Understanding Addiction

Hi my lovelies! I want to wish you a very very good and in fact wonderfully happy and even exemplary new year!

We flew into Amsterdam this morning. No sleep last night. The scary thing, after trying to bid the van-taxi driver down below his 200-euro fixation, was cruising along the freeway, wife and kids asleep in the back, waiting for the day to start. By 8:15 I was getting worried that the sun wouldn’t rise till late January. But the sky did lighten by about 8:30, and we got to Arnhem by 9:00.

And everything here is just the same as it was five months ago. The house is here, the key was still under the flowerpot, the car woke up once I remembered to depress the clutch while starting it. The next-door neighbor gave me a big hug when I knocked on his door. My friend, the woman down the street, nearly burst into tears when I showed up. Julian’s 8-year-old friend came by, just now, with his mother, to drop off an oversize postcard that read “Welkom T’huis” — Welcome Home. And even the guy at the nearby SPAR store was happy to see me this afternoon — he beamed that sweet openness that you just don’t see in big cities in North America. Not that Arnhem is a big city. And when I left with my bag of groceries, it was of course raining in the grey, soggy streets.

The weather in L.A. was fantastic, but I’ll take the people in Arnhem any day.

I know I’ve been talking about finishing my book ad nauseam. But it really is finished AS OF YESTERDAY!!! I wrote “THE END” at the bottom, a couple of days ago, and I’ve been picking away at edits since then. While Isabel took care of all social and child-related responsibilities, I sat on various friends’ and relatives’ sofas and wrestled with so many meticulous decisions, such as…: Should I refer to the amygdala or just the dorsal striatum in the chapter about Johnny, who nearly drank himself to death before quitting? Should I include “hair on the bathroom floor” — or is that overkill? — and just go with “clumps of hair in her hairbrush” when describing Alice’s descent into anorexia? Should I call the neural network that churns out DESIRE the “motivational core” or the “motivational engine” in this paragraph? Many of these edits were triggered by the thousands of comments/suggestions along the side of the page, from my editors and from Matt Robert and his partner, Cathy, who noticed everything that needed noticing… But I had to ruminate about each one before I was satisfied.

Have I mentioned the parallels between OCD and addiction?

But it’s all done. Edits x 3 throughout most of it, and a final chapter that actually comes to a conclusion, rather than ending with the ubiquitous but lame “……more to come…..”

So I’m high on fatigue — little dreamies sauntering in from the corners while I’m trying to sleep this afternoon — happy to be back here, really glad that the book is done — at least until the page proofs are sent back to me — and not even curious about what I’ll be doing next.

The book will be out in May. And my only request is, simply, BUY IT!

Hi you guys! I finally got back here to Holland last week. It’s good to be back. Isabel and I really missed each other and made up for lost time before she picked up the kids and I crashed out. She left for France two days later — for meetings with colleagues. (yeah, right!) The unavoidable reunion scrapping was mild and short-lived. Isabel: how badly was I going to screw up the military precision with which the kids were obeying her every command? Marc: why don’t you just trust me? It’s not like this is the first time. And it was great to see the kids — they are so beautiful to me. Julian’s teeth have almost filled up his mouth again, the better to argue with, my dear. Ruben is still a wild man when he kicks a ball and a lamb when you ask for help.  And they liked the presents I finally remembered to get, last minute, at an airport store that sells useless things to guilt-ridden parents.

So about the last three weeks: where do I start? Maybe with the culture shock of being back in the USA. Of course North America is where I come from, but the Marriott in Boston boasted new heights of excess. There were fully 50 TV screens in the one and only restaurant. Two banks of them, entirely circling the seating area. The drinks had so much ice in them, my mouth felt loaded with novocaine. And every server seemed compelled to smile brilliantly, ecstatically, whenever making eye contact. They would say things like “And how are we doing today?” And I wanted to say “I have no idea how you’re doing. But where can I get some of whatever you’re on?” Or was this just Pavlovian conditioning of some network of facial muscles in response to the smell of a tip? What a weird country. But I must admit that some of the most interesting people in the world happen to live there.

After spending a week at that Mind and Life conference/retreat, and driving around New England with my dear daughter, I finally found myself in Boston for the main act — the “pre-meeting” for the meeting with the Dalai Lama (who they call His Holiness: I’ll just call him HH in this post.) I’m sitting there at a long table, it’s 9 AM Monday, and I hadn’t slept very well. A true case of “opening night nerves.” Today we were supposed to run through all the talks and I was slated to go first. They wanted to start off with a real-life portrayal of addiction. Just in case HH and/or the couple of hundred monks and scholars who would be there in the room, sitting behind the inner circle of us, or the 5,000 or so camped down the road in front of a jumbotron, or the tens of thousands who’d watch us live on the net — just in case some of them didn’t know an addict or weren’t one themselves — seems rather unlikely.

My nerves start to mellow while I’m giving my talk. People seem engaged. Here’s one of the slides I like best. I wish I knew how to include the animation, but you can imagine these different stages of the cycle popping up consecutively.

But then I get to this slide…

This image was created by John Harper. Used with thanks.

…and I’m pointing out how the cycle of brain states involved in addiction fits so nicely on the cycle of states in the Buddhist wheel of suffering, or whatever it’s called, when this guy thunders out from the far end of the table: “That’s not Buddhism! I don’t know where you got that but it’s not Buddhism.” And I sagely reply: “Well I looked through about 200 Google images and this was the only one in English.”

But what raised my pulse the most was the presence of some very renowned brain scientists. There was Richard Davidson, across the table. He’s the guy who first put Buddhist monks — long-term meditators — in the scanner, to see what brain regions light up when you’re not thinking about pizza. And Nora Volkow was present on Skype from Washington. She’ll be coming to Dharamsala in the flesh, so that should be interesting. She seemed relatively tame, at least on the screen, but when the “disease vs. learning” issue came up, she got right into it. Spunky for sure, but also willing to listen to other opinions.

And who should be sitting beside me but Kent Berridge. If you’ve been following this blog or read my book, you know I worship the ground he walks on. His theory of addiction is unique and it’s pretty much universally acknowledged to be in first place. He divides “wanting” from “liking” and describes them as independent neural systems that work together in normal learning. In addiction, however, the “wanting” network, which is fueled by dopamine, gets highly sensitized to drug (or alcohol, food, or whatever) cues — so addiction is a runaway of process of “wanting” and has little to do with “liking”.

So this brilliant guy is sitting next to me. And he seems so…human. Humble, shy, self-effacing. But most obviously a kind and compassionate man. How do I know? When he, Davidson and I were walking to lunch, Kent continued to drop back a pace from walking shoulder-to-shoulder with Davidson so as to keep me in the loop, so that I was with them rather than following them. That’s a kind of social sensitivity you don’t often get from strangers, or from anyone, and I immediately liked him for that if nothing else.

On my other side is a guy name Jinpa — a very poised and polished Tibetan who apparently serves as the interpreter for HH in these dialogues. HH speaks English fairly well, I’m told, but misses some of the technical bits. So there’s Jinpa, a Harvard grad, or was it Oxford? Definitely in his element with this crew. And then comes Joan Halifax, a famous Western Buddhist scholar who apparently spends her days helping people in the process of dying. No kidding. That’s what she does. And then Vibeke Frank from Denmark, who looks at addiction as a social construction. In other words, you’re not really an addict unless you’re defined that way by your culture. Next, at the end of the table, sits this grandiose philosopher dude who told me my slide was wrong. And then, on  the other side of the table, Sarah Bowen, who heads up the Mindfulness-based Relapse Prevention (MBRP) camp — a very cool approach to addiction treatment that uses mindfulness/meditation to get through to the other side of craving episodes. And someone named Wendy Farley who talks about  some ancient body known as Christian contemplatives. I thought her stuff was terrific — certainly a face of Christianity that emphasizes forgiveness rather than sin, and that sees “desire” as a good thing, until it gets overly focused on filling yourself up. Then some Mind & Life staffers. Mostly people in their thirties, but including one very seasoned Buddhist scholar, who later sat me down and explained what was wrong with my slide. She showed me how incredibly complex the Buddhist cycle actually was. What I thought (and I guess I wasn’t alone) was a cycle of consecutive states actually looked more like a 12-sided sphere, with all twelve sides linking to one another, so that it ends up looking something like this!!

I told her I’d dropped out of Hebrew school when things got too complicated, so maybe she should just give me the dumbed down version. I think she finally did.

Now you’ve got the setting and the characters. Next comes the content. I’ve taken care of a few pressing matters, so I can put up another post in a day or two. There’s lots more to tell.

I haven’t been blogging since last spring, and even then it was pretty sketchy for a couple of months. Why the melt-down? For one thing, I was on drugs. Uh-huh, it’s true. And I was in pain and fairly miserable. So today’s post is about my own drug use, not anyone else’s. No theories to postulate, no models to spin, nothing very abstract at all. Just a field report: what it was like for an old veteran like me to get back on opiates…then off again.

Since moving to the Netherlands nine years ago, this was my third — yes third — spinal surgery. You wouldn’t know it. I’m limber, I can do anything from a 2-hour Tai Chi class to a half-day of zip-lining. But my spine has this uncool tendency to grow too much bone, called stenosis. The bone squeezes my nerves, and then I get pain. For example, leg pain. Sciatica.

The MRI confirmed what my nerves were telling me (about my bones). Not enough room in this town for both of us. So a surgery was planned and I asked my doc for some oxycodone — lots of it — or an equivalent. I’m not fond of pain.

I don’t for a moment think that people who need opiates for bodily pain are more decent, correct, or upstanding than people who need them for psychological pain. (I’ve needed them for both in my life.) It’s a false dichotomy passed down through generations of puritans. Suffering is suffering, and opioids are nature’s first-line defense. (That’s why your nervous system manufactures buckets of them.) But we’d be foolish to overlook the addictive properties of any drug that makes us feel better — and that part is psychological. In the case of opioids it’s physiological too. (See my debate with Maia Szalavitz in the comment section, last post.) Hence the notorious feedback effect: what you take to reduce your suffering leads to more suffering. Super bad planning!

Anyway, there I was, feeling no pain — or at least less pain — in both departments. So a couple of weeks after my operation I was faced with the inevitable quandary: did I still need these drugs to control the physical pain…or was I really just starting to crave their psychological embrace, that caress of warmth, as I have in the past?

This is obviously an important question when it comes to treating former addicts with opiate painkillers. The statistics are clear: those with previous drug problems are far more likely to get addicted to opiates prescribed for pain than those with no such history (who rarely do get addicted). That does NOT mean that opiate painkillers should be withheld from former drug users when they need them. What it means is that patients and doctors need to communicate honestly, in depth, and tread carefully, when patients find themselves in that grey zone — often not really knowing whether they’re asking for a refill to deal with physical pain or to deal with the profusion of psychological issues that former addicts contend with.

Well, I said I wasn’t going to get all abstract and theoretical. I really just wanted to tell you about my own experience and what it taught me. Doctors in the Netherlands don’t see themselves as judge, jury, priest, rabbi, cop and shrink all at once. They’re not being driven by guidelines shaped by profit and reinforced by fears of being disciplined or sued. So…decisions about what to take and how long to take it are shared between doctor and patient. As they should be.

That meant it was largely up to me. Two weeks after the surgery, with my pain considerably reduced, I had to admit that I liked the feeling the drugs provided. Yet it was no longer the grand euphoria itself that I (and almost everyone else I know) tend to get from oxycodone the first few days. That part was getting boring. No, this felt like addiction. Like I don’t want to stop, I’m afraid of being without it, how many do I have left? Will the doctor refill my script when I ask? Would I have to beg?

When that feeling came creeping in, I knew I was approaching a fork in the road. The pain is still there, but it’s not that bad anymore. I could quit now, or quit a month from now. Either way, I’ll have to do some tapering — more if I wait a month. I still need them, “legitimately,” for pain…but I don’t really need them.

Yet the bigger issue (for me as a former addict) was that I was starting to ruminate about the drugs. This was occupying too much of my thoughts. It was anxiety provoking. It was a stupid-ass waste of time. I started ruminating about the rumination, and then I ruminated about that, and…you get the point.

One night I lay in bed for literally three hours trying to decide whether to quit right now or wait for a few more weeks. I mean, why rush it? I still had over 30 tablets. Enough for several days of being pretty high (did I say “high”? I meant pain-free of course) and if I was going to get a refill, I’d better call my doc tomorrow since a holiday was coming up. Better not forget, except that…

Finally there was nothing to do but take the package to the bathroom, grit my teeth, tear each tablet from its bubble wrap (an ancient form of torture still used in Europe) and plunk it in the toilet. One after another. I left myself seven for what I expected to be a mild withdrawal. (It was.) And I went back to bed.

What I didn’t expect, the bonus card I’ve held out to people in addiction — clients, friends, strangers met online — was that I felt fabulous. Just lying there in bed. That’s the only point I wanted to make. This was the thing we call “empowerment” — this was choice, this was a treaty between my “addict self” (yes, he lives on) and the rest of me. This is what I generally hold out for other people with addiction problems. This was me taking care of me.

What I learned from this brief return to the Promised Land was really quite simple: Empowerment and self-care (self-compassion) come together with a thunderclap when you quit. On your own — even if it takes some effort. Because it’s time. Because you want to.

That’s the pot of gold.

Now that we are stepping firmly away from politics, I thought I’d end the season with a couple of excerpts from an article I recently published in Aeon. Please go to the publication website for the full essay and links. Otherwise, I’ll present an edited (shortened) version in two installments. Here’s the first:

……….

The view that addiction arises through learning appears to be gathering momentum. In fact the famous “disease model” of addiction remains fully dominant only in the U.S. (It is less prevalent in the UK, Europe, and Australia, though it still has a strong following in the treatment world.) Yet the question remains: if addiction is learned, how does it become so much more crystallised, entrenched, in fact stuck, than other learned behaviours? Given that what we learn we can often unlearn, why is addiction so hard to get rid of?

Johnny was a British plant manager, and his childhood included several years in a boarding school where sexual abuse by clergymen lurked insidiously behind the rustlings of bedtime. Johnny grew up anxious but competent; he married, then divorced, and enjoyed regular visits with his grown children – a relatively normal and predictable life. Until it all unravelled. His friends and business associates found it hard to watch, and impossible to interfere, as Johnny approached end-stage alcoholism. He drank himself so close to death that his first reaction to waking up was surprise. By the final six months, Johnny’s days acquired a strange rhythm. They began with a walk to the fridge, rum and ice already crackling by the time he got to the toilet. They would end 4 to 5 hours later when he crawled to bed on his hands and knees, unable to stand. After a few hours’ sleep, there’d begin another ‘day’ of drinking, which lasted only until his next collapse. Johnny told me he would have committed suicide, but it was happening by itself.

Why was it so hard to overcome this behaviour pattern when it got close to destroying him? Why the horrendous sameness, the insidious stability? Why couldn’t he stop? These are the questions that a learning model of addiction has to answer.

I would call addiction a learned habit. In fact, the word ‘habit’ has been used to describe addiction for ages. Yet habits can be hard to specify. They don’t just show up in behaviour. Racism is a habit that’s invisible until it shows itself in a particular context. I would term addiction a ‘habit of mind’ – a habit of thinking and feeling that sometimes gets expressed in behaviour. But then how can we examine habits that aren’t clearly observable? Let’s look to the brain to find out.

From a neural perspective, habits are patterns of synaptic activation that repeat, when connections among neurons (ie, synapses) fall into the same pattern over different occasions repeatedly. When a person thinks familiar thoughts or performs familiar actions, a vast number of synapses become activated in predictable – ie, habitual – configurations. Patterns of neural firing in one region become synchronised with patterns of firing in other regions, and that helps the participating synapses form these habitual connections.

With each repetition, activated synapses become reinforced or strengthened, and alternative (less used) synapses become weakened or pruned. Meanwhile, active synapses give rise to the activation of other synapses with which they’re connected, and because connections between brain cells are almost always reciprocal (two-way), the reinforcing activation is returned. Thus, repeated patterns of neural activation are self-perpetuating and self-reinforcing: they form circuits or pathways with an increasing probability of ‘lighting up’ whenever certain cues or stimuli (or thoughts or memories) are encountered. According to Hebb’s rule: ‘Cells that fire together, wire together.’

In this way, the brain exemplifies the way all living systems evolve and stabilise. All living systems, from organisms to societies, ecosystems to brains, are complex systems with emergent properties. That means that their structure, their shape, emerges from the interaction of many components that change each other over time. In other words, these systems self-organise due to recurrent interactions (feedback loops) among their elements.

It so happens that there is a robust scientific language for understanding habit-formation in self-organising systems, centred on the term ‘attractor’. An attractor is simply a stable state, which can emerge for a while in a complex (e.g., living) system. So: seeds grow into trees and then stabilise to an attractor: the tree acquires a shape. Birds fly in sync with each other and form a V-shaped (or other-shaped) flock. Ecosystems go through periods of massive change (eg, speciation and species death) and then stabilise. Cities stabilise. Cultures stabilise. Even family dynamics stabilise. Family arguments inevitably fall back into the same infuriating script.

Complex systems are composed of elements such as individuals in a society or ecosystem, or cells in an organ or organism. These elements continue to interact – they cause changes in each other, which cause further changes in each other, and so forth – until they arrive at stable states, at least for a while.

So what’s the point of a word like ‘attractor?’ Complex systems such as us and our brains reach stability in a very different way than cars or billiard balls (nonliving systems). They have not lost their energy; they continue to grow and develop, to live. But for some period of time, the feedback loops that comprise them provide steadiness or balance, like your body temperature after you’ve gotten used to a blast of wintry air. At that point, we can say that the system has reached its attractor. Its components now interact in a way we might call a temporary equilibrium.

The attractor idea is tremendously useful for describing the development of human habits, because human habits settle into place; they are not programmed by our genes or determined by the environment. But how exactly do attractors form in growing systems, why do they form, and why do they hold the system in place? Attractors are often portrayed as valleys or wells on a flat surface, that surface representing many possible states for the system to occupy. The system, the person, can then be seen as a marble rolling around on this surface of possibilities until it rolls into an attractor well. And then it’s hard for it to roll back out. Physicists will say that the system requires extra energy to push itself out of its attractor. The analogy in human development might be the effort people require to shift out of a particular pattern of thinking or acting.

In human development, normative achievements can be seen as attractors. These might include learning to be a competent language user, or falling in love and having kids. But individual personality development can also be described in terms of attractors – recognisable features that characterise the individual in a particular way. And these features can be seen to branch out with development and form ruts — ruts that can remain in place for a long time.

Addiction is just such an attractor. The staying power of addiction doesn’t derive from a good fit with the social world or the playing out of some innate human tendency. Addiction involves an intense relationship between a person and a substance or behaviour. That relationship is itself a feedback loop that has reached the stage of self-reinforcement, and it is interconnected with other feedback loops that facilitate the addictive pattern. These feedback loops have driven the system – the person, the person’s brain – into an attractor that deepens over time.

…THE REST TO COME IN A COUPLE OF DAYS…

I got back yesterday around noon. What a relief it was to be home! India is overwhelming in so many ways, with poverty and raw need topping the list. To get back to this calm, orderly place was a reprieve and a pleasure, tinged with guilt at leaving all that suffering behind.

For anyone just tuning in now, I was at a week-long “dialogue” with the Dalai Lama on the theme of “Desire, craving, and addiction.” I was one of eight presenters, each of whom gave a talk to His Holiness (as he is called) and to the surrounding experts, monks, movie stars and what have you. All the talks are posted here. My talk is here. I want to tell you about two of the talks I found most fascinating and most relevant for people struggling with addiction.

The first was by Matthieu Ricard. This guy is amazing, He’s a Frenchman turned Buddhist monk for the last 20 years or so. He has a shaven head, glasses, and eyes that are kind and beaming with intelligence. And he’s humorous, human, and incredibly knowledgable at the same time. He just finished a thousand-page (!) book on altruism, he’s very close to His Holiness and sees him often, he’s participated in studies of brain states related to meditation, and he says his favourite thing to do is retreat to his retreat in the Himalayas — where he meditates all day long and essentially alone (there are a few other monks around, but they don’t talk to each other). Yet he spends most of his time running the Karuna-Shechen organization, which has established roughly 140 projects aimed at improving the lives of children in Tibet, Nepal and India. Please check out his talk.  Or, if you don’t have time at the moment, here’s a summary:

Matthieu talked about the elements of Buddhism and general mindfulness (including but not limited to meditation) that can be of practical use to recovering addicts — or addicts who are trying to quit. He talks about the roots of suffering in our determined, unshakable view of ourselves as the center of the universe. That’s the primary delusion. And it requires us to be constantly protecting, improving, and caring for this self — this selfish self. In fact we’re willing to give up our freedom and control, just to continue to feed this self with drugs, booze, or whatever we think will protect it.

Matthieu recognizes the fundamental importance of craving in addiction. Craving and attachment. Here are his three suggestions for getting on top of it:

1. Apply a direct antidote: Find a mental state that is incompatible with craving. That is, focus and/or meditate on the unattractive qualities of the thing you’re addicted to. For example, focus on freedom, which is directly incompatible with the out-of-controlness provided by the addictive substance. Or maybe focus on the anxiety that accompanies withdrawal and on how that anxiety creeps in, even while we’re high and supposed to be having fun.

2. Examine the nature of craving itself: The fact that you’re craving doesn’t mean that’s all there is going on in you. Since you are aware of your craving, there must be a part of you that is outside the craving, looking in. By continuing to experience this awareness, through mindfulness or simply reflection, that part of you — the part that is outside the craving — will continue to grow. While you are looking at the craving, you will notice that, yes, it’s strong, but it is just a feeling, it comes and goes, there is nothing permanent of concrete about it. So you don’t have to obey it after all.

3. Use craving as a catalyst: This may be the most difficult, says Matthieu, but it can work for some people. There is a feeling of strong clarity that comes with the onset of craving. Stay with that feeling. It is a version of your energy, your wish for betterment. Go with that momentum in a direction that’s opposite to what we normally do. Use it to strive for betterment rather than relief. Easier said than done, he admits. So are the other two suggestions. But they can work.

Matthieu concludes that the cumulative nature of addiction, building on itself over time, means you can’t stop on a dime. It took time to build up this habit. It will take time, and effort, to overcome it. But how do you find the motivation to change? This is a tough one. He says: look for it in the way you’d look for inspiration. You try different environments, find different people to talk with. He even talks about the role of neuroplasticity in shaping both the habit and its undoing. It’s good to listen to him talk. His humility comes out in recognizing that these ideas are not directly translatable into clinical methods. Yet they are strong ideas, and that gap is waiting to be filled. That’s where Sarah Bowen comes in.

She was the last speaker of the week, and she and I agreed that we liked being the bookends — the conference starting with me and ending with her. My talk mostly posed the problem, hers, the solution. Without the need of concepts such as disease or brain hijacking to thoroughly address addiction and recovery.

Sarah Bowen is focused and rational. A good listener and a sharp thinker. She’s attractive, 30-something, and nothing resembling a Buddhist monk (or nun). She’s a clinical scientist devoted to the development of Mindfulness Based Relapse Prevention (MBRP), the first and only treatment approach that is built around mindfulness training. Sarah inherited this nascent program from her mentor, Alan Marlatt. But she is taking it to new heights, I think, and conducting well-controlled outcome studies to prove it. Here is Sarah’s talk. And here’s my summary:

MBRP is modeled on Jon Kabat-Zinn’s very effective programs for stress reduction, recovery from depression, and coping with chronic pain. This is where East meets West with a bang, generating success after success where Western psychiatry was left flailing. The program Sarah has developed uses group process (and the sense of companionship it entails) to take addicts through orderly steps of training in mindfulness, awareness, and self-compassion. This link is intended for clinicians but it provides MP3 instructions on each of the steps. Very helpful! The goal is not to get rid of craving but to be aware of it, understand it, see through it, and move beyond it. As a bonus prize, people who go through the program actually report a reduction in the intensity of craving as well as a drop (or cessation)  in substance use. And these outcome statistics are gathered through well-controlled, scientifically valid studies.

Skills for tuning your attention, letting craving come and go, relaxing in response to stress, and talking to yourself in a more compassionate way are methodically developed through a series of exercises, performed by each individual in the group context (over an eight-week period) and guided by a moderator who is already advanced in her own mindfulness practice. A compelling example is “urge-surfing,” a mind-set that allows you to coexist with your cravings in an almost playful way, moment by moment, while staying upright. Then these skills are systematically brought to bear on life outside the treatment setting — so they can be accessed when it counts most, when you’re home alone at night or whenever and wherever you’re at your most vulnerable. I can’t provide more detail in this summary, but I urge you to check out the talk. Not only does MBRP translate Matthieu’s ideas into concrete practices, but it is shown to be far more effective than other treatment approaches — even for people who have bottomed out in their lifestyle or…their lack of a lifestyle. When asked to suggest a treatment course for addicts, this is the program I’d feel most confident recommending — if only it were available more widely. Maybe some day it will be.

That’s enough for this very long post. I have more to tell. I didn’t even get to the neuroscience presentations, nor the string of objections Nora Volkow voiced in response to my (you guessed it) contention that addiction is NOT a disease. Nor the singular perspective offered by the Dalai Lama himself. Coming soon…