Understanding Addiction

You know, there’s this little device invented to help organize people’s pill popping. It’s a plastic oblong container divided into seven units, one labelled for each day of the week. A certain number of each kind of pill goes in each compartment, according to a preordained plan, of course. It looks like this. At least it does in the Netherlands, where we go Mondag, Diensdag, Woensdag, and so forth.

All I need right now is painkillers, i.e., opiates (which I like) and muscle relaxants, i.e., benzos (which I hate). My neck still hurts about three times more since the surgery than before. It’s a Christian country, the Netherlands, so maybe they perform surgery in order to maximize pain now, in order to minimize the bill you’re going to be presented with when you die. I think that’s called penance. But probably it’s not that complicated. Bodies don’t like being sliced and diced and they register their dissatisfaction in the clearest possible terms.

So painkillers it is. And what’s to prevent me from taking an extra one or two today, and ending up a couple shy later in the week? The answer is self-programming. And that’s what the little box helps me to do.

I wrote a post on self-programming a few months ago. Here it is. The reason I bring it back up now is because I think it’s such a brilliant idea. Our brains are built in such a way that we are highly attracted to immediate rewards — pleasures, relief of various sorts, winning an argument at the expense of someone else’s self-esteem, or at the expense of the guilt you’re going to feel when you think about what a shitty, selfish thing that was to say. In general, present wants, needs, urges thoroughly trump wants and needs that can’t be cashed in till later. But the kicker is that we think we’re in the driver’s seat. We think our present actions are actually generated by the conscious intentions that preceded them. Psychological and neuroscientific research is pretty clear: they’re not. They’re mostly generated by habit, context (including cues), and biased thinking. So we keep up this mythology about deliberate intentions while coming in for a landing based on factors beyond our control. This common human dilemma is nowhere as clearly demonstrated as in addiction.

The solution: self-programming. The prefrontal cortex and it’s good buddy, the anterior cingulate, are beautifully designed for self-programming. That’s why these brain parts evolved over the last few hundred million years. So that we don’t just act on impulse; we create plans in advance that will filter, constrain, and otherwise improve our behaviour so that it isn’t just driven by impulse. Long-range planning works pretty well. Short-range planning is usually a sham, a rationale, for what you’re in the process of doing anyway.

So here’s this dandy little device that not only facilitates long-rage planning but actually helps us learn it — a critical skill for those prone to addiction. Simply a box containing compartments that tell you what you may do (take) and what you may not do (take) based on long-range reasoning. I love it! And do you remember the post in which I reported on research showing that regions of the anterior cingulate cortex increase in grey matter volume (synaptic density — probably a good thing in these regions, especially since it got eroded during all those years of using) after you quit? In fact, GM volume rises in a pretty straight line over months of abstinence, crossing the baseline estimate at about 9-10 months. Here’s the source article.  The authors conclude “that recovery involves distinct neurobiological processes rather than being a reversal of disease-related changes. Specifically, the results suggest that regions critical to behavioral control may be important to prolonged, successful, abstinence.” I’d be willing to bet that the regions showing increased grey matter volume are where the neural basis of self-programming is strengthened — through practice!

Of course, for many of us ex-addicts, many of those compartments, maybe all of those compartments, contain a big fat zero. (I mean for people on a full-abstinence program). But it’s not really a zero, because you fill up the compartments with other stuff. Is Friday night going to be a difficult time, being at a party with a glass of iced tea in your hand? Well then you fill that compartment with two hours of your currently favorite mini-series, or a visit to a dear friend, or a chapter from a book you love. And you leave early to get your dose. It’s your reward, decided on in advance. So you don’t have to think about what you will or won’t do on that particular evening. It’s already programmed. You programmed it three weeks ago when you got the invitation. And now you’re free to enjoy or at least endure the party. You have a nicely evolved cortex and you’ve learned to use it well. Keep learning.

Here are a couple of Buddhistic-type figures smiling down on my new self-programming aid. They recognize that good planning is the route to nirvana.

The coronavirus pandemic reminds us not only of the proximity of death (and other fun stuff) but of the contradictions we face throughout our lives. Some of which seem truly unsolvable. Here’s one that’s had me chasing my tail for awhile:

How should we address ourselves with compassion and love when in fact, according to the Buddhists (and according to neuroscience), selves don’t actually exist. The self is an illusion, says the Buddha, and I have a hunch he’s right. What has any of this to do with addiction and recovery? You’ll see.

(I’ll get to the neuroscience view of the self another time. Just wanted to throw it in as a teaser for now.)

Trapped in the living room

For the last four days my family and I have been camping out at home. On Tuesday, my wife Isabel told her grad students and colleagues that she’d meet them via Skype of Zoom. She said group meetings at the university weren’t safe. They thought she was nuts. Over-reacting. How many times having have you heard that term this week? On Wednesday, she decided to keep our boys (almost-14-year-old twins) home from school, and left me to explain to the school authorities that, no, Ruben and Julian don’t appear to be sick at all. We’re just being cautious. Um, you can’t really do that, they said. The law is that children must be in school. But growth curves show no mercy. On Thursday, the university announced that large classes were cancelled, were shifting to online lectures. On Friday, the university announced that it was closing completely. And the boys’ school sent out an urgent email: keep your kids at home. No more school this week. Not much joy in saying I told you so. We figure that here in the Netherlands we’re about a week behind Italy (a close neighbour) and quickly approaching the UK scenario.

Our boys have been studying, reviewing, forging ahead with new chapters in schoolbooks whose names I no longer feel I need to know how to pronounce. They earn an hour of screen time for every two hours of studying. So…not a total loss in their view. Sometimes it’s eerily quiet in the living room, while four medium-to-large-sized mammals sit and whisper to themselves, until the sounds of clashing swords tear through the silence. No, not the long-awaited Gen-Z rebellion. Just somebody’s headphones coming off during a video game. And I watch Alexios, Julian’s ruggedly good-looking ancient Greek mercenary, try yet again to defeat Medusa and her guards. That’s father-son bonding, right? — justifiably my homework. I love it.

We Dutch (we’re actually Canadians, still searching for an identity) are known for our confidence, everything under control, we know how to deal with floods and such. And we’re super industrious and smart, highly skilled at cooperation. In fact this has evolved into an almost animal instinct to follow rules — all rules, any rules (e.g., the rule that kids must be in school unless they’re really sick, even during a pandemic).

How to torture the Dutch

Want to know how to torture a Dutch person? (I say this with real affection, and  just a bit of mockery. I’m allowed…after living here for nine years). When there is absolutely no traffic, anywhere, in any lane, as far as the eye can see, you cross the street, EVEN THOUGH THE LIGHT IS RED. (This can be done either on a bike or on your feet. It works best when it’s raining, which is pretty much always.) Halfway or more across, gaze back at the people still huddled on the sidewalk. Look at their faces, twisted in the agony of, not only indecision but true existential paralysis, a sense of doubt (that extends back to the Big Bang and covers everything up to this morning). They see you crossing, they want to cross, they wish they could cross, but the light’s red. Their expressions reveal horror, confusion, contempt, envy, and most of all shock. Because there it is: the fundamental impossible-ness of life — the paradox that can’t be mended, the incompatibility of two totally logical, obvious, unarguable truths. The epitome of unsolvability. (see above) And you know, some of them will cross and others won’t, and regardless, in both sets of people, you can detect the early signs of mental breakdown. I’m no Buddhist scholar but some of the stuff I’ve read, like Robert Wright’s “Why Buddhism is True” and Sam Harris’s “Waking Up,” suggests that the Buddha might have been deliberately trying to get you to have a mental breakdown anyway.

The point

Here’s another paradox, a logical polarization, that could drive you as crazy as the Dutch people on the sidewalk facing freedom directly, right now, but longing for a green light regardless.

What’s the worst that can happen, coronavirus-wise? It’s obvious: you can die. Or perhaps worse, one or more of the people you love can die. So, there’s death. And we’re all going to die anyway. So, is death really such a big deal? According to Buddhism, and as expressed so starkly by the authors I mentioned, the problem with death is that we are attached to the illusion of having a self. When you get right down to it, the self just isn’t real. The stuff going on inside you and the stuff going on outside you is all just stuff going on. (I realize this is a truly inadequate summary of the main tenets of Buddhism. I’m no Buddhist scholar, as mentioned, so why pretend.) True, consciousness seems to illuminate the stuff going on inside you and around you in a particular way, but the idea that you own this stuff, the idea that it’s special, that you’re special, is just a convenience that we stumble upon some time in the first year or two of life (and that gets reinforced by some ill-conceived strains of parenting, perhaps designed to foster life-long anxiety. I mean, being the centre of the universe has got to be hard to keep up).

So let’s say the Buddhists are right and there really is no self. I believe this to be true. And yet: I have advised many clients (and other people) and myself (frequently in fact) to talk to oneself (Notice that words containing “self” reappear annoyingly often.) In particular, if you’re depressed or feeling empty, or a dark, anxious state is settling over you, as is often the case AFTER (or during, or even before) a period of addiction, then one of the most helpful things you can do is talk to yourself, either out loud or in your head, in a friendly way. This corresponds to “self-compassion,” which is all over the Net these days, which I sometimes discuss on this blog, and which is one of the driving principles of “lovingkindness” meditation: you start by loving yourself, and that makes it easier to love others. Addicts are notorious for self-hatred. We’ve discussed the reasons why over many previous posts. I see it as a key goal of addiction psychotherapy to get rid of this self-hatred before it gets rid of you.

I often advise people specifically to say things like “Good morning Jo (one’s own name). Hey, how’s it going? Not so great? Don’t worry. You’re not a bad person. Even if you slipped up last night, even if the label “addict” still hangs in the air, you’re not some despicable reptile. You’re just trying to hurt less. Self-blame and self-hatred simply aren’t appropriate. You didn’t ask to have the life you’ve had, to be exposed to that kind of pain and then discover an escape route, and you’ve been doing your best to get it under control — and succeeding! When you switch to first-person and say these friendly, nurturing things to yourself, it sounds like, “I’m okay…I really am trying…I’m not bad” and then you start to feel different. Whether you pitch this conversation in terms of a you or in terms of an I, there’s an explicit assumption that there’s a self, a self that you are trying to accept, comfort, nurture, and love.

But what if the self is an illusion? Maybe something like that tortuous stoplight? How would we make sense of this paradox?

Here are three approaches:

1. Tonight I had dinner with a good friend and his 15-year-old daughter, Bo. When I revealed my conceptual conundrum at dinner (Pieter is a philosopher, so this would be acceptable table talk) Bo said: If there’s no self, just a bunch of thoughts, then don’t try to be nice to your self. Just be nice to your thoughts. (Brilliant, don’t you think?)
2. Saying to yourself that you really are a good self, and you shouldn’t carry around this load of self-blame and so forth, is absolutely the right thing to do. Because, first, it works: it makes you feel happier, lighter, more open, less depressed. And second, talking to your “self” this way doesn’t mean there has to be a real self in operation. The reason it works, the only reason it works, may be that it dilutes or refutes the conviction that you are a BAD self. Not even that you have a bad self; that you are a bad self. Getting rid of that just brings you back to neutral, back to zero, which seems approximately where the Buddha wanted you to end up. Not so you could just be dull and blank and detached, but because “neutral” in this sense is an open gate, or maybe, better yet, a roundabout…from where you can move in any direction.
3. Here’s an extension of #2. You probably do blame your “self” for all the shit you’ve done, all the trouble you’ve gotten into, all the hurt you’ve caused others AND yourself. Not only from being an addict, but probably from well before that started, when the lesson filling the blackboard in the kitchen was that there is indeed a you, who happens to be selfish, and greedy, and envious, and probably many other not-nice characteristics, like mean and manipulative. (What kid isn’t manipulative?) That’s a lot of badness to have to face every day of your life. Certainly no advantage when you’re trying to stop drinking or snorting stuff. And wouldn’t it be something if this flawed and fantasized vessel, the self, just happened to be the most effective means for packing guilt and shame — hence anxiety and depression — into your sense of being alive. So, being nice to yourself, being friendly to yourself, might already be accomplishing something fabulous, even if the self was always just an illusion: using one side of the illusion to dispel the other.

So, talking to your “self” in a friendly and comforting way simply diminishes the enormous weight you carry around, consisting of the sense of having a very big, very central self, who’s defining characteristics are really quite unpleasant, even ugly and revolting. In other words, maybe, if the metaphor works, when there are no cars coming, when you’re really not in any danger, then don’t worry whether the light is red, or green, or even real. That’s no longer the issue.

And here’s a little secret that I think fits just about perfectly with the thrust of ACT, which was the topic of last week’s post. If the light remains red for a very long stretch of time, and there really are no cars coming or going, then the light is probably broken. That could be an ideal time to see if you can approach things in a completely different way.

In the comment section following the last post, a fruitful dialogue sprang up between Matt (the author of the post) and Cheryl, a reader. In a comment following his post, Matt admonished us (addicts, ex and otherwise) to remain aware of our vulnerabilities (like fluctuating willpower, loss of perspective), to not get too cocky, to continue to remind ourselves that we still think and feel and even act like an addict. Cheryl’s response was a sort of call to arms in the other direction — an invitation to shut down the voices of self-doubt and take stock of our strengths instead. To trust in those strengths, to dive into that pool of self-trust without looking back. These approaches to recovery sound almost diametrically opposed. Yet it seems to me there is  some crucial truth in the space between (or stretching to include) both of them. In fact, this could be one of those magical tensions. Like wave-particle duality, or the impossibility of life without death, or the fact that humans are both totally selfish and totally altruistic — the kind of tension that gets you thinking more deeply about a topic than any one perspective ever could.

The sort of self-trust that Cheryl mentions is, I think, similar to what I was trying to emphasize in several posts, including this one, nearly a year ago. I was pointing to a special kind of power in self-trust that turns up its nose at the reminders of past failures, to the shame and guilt that go with them, and to the moralistic (and sometimes, hate to say it, but realistic)  judgements of others, those judgements that bounce round and round inside our minds in self-defeating rumination. That kind of total self-trust is a lot like hope, in that it’s at least partly irrational, maybe even deluded in the grand scheme of things, but absolutely essential to moving forward, potently, effectively, without looking back, eradicating that massive tangle of self-defeating habits in one giant twist rather than a bunch of little adjustments.

And yet — hey, we’re not idiots! — after what we’ve been through (i.e., addiction) we’ve learned a thing or two. We know the value of staying on top of the little things, continuing to evaluate just how vulnerable we might be in certain contexts (like the aftermath of rejection or loss, driving past a particular neighborhood) and situations (like parties, especially when things get a little late) where the dangers lurk. Even little dangers, because they can easily blow up into big dangers. We’ve learned to remain cautious so that we can avoid those dangers before they spring up in front of us. Like a dog suddenly caught in the headlights of a speeding car, it’s too late for the dog, given that we didn’t start slowing down half a block away. This view has a lot in common with the concept of “self-programming” that I got into a few posts ago, and that Jeff Skinner and Shaun Shelly have also remarked on in different ways.

I quote my esteemed self from that post:

Proximal intentions don’t matter. By the time you are getting close to the point of action, the dye is already cast. Setting up intentions in advance is called “self-programming” by [a philosopher named…] Slors, and I think that’s a great name for it. You are indeed programming your own future, by changing contingencies, determining circumstances, setting up non-negotiable outcomes. You are programming your life, and your brain, and your environment…

As Matt says, it is really crucial to stay ahead of the game, i.e., to adjust your speed, or pick a different route, before you hit the dog, before the urge (and/or the opportunity) to use is staring you right in the face.

Come to think of it, both those strategies — total self-trust and vigilant self-monitoring — so seemingly opposite, are resolutions to the fundamental problem of delay discounting…or to put it more colorfully, the problem of being stuck in our over-the-top attraction to the IMMEDIATE FUTURE, at the expense of long-term contentment. If you’ve followed this blog, you might remember how I went on about the role of dopamine — which geysers in our nucleus accumbens when addictive “rewards” become present, possible, available. I claimed that an unfortunate side-effect of dopamine is to exaggerate the (perceived) value of immediate rewards (e.g., a few lines of coke in half an hour; a chocolate cheese cake for dessert) while “discounting” the importance of future outcomes (e.g., being broke, fat, and/or increasingly addicted).

So….isn’t that cool? These opposites — whose tension feels creative, productive, maybe even necessary — are both good answers to the same question: how do you free yourself from the fierce and unpredictable tug of the immediate future? Do you trust yourself and thereby project yourself directly into the future you really want, or do you slow down and turn up the vigilance dial by remaining painfully aware of your past?

I could try to collapse this tension by saying something like: trust yourself to be exactly as cautious as you need to be… But some tensions are more creative when left alone.

I want to talk about the feeling of emptiness so many of us experience (sometimes as depression) and our sense that substances (i.e., drugs, alcohol) can fill that void. Why is this conceptual sinkhole so universal…and so relentless? Can it be overcome? If not, it seems we’re doomed to live our lives between two crappy alternatives: emptiness and addiction.

I know I said my next two posts would try to apply some of Peterson’s suggestions to strategies for moving beyond addiction. But that can wait another week. I need a break from writing and thinking about Peterson. The comments on my last two posts were mostly polarized — people either loved or hated Jordan Peterson. I wasn’t completely surprised. Peterson is nothing if not controversial. But political arguments gets tiring. So I’ll take a week off to write about something different.

Ever hear of Metaphors We Live By? That’s the title of a book by Lakoff & Johnson (2003) — and a powerful idea they’ve been pursuing since at least the early 80s. The idea is that metaphors are not just comparisons we make to clarify concepts; metaphors are actually the basic organizing structure of our cognition. In other words, we think in metaphors. We use metaphors to make sense, not just of unusual or novel ideas but of everything.

Think of everyday concepts like, say, arguments. We tend to think of an argument as a war, with a winner and a loser, and a certain amount of damage. The war metaphor gives the concept “argument” its meaning. It’s not a matter of listening or sharing; it’s something you either win or lose. How do we conceptualize “communication”? Often as a conduit, a tube connecting speaker and listener. If you see communication as a conduit, then your main concern is sending a message down the tube and having it received at the other end. A failure in communication is seen as an obstruction or break in the tube. But if our metaphor for communication were different, say a pool of water encompassing speaker and listener, then we’d view communication failures in a completely different way. Maybe as a drought.

Because metaphors have (a limited number of) attributes or features, they get us to see things in certain ways and prevent us from seeing things in other ways. And of course all this is unconscious — under the hood.

I often think of addiction as a thought problem (as do many others). But what if, instead of seeing addiction as a cognitive bias, we see it as the result of an unconscious metaphor with a powerful attribute that holds us prisoner (another metaphor: addict as prisoner).

When we think of ourselves as “empty” or “lacking”, we are using a universal metaphor lifted from everyday life: the metaphor of the container. My self is a container. Containers have one prominent attribute: degree of fullness. Containers are either very full or partly full or partly empty or very empty. See the point? The only other attribute that comes to mind is “leakiness”. If you suffer from anxiety rather than depression, this may strike a chord.

So you wake up in the morning and you feel empty. You say to yourself: shit, I feel so empty. I’d really like to feel more full. So I will take a drug or a drink to fill myself up. Maybe not right now but soon. I really dislike this sense of emptiness so I will put something into my self to fill it up. If you’ve ever been in addiction you know exactly what I mean. Yet the reason we feel “empty” in the first place — rather than, say, uninvolved, or emotional, or out of sorts — is because of the container metaphor. Empty containers need to be filled up.

Now let’s say this is a problem for you, or maybe someone you know. How could you help relieve the feeling of emptiness so completely that the attraction of substances would pretty much vanish? I’m trying this on myself, as an experiment, because sometimes I do feel empty. (I don’t take illegal drugs anymore, but I find it hard to resist a drink at the end of the day, to fill me up.) Well, what you could do is feel your own insides and/or touch or pat yourself (on the outside). You’ll find that you are in fact very full. Of stuff. Tissue and muscles and blood and bone, or, maybe more to the point, you are full of chemicals; neurotransmitters (including opioids!) coursing around inside your body constantly. If you are a container, you’re certainly not an empty one.

The first thing I did this morning was pat my chest and stomach: Yep, full. And the feeling of emptiness I sometimes wake up with just disappeared.

You are also full of feelings. And perhaps other qualities that I haven’t mentioned. Sensing what it’s like to be inside yourself is a pretty standard practice in mindfulness meditation. And it’s known to bring peace and contentment.

What about changing the metaphor? Would that work? The self isn’t really a container. The self is an exquisitely tuned network of nerves, neurons and their synapses. Or the mental activity that moves through them. The self is open, yet containers are (or can be) closed. So maybe we can experience the self as something like an antenna or radar dish or…I don’t know…something very uncontainerlike.

Another thought: Let’s say you can’t shake the container metaphor but you recognize that your container is open. Maybe it’s open at the top, where stuff flows in, but also at the bottom, where stuff flows out. (or in as well, if you take to the metaphor of roots) Then you are rejigging the container metaphor: the container becomes something more like a wide, rich, pipeline connecting “you” to everything else — an open passage.

I’ve often wondered why substance addictions are so tenacious, so difficult to wrench yourself out of. And why one substance tends to replace another. I’ve long believed that addiction is a problem in how we experience ourselves and the world. For now I’m just playing with ideas that might bring this abstract principle a little closer to our lives…and actually evolve into therapeutic (or mindfulness) practices.

In comments following a recent post, many of you saw addiction and religion as different versions of a similar enslavement. Then last post we talked about the terrifying loss of meaning at the finish line. But today I want to show that these parallel prisons arise from the same fundamental longing — one that’s almost noble in character.

In your comments, many of you wrote that religion, like addiction, can be viewed as an extreme form of attachment, with all the bells and whistles: the narrowing of attention and emotion to a small range of rewards, rigid adherence to methods for getting more of what you need and rejecting anything that gets in the way, blind commitment to something that satisfies your needs, at least in part, and attempting to put all your needs into that basket and neglecting whatever doesn’t fit.

And then we got to the fear of meaninglessness that confronts the addict contemplating abstinence.

Well it seems that this implosion of meaninglessness is just as terrifying for a deeply religious person who no longer can believe in his/her religion (e.g., in God)  as it is for the addict staring into a life of total abstinence. James Joyce and Graham Greene wrote fine novels about the malignant anxiety facing priests who could no longer believe. And about their nihilistic attempts to keep going through the motions, living off the remains of a dying addiction to God.

For both the believer and the addict, that loss of meaning is terrifying. It’s a loss of everything that filled one’s thoughts, dreams, and hopes. In fact, I’d say it’s much more about loss than it is about meaning per se.

So what is it that we so greatly fear losing?

There’s a flip side to this ungainly partnership of religion and addiction. What we want so badly, and what both religion and addiction appear to offer, is a sense of connection that binds our lonely little selves to something else, something bigger, something that offers certainty in a world that is beyond control. This longing for connection and “ongoingness” is pretty fundamental. So much so that it embeds itself in the neural circuits responsible for desire and goal-pursuit — yes, the infamous striatum (including the nucleus accumbens) that I’ve referred to so often. We wish, and we seek, and we crave, and we long for that thing we seem to be missing, because our brains are made for seeking what we don’t have.

In the talk he’s preparing for the Dalai Lama, Kent Berridge emphasizes something very important about the brain. The neural machinery of desire is this rather extensive network of  brain matter — literally, it includes a large area in the middle of the brain, and its tentacles reach into the brain stem, the amygdala, and the prefrontal cortex — that’s a lot of territory. Whereas the neural machinery of pleasure is this little hunk of tissue about a square centimeter in size (e.g., a part of the ventral pallidum). In other words, desire is much more important than pleasure, when measured in terms of neural real estate. That’s how central it must be to our survival as a species. (And so, no, I wouldn’t call it “The Beast,” in the parlance of Rational Recovery.)

So it goes. We are built for wishing, for wanting, for craving. And the fact that what we sometimes crave is a sense of connection is why so many of us turn to religion, or addiction, or both. But the wish itself is not an evil thing. It’s a very human thing. It even seems noble, or courageous. It expresses a need we know intimately in ourselves and that brings out our compassion for the vulnerability we see in others.

We can respect the religious person, and we can respect the addict, not for the way they live their lives, but for appropriating the machinery of desire for the pursuit of connection. Not money, not power, not even pleasure — the paltry goals of everyday life — but something very special.

No one expresses that longing better than Eddie Vedder in this song. (Warning: you probably have to be extremely weird to like this song as much as I do). Here’s the first verse:

And I wished for so long… cannot stay.
All the precious moments… cannot stay.
It’s not like wings have fallen… cannot stay.
But I feel something’s missing… cannot say.