Understanding Addiction

Obviously the impact of lockdown and social distancing has been serious for many of my readers, and I’ve struggled to think of what I could share that might help. Finally I think I’ve got something to say. Even as the world closes down around you, you have to stay open!

In my last scientific article on addiction and recovery, I set out a new and improved model of addiction (described in more detail here). I looked at addiction as a “narrowing” of the brain — a setting and solidification of neural networks focused on drug rewards — paralleled by a narrowing of the (available, meaningful) social environment.

This is not rocket science, or even brain science.

The main trouble with the “brain disease model” of addiction is that it ignores the massive impacts of the social environment. Yet we know that emotional challenges create the predisposition to later addiction. We know that the social environment (including one’s family history) matters hugely. We know that abuse (including emotional abuse) and neglect during our growing-up years are by far the best predictors of addiction in adulthood. The brain disease model simply can’t make sense of these facts. How could a brain disease develop from hard times growing up?

So in my model I emphasize that harmful social experiences have a shrinking or narrowing effect. If caregivers or peers make you feel off or wrong or insecure, or unable to trust, unable to just be, then you ingest what gives you the next best thing. Something that soothes you and defines you. And then, as time goes by, you connect with people more shallowly, you connect with fewer people, you connect with fewer people who might actually love you — family, friends, lovers. That’s the outer garment of addiction: the thinning, the contraction, of the social world. And it parallels the “contraction” of available neural networks in the addict’s brain.

The social shutdown isn’t just in the words and deeds you receive from people you know. It’s also a reduction in the places you go, activities, walks in the park, the freedom to be buffeted by babbling crowds shopping, living, watching, listening. When drink or drugs seem all that’s available to provide what you need, you let go of other possible sources of pleasure and satisfaction, energy, and identity. They were never that reliable to begin with. And before long you forget about them, you forget how to find them, you forget they even exist. That’s what locks addiction in place.

It’s what Johann Hari wrote about in Chasing the Scream: the opposite of addiction isn’t sobriety; it’s connection.

So living through this pandemic, here’s the main problem. The impact of social distancing on many people is increased loneliness, greater contraction of the social world, an accelerated plunge into being by yourself. For people with addictions, that’s the opposite of what they need most, the opposite of what they need in order to forget about getting high, at least for awhile.

Maybe it’s obvious, but it’s also what I’ve been told by my psychotherapy clients, especially those who haven’t quite found their way back to a drug-free (or drug-reduced) existence. The four walls feel more like concrete barriers than dividers in a lively hive. The doors and windows start to feel like relics of an existence that’s no longer possible. You can’t go out, you can’t mix, you can’t meet up, except online. And that’s just not quite the same. All you’ve got left is your addiction…or so it seems.

For those who are taking care of kids who are also stuck at home, the increased contraction of possibilities is laced with stress. You have to attend to these little buggers all day long. You love them, okay, but they’re kids. They’re not there for you. You’re there for them. So, infused in your isolation are the toxic currents of stress, not only boredom but frustration and anger and a sense of inadequacy. All of which derive from the situation, but it feels like they derive from you, from your own shortcomings. There you are, trapped inside your bunker, with heightened demands and anxieties that would be hard enough to deal with if you were free to get out and mix with other parents and relatives and the world at large. Forced captivity with junior cell-mates is nothing like being free to wander and connect.

So here’s what you should do. If you’re trying to quit or control substance use (or other addictive activities — porn, online gambling, whatever), get your ass out of the house! Social distancing doesn’t mean solitary confinement. Here in my city in the Netherlands, I’ve seen more and more people strolling over the last two or three weeks. People walk, and when they’re about to pass by, either they or you or most likely both of you move aside, so there’s a good two meters (six feet) separation. That separation doesn’t prevent, in fact it seems to enhance, people’s tendency to smile at each other, say Hi, wave, even utter a few words of greeting.

And it’s springtime! (at least in the northern hemisphere) The bushes and trees are budding and leafing like crazy, the flowers are coming out. My mood improves about 300% after I’ve walked around for awhile. And when you get home, call or zoom someone you care about. Ask about them. They’ll ask about you too. It’s easy to imagine that our isolation is some kind of penance for imagined wrongdoings. It’s not! The world is still full of people. And you still have an instinctive need to connect with them, in whatever way you can.

Getting out of your home is going to make you feel like you’re a part of the world rather than a prisoner on Rikers Island. And that’s going to help you feel like you don’t need to get loaded, or maybe have two drinks instead of eight, or maybe watch a movie, read a book, and fall asleep gently, wondering about the mysterious mix of chance and destiny that’s landed us in this crazy time. Together.

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If you haven’t yet, please visit and maybe subscribe to my YouTube channel. It’s new, and it features videos of my talks and interviews over the past few years. No spam or junkmail of any kind, I promise.

Here it is, guys. A write-up of that talk I’m going to present. Actually, it’s a bit of an approximation, because I have to give another talk next week, before TED, at something called PINC, and I’m allowed 20 minutes instead of 8 minutes. So….this is more elaborate than what I can say on TED. It pretty much captures what I think about the issue of trust.

Nobody can trust an addict, least of all him- or herself. And that’s what I’m going to talk about: this lack of self-trust and why it’s so pivotal in addiction and recovery.

First — my history of addiction…(blah blah). And then, the 187th time I tried to quit, it actually worked. I think quitting became possible because, this time, I found a part of myself I could trust.

But why was it so difficult until then? Why is it so hard for addicts to “just say no?” We can answer this question only if we can explain what it is about addiction that works against self-trust.

There are two psychological phenomena that help explain it.

First phenomenon: Ego depletion. The inability of people to maintain impulse control for a long period of time.

Areas of prefrontal cortex in charge of self-control run out of fuel. Like muscles, these areas get weakened and strained with continuous use. So, you can maintain self-control for a while — but not for very long.

Classic experiment described: subjects come to the lab hungry. They are told not to eat from either a bowl of chocolate chip cookies (one group) or a bowl of radishes (the other group) sitting right in front of them. After 10 or 15 minutes, they have to complete cognitive tasks requiring self-control. Those who had had to suppress their impulse to eat the cookies did less well on those tasks. They had used up some of that precious cognitive resource.

Ego depletion is a serious problem for addicts of all stripes: because the thing you’re trying to control is there all the time. The bar on the corner, the phone number of your dealer, waiting in the phonebook — cues associated with your addiction are always present.

And addicts have to control their impulses, not just for minutes, but for hours, day after day, week after week. So, they run out of capacity, and they give in.

Recent research shows: people who believe in their capacity for self-control are less affected by ego depletion. But why should this be so? How can a subjective state, a feeling, have such influence on a fundamental brain mechanism?

I think it’s because, if you don’t believe you can do it, the task is actually two tasks. You have to control not only the impulse but also your own doubt. Trying to maintain that double inhibition, to maintain your confidence while controlling your actions…. it exhausts your resources all the sooner.

That makes it very tough for addicts. Why should they trust their impulse control? They’ve failed time after time. So for them, ego depletion is like a sledgehammer, quick to overwhelm them. And they fail yet again.

I’m always struck by a certain irony: People think addicts are weak and lazy. In fact it’s the opposite. Addicts work harder than anyone else at the task of self-control.

Second phenomenon: Delay discounting. This is the tendency to devalue long-term rewards in favour of immediate rewards. Example: You might choose 5 euros today vs. 20 euros in a week. The immediate reward is exaggerated in value.

For addicts, this amounts to getting high tonight, or going to the casino, or eating the whole cake, at the expense of future happiness: e.g., having a happy marriage, a good figure, or keeping your job, or money in the bank, or staying out of jail. These future reward are devalued — they seem not to count for much.

But the appeal of addictive substances and acts is made all the more powerful by the release of dopamine. Dopamine’s job is to rivet attention to immediate gains.

Dozens of studies show greatly increased dopamine when addicts encounter cues associated with their addiction. A kind of hyper-conditioning. This narrows their attention, and their desire — to what I call the neural now.

The only antidote for this delay discounting may be: having a dialogue between your present self and your future self, whereby the future self takes your present self in hand and says: trust me — things will soon get better. Stick it out…with me.

But addicts have a very hard time seeing their future self as anyone but an addict.

Yes, addicts have dialogues with themselves, but the problem is that they can’t find a future self who is trustworthy, who can carry the present self past the intense attractions of “now”. Any future self they that’s credible is NOT where they want to end up. There is no future to value.

Because it’s so hard to trust themselves, addicts trust the only thing they can trust: their drug, their drink, or the behavior that brings them temporary relief. And that works for a while, but then you wake up, empty, broke, betrayed, in even worse trouble, perhaps with withdrawal symptoms starting up….and you have failed yourself yet again.

Self-trust is hard for addicts to find, but when they find it, they may also find a pivot point. Their whole life can swing around: they may start controlling themselves because they believe they can, because they’ve caught a glimpse of a self they can rely on.

Unfortunately, current treatment approaches often don’t encourage you to trust yourself. They encourage you to see yourself as a helpless addict, a person with a disease. They encourage you to trust in a higher power — in God, or the group, or the doctor — not in yourself .  (Trust in the group is not a bad thing, and it may be a means to an end — the end being self-trust. But the question remains, do they help you find that self-trust?)

Yet treatment centers based on empowerment are starting to spring up, and I think that’s an encouraging sign.

Here’s how I quit. Quitting attempt #187: I wrote the word “No” in big letters, tacked it to my wall, and recited it 50 times a day, so that I couldn’t stop imagining it. And I saw that I could keep saying “No,” next minute, next hour, next day. I’d found a way to believe in my ability to stop, and that felt like a new self — or at least a different part of myself — I could rely on.

So, for me, self-trust and recovery started at exactly the same moment. In a way they were the same thing, as self-trust initiated the first steps of recovery, and those steps reinforced the sense of self-trust.

So here’s the resolution that occurred to me.

The problem was that the learning curve that describes addiction onset is often unusually steep — what I’ve called accelerated learning. But the biographies I include in the book, and other tales of addiction sent my way, sometimes show a gradual onset — a period of coasting before substance use takes off. And sometimes there are plateaus, or even remissions, when our addictions may live underground. We might hear them stirring late at night, but they don’t always rise up and send us on another cliff-hanging romp with self-imposed torture.

So I wanted to come up with a description of addictive learning that allows for accelerated learning but also gradual onsets and plateaus. The following is a (slightly edited) passage from the final draft of the second-last chapter, sent to my publisher this morning. It’s not particularly new or amazing, but I think it covers the issue. And serious thanks to you guys for the suggestions and insights you posted or emailed to me. They helped me think it through.

Brain changes naturally settle into brain habits — which lock in mental habits. And the experiences that get repeated most often, most reliably, and that actually change synapses rather than just passing through town, are those that are emotionally compelling. Most important, combining strong motivation — such as desire — with frequent repetition changes the rate of learning. It speeds up the feedback cycle between experience and brain change. This kind of accelerated learning is bound to boost the entrenchment of long-term habits, for several reasons:

• because desire focuses attention like nothing else, and attention is the springboard to learning.
• because addiction offers highly desired rewards that disappear before long, thus priming the desire pump repeatedly.
• because a feedback loop that cycles faster will generate more of whatever it generates, thus accelerating its rate further. This is the well-known snowball effect.
• because any growth process that is speeded up enough will outrun its competitors. Since synapses fade and disappear when they are no longer in use, and since addictions are pursued at the expense of other goals, addictive habits come to usurp habits incongruent with addiction — like caution, integrity, and empathy.

The onset of addiction doesn’t always looks like an accelerated learning curve. The biographies of Brian and Donna show us that people can take drugs for a long time before they become addicted. Brian’s use of stimulants and Donna’s use of opiates had little motivational thrust for that initial period. Brian was trying to remain awake and alert so he could accomplish work goals, and Donna was taking Vicodin for pain long before she took it for pleasure. Nevertheless, both Brian and Donna reached a turning point, at which the learning curve must have risen steeply. For Donna, this occurred more than once, since there were periods of calm between her drug-stealing storms. The learning spiral would have first quickened, showing a snowball effect in behavior and a cascade of neural changes, when Donna and Brian began to pursue drugs for the feelings they provided, not as a means to an end — when desire kicked in and their quest for drugs overrode their other goals, including the wish to avoid big risks. That’s when their lives started to unravel.

Because the onset of addiction must include one or more phases of accelerated learning, but can also simmer for long periods, I’ve settled on the phrase “deep learning.” This is meant to cover the overall profile of addictive learning, including periods of rapid change and periods of coasting (or even periods of abstinence — “remission” in medical parlance). Note that this profile corresponds with models that view the onset of addiction as a series of stages or steps.

That said, I want to wish you all a calm, happy, warm, peaceful holiday. May we all be free of our demons and let the holiday maelstrom of emotions pass without harm.

Hi all. I haven’t written anything since New Year’s, and I guess it’s time to crank up the blog machine. I can see that we have a lot of new readers. I want to welcome you newcomers as well as ye olde and faithful — I hope there’s something here for you and I hope you’ll join in the dialogue with comments.

I just got an email from someone confused about the genetic roots of addiction. I get questions like this all the time. It’s a big issue that nobody’s very clear on. To be honest, I’ve been somewhat confused about the heritability of addiction too. One of the things I’ve found most confusing is that the heritability estimate keeps showing up in the 40 – 60% range, for drug addiction and alcoholism. How can it be that high, when most experts agree that the idea of an “addictive personality” is just plain wrong?

Over the past month I’ve been reading an advance copy of Maia Szalavitz’s latest book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction (St. Martin’s Press, upcoming). Maia is one of today’s brightest, most insightful commentators on addiction and related issues. She’s been writing articles for the popular press (e.g., The Fix) as well as scientific publications (e.g., Nature) for years. In her new book she explains addiction as a learned style of thinking, a coping style that isn’t working, or a developmental disorder — a rigid system of behaviours and beliefs cemented together over development. Her focus is mainly on trauma — hurtful, often devastating events impacting on the lives of children/adolescents and/or their families. Yet despite (or maybe because of) this emphasis on environmental forces, her explanation of genetic factors is as smart and as accurate as they come.

The Big Three.

There are really just THREE things to keep in mind:

1. Yes, heritability can be in the 50% range for many different addictions. That means that identical twins (with the same genetic makeup) share a strong inherited tendency to become addicted. Specifically, if one twin becomes addicted, there’s a 50% probability that the other one will too, and the commonality has to come from their parents’ DNA (and possible “epigenetic” influences too). The rest of that 100% is made up of environmental factors.
2. This 50% figure is actually very typical of personality traits in general, such as the famous “Big Five” traits, like sociability or extroversion.
3. And yet the 50% figure for a genetic influence on addiction does NOT come from any single trait. There is no such thing as an addiction trait or addictive personality!!!

So how do we explain that 50%?!

Let’s say you and your brothers have big noses, or bad teeth, or muddy coloured eyes… And let’s say that this tendency comes from your shared DNA — which would not be surprising if it’s a trait you all share. Because you all carry the “big nose” gene, your chances of getting hot dates in college are diminished. You each have a strike against you.

Now let’s say that another set of brothers (or sisters) is congenitally shy, or has poor colour vision and thus poor taste in clothes. These are other genetic factors that might increase the risk of sitting home alone on Saturday night.

So we’ve got at least two radically different genetically-loaded traits that predict the same outcome. If we were doing a study on genetic factors that contribute to a diminished social life, both traits would show up as predictive. And if each one correlated 50% with its appearance in a twin brother, then it wouldn’t matter that we pool them together in our study, because genetic studies always pool individual traits and add up how much of any outcome is shared by family members (specifically,  family members living apart, since that’s the only way to isolate the contribution of genetics).

The last thing to note is that, if you were unfortunate enough to carry the colour-blindness gene and the big nose gene, then you and your sibs would have an even higher chance of a disappointing sex life, unless these traits happened to work together in a particularly charming combination (Leonard Cohen?) And even though that’s very possible, it wouldn’t matter much. Genetics is sort of a dumb science and all it cares about are averages.

So what traits predict addiction?

Several. The strongest predictors are (1) an impulsive or antisocial personality style, and (2) an anxious, overly-sensitive, perhaps OCD personality style. Note that these personality clusters are almost perfect opposites: the brash, uncaring person vs. the anxious, neurotic person. In fact, they may be based on opposite extremes of certain ingredients in the chemical recipe of personality: too much dopamine or too little serotonin for the anxious kid; too little dopamine or too much serotonin for the impulsive thrill-seeker (who needs to try harder to feel excited). Yet both these traits increase your odds of becoming an addict, and both are (partly) heritable. Which is to say they are shared between parents and children and between siblings (who carry much of the same DNA).

According to Maia Szalavitz in her new book, there’s a third heritable package that strongly predicts addiction: a combination of  reckless drive on the one hand and sensitivity to failure or loss on the other. Maia says that this disposition was her royal road to addiction, and I believe it was mine too. And by “royal road” I don’t mean a direct cause but a causal contributor — one variable among many. Like me, Maia is a developmental thinker, and she sees these genetic predictors as early conditions that can lead down many different roads, depending on environmental circumstances.

Next post I’m going to go into a lot more detail on how these very different personality styles can make one more vulnerable to addiction, and how other personality (and environmental!) factors can make one more resilient. And I’m going to remind you that these factors can interact with each other in all kinds of interesting ways.

Hello again. This is a follow-up to my recent post, concerning the online salon hosted by Shaun Shelly and me, tomorrow at 1pm EST.

I just wanted to remind anyone interested in attending to please register and get your ticket right away. The $20 cost for the first of our salons will be waived if finances are an issue. Please let me know by DM or the “contact” button on the right. Also note that all our proceeds will be donated to SMART recovery.

There is a link for getting your ticket at the bottom of the page outlining tomorrow’s salon.

Hope to see you there!

Shaun and I see addiction as a path that gets easier and more tempting the more you walk it. But it’s a path you can step away from just about anywhere.