Is addiction one thing or many things?

Hi again. My work was recently criticized (politely) by a respected philosopher — Owen Flanagan — who specializes in the study of addiction. Here is a very nice article of his, on the topic of addiction and shame. His point was that the word “addiction” is an umbrella term used to refer to many distinct and diverse phenomena, and it is therefore unhelpful and should be replaced. If he’s right, then obviously I’m not the only perpetrator. Most of us in this field use the term “addiction” to describe what we see as a holistic phenomenon. But that doesn’t mean he’s wrong.

I’ve had to take a break from blogging because I’ve been so busy writing pieces for a journal called Neuroethics. I sent them a fairly dense article about a year ago, basically a summary of my book. I vowed to myself that this would be my final piece of academic writing. I much prefer writing “pop science” these days. Surprised? Anyway, I was told that my piece would be followed by several overworkedcommentaries, and half a year later the total came to 15 — shock! — many from well-known researchers and journalists, including Kent Berridge, George Ainslie, Maia Szalavitz, and Sally Satel. The punchline for me was that I had to write replies to each of these commentaries, to be printed along with them in the journal. And let me tell you, these were sculpted pieces of academic writing — some of them many pages in length — so I’ve had to sweat blood to reply to them. And I’ve still got more than half left to do.

Enough whining?

So let me share with you a few paragraphs from my reply to Flanagan — edited as a brief stand-alone: my answer to the claim that “addiction” is too general a term, given all the distinctions it tries to cover.

According to Flanagan, we should recognize that different attractions to different substances or behaviors really are distinct, and that the umbrella term “addiction” does the field a disservice by nervousbreakdownlumping them all together. So, he said, it’s a good thing that the DSM has dropped “addiction” (almost) from its vocabulary. Just like the phrase “nervous breakdowns” has disappeared from the popular lexicon: it’s about time we got rid of the outmoded term “addiction.” The culprit, for him, is imprecision. Addiction is an imprecise term, and worse, it brings with it “many problematic accretions and connotations” — no doubt he means accusations of blame, self-indulgence, moral decay, and the resultant stigmatization of addicts.

hierarchySo Flanagan replaces the word “phenomenon” with “phenomena.” But what are these distinct entities? To me this is like trying to describe and differentiate the various species included under the label “birds” — so that we can do away with the term “bird” altogether. Is that a good idea?

It may seem surprising but Flanagan and I agree on the value of finer distinctions in talking about the phenomena comprising what we’re in the habit of calling “addiction.” The variations in personality factors, the diversity of negative feelings that fuel addictive tendencies, and the nature of the substances or behaviours themselves…altogether provide a cornucopia of distinctions that I think we should discuss and analyze in far greater detail. Here’s just one example:

I have long believed that the kinds of feelings and personality patterns that attract some people to psychostimulants are fundamentally different from those that attract others to opiates. I think that lonely2people who get addicted to meth have tended to feel an absence of power, or commitment, or boredrelevance in their lives. They are most bothered by the flatness of their existence. Whereas people attracted to opiates (like me) are fundamentally afraid of losing warmth, acceptance, and connection with other people. We grow up feeling unsafe because we are hyper-aware of our aloneness, and the soothing quality of opiates eases the hurt.

So, lots of differences — important differences! But in my mind, that doesn’t erase the commonalities — the features that different addictions have in common. Such as the growing magnitude of our attraction to one reward at the expense of all others, the impulsive and then compulsive nature of that attraction, and the way that “now appeal” — a cognitive distortion that overvalues immediate rewards — funnels that attraction into a self-reinforcing cycle of thought and behaviour. In other words, all the stuff I wrote about in my recent book.

I believe that neuroscience can move us forward in specifying and understanding what different addictions have in common. But it can also help us understand the distinctions. Depression looks different from anger on a brain scan, impulse looks different from compulsion, and so forth. Our next step should be to discover the brain pathways that tie these mental states to specific addictive patterns.

dunceAs for the term “addiction,” I don’t think replacing it with “substance use disorder” is going to get rid of the “many problematic accretions and connotations” Flanagan worries about. That kind of modernization of terminology doesn’t seem to help alienated or marginalized groups. For example, replacing “retarded” with “delayed” never erased the stigmatization of people who can’t think as quickly as others. So in this case, let’s not throw out the baby or the bathwater. Let’s continue to explore how all addictions embody fundamental changes in how we think, feel and act. But let’s also try to clarify how those changes take different forms, leading to different outcomes, for different people.

 

60 thoughts on “Is addiction one thing or many things?

  1. sue February 20, 2017 at 4:39 am #

    Not sure I agree with your summation of personality types/patterns attracted to particular which drugs .As a parent my experience has been of a son who was addicted to opiates for many years and then methamphetamine for many more — so I guess he felt irrelevant powerless and alone unloved and not connected. A drug for all reasons and seasons ?

    • Marc February 20, 2017 at 5:07 am #

      Sue, I know that the experience of “multi drug users” works against my little theory. I’ve never tried to publish it, since it really is just a speculation. But it’s possible to suffer in both these categories — aloneness and powerlessness. In fact one can build on the other in a developmental sequence, I mean over several years, and I’ll bet those sequences can tell part of the story of one’s personal challenges. So I think the distinction is still valuable.

      I also used to like coke, even though my main dish was opiates. I even did meth a quite a few times. The experiences were radically different, of course, but each appealed to a different part of me.

      Maybe that would be a better way of framing the model…yet a lot of people have a strong attraction to one kind of experience or the other at a given stage of life. And for me, I always wanted the opiate following the upper. It was mandatory. Never the other way around. Because I needed to find a soothing place to land at the end of the roller coaster.

      I hope your son gets it together. It took me awhile, but it finally clicked.

  2. Mark February 20, 2017 at 8:23 am #

    I suspect that to a few ultra-integrated human beings like Buddha, Jesus, Muhammad, and Rudolf Steiner, etc., most of humanity looks and feels like it’s developmentally delayed. I often feel that way as a senior citizen.

    • Marc February 20, 2017 at 1:14 pm #

      I imagine that, being ultra-integrated, they probably wouldn’t mind global (comprehensive) category labels, like karma, impermanence, heaven, hell, and, well, addiction.

      I know what you mean about aging. It doesn’t come as fast, but it still comes. I’m talking about cognition!! …o thou dirty minds…

  3. james morris February 20, 2017 at 8:23 am #

    I think affect regulation – i.e the use of certain drugs to control our feelings – is one of the most intuitive interpretations of drug addiction. And since we all have different feelings and experiences it makes sense different folk are drawn to different drugs.

    On the issue of language, of course avoiding stigmatizing or labelling terms isn’t going to solve addiction. However I do think use of those terms can hold us back a lot. There are no simple solutions but reducing the use of language that entrenches negative interpretations of addiction and those who experience it will surely help us move forward with other efforts.

    • Marc February 20, 2017 at 1:25 pm #

      I agree, James. The trouble is that different terms have different connotations for different people. Sound familiar? I’ve been told more than a few times not to use the term “addict”…because it offends, by implying that you are defined as an x. No end of complexities there. AA has been using that kind of terminology for ages. And I just can’t bring myself to replace “addict” with “people in addiction.”

      You can’t avoid the continental drift of what one of my professors called “implicature.” Because it’s got everything to do with associations, group norms, and social politics, rather than the structure of language.

  4. matt February 20, 2017 at 10:04 am #

    Both “addiction” and “recovery” suck as descriptors for this phenomena (or phenomenon).

    I guess I lacked power and comfort and relief and self-worth and escape and expanding my mind and the ability to have fun like a kid— because I was a chemical garbage disposal. Humans are not that simple…speed or skag. This is a hard-wired, adaptive propensity– desire. We wouldn’t be here without it. But when it goes off the rails…more seems better, but it’s an illusion.

    “Addiction” is hyperfocus on an immediate, yet increasingly empty reward. And since humans are complicated, we tend to overcomplicate things. “Addiction” is an adaptive function of a brain gone bonkers, of our physical brain messing with our mind. Everyone’s reward is gonna be different, just like our genes and development and experience. You can get sober by getting rid of the addictive substance. But people don’t stay sober till they figure out what’s missing— and deal.

    Here’s an example from a SMART group last night. A woman had relapsed after 12 years of sobriety. What happened? No major catastrophe, like the death of a loved one, major injury, financial catastrope… But she finally realized that her grown son who had been living at home had recently, happily gone off to school. Empty nest stress. It doesn’t seem like trauma, but if her child has been her focus and motivation to stay sober for all those years, it is. She didn’t have anything for herself to fill that seemingly inconsequential void. But the mothering instinct goes deep, and it caught her by surprise.

    Another guy with just 10 days talked about familiar behavior in addiction…the hiding, the lying, the shame that comes with it. He also mentioned that his dogs kept him in a routine that kept him from losing everything. He would wake up in the morning when it was quiet, have a few belts and watch the sunrise with them to start the day. Routine and structure are important in early recovery, and have to be practiced to keep busy and distracted from urges. You also have to immerse yourself in routine and structure, if they are to replace the addiction, become a new habit. That morning ritual can become a sacred moment for starting the day…of anchoring one’s resolve to stay sober. I like the way Gabor Maté differentiates “ritual” from “ceremony” that I think aptly fits this. This guy can take his ritualized routine behavior, his coping behavior and reframe it to a spiritual awakening, a meaningful start to the day where he recognizes who he is, sees the beauty and wonder in it and in the world, and is grateful for it.

    .

    • Marc February 20, 2017 at 1:37 pm #

      Wow, Matt. I love your writing as always: both your stories and your thinking. As far as the thinking, you’re so right about immersing yourself in routines — a completely pragmatic and simplistic solution to a pretty abstract, complex problem. And your story highlights the value of using hinge-points or inflection points for all they’re worth — dropping the content and capitalizing on the symbolism.

      As for empty nest syndrome, I sure notice how my kids structure my day and hence my life. Sometimes I wake up disoriented and somewhat depressed. Remind me: what are we doing in Holland? And then: gotta get em up, get em fed, make em lunch, pack up homework, and get em out of the door on time. And they light up a room like nothing else — sudden loss of all that would be pretty hard to take.

      What any of this has to do with the post I’m not sure. But who cares… oh yeah, descriptors.

  5. Walter Haas February 20, 2017 at 10:19 am #

    I loved your brilliant books and posts, and S.Peele’s as well, but to be honest they overlook the salient core, from the internal point of view of the addict experiencing the trap. It all comes down to simple desire and what you believe about desire. If you believe you should run from desire, mitigate it, manage it, flee and get to your meeting, then you are forever trapped and missing the point. Desire’s POWER comes from the BELIEF that you are powerless over it and need to run internally. Its what you BELIEVE about the experience of desire that makes the addict/alcoholic. Once I realized that, I hunted IT..I WANTED desire, welcomed it, I moved TOWARD my triggers instead of away and enjoyed the process of welcoming desire and standing up to it. And poof, I’m clean and sober for years now. No meetings, no program, no therapy. I enjoy my life daily now. Desire has no power over me, I have total power over it.

    • Janet February 21, 2017 at 7:49 pm #

      Brave and wonderful. We do have to believe in ourselves.

      • Marc February 22, 2017 at 10:48 am #

        What an interesting, original, and penetrating way to talk about addiction. It’s a bit like the emphasis in mindfulness-based approaches called urge surfing: learning that you can let desire flare and then subside, watch it come, watch it go, without ever having to DO what it tells you.

        I don’t think Stanton Peele or I would disagree with you, and in fact we both highlight the value of self-empowerment over “powerlessness”. But indeed neither of us put it in quite these terms. To put it in terms of “belief” is original and could be very helpful to others.

  6. Elizabeth G February 20, 2017 at 10:37 am #

    Agreed – the distinction between “addiction” and “substance use disorder” seems like meaningless quibbling over semantics. Understanding the experiences and brain networks involved in the drive to use drugs in a compulsive manner is the next step, but we still lack the comprehensive understanding of exactly what brain networks are involved (although we have a general understanding) and how activity within them may be similar or differ across individuals. I suppose until we are at that point with neuroimaging technology and data collection, we will continue to struggle with semantics?

    • Marc February 22, 2017 at 10:52 am #

      Maybe. I don’t know if the people doing brain research care that much what you call it. They often use more specific terms than either “addiction” or “substance use disorders”. They talk about drug seeking, impulsive and compulsive learning, self-regulation and its failure. These terms are in a way more concrete, thus of more use to scientists.

      • Elizabeth G February 22, 2017 at 11:48 am #

        But they DO refer to “addiction” or “substance use disorder” as a diagnostic criterion, then look at measures of impulsivity, working memory, etc… and the brain networks involved as a sort of endophenotype distinguishing drug abusers vs. non abusers. Yet, we still categorize people with differing reasons for drug use, differing personalities and such under the same umbrella term as substance abusers.

        • Marc March 3, 2017 at 7:38 am #

          Yeah, but those aren’t the brain research people. They’re the psychiatrists, most of whom don’t know or care much about the brain.

  7. shaun Shelly February 20, 2017 at 11:44 am #

    To quote Derrida: “No, in the case of “drugs” the regime of the concept is different: there are no drugs “in nature.” There may be natural poisons and indeed naturally lethal poisons, but they are not as such “drugs.” As with addiction, the concept of drugs supposes an instituted and an institutional definition: a history is required, and a culture, conventions, evaluations, norms, an entire network of intertwined discourses, a rhetoric, whether explicit or elliptical.”

    Addiction is construct. It is something that is defined by the times. I certainly have used the term, but I use it in the broader sense, beyond the limitations of “drug addiction”, like Bruce Alexander uses multiple meanings of the word with subscripts 1-4 in the Globalisation of Addiction.

    And then of course, from this comes the word “addict” which reduces people to an homogeneous set of brain-hijacked zombies. Of course this is not true – these narratives of being unable to stop and being trapped by addiction are constructs that become self-perpetuating.

    People use drugs for reasons. When those reasons are conscious and informed the majority of the time, when they are the means to an end and not an end in itself, the use of any drug is seldom problematic, even if dependent. But often circumstances and structural issues make the habitual dependent use of drugs a logical if not conscious choice. We label this as “addiction” to appease our individual and collective shame that we live in a world where the habitual dependent use of a drug is the most meaningful relationship some will have.

    While I think there is some utility in the word “addiction”, as a construct, as it applies to all people in different states of ‘relationship” at different stages of their life (it is essentially an all-encompassing relationship), I believe there is no utility in the term addict. It comes with a preset stigma that cannot be avoided.
    This is not semantics. Words like “addict” are tools of oppression, tools designed to elicit shame and self-exclusion. Tools that shape both the individual and the response, forcing them into the Procrustean bed of the “addict” and “addiction”.

    • Donnie February 20, 2017 at 1:40 pm #

      “Procrustean” is a wicked bitchin word .

      • matt February 20, 2017 at 6:10 pm #

        hella bitchin 🙂

    • Elizabeth G February 22, 2017 at 11:49 am #

      Here, here!

    • Marc March 3, 2017 at 7:51 am #

      Shaun, This is very thoughtful, as always. I still use the term “addict”, but what you say may make me rethink this.

      As for “addiction”, you say:

      “But often circumstances and structural issues make the habitual dependent use of drugs a logical if not conscious choice. We label this as “addiction” to appease our individual and collective shame that we live in a world where the habitual dependent use of a drug is the most meaningful relationship some will have.”

      The shame part is very often correct, and it is wonderfully clear how you frame this in terms of relationships one can or cannot have. As for “logical if not conscious”, I think we disagree. Certainly addiction is not entirely conscious, though consciousness is part of it. But I think “logical” is the bigger problem.

      You talk about addiction as though it’s merely a response to environmental conditions, social resources, etc. You describe habit as though it is simply repetition leading to learning. But there’s more. Addiction is a narrowing spiral that, by its nature, extinguishes the salience of alternative goals, alternative relationships and possibilities. It is self-narrowing. For that reason, I’d say it definitely crosses a line past which it is no longer logical. At that point, logic has almost nothing to do with it.

      What do you think?

  8. Carlton February 20, 2017 at 12:57 pm #

    I think many questions like this will be answered and understood, even by the general public, when Addiction and Recovery are re-categorized as being something other than a malady, disease, etc.

    The breakthrough of understanding and definition will probably come from research of ex-addicts who feel the want and desire are no longer pulling on them, which is profoundly different from studying people that are maintaining sobriety.

    This discovery may be as revolutionary as the discovery of the Copernican model for the solar system and the planetary movements, which is so much clearer and understandable than the model that existed before.

    It is also seems understood the general public.

    • Terry February 20, 2017 at 4:22 pm #

      yes Carlton – when society wakes up to the idea that addiction is in fact a normal human state will the lexicon change – by normal I mean that habitual behaviour in multiple forms is a part of every human. The word addiction however fixes the behaviour into one which is unmanageable – and this ignores the fluidity of many security seeking behaviours that wax and wane over time depending on the stresses in the person life. Peele talks of this well in his description of addiction. Addiction also becomes a label, and the use of the word helps to stigmatise those upon whom it is stuck to – once an addict always an addict – but is it merely; once human always human, and thus once insecure always looking for ways to feel better or avoid pain. Those labelled addicts operate habitually and compulsively, have high level insecurity and anxiety and continually seek relief. the term addiction is used derogatorily when describing drug use but jokingly when describing socially accepted behaviours. recently we are seeing in Australia a lot of news stories related to ex sport addicts, elite sport people who cannot handle the loss of their addiction and in one case change to alcohol and in another to suicide, in what really is a manifestation of addiction that most of society would not ever call addiction but an elite sportsperson has to be as obsessed as any junkie to succeed. the context is very important in how this word is perceived.

      • Carlton February 20, 2017 at 6:14 pm #

        Although I have a profoundly different notion, An answer to Marc’s question
        may be found in a question itself.

        • Terry February 20, 2017 at 6:22 pm #

          I was looking for a way in and chose your entry to impose myself – you do beg the question – why don’t we question successful addicts more or those who have matured out of addiction or changed habits to those more positive without so called treatment, those people who live their entire life addicted but don’t unravel to the degrees that stereotypical addicts do. I suspect there are squillions of those. the one thing about addiction is that it is almost always seen in a negative light, about how it harms a person rather than how it may serve a person needs or in fact save them from insanity.

          • Carlton February 21, 2017 at 12:40 am #

            Terry, this quote could underscore your last point;

            “For many an individual those things that are of sorrow are of a greater help for unfoldment. ”

            Research may find that a large percentage of ex-addicts may relate to this, and there have been a few people hinting at thoughts and experiences of this notion on this Blog in the past, but unfortunately, it does not change the ongoing trauma and carnage that addiction is constantly causing.

            But perhaps facts like this may help lead to an understanding and definition of addiction that has been obscured by the beliefs and speculations of what addiction and recovery is.

            It may eventually help people by offering hope and putting a new perspective on the un-constructive feelings of shame, guilt, self-criticism and despondence that accompanies addiction.

            • Terry February 21, 2017 at 4:08 pm #

              Yes, one cannot ignore the pain and suffering. The fact that addictive use continues despite that suffering is a testament to the power addiction has over some yet I cannot also ignore the possibility that social attitudes etc lead to more suffering than might occur if addicts weren’t so often forced underground or to suffer in silence because of the illegality of what they do. Of course alcoholism and many other addictions are to legal substances and behaviours yet the shame individuals feel in acting outside of their values with their addiction sees them hide until such time as the addiction is so powerful within the individual that attempts to hide it become impossible and efforts to change often short lived. one equation I will contest is the often made assumption that anyone who uses drugs is an addict. Addiction in its purest and most destructive forms is limited to a small percentage of the whole no matter what the substance or behaviour is. Cheers Carlton.

              • Marc March 3, 2017 at 8:09 am #

                Terry, I hope you read Shaun’s comment, above. He echoes your views about shame and more. Also, if you haven’t yet, get a hold of Johann Hari’s Chasing the Scream.

                • Terry March 5, 2017 at 3:59 pm #

                  Thanks Marc – I have read Hari – and it underscores the reality that drug suers are one of the most discriminated against groups of our time. while advances in tolerance in others areas are evident little is changing in societies view of drug users, at least here in Australia. As Shaun says the whole notion of addict/addiction is loaded with social criticism and scorn and for me the reality is it is so near to normality as evidenced by the myriad other ways humans habitually do in order to avoid reality, take todays trends in computer gaming and mobile phone compulsion as examples. .

      • shaun Shelly February 20, 2017 at 10:20 pm #

        Terry, spot on and well articulated.

        • shaun Shelly February 20, 2017 at 10:23 pm #

          And your second comment as well. I argue that we don’t have a “drug problem” but a “drug solution” much of the time. https://medium.com/@shaunshelly/our-drug-problem-is-not-about-drugs-67e2885f7fa3#.ljobyk36m

          • Terry February 20, 2017 at 10:35 pm #

            Cheers. One day perhaps we might see that in sanctioning illicit drug use we are throwing the baby out with the bath water (in so many ways). Drug users are smart, initially. They manage to find chemicals that work much better than many of the medicines supplied in chemists or by doctors to treat their trauma or anxiety or social isolation. Too little is said about the benefits of drug use and too often we ignore the plain fact that despite the efforts of the DEA and the CIA millions the world over want to use drugs and find solace in the world drug use takes them to – the UN says around 250 million people use drugs each year. they are not all fools and sinners.

            • Marc March 3, 2017 at 8:11 am #

              Ah, so you are conversing with Shaun. Good!

    • Marc March 3, 2017 at 7:59 am #

      Hi Carlton. You have been beaming the same message at us for a while, and I always find myself nodding in agreement. But still I think there is a gray zone. You talk about the desire as though it flat-lines once one is truly finished. Not always. For some people (e.g., me, at times) the desire returns.

      The brain is much too complex and dynamic to maintain a static reinterpretation of a once-highly attractive goal.

      Yet I do think you are talking about a stage of “recovery” that does become a plateau, a final resting place…for many people.

      Perhaps try to make your model less absolute so it will encompass more individuality.

      • Carlton March 4, 2017 at 5:13 pm #

        Hi Marc,
        Thanks, and thank you for offering this Blog for open talk ..very valuable.. and rare!

        Not being a person of words, this radical but self-evident model of addiction is very hard to describe clearly and comprehensively. It is not a projected theory per-se, but derived from hindsight and talking with people that eventually left recovery groups before going their own ways.

        In reply to your reply here;

        Flat-lining, or “no longer having the desire”, is only one of the MANY scenarios an addict may experience, yet RETURNING to the addiction is currently the most known, but it is certainly not the larger percentage of what occurs.

        Here is a way to illustrate the many possible scenarios;

        Each of us can look back at our substantial relationships through-out our lives and most likely relate to some of these:

        …we would want to return to some,
        …we would avoid returning to some,
        …we would definitely WANT to return to some,
        …we would definitely NOT WANT to return to some,
        …we would like to return, in some way, to some,
        …we would like to return, but know in our heart it will never be the same,
        …we tried to return, but it was not the same.
        …we try not to return, but keep returning,
        …we tried to return, it was no longer the same, but not a problem,
        .. etc..etc.

        The point is that there are many more scenarios than just :

        …we try not to return, but keep returning.

        These numerous scenarios are not easily figured into the current models of Addition, especially the disease model.

        I believe ALL the scenarios can be accounted for in a single model, and that is why I keep trying to put this into words.

        This new model would also account the the many other models, including the disease model. Although it would not change addiction, it could put new light on the currently ominous and looming specter known as “addiction”, and help addicts understanding what they are experiencing, and help the public-at-large empathize and relate too.

        I have approached several writers/editors, but unless this topic is something one relates too, the hourly rate would exhaust my funds in a day or two, so I am doing this on my own at the moment.

        If there are any readers here that are writers, feel free to get in touch 🙂

        Carlton

        • Marc March 6, 2017 at 6:22 am #

          Well I’m glad you appreciate the blog as an open forum. That’s the intention. And it’s great that your putting out the call. But you know writing is such damn hard work, for me as well. There’s hardly enough energy, time, patience, sensitivity, and motivation to say the things we want to say so well that others will actually pay attention!

          • Carlton March 6, 2017 at 11:32 am #

            Yes, agreed, and even though only you and Tom Horvath have been interested and kind enough to correspond about this new model so far, there has been no replies from any of the of the other, “not-a-disease” people yet.

            Perhaps a few may run across this blog and will post here directly in the near future… 🙂

          • Carlton March 6, 2017 at 7:25 pm #

            Marc, to complete this reply, you also said:

            “The brain is much too complex and dynamic to maintain a static reinterpretation of a once-highly attractive goal.”

            This Model is based on the experience and idea that discoveries, realizations and changes of a persons feelings CAUSE changes to the brain, not the other way around.

            I think most people can look back at something they thought they could never live without yet have lived on.. and may even be surprised at the profound change in passion, want and desire.

            Not to be funny, but divorce courts are active with a full spectrum scenarios.

            A percentage may even end up being “flat-liner” type-scenarios..one of many possible end-results.

  9. Tom B February 20, 2017 at 1:48 pm #

    I suspect that the concept “addiction” is tangled together with the concept “depression.” Brain scans and psychological history-taking aren’t yet sophisticated enough to identify what important differences we hold. If it were otherwise with depression, psychiatrists wouldn’t continue their throw-antidepressants-against-the-wall-until-one-sticks strategy of prescribing them to hapless patients.

    I’ve lately fantasized that we could crowd-source gazillions of drug-of-choice reports with antidepressant-efficacy reports. How correlated are they? In away, use the drugs of our addictions as probes of our individual biochemical/genetic differences.

    • Marc March 3, 2017 at 8:15 am #

      I agree with everything you say, and I’d lay money on the results of your experiment. SSRI’s are nearly useless, while street drugs offer a wide array of “soothers” that people select from, according to their individual needs and physiological makeup. It would be nice if such drugs were more refined and even regulated. Some are very dangerous. But the argument still holds.

  10. William Abbott February 20, 2017 at 2:27 pm #

    Like Matt I think the words addiction and recovery are messy and vague– but thats the way of psychiatry . But those are the words we use so until we know a bit more about the actual phenomena ( plural) , seems they are about as good or bad as any– like the waste basket of most psychiatric ” illnesses ” .

    And then let the science lead the way and lets us focus on what we can do to help ease the suffering no matter how it is manifest.

    • Marc March 3, 2017 at 8:17 am #

      Good points, Bill!

  11. Carlton February 20, 2017 at 6:19 pm #

    Marc, although this answer is a question itself, each reader may have their own answer, and be correct for themselves.

    Is Love one thing or many things?

    I mean this sincerely, and the notion is a basis for the DILECTION Model of Addiction.

    Carlton

    • Marc March 3, 2017 at 8:18 am #

      Next time I have a couple of months off, I’ll try to give you an answer. Though as you say, it’s in the question. Shakespeare spent a lot of energy on that one!

  12. cheryl February 21, 2017 at 10:12 am #

    “habit”

  13. Donnie February 21, 2017 at 12:04 pm #

    It is really refreshing coming on this site and reading these great articles. Also everyone’s insight with their responses are wonderful. It shows there is a lot of hope moving forward with addiction. I was addicted to opiates for years. Now I am fighting another thing with food addiction. I mean it is definitely harder than opiates for me because food is everywhere and my mind craves it. Some are saying abstinence from refined sugars and starches is the only way, but I wish I could handle in moderation. Anyway take care everyone.

    • Marc March 3, 2017 at 8:20 am #

      Thanks for tuning in, Donnie. Yes, it’s a great community. And as for your food addiction, I’d try for moderation if you can pull it off. It might get easier as you learn more tricks — timing, amounts, and so on. Good luck with it!

  14. Carlton February 23, 2017 at 9:12 am #

    Marc, 
    Your “Bird” analogy is very clear, so propose this;

    By using “Music”, the element of Addiction/Desire is added.

    There are various “versions of music” being Jazz, Rock, Country, Classical , etc.

    This opens up another way to look at Addiction and Recovery.

    … If a person feels they are spending too much time or money on their music, and stops, (abstains), does it mean their love of their style of music stops too?

    …and If not, how would a person change, or end , their desire for their style of music?

    ..,,how do you measure or diagnose that a person has lost their desire for a certain style of music, evne though they stopped listing for a long period?

    …How can the Medical Field, Government or other Organization help a person stop listening, or changing their desire for a style of music?

    …Perhaps a person simply would switch to another style of music… or, “Go Clean” and not listen to music altogether?

    …How would a person prepare themselves for running into a situation where their may be music being played?

    ..there are other questions that could be asked in this manner, but I mean this is the hopes of shedding some light on looking at Addiction and Recovery from a different perspective.

    This is not my career, but I am a person who spent decades as an addict, and now years as an ex-addict, and find the current models of addiction
    quite different from what addiction and recovery look like in Hindsight, and see a model that is common-sense-ical, but hard to put into words.

    And agree with you that Understanding Addiction while recovering could be a great help to people currently struggling, (i.e. people currently labeled as addicts).

  15. carl February 23, 2017 at 10:59 am #

    Matt you say “Another guy with just 10 days talked about familiar behavior in addiction…the hiding, the lying, the shame that comes with it. He also mentioned that his dogs kept him in a routine that kept him from losing everything. He would wake up in the morning when it was quiet, have a few belts and watch the sunrise with them to start the day. Routine and structure are important in early recovery, and have to be practiced to keep busy and distracted from urges.”
    What do you mean the guy has “a few belts” because you seem to contradict whether this was helpful for him or not-It seems very unclear to me what you are getting at. I assume you mean he’s drinking with his dogs.

    • matt February 23, 2017 at 5:18 pm #

      Thanks Carl. Sorry, it was unclear. I was rushing and it shows.

      The two anecdotes were to exemplify both the seemingly random danger of relapse, and the possibility of throwing the baby out with the bathwater by misreading a beneficial sobriety support.

      A woman with 12 years sober missed an ostensibly innocent trigger after the bittersweet stress of her son leaving home for college.

      A man trying to get sober misread the potential sobriety support of watching the sunrise with his dogs because of its association with having a couple drinks in the morning. He thought that was a behavior he should change. He couldn’t see the significance and connection of that daily practice without alcohol. He didn’t see that incorporating it as a daily practice could be more powerful than its association with the substance.

      Does that clear it up any?

      • Carl February 26, 2017 at 6:53 pm #

        Matt-thank you! Yes it does.

  16. Marcus February 25, 2017 at 10:43 pm #

    This topic always interests me, thanks for writing about it. I certainly get what you said: “people attracted to opiates (like me) are fundamentally afraid of losing warmth, acceptance, and connection with other people. We grow up feeling unsafe because we are hyper-aware of our aloneness, and the soothing quality of opiates eases the hurt.” I still believe in the old medical adage “one disease, one pathology,” and that addiction itself is an unintended consequence of evolution. And its very nature resides in how the brain’s built and works. Iatrogenic dependency, or neurophysiological adaptation, is normal & in fact predictable. Whereas addiction is not. Only certain people have a genetic “liability to initiation” (as K Kendler at MCV said). So, these distinctions are important in my view

    • Marc March 3, 2017 at 8:24 am #

      Marcus, I thought I was following you, but if addiction is a consequence of evolution (like back-aches, for example?) then why isn’t it predictable. You stress the system enough, and that’s what you’re going to get. Is that really any different from iatrogenic dependency?

  17. Carlton February 26, 2017 at 7:34 am #

    Marc,
    Your well-worded differences are followed by:

    “So, lots of differences — important differences! But in my mind, that doesn’t erase the commonalities — the features that different addictions have in common.”

    The same can be said about the many differences that exist for people in love.

    The terms; “In love” and “not in love” cannow be seen as similar to the terms; “being addicted and “not being addicted”.

    The important differences you mention are good to discover, recognize and know, because it can lead to self-understanding and common-sense about the dependence on an addiction that it not really helping.

    Common-sense can gain gravity, and even return, helping a person become “no longer addicted”.

    However, whether in Love or addicted, common-sense can, once again, always be eclipsed.

    But once you know how illusions, such as a fish-bowl seeming to balance on a string works, you can no longer believe the illusion the same way again…unless you really want to.

    • Marc March 6, 2017 at 6:19 am #

      What a beautiful analogy!

  18. Molly February 28, 2017 at 12:18 pm #

    Yes! You said, “I have long believed that the kinds of feelings and personality patterns that attract some people to psychostimulants are fundamentally different from those that attract others to opiates.”
    I love this, and as a practitioner in the field of counseling, this is what I have seen as well. I have also noticed that people with different underlying mental illnesses seem to develop a certain bent for specific substances. For example, often people with undiagnosed/untreated ADHD develop an affinity for meth.

    I still choose to use the word ‘addiction’ because the people who struggle with addiction prefer it. I’m more of a fan of working to shift the unnecessary stigma behind the word, not the word itself. No matter how many times I try to say it, “substance use disorder” just doesn’t roll easily off the tongue.

    • Carl March 1, 2017 at 8:21 am #

      These days-It sure seems like the field can’t figure out what the call -let alone define it. Itsd great to challenge all the old paradigms but its not as easy to build a new model-Can you say “Obamacare?”. I’m a big fan of Marc and Stanton-that’s where my definition lies but when an individual asks me what else is there besides the 12 steps and disease model-its difficult. I explain that there are alternatives out there and i certainly push the one SMART meeting we have in the area but it gets really difficult to explain what they need to do after that. I love the analogies I get from this blog but what a mess after awhile. Addictions are complicated-I get it. brains are complicated-I get it. Explaining all of it has really gotten difficult, I need to be able to explain it to people better and i’m struggling.

  19. Carlton March 1, 2017 at 10:18 am #

    Hi Carl,
    You wrote:

    “I explain that there are alternatives out there and i certainly push the one SMART meeting we have in the area but it gets really difficult to explain what they need to do after that. ”

    It seems that the majority of people that no longer feel addicted, don’t have to do anything anymore.

    As Stanton Peel and others have noted, a large percentage of people don’t utilize recovery programs, and many people that eventually leave recovery groups, may also find they no longer have to do anything.

    But many people that experience addiction , find the various recovery communities and support groups a valuable and preferred way of life.

  20. Carl March 1, 2017 at 11:12 am #

    Hi Carlton:
    I should have said “with SMART”. Folks say to me “So what else is there?” (besides AA ) and I dont know if I’m selling things well. I mention they need to google addiction, i’ll mention rethinking drinking, blogs like sundaymorning as a support and this blog, i mention books by lewis and peele and i encourage them to find a counselor somewhere but I feel like folks dont get it. Like they look at me and are thinking “wait-why don’t i just go to an outpatient facility or AA?”

    April Smith inspires me to want to start a SMART meeting -but Its not going to happen.

  21. Matty H. March 5, 2017 at 1:27 pm #

    Well, as for mental illnesses and brain scans:

    ‘Sprooten et al.’s analysis included 537 studies with a total of 21,427 participants. Five mental illnesses were examined: schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders, and obsessive compulsive disorder (OCD)…The results were rather surprising. It turned out that there were very few differences between the different disorders in terms of the distribution of the group differences across the brain…In other words, there was little or no diagnostic specificity in the fMRI results. Differences between patients and controls were seen in the same brain regions, regardless of the patients’ diagnosis.’

    http://blogs.discovermagazine.com/neuroskeptic/2017/01/14/fmri-mental-illness/

    • Matty H. March 5, 2017 at 1:34 pm #

      P.S.: And more on what more and more people are beginning to call neuromania:

      ‘Suprana Choudhury & Jan Slaby have published an edited collection entitled Critical neuroscience (see website). This is a response by a group, which began meeting in Berlin, to what they call the “neuromania in the natural and human sciences”. They describe the “shared sense of irritation about the hubris of neuroscience and the reverberations of ‘brain overclaim’ in areas of everyday life far beyond the lab”.’

      http://criticalpsychiatry.blogspot.si/2012/07/neuroscience-needs-to-be-more-critical.html

      ‘claim that neuroscience will revolutionise psychiatry is no different from the one made by modern psychiatry since its origins with the asylums. How many more blind alleys will psychiatric research lead us down? Faulty brain circuits in mental illness are as much of a myth as biochemical imbalances. ‘

      http://criticalpsychiatry.blogspot.si/2010/09/mental-illness-as-faulty-circuits-in.html

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