Understanding Addiction

Self-destructive thoughts and feelings grow from ripples to tidal waves in people who develop addictions. But how does self-directed aggression become entrenched in our inner worlds, and how can it be dislodged?

Everyone who’s ever been addicted to anything is bound to know two feelings — craving and self-hatred. These feeling states essentially define addiction. They’re coordinates on the map. We more or less understand craving, biologically as well as psychologically. I’ve written about it and so have others. But we don’t understand its infamous partner in crime. How do people come to hate themselves? And why might this feeling be central to addiction?

Self-hate isn’t exclusive to addicts. Almost anyone you talk to about their inner world will admit to a hostile self-critic who blames them, sometimes savagely, for whatever they did that was wrong or stupid. Self-directed aggression spans many cultures. The tradition of seppuku (suicide motivated by shame or guilt) grew up in the warrior classes of ancient Japan. The Catholic Church spread the idea of original sin (leading to repentance) wherever colonialism took hold. Self-nastiness seems to have quite a hold on human civilization. But how does it seed itself in young minds? How does it grow?

Kids everywhere are notorious for one overarching concern: “I’m gonna get in trouble!” You hear it on the way home from school, when someone’s buddy suggests cutting through the construction site. Or when your friend starts opening drawers in your parents’ bedroom. Or when you lock the dog in the bathroom. There’s only one reason not to try and have some illicit fun. That if you do, and you’re caught, someone is going to get mad at you, which probably means you’re going to get punished.

Getting in trouble turns the world from bright to grey. It replaces ease and freedom with a sense of doom. So…when your friend or your little sister gets you in trouble, you get pissed off at them. Now look what you did! If that happens repeatedly, you start to avoid them, mistrust them, and dislike them. With friends like that, who needs enemies?

But around the age of four, little kids make several potent discoveries. They begin to understand that other people are defined not only by their behaviours but by the thoughts, feelings and intentions that generate those behaviours. They realize that other people have private and unique minds, and this discovery is called Theory of Mind. Shortly after that, kids begin to appreciate that they themselves have minds, and that their thoughts, feelings and intentions cause their own behaviours. They start to see “myself” as a human category, comparable to other selves.

This universal advance in cognitive development makes the social world a complex place and joins it irrevocably to the internal world. If you’re the kind of person who’s impulsive or defiant, I’d better stay away from you, so I won’t get in trouble. But if I’m that kind of person…then what? I can’t reject myself…or can I?

That’s the crux of it. We start judging and classifying others by age five or six. We start taking needed precautions so they won’t get us in trouble. And we start judging and classifying ourselves around the same age. But we can’t avoid being ourselves, being with ourselves, and we can’t avoid the feelings of desire and defiance that well up in our own minds. So…just as we reject others for being the kinds of people they are, we begin to criticize and reject ourselves for being the kinds of people we are. We can’t delete our inner states — states such as craving — but we sure don’t like it when they get us in trouble.

There are many ways adults get in trouble — saying the wrong thing, at the wrong time, in the wrong tone, looking too long or not long enough at the wrong person. But there is no more surefire way to get in trouble than to take powerful drugs (including alcohol) against the wishes of those around us. Other people reject us when we do these things. Yet somehow some of us continue to do them. And we quickly learn that these behaviours are generated by the very mental states — craving, anxiety, defiance — that define us.

We silently yell, Stop it! Don’t go there! I hate you for doing this to me! I hate you for getting me in trouble! The only glitch is that the person we hate happens to be ourselves. (And in case you didn’t see it coming, these are among the “parts” that IFS tries to identify and soothe.)

Most everyone is self-critical, to a degree. But addicts raise this human pastime to some kind of art. In all my interactions with addicted clients, in my reflections on my own years of addiction, I find no more lethal volley of self-abuse than the tuned self-denigration addicts level at themselves the morning after. I did it again. I hate myself. And there’s nothing more likely to trigger renewed craving than the sense of assholeness left simmering for the rest of the day.

So how do we overcome this dark spiral? For healers and humanists of many stripes, self-compassion is what’s needed. Self-compassion breaks through self-hatred, saying “I get what it’s like for you. You’re not so bad!” But self-compassion can feel foreign, and people often need help discovering it. It’s no coincidence that self-compassion is the main message behind many forms of psychotherapy, including ACT, EFT, IFS, and mindfulness-based approaches. Once you get the hang of it, self-compassion starts to extend itself, and that’s a lovely thing. Maybe that’s the reason former addicts often end up in better shape than those who’ve never strayed.

I just got a piece published in Newsweek! This makes me happy, to be sure. But if you see the paper version, the headline they picked does NOT appeal to me:  “My Kool Acid Test”. Hmmm….not my choice, but I couldn’t talk them out of it. Oh well, it’s Newsweek, and I’m a shameless publicity hound these days…

Here’s the link to the online edition. Below I’m going to paste in the UNABRIDGED text. Although I was after a story-line that focuses on the sixties, I think the “then and now” aspect is really interesting. And though they cut this part for the publication, check out the contrast between Ecstasy, today’s favourite party drug, and LSD, our drug of choice 40 years ago.

I’m a neuroscientist, I try and understand how the brain works, but I take a special interest in how it doesn’t work when people take drugs. That interest arose from memories of my own troubled youth: I used to be one of those people. For most of my late teens and twenties I ingested every drug I could find, and I became seriously addicted to hard drugs for part of that time. Now I try to make sense of those years, by exploring how different drugs modify brain function and how those modifications can become so terribly attractive. The drugs we find appealing reveal much about who we are; yet their effects remain mysterious, almost unknowable, until we look at the brain and its own intrinsic chemistry.

My drug-taking adventures began in the late sixties – when the world seemed wide open, waiting to reveal its wonders. I had just arrived in Berkeley, California, and my newfound friends and I were spellbound by the mind-expanding potential of LSD. But the world has changed since then, and the drugs we take today, including SSRIs and ecstasy, send our brains in a very different direction, toward comfort rather than freedom. The irony is that both these pathways begin with one very special molecule: a neurotransmitter called serotonin.

LSD (lysergic acid diethylamide) goes to work in the brain by blocking serotonin receptors, the gateways that allow serotonin into our neurons. As a result, serotonin molecules flowing from our brain stem have nowhere to go and nothing to do. Serotonin’s job is to reduce the firing rate of neurons that get too excited because of the volume or intensity of incoming information. That’s how it calms synaptic traffic, modulates extremes, regulates and supervises the brain. Serotonin filters out unwanted noise, and normal brains rely on that. So, by blocking serotonin, LSD allows information to flow through the brain unchecked. It opens up the floodgates – what Huxley called the “Doors of Perception” – and that’s just what it felt like the first time I took it.

My first acid trip was both wonderful and terrifying. I was in a friend’s apartment, among a rag-tag assortment of hippie types, and I swallowed a little purple pill during a prolonged Monopoly game. About 45 minutes later, the room started to disintegrate. I had to stop playing; I could no longer read the numbers on the dice. The dice, the plaster walls, the chattering voices, the facial hair of my compatriots – each perceptual gestalt broke apart into its constituent details, moving, changing, swirling, arranging themselves into patterns of geometric beauty or turgid ugliness. My senses and thoughts were out of control, and the world rushed in relentlessly.

LSD was invented by Albert Hofmann in the 30s, but its psychedelic properties were not apparent until he tried it on himself, in 1943, and thought he was going mad. For a couple of decades, psychiatric researchers tried  to treat disorders ranging from schizophrenia to alcoholism with LSD. The CIA and US military got into the act in the 50s and 60s, with the hope of manipulating potential informers or instilling mass confusion in enemy troops. But the effects of LSD remained elusive and unpredictable. It was deemed more trouble than it was worth in government circles, but it found its true calling as the emblem of a generation intent on change. For my friends and I, LSD was revered as a key that could unlock human perception and redefine human potential. So I took acid at least once a week and watched the grain of the sidewalk separate into rainbow fragments, gazed at the canopy of a redwood forest devolving into geometric scribbles, or tossed in the surf of my own cognition as it swelled in profundity. I wanted to open up my senses, strip off my mental armor, and let reality enter. And I didn’t give up for several years, until acid finally became routine, and I got drawn toward darker adventures with addictive drugs, heroin among them.

Still, for those few years from 1968 to 1972 , acid seemed the leading edge of a culture bent on charting new territory. “The times they are a changin’” chanted Dylan, and the world seemed rich with  possibilities. As far as my friends and I were concerned, LSD, mescaline, and psilocybin – all compounds that torpedoed serotonin – made that world accessible. Move over, serotonin. Safety is out. Infinity is in. So we popped our pills and wandered the frontiers of inner space. At least until the drug wore off and our serotonin molecules flowed huffily back into place.

In the last ten years, serotonin has again been the target of a culture-wide chemical invasion, but the new drugs shift human experience in the opposite direction. SSRIs (selective serotonin reuptake inhibitors) — like paroxetine (Paxil) and fluoxetine (Prozac) — are used to treat depression, anxiety, PTSD, OCD, and undefined feelings of ickiness. Instead of getting rid of serotonin, these drugs block the reabsorption process, so that serotonin keeps piling up in the synapses. The result: an extra-thick blanket of serotonin that filters out the intrusions of anguish and anxiety, making our inner worlds secure. Instead of turning on, tuning in, and dropping out, they help us turn off, tune out, and drop in – into a solipsistic safety zone, protected from too much reality.

Unlike the psychiatric researchers of the 50s and 60s, today’s psychopharmacologists are pleased with their progress. Every year or two, new and perhaps improved SSRIs are dumped into the waiting hands of millions of needy patients. (By 2007, antidepressants were the most pescribed drugs in the U.S., according to the Center for Disease Control.) But what do these new molecules tell us about our culture, about how we perceive our world? Apparently, now is not a time of exuberant exploration, but a time to hunker down and play it safe. The world seems too upsetting to wander in search of new adventures, too dangerous to explore beyond our own front porch. Instead of letting the world in, with all its uncertainties, we try to keep it out. And a barricade of serotonin makes that possible.

Even the recreational drugs of today’s youth point the weather vane of serotonin toward comfort rather than freedom. Ecstasy (MDMA) increases serotonin in the synapses, like a hyped-up antidepressant, making the world feel cozy. And while it’s true that most people don’t take serotonergic drugs, either from their doctor or their dealer, it’s no accident that those who do are resonating to a cultural theme much different from the optimistic vision of the sixties: Life is dangerous, protect yourself, or at least make yourself comfortable.

The drugs we take, the drugs we create, offer an idealized antidote to the cravings of our times. LSD was born from our craving for freedom. SSRIs reflect our need for security. Molecular makeovers never quite get us there, but they can show us where we are and where we’ve been.

Following that invitation to meet with the Dalai Lama, I’ve been looking more into Buddhism and studies that link it with neuroscience – and with addiction. In one recent article, I learned that mindfulness/meditation (let’s call it MM) changes the brain in one important way. From the treatment community, we also know that MM helps people recover from addiction. Research has been sparse so far, but there are good results with respect to smoking. So my question is this: if we know that MM changes the brain in such and such a way, and if we know that it helps reduce addiction, will we come to understand what neural processes are at the core of addiction?

An important brain region has been identified in many labs in the last few years. It’s called the Default Mode Network. This area (which includes the posterior cingulate and medial PFC) “lights up” when we are daydreaming, self-reflecting, imagining our selves in past or future situations, or imagining interactions with other people. In other words, the default mode is where we go when we are going with the flow and thinking in an undirected way about ourselves. Most interesting is that the default mode network turns off when we become focused on a task. When we have to do something novel or challenging, we leave the default mode and enter a focused mode, supported by very different brain regions, including the dACC – a region I’ve discussed as critical for self-control.

This particular article shows that MM changes activity in the Default Mode Network – a finding supported by other studies. The more you meditate or practice mindfulness, the more likely you are to activate the “focused” brain regions and turn off the default mode, especially when you’re required to pay attention. This article also claims that the reason MM helps people recover from addiction is because addicted individuals have too much activation of the default mode network. In other words, the images, cues, plans, ideas, associations, etc, that come to your mind when you’re addicted are more like daydreaming than focusing. You are using a brain region that DOES NOT solve problems but maintains a habitual sense of who you are.

I found just two articles that show that addicts have more activation in the Default Mode Network than other people – not a huge number of studies so far, but still… One of these showed that the default mode network is highly activated in heroin addicts, and this activation does not go down when they’ve had a dose of methadone. So whether you’re high or not, this is home base.

I’ve usually considered addiction as being too focused. After all, craving – the main ingredient of addiction – means having one goal and only one goal consistently at the centre of your attention. But it’s also true that there’s something very unfocused about addiction. Your thoughts are following such familiar ruts, without conscious guidance, and your sense of yourself is habitual rather than flexible. Oh wouldn’t it be nice if…..here I go again…not too surprising….well I don’t have to quit this week….could wait till things get less stressful, etc, etc. So maybe that unfocused state is where the addictive plan starts to form. Look at this snatch from John’s Guest Memoir:

Resting after the first set [of exercises]; I do something I should not do: I trace with my finger along a raised vein on the back of my forearm, slowly, gently, slightly, thinly smiling — the blood’s rushing to my head already anyway — tap on that one good spot a couple times, and now here comes the idea. Ohhhh… and oh fuck that reminds me of the dream I had last night.

That pretty much typifies the default mode…not paying attention, letting your thoughts go, which includes letting them go to places where they really should not go.

So, if addictive behaviour arises from a brain network that supports habitual, undirected thoughts, and if MM helps bring focus and clarity to one’s thinking, by deactivating that network, then it wouldn’t be surprising that MM is an important tool for recovery. And this kind of research, which is starting to grow exponentially, teaches us critical lessons about how treatment can tackle addiction – right in the middle of our brains.

The concept that a person is either authentic or inauthentic (either a liar or not) is based on the premise that people have unitary, coherent personalities. In contrast,  IFS takes the view that people’s inner worlds are made up of parts, or sub-selves, each of which has its own distinct style, motives, and beliefs. Interestingly, this idea corresponds with the idea — quite familiar in psychology — that people’s fundamental attributes (e.g, racist or not, selfish vs. generous, flexible vs. rigid) vary hugely, depending on their social context — who they’re interacting with, whether they feel safe or insecure, what they feel is expected of them. Just having a trusted friend nearby can make all the difference in how one thinks, feels and behaves.

According to IFS, different parts become activated at different times, especially when triggered by painful emotions. When you feel threatened, your scared child self comes to the surface. You become hypervigilant and/or you retreat. When you feel like you’re not good enough, the critical part takes over. You become hard and punitive, maybe angry and controlling, toward yourself (selves?) and/or others.

So maybe the idea of having a unitary personality is just wrong. In which case, there’s no such thing as being an inauthentic person. Instead….there are situations in which it becomes necessary to hide stuff, and that’s when a distinct part comes online.

Instead of seeing someone (or yourself) as inauthentic, try thinking of them as being afraid of rejection, so that the part that takes over is the hiding part — the same part that hid the remains of the cookies you shouldn’t have eaten when you were a kid and mom was in a bad mood. The urge to hide one’s bad behaviour — or unattractiveness, or neediness, or aggression — is not inauthentic. It’s authentic. It’s an authentic effort to stay safe.

(Of course there are other ways to define “authentic”. If by “authentic” or “truthful” you mean someone who should be trusted, then we enter very different conceptual territory — territory defined by social contracts or rules. But if you think that simplifies matters, think again. No one can be trusted entirely, about everything; in other words, we all have secrets. In fact, most people can be trusted about some things and not others — try asking someone about their sex life or toilet habits! — which is why we often make a distinction between people’s private worlds and public worlds. So everyone lies or at least misleads…at least sometimes or about some things. And we end up at the same place: everyone hides what they fear will lead to humiliation, denigration, or rejection. Once you see this, you see that those referred to as drug addicts aren’t more or less “authentic” than anyone else.)

People with addictions are almost constantly struggling to stay safe — safe from other people’s opinions. So it’s not surprising that they try to hide the thing that will make the world even more dangerous.

In IFS terms, the hiding part is not inauthentic. It’s authentically trying to protect you. Whether that works well or not is a different matter.

Hi you people! I haven’t forgotten about you. In fact I really miss you. This blog community has been like a second family to me, and I’ve gotten a lot of warmth and a lot of learning from communicating with you.

As I mentioned last summer, I’ve moved to L.A. with my family — temporarily. And I’ve spent the last two months feverishly trying to finish my new book: The Biology of Desire: Why Addiction is Not a Disease. That’s why I haven’t been posting.

I have to get a full draft to my publishers by tomorrow, then I’ll be off traveling again (this time to South America!) for two weeks. Then I think I’ll be able to start regular posting again.

For now, I’ll copy the first few paragraphs of the book. It’s still only a draft, and the argument will be old news to those of you who have followed this blog. But it’s the best summary I can give you of what I’ve been thinking and writing about.

“Public attention has been riveted by the harm addicts cause themselves and those around them. More in the last few years than ever before. And the way we view addiction is changing, molting, and perhaps advancing at the same time. We’ve begun to separate our ideas about addiction from assumptions about moral failings. We’re less likely to dismiss addicts as simply indulgent, spineless, lacking in willpower. It becomes harder to relegate addiction to the down-and-outers, the gaunt-faced youths who shuffle toward our cars at traffic lights. We see that addiction can spring up in anyone’s backyard. It attacks our politicians, our entertainers, our relatives, and often ourselves. It’s become ubiquitous, expectable, like air pollution and cancer.

To explain addiction seems more important than ever before. And the first explanation that occurs to most people is that addiction is a disease. What else but a disease could strike anyone at any time, robbing them of their wellbeing, their self-control, and even their lives? There is indisputable evidence for physiological changes with addiction. Research over the last 20 years reveals distinct alterations in brain structure and function that parallel substance abuse. This seems to clinch the definition of addiction as a disease — a physical disease. And it gives us hope, or at least forebearance; because the notion is sensible, comforting in its own way, and part of our shared reality. If addiction is a disease, then it should have a cause, a time course, and possibly a cure, or at least agreed-on methods of treatment. Which means we can hand it over to the professionals and follow their directions.

But is addiction really a disease?

This book makes the case that addiction results from the motivated repetition of certain thoughts and behaviors until they become self-perpetuating habits. Thus, addiction develops, and it can develop quickly, through a process I call accelerated learning. A close look at the brain tells us why this occurs: because the neural circuitry of desire governs many other brain functions, so that highly attractive goals will be pursued repeatedly, and that repetition (not drugs, booze, or gambling) will change the brain’s wiring. As with other entrenched habits, this developmental process is underpinned by a neurochemical feedback loop that’s present in all normal brains but now spirals more quickly than usual because of the allure (and repeated pursuit) of particular goals. There’s mounting evidence that addiction arises from the same neural hardware that binds children to their parents and lovers to each other. And it builds on the same cognitive mechanisms that permit humans to seek goals selectively and to pursue symbols — goals that stand for something. Addiction is unquestionably destructive, yet it is also uncannily normal: an inevitable feature of the basic human design. That’s what makes it so difficult to grasp — societally, philosophically, scientifically, and clinically.

I believe that the disease idea is wrong, and that its wrongness is compounded by a biased view of the neural data — and by scientists’ habit of ignoring the personal. It’s an idea that can be replaced, not by shunning the biology of addiction but by examining it more closely, and then connecting it back to lived experience. Medical researchers are correct that the brain changes with addiction. But the way it changes has to do with learning and development — not disease. Addiction can therefore be seen as a developmental cascade, often foreshadowed by difficulties in childhood, always accelerated by the narrowing of perspective with recurrent cycles of acquisition and loss. Like other developmental outcomes, addiction isn’t easy to reverse, because it’s based on the restructuring of the brain. Like other developmental outcomes, it arises from neural plasticity, but its net effect is a reduction of further plasticity, at least for awhile. Addiction is a habit, which, like other habits, gets a major boost from the suspension of self-control. Addiction is definitely bad news for the addict and all those within range. But the severe consequences of addiction don’t make it a disease, any more than the consequences of violence make violence a disease, or the consequences of racism make racism a disease, or the folly of loving thy neighbour’s wife make infidelity a disease. What they make it is a very bad habit.

Although this book uses scientific findings to build its case, it works through the testimony of ordinary people. I relate detailed biographical narratives of five very different people, each struggling with addiction, as the scaffolding on which brain science is introduced and interpreted.Through these stories, I show what it’s like and how it feels when addiction takes hold, while explaining the neural changes underlying it. There’s no doubt that these changes mark a difficult passage in personality development. But I conclude each chapter on a positive note, following my contributors through their addictions to their growth beyond it — a phase often termed “recovery.” And I provide the neuroscientific facts and concepts to help us understand how they get there. Most addicts end up quitting: uniquely and inventively, through effort and insight. Thus quitting is best seen as further development, not recovery from a disease.”

Sayonara! More soon….