impulse control with a much shorter fuse. I know exactly what you mean about the “any random thing…will cause me to instantly decide to go cop.”
I haven’t compulsively used drugs for 8+ years now, but in that time I know I’ve need to learn and re-learn a lot of seemingly silly practices in order to *not* act on that internal *click* that happens that wants me to get to use.
Congratulations on deactivating the beast-within. Best wishes on continuing, flourishing and becoming all there is to be. I’ll look for your comments.
I think there are ‘pivot points,’ and I’m sure they have some neurochemical basis. I’m not sure about your proposal, Marc:
“Picture your ACC, sitting near the top of the brain, trying to keep control, but finding it slipping, slipping. Two floors down there’s the amygdala, the organ of emotional colouring. As your ACC starts losing it, your amygdala begins to panic”
I don’t know how the ACC can “try” and can “find it [control] slipping”; this sounds like a little man in there, and suggests the ACC itself has a monitor.
I think elsewhere you’ve highlighted broader approaches not based on strong craving, more or less physical, and a moment of ‘giving in.’ As one in the grip of certain sexual compulsions, I think the broader feelings of ‘lack’ or desperation or despiritedness are crucial. In such a context, as you’ve point out, ‘acts of will’ can provide temporary solutions. I think behavioral compulsions need a broader analysis, since, for example, an inveterate gambler CAN stay away from the tracks for a few days, if he’s about to forfeit his house. I can and have stayed away, for example, from ‘strip clubs’ for months at a time, e.g when without money. Of course there might be a slip with a clear ‘pivot point,’ where i say, “What the hell…” but I don’t think that is to be emphasized at the expense of some underlying dynamic. The 12-step programs, including those for sex “S” related issue try to address this in terms of some spiritual malady, but in simple secular terms, matters of grandiosity and self hatred and self-isolation seem to be part of the underlying picture.
.
Thanks for your comment. I don’t disagree with anything you say. In fact I think you put it very elegantly. By emphasizing the pivot point, I want to talk about a “moment” in a long stream of internal dynamics. Sure, there’s a lot that goes on before, and perhaps even after, that point. You don’t always get to a pivot point, as you say, perhaps because the consequences seem so severe that you simply are not attracted enough to whatever it is you are addicted to. I avoided taking drugs when I thought that the drugs might harm or even kill me, even while I was in the grip of a serious addiction. When I finally quit for good, the aversiveness had built up tremendously. I was so deeply disgusted with drugs and with myself as a drug addict. So….I did not have to wage a difficult war with myself this time, whether to do it or not. It was easier than that. I just had to say No and then keep saying it over and over, like a mantra.
As to my personalizing the brain, yes I know I do that. I sometimes describe brain systems as if they really had intentions, wishes, fears of their own. I know that it is we who have these feelings, not our brains. Our brains just do what they do, electrically, chemically, molecularly, etc, but we as people have the feelings. I use this metaphoric approach to make the brain more accessible to non-scientists. I think it usually works quite well.
I would like to ask if you are saying that it is, in some way, unfair to hold one responsible who succumbs to this mental process? Or, do you feel that the process is physically and/or neurologically possible to overcome, no matter how seveere the episodes are?
It sounds as if Marc is saying the process can be ‘unlearned’…but it takes time, just as it took time for your brain to learn its current mental processes which perpetuate addiction. Clearly this can be overcome, as there are many people out there who have cleaned up after years of addiction. The trick is in controlling your environment long enough for your brain to learn new mental processes and establish a new type of reward system which makes you feel ‘good’ as a reward for staying sober.
Whether or not to hold someone responsible sounds like asking if you can blame someone for their own drug problem. By the time you get to the point that serious intervention is needed to become sober, the issue of who or what is to blame is irrelevant. To a certain extent, everyone should be held accountable for their own actions.
Marc even says in his book that addiction is a disease, but not a disease like diabetes, etc that you can’t blame someone for getting.
I agree with almost everything you say, Cincinnatus. See my comment below. Yes, it takes time, and blame is not the issue.
But I disagree with one thing. I don’t call addiction a disease, either in my book or elsewhere. I call it a form of corrupted learning. There are many definitional issues and many heated debates about these things. But for me, a disease is something that you get at some point, and then you have it, until it’s cured, and then you don’t have it. Whereas addiction develops gradually, gets stronger and stronger with repeated lapses, and it may never be cured. But you can learn ways to work around it so that you never have to be a helpless victim again.
I don’t really think of it that way, Herman. People do what they do. They usually try very hard to be the best they can be, but they often fail. Addicts perhaps fail more than most. I’m not saying that addicts should not be held responsible. They are responsible for their acts, like anyone else who is not completely insane. But when they fail, I don’t want to be moralistic and judgmental about their failings, and that’s partly because I understand their failings, both as a former addict and as a neuroscientist. That doesn’t make it okay, but it makes it easier to understand and, I hope, easier to help.
Herman, you said,
“I would like to ask if you are saying that it is, in some way, unfair to hold one responsible who succumbs to this mental process? Or, do you feel that the process is physically and/or neurologically possible to overcome, no matter how seveere the episodes are?”
My answer is that the matters are not simple, but no, it’s not unfair, and yes, I agree that the neurological process can in many cases be ‘overcome,’ though of course that itself is a neurological process. There is no Archimedean point. Too, it should be pointed out that the seizures attendant on withdrawal from some substances cannot be overcome by act of will, though perhaps by compliance with a program of medication within treatment.
I think the idea, for the mental (and brain-behavioral) realm, is that a disease/disorder/illness is something that (so it seems) ‘happens’ to us and impairs our functioning for some time, and that we simply cannot ‘choose’ to have it stop or ‘will’ it to abate, except temporarily. Think, for example, of PTSD. It might be objected that a simple ‘bad habit’ –like watching too much late night TV, though one has to be a work at 8 am–fits my description. But for many habits, with some planning and systematic effort, they can often be broken. The mental disorder is peculiarly resistant to such, however. It’s hard to establish a fulcrum from which to ‘lever’ the change.
Why? For one thing, adequate understanding and will may be lacking. There may, in fact, not be any such will, as for example, in the “personality disorders,” where the person often coasts along happily, w/o subjective distress, and thus likely w/o will to change. I’d say this lack of will is true of many early stage ‘addicts’ of various types, and also true of some ‘high functioning’ ones at later stages.
Those with a mental disease/disorder/illness,–perhaps at least some ‘addicts’ may qualify under these labels– need something more than ‘Get off your butt,’ or ‘You oughtn’t to make those choices’ or even, “It’s time you learned a new habit.” At very least, it’s widely recognized that such approaches generally doesn’t work. At the same time, the AA people, not to say, most therapists, have agreed that ‘taking a step,’ i.e. doing something for oneself, is crucial in recovery/improvement; and indeed, ‘learning new habits’ is one ingredient. Thus in general, “I have a illness” or “I have an addiction” cannot function as an overall excuse for inaction or ‘get out of jail free’ card for all harms being done to oneself or others.
> Message: Hi Marc, I heard an interview that you did on public radio.
> You made the comment that if your daughter had started using Meth,
> Crack or Heroin that you would chain her to the bumper. I wished
> someone had done that to me 30 years ago. I have been through
> treatment at a Substance Abuse Therapeutic Community, I lost my home,
> been to prison for selling drugs, sister raises my only daughter who
> is getting ready to turn 16. No one in my life knows that I still have
> a problem with Meth. I have isolated myself from anyone that tries to
> become to close to me. I am really glad that you were able to pull
> yourself out of your addiction. I was a functioning addict for 25
> years, it has only been in the last 3 or 4 years that it has started
> to affect me. I have lost all self confidence. I go to school now
> but,I am worried that when I finish that I will then have to actually
> get a job. I am 51 and I am attractive and physically there has been
> some affects but not anything like
> what is advertised. I know that while I am in my addiction, that I
> cannot imagine my life without my drug. I do not know why I am
> contacting you except that maybe you could give me any hope at all.
> After using meth for 30 years, is there any hope at all that I could
> stop and then get passed the feeling that nothings matters anymore and
> overwhelming feeling as if I had lost my best friend. I have suffered
> much loss over my addiction but, not from the things that I did to get
> the drug. It is in how that I push everyone away from me. I feel
> really crowded when someone tries to get to know me and I feel like I
> have to defend my privacy as much as I can. At this point in my life,
> I do not have anyone still that cares enough (through my own design)
> to try and change it. I know my brain is hard wired now for meth. How
> long would I have to stay clean before I would start having some sort
> of zest for a real life? Thank you for your research.
Hi JP. I find your story particularly tragic: partly because of how long you’ve been fighting this battle, partly because of the courage and honesty you express, which come through loud and clear in your candour about your drug issues, partly because of the hopelessness you feel, and partly, I guess mostly, because of the two kinds of loss you express. The first is the loss of the drug, what you call your best friend, leaving you with a life that feels empty, flat and meaningless. The second is the isolation you feel from others…so that you REALLY don’t have anyone/anything else to turn to. Just the drug. And the drug is forbidden. You are describing the most hellish aspects of the experience of flat-out addiction.
I resonate very much with the first kind of loss. It wasn’t only the drug that gave my life meaning, but it was all the activity and structure built around the drug: the planning, thinking, getting, using…all of these facets of the drug gave my life a huge amount of structure. Even the badness of it gave me a pole, an anchor point, in space… Without that there seemed to be no way to get my bearings. Good and bad, right and wrong. At least I knew where “bad” was.
I never gave up people quite as much as you. But I never felt I could really be a part of other people’s lives either. I would come and visit friends or relatives, share some stuff, hide other stuff, and then go back into my own dark world. That shift from “with” to “without” was often a major trigger for me. It would initiate another cycle of addiction. Maybe that’s part of the reason you avoid closeness with others.
For me, this phase lasted about six years. For you….25-30 years…it’s almost unimaginable.
How can I help? I don’t know. You ask one specific question that maybe I can try to answer. How long do you have to stay clean before you start having some zest for a real life? I think the answer varies tremendously, based on what else you’ve got going in your life. It can start within a few weeks, or it may never happen. You need to build up networks of meaning that don’t include drugs. Otherwise, all the MEANING in your life will remain in the domain of drugs, and life will always involve choosing between drug-meaning and utter meaninglessness.
So how to build networks of meaning? They have to be not only meth-free but also emotionally compelling — otherwise they won’t hold your attention. Something like helping others can be a powerful approach. Roll up your sleeves and volunteer at a nearby drug rehab centre. You will have much to offer — you know this world inside-out. Or work with kids with behaviour problems, as a Big Sister or something, because you know damn well where these kids are going to end up if they don’t have someone to talk to. Your career can pull you into a new network of meaning too. I don’t know how you feel about it, but it sounds like you’re studying a lot. How well can you do? How far can you go? These personal challenges can also stoke up the emotional system and begin to connect fragments of meaning into a larger, more stable network.
Another possibility is to think very concretely about where you will be at in 10 years if you keep doing meth. You are 51 and still in one piece. I don’t think you’ll still be in one piece if you keep it up for another ten years. I’m 61, old enough, but also happy and healthy. Getting old doesn’t have to be terrible. But think of what it will be like after 10 more years of meth. Draw a picture of your body after 10 more years of abuse and put it up on your wall. If you can scare yourself silly, that might help to loosen the attraction.
Maybe other readers have other suggestions. In any case, I hope you continue to tune into this blog or others like it. There must be some comfort in knowing that others are or have been in the same boat, and many of us eventually do beat the odds!
I find the whole concept very interesting but perhaps in a different way.
What if our resistance to temptation or if you prefer stress or what have you is actually designed to fail like any other type of safety equipment or armor.
Take the Glass Lizard which will shed it tail, which takes a lot of energy to regrow to survive.
In time of danger, might we not need better tools than our social programing which is all the internal dialog is. Flexible it is, consisting or many contradictory voices, much like Grand Central Station at rush hour.
Per Gavin DeBecker and others, we sometimes have to trust our instincts and put our training in abeyance in order to survive in unique, dangerous situations.
Clearly addicts are mostly not in danger, but the internal dialog’s pressure is very painful and very real, and there are certainly other ablatives than substances which can come into play, hoarders for instance. AA always made a point about ‘dry drunks’ people who are angry like alkies but don’t drink.
I would suggest that the internal dialog in creating the stresses that lapses try to escape. The trouble is that people see their internal dialog as part of their self, rather than making it ego alien and going to something new.
This is truly fascinating, George. Other readers have talked about the internal voice as a representative of society. This voice is indeed moralistic, demanding, and sometimes aggressive and pitiless. Why shouldn’t we disengage, so that we can be free of that nasty hubbub and go off on a more independent path?
Going back to Freud, the ego is constantly wrestling to accommodate both the id, the source of drives, and the superego, the source of constraints. The trouble is that severing either of these voices is trouble. If we buy into the superego too much, we become obsessive, moralistic, and divorced from our feelings. But if we break away from it completely, we become amoral, even immoral, greedy, selfish, and ultimately self-destructive. I guess the point here is that, even though the inner voice demanding restraint represents the side of society, it’s main goal is to keep us safe. So, no, I don’t think it’s adaptive to break away from it (as from the glass lizard’s tail). Rather, it’s adaptive to give that voice some lessons in anger management. Help it become less judgmental, less harsh, so that one can actually listen to it, free of the abject shame it often induces.
I think this is actually possible to do, through meditation, therapy, or similar practices. Once upon a time I was in Gestalt therapy. There, using the “two chairs” technique, I confronted that harsh voice and complained: What the fuck! Why are you such a heartless bastard?! Then I switched chairs, and BECAME the judgmental voice, and my answer astounded me: Because I’m really scared about what you’re doing to yourself (to “ourself”?!). I’m basically panicked by your behaviour, and the only thing I know to do is to shout at you.
Yes, there is relief in shedding our tail when it’s really stuck, as in under a rock or something. Many of us have talked about that relief. I suppose any relief is adaptive in the case of overwhelming stress, as you suggest. But we’d better not make this kind of detachment a habit.
Actually we should make that detachment a habit and use the internal dialog and the tools that come with it as tools.
Our internal dialog is socially conditioned and we are trained like dogs are trained and for the exact same reasons. As proof, I offer the multiplicity of cultures and folk ways, and how each dies and is replaced. Any appeal to some sort of unchanging law or deity is foolish and simply against experience. You can believe it as an act of will for the good it does you.
I also suggest that substances can help us break these controls. Most of us just use them as escapes and alibi, a cover for laziness. Used properly, we can stop the cycle of words, and see that words are not the reality they claim to represent.
Most people like their familiar hells to freedom. Zhuangzi had it right. People are like fish who prefer to wet themselves with the slime of other fish rather than swimming free.
Culture places the collective over the individual. As my old professor Neville Dyson-Hudson put it: “People get screwed, the system never gets screwed.” Look to your six.
I think that psychedelics and a few other drug classes can help us see through the symbol-strewn contents of our cultural norms and rules, but even those drugs offer insight on a time-limited basis. Your 51st acid trip doesn’t teach you much that you didn’t already know.
Yet other drug classes, including especially speed and probably opiates, don’t have much to offer in terms of insight. Except maybe insight into our own dynamics of striving for pleasure and/or safety.
Couldn’t agree more. There is a whole literature, much ignored about people who got bored with opiates and quit. Seems kind of common on Wall Street, and based on my experiences it is most funny.
Actually I think you can get very bored with any of the psychotropics, and the comments on LSD are especially germane. A guy from the NIMH came to Hopkins and discussed drugs and monkeys. They like marijuana, and went for coke in a really big way. The would take downers for funsies, and uppers to wake up to do more downers. LSD, however was a bust: they saw it as time wasted and showed their indifference.
Fashions change too: quaaludes used to be big, and are not recognized by spelchek even as words.
I really like the discussion of this issue. In my “addictive disorder” (anorexia nervosa-binge purge subtype), I’ve often found extreme relief in that moment when I “engage” in binge behaviors after a period of stress/conflict, whether it is surrounding decisions to eat normally or due to inner conflict surrounding negative feelings of self worth (which I have identified as a major contributor to the development and perpetuation of my ED). Also being a neuroscientist studying addictive disorders (yes…I like to study myself), I found it useful to remind myself of the progression from impulsivity to compulsivity in engaging in my disorder during that “pivot point”. Basically, I get to activate a sort of “habit” where all self-awareness (e.g., prefrontal cortex activity) is shut down and I’m in a ritual, almost meditative state where I’m not thinking of any of the consequences of my actions nor am I thinking of the stressors that triggered these behaviors. It took an immense amount of practice to slowly become aware of when I was engaging in a “habit” behavior so I could, at least partially, stop reinforcing that habit. With this came new learning and increased awareness as my PFC became more engaged at the onset of subsequent binge episodes. With this I am able to make decisions at the so-called “pivot point. For example, “will engaging in this behavior fix my problem?”; “are there other alternative behaviors that can alleviate stress and not lead to negative after-effects?”
I’m still continuing to build on this change in my recovery and I’ve found it to be frustratingly slow. I guess it’s always good to remind ourselves how entrenched these habits become in our brains. Our neurons are wired to fire in the way that activates the “old habit” pattern we have reinforced over and over again for years. Thus, it is reasonable to expect years of learning a new pattern of behavior are necessary.
I hope this is of encouragement to others out there! We are all in this together!
Hi Elizabeth. It’s really good to hear from you. Your description of the impulsive/compulsive behaviour and the sort of mindlessness that it achieves….well, I couldn’t say it any better. This resonates with many recent comments, all of which bear on one core experience: relief. You describe the mindlessness of letting yourself slide, forgetting about the consequence, even forgetting about the thing you’re trying to escape. Another reader called it “free fall”, and George (above) describes its possible adaptive advantage. I’ve talked about the nastiness of the critical voice, and the relief one gets from ignoring it or shutting it off. We are all talking about the same experience — an experience that non-addicts are unlikely to understand.
Indeed, getting your PFC (prefrontal cortex) in on the act, just as you approach the pivot point, is a fundamental way of steering away from the “habit” — and yes, it’s tricky, because you’ve got all this momentum (read: dopamine) urging you toward the goal. I actually think you’ve named the ultimate challenge. Another way to put it, perhaps, is to recognize that there is still CHOICE available even while you’re in the process of accelerating toward the expected relief — the choiceless act.
It does take some time to build alternative networks. But there are tricks that can work in the meantime. For example, think of the path toward the impulsive act as a track, and you are on that track, hurtling downhill. Even a slight jolt at that speed can send you in another direction. For example, you can say “right now I’m going to put on a movie I’ve been meaning to watch for months.” Use the momentum you’ve already built up to switch to that alternative act, and in a few moments you may find the “pot of gold” receding in the background.
Yes! I totally agree with the suggestion of acknowledging that there is still a CHOICE involved, even in habitual, well-practiced acts. I used to downplay how important it was to be aware of participating in the motions of the disorder because I was still engaging in the disorder. However, I didn’t realize how I was actually taking some of the preliminary steps towards moving my compulsive act into a much more controlled act. I’ve found it much easier to disengage from my ED behaviors in the recent months and, in fact, I haven’t engaged in over 3 weeks! (one of my longest stints).
I also wanted to mention that I brought up this book in my support group and it really resonated with several of the participants. At
least one individual was very enthusiastic about reading it and will likely be purchasing it in the near future!
What I find interesting is how much of a lasting stronghold allowing ourselves to cross the pivot point has on the conscience. I can only offer a minor example in the form of making unhealthy diet choices, but I’ve noticed that if one morning I decide to indulge in, say, a large sugar-laden “treat” later in the day, my sense of guilt starts IMMEDIATELY – not when I actually eat, or even buy, the afore-mentioned item.
And even if I do manage to talk myself out of it, the sense of guilt still lingers, rather than swiftly evaporates. I guess I’m perhaps chiding myself for the initial mental “fail”, even if I don’t actually follow through. I find this odd though: one would think that overcoming negative urges would make one feel triumphant – but it seems once guilt has been triggered it’s hard to shake it off?
Hi Fiona, Sorry, I meant the last comment for Elizabeth. I find my own blog somewhat confusing at times. Anyway, it is interesting about that lingering guilt. I know what you mean about the guilt springing from the mental act of failing, even if it remains unfulfilled in reality. But my experience has mostly been different, in that the triumph has usually replaced the guilt…unless, that is, there is an unconscious (almost) plan, secreted away, to indulge later…even later by a few days.
What you describe does fit into my view of internal voices. The critical voice has such determination and such consistency, it almost seems like background music much of the time. It sounds like your internal critic has the quality of a terrier, not letting go once it’s got you in its teeth. Strange to think that these voices we carry around really do belong to us, and at some level they are actually on our side!
Okay, it was the NEXT comment. Sheesh!
I never replied to this. But all I really want to say is, Congratulations! I don’t know if your ability and choice to disengage has continued, but even if it hasn’t, I go by the principle that resisting the impulse for periods of time makes us stronger, and leads to eventual recovery, even if the change isn’t permanent. Hell, it’s really only permanent the last time anyway. And I am a staunch advocate of what they call harm reduction. Reducing the frequency of addictive acts is itself a recovery, in my view.
Also, thanks for bringing my book to others. I’m really pleased that the people in your group find that it speaks to them as well.
Hi all from downunder, where I have just finished Marc’s wonderful book in a couple of days after luckily seeing it in the library. Congratulations Marc, and thank you for having the courage to bring this out in the open where it so badly needs to be!
I have also been writing of my experiences with depression and addictive behaviour, trying to understand the causes, how it works, and the slow path to liberation. As a teenager, my mother dying slowly with MS, I began to self-medicate with whatever I could get my hands on, almost fatally. It’s a long story, but this snippet from my as yet unpublished book ‘Wild life’ is relevant to the conversation.
…As a teenager, a part of me that was sensitive, emotional and empathic could not cope with the pain, grief and loneliness it felt and took me away from being in the present, retreating into a fantasy world and resorting to drugs, sex and alcohol to escape the mess my life had become. Another part of my mind was constantly analysing, criticising and running a verbal commentary on all my failings and inadequacies. This inner critic would lay into me for being unable to cope and letting my life fall to bits, for failing to live up to its exacting requirements. This conflict inside myself became so severe that I reached the point where I nearly destroyed my own life. I did not care for or like myself. I felt a lot of guilt for failing to live up to my father’s and my own expectations, I felt guilty that I dreaded going to the hospital to see my mother, and punished myself with self-defeating, self-harming and masochistic behaviour. At the same time, the desperation to escape the pain inside me grew and grew until it over-rode all else. It was a lot like having different warring personalities within me.
My experience was of a mind often stuck in ruts, in obsessive negative ruminations I had no control over, in ‘awful-ising’ and projecting–expecting, and thus creating–the worst. I had no strategies to deal with this as a teenager. I had no knowledge or cultural heritage to help me work out that this mind was not who I was. I was the consciousness that was aware of this sick mind. It’s a bit like having a 3-year-old child running the household.
I had to learn to accept and love myself, forgive myself for not being perfect, and see that actually just surviving was an achievement. I learned discipline, first from swimming training and later from learning to play the guitar, and gradually applied this to establishing a regular meditation practice. Meditation gave me a place to stand, to get a little distance from my thoughts and emotions. I began to see that escaping into drugs or alcohol was not going to fix anything, only make life harder to face in the morning.
As I started the slow but powerful process of watching my addictive behaviours, gradually things changed. This took many years. It was not a process of criticising, punishing or condemning myself, for that is splitting yourself in two: the weak-willed part that does these things and the boss/critic who condemns them; rather it is the process of watching, being conscious, and understanding the circumstances that create the need, allowing, without creating a split. Watching carefully when you give in to the urge, what you are doing to your body, and whether it really makes you feel better, or is just an old habit, a memory, a projection. Looking honestly at what this behaviour costs you in other ways: your health, self-respect, the drain on finances, time or energy, and how it affects those around you…
That’s part of how it was for me, anyhow.
Cheers,
Dinesh Moylan
Hi Dinesh. Thank you for sharing this. There are so many parallels in what you write, parallels with my own experience and those of others on this blog.
For one, there’s that split between the impulsive and desperate child who’s “running the household” and the critical, judgmental, “boss” who condemns him/her. I find it amazing how many of us have split ourselves in precisely this way. For me, too, as you may know from my book, this warfare eventually took the form of a total personality breakdown. I would escape from my condemning, judgmental self by going out into the night and doing the wildest, most self-destructive things, like breaking into medical centres despite a high risk of being caught. I would revel in that freedom, at least until the dread and the loss caught up with me, whether later that night, the next morning, or soon after.
You also talk about the curative power of meditation, and this has come up on this blog time and time again as well.. Indeed, it’s nothing like “stopping yourself”, criticizing, or condemning. It’s a process of getting to understand the different parts — the very needy parts and also, for me at least, the desperation of the angry boss who seems, on reflection, to be at a total loss as to how to control things. Yes, a slow process, but one of the few that can really change us from the inside out.
Thanks for you kind words about my book, and good luck with your own. It sounds like you have an amazing story to tell as well, and I hope you’re able to tell it loud and clear to anyone who can hear it.
Very best,
Marc
I just had another relevant thought about this topic. I’ve been reading a bit about stimulant drugs (e.g., amphetamines, nicotine, etc…) and the propensity to develop a seemingly “maladaptive” pattern of behavior in which cues that predict a reinforcer become effective motivators of behavior themselves. I think about this in terms of seeing a drug or food related cue (e.g., person one associates drug-taking with, McDonald’s sign, etc…) and immediately activating a pattern of behavior that is indicative of consuming that substance without regard to the interpretation of the “end goal.” It’s sort of like the normal pattern of seeing a cue, remembering what that cue represents, and then pursuing the reward (i.e., drug or food) gets disrupted; with the middle step left out. I definitely believe this is the benefit of mindfulness practice: slowing down the behavior again, becoming aware of each and every action, toward the goal of developing a normal pattern of reward pursuit and CHOICE over whether one wants the end goal or not. I’m amazed by how animal models robustly demonstrate this phenomenon; with the stimulant drug altering reward pathways to the point that the animal starts approaching and chewing on a light that predicts a reward, rather than going to the receptacle to obtain the reward. It’s like the end goal itself no longer has a mnemonic representation.
i am there RIGHT NOW. I can feel this tightening in my chest . . . tightening and heat radiating from my center. As I approach that pivot point, when I accept that I will quit arguing with myself and do what i do, the relief of knowing, of deciding, brings a certain heaviness to my limbs as the tightness in my chest evaporates.
I HATE THIS.
Sorry, I missed this comment. Jacqueline, but I think I know exactly how you feel. So do other readers here. You get the relief, the vanishing anxiety, and yet there is a blanket of heaviness, or failure, that descends in its place. You no longer have to struggle, but the sunlight somehow goes dim. Is it something like that?
Yes, hate it! Keep hating it…it will help you to stop. Hate IT, not YOURSELF. That’s the ticket!
(I sometimes fail to see comments on posts that are more than 2 weeks in the past…if you want to be part of the immediate dialogue, you can move your comments forward to more recent posts)