Author: Marc

I didn’t think I’d do another blog post for a few weeks, but I am learning so much about addiction — from gamblers! — I have to share it with you.

Gambling really is a problem in Australia, and here’s what it looks like. The night before last I was walking around Melbourne, searching for a restaurant, when someone pointed me to the casino — a magnificent building with an enormous neon crown emblazoned on its glass and concrete exterior. The Crown Casino. I entered, past smiling security guards, and strolled down a central corridor infested with slot machines, one glittering gallery after another branching off it. Different rooms sported different games: roulette, baccarat, poker, some blackjack tables, but the most riveting signs above each table announced minimum bets per hand: $50, $100, $200, $500. Per hand! (at one point I located a $10 blackjack table and calmly surrendered my $50 stake.)

The roulette and card tables weren’t really that interesting. Very rich, mostly Chinese people stood around throwing away tremendous amounts of money, not much moved either by winning or by losing.

But there were some roulette tables where one or two dowdy looking men stood, intently calculating. Just before each spin they would spread their chips in some intricate cabalistic pattern of numbered squares and intersecting lines. And when the wheel slowed down and the white ball finally settled, it mattered. You’d either see a flash of triumph or else despair. And sometimes a protest:

“Oh fuck, again?! You couldn’t do me a favour this once!” shouted one man, only slightly conspicuous by the sweat stains in his armpits.

And then he’d shovel another $50 or $100 at the dealer and get another pile of chips in return.

“Who was he angry at?” I asked the dealer, after the guy stormed away. “Is he angry at you?”

“I’m just doing my job,” the young man replied. He looked like he might be working his way through law school.

“Yeah, but they know that, right? And they know that whatever number comes up is completely random, right?”

“Sure, they know it, rationally they know it, but they still think they’ve figured out the pattern. And I don’t know why that guy was so mad. He won a thousand bucks in the last hour.”

I think his anger came from shame. Losing makes you a loser, especially when someone’s watching. But the most horrific sights in the casino were the slot machines. These high-tech electronic monsters are designed to instill a sense of triumph while you continue to lose your shirt. Men and women of all ethnicities and incomes sat there and hit one of a short row of buttons mindlessly, repeatedly, watching their net balance dwindle, roll by roll. But with occasional rebounds — accompanied by flashing lights, prancing cartoon nudes, and peppy jingles. Only to continue their downward journey a moment later. I watched a middle-aged Eastern-European couple shovel bills into the slim mouth of the machine every few minutes and keep on playing. Did they actually think they would win? I asked them that. The man told me to go away.

What was so spooky about this robotic ritual was the flatness of the facial expressions. The players hardly reacted to winning — or losing. Their expressions didn’t change. They just kept punching those buttons, every time the machine reset, which was every few seconds. And for them it mattered.

Losers eventually have to give up. Then they go home and lie to their loved ones, take out another loan or ratchet up their credit card maximum, and come back to press that button again in a few more days. The only time you see emotion on their faces is when they finally stop, transfigured by despair and disgust.

Nobody has to tell you that gambling is addictive. It’s obvious. But here’s what I learned that night and in my readings and discussions since then:

First off, the compulsive slot-machine players looked exactly like end-stage drug addicts. People who snort or shoot up hour after hour or minute after minute. They’d display almost no pleasure. And then, when it was all gone, they’d go out to score, because that’s just the next step. I’m reminded of a guy bedded in the cot next to mine in a cheap hippie hotel in Delhi, many years ago. This guy would rise up on his bed, reach down below for his carton of morphine ampoules, break the top off one of them, load it, shoot it, and then lie back down for almost exactly four hours. Until he started to twitch. Then he’d do it again.

Maia Szalavitz calls it the hedonic treadmill. And it’s got everything to do with our standard biological computations. It’s about dopamine and reward prediction error. If the reward is the same or less than what was anticipated, the dopamine surge that came with anticipation drops back down to zero. With heroin, that takes place soon after you get the rush, the buzz…once you realize “oh this is all it is? — Now what?” With coke you get it in a few minutes, once you perceive that this little bump was merely a flash in the pan. False advertising. Ice-cream melting. But with gambling?! These folks lose almost every bet, and the bets they win are tiny.

So that’s the exaltation offered by gambling.

But then there’s the longer-term loss. The loss you feel when you get up after you’ve given up and look in your wallet (as if you had to) and realize that you lost it all.

Then there’s the blunting. I won’t get into that here, but addiction neuroscience is pretty clear that dopamine receptors thin out with all that action, so all rewards — both those provided by the addiction and those provided by pizza, sex, and playing with your dog — become flattened, diminished, boring. In which case, all you can do is to take bigger hits (more coke, more smack, or bigger bets at the tables) or else — finally, once you’ve had enough — quit. (Note that disease-model advocates conflate this effect with tolerance, which often rises in parallel though it’s not the same thing.)

And then there’s the really long-term loss: the loss of self-esteem. That’s the shame and mortification and self-disgust that shrouds you the way mist clings to the branches of a dying tree. That’s what gave rise to the rage of mister sweaty-armpits roulette player — anger borne of shame. That’s what gave rise to the despair shown by the couple with the Eastern-European accents as they staggered away from the slot machine, the machine that betrayed them.

Sound familiar?

 

 

I’m off to Australia for two weeks. I’ll be doing talks, public debates, etc, on the subject of gambling as well as substance addiction. Apparently gambling is a more serious public health issue than alcohol or drug addiction in Australia. I’ll also be spending some time on a farm somewhere where they shear sheep and herd cows. Should be a nice break from urban life in Holland.

So in lieu of a blog post, let me leave you with a link to an article recently published by David Schimke in the Chronicle of Higher Education, August 7, 2016. Despite the title, it’s a broad and thoughtful review of the whole gamut of current trends in the study and treatment of addiction, covering perspectives from biological science, social science, public health, psychiatry, and so forth. As a touchstone for this review, Schimke describes choice moments in a conference I participated in (along with Carl Hart, Owen Flanagan, Sheigla Murphy, Michael Pantalon, Mark Willenbring and others) a year ago in Minnesota. The talks, panel discussions, and ad-hoc debates ranged from antagonistic showdowns to insightful analyses of where we are now and where we’re going — which pretty much epitomizes the field overall.

Here are a few paragraphs, to give you a sense:

The panelists at the conference expressed a range of opinions about the disease model. Though their views did not break down entirely along disciplinary lines, the social scientists tended to be the most wary of the label. On the one hand, nearly everyone ceded, it’s an established fact that addiction alters dopamine receptors in the brain and can affect how the limbic system functions. There’s also compelling research that some drugs, such as naltrexone for opiate abusers, can help curb certain cravings, which suggests that dependence is at root a biological phenomenon.

Still, a slim majority of the panelists…did not want to emphasize the word “disease,” because it implies that chemical dependence is primarily a function of pathology, when in fact environmental factors (dysfunction at home, stress at work), learned behavioral patterns (binge drinking, for instance), and economic disparities have been shown to play a significant causal role. Clearly, the debate was not just semantic.

The disagreement over terms is rooted in the 1930s and 40s, when AA came of age and provided a life raft for chronic alcoholics, many of whom had been doomed to suffer crippling isolation, institutionalization, and early death.

Schimke then goes on to cover the goals, achievements, and failures of AA as it has evolved over the decades. He also reviews recent, cutting-edge research, the differing implications drawn from it, and the diverse politics, treatment philosophies, and public-health agendas that often come together more like a playground brawl than a maturing field of study.

Here’s another tidbit:

That institutional bias is, in large part, what upsets many social scientists. They’re concerned that precious federal funds are too often pushed toward studies and programming steeped in status-quo assumptions, instead of challenging longstanding treatment paradigms and biases.

And near the end:

Sheigla Murphy says she would like to see more gatherings like the conference at Gustavus Adolphus, where people from different disciplines can engage in public debate and, ideally, find more opportunities for mutual understanding and compromise.

Anyway, take a look and see what you think. I’ll be back in two or three weeks.

This is an intimate, personal account, unlike my other posts. I’ve thought for a long time about whether and how to share it with you. I decided I had to try.

Picture yourself in a large, dark circular chamber, sleeping bags and cushions arranged all around the perimeter of the room, with an interesting looking (often long-haired, colourfully dressed) man or woman seated on each of them. About 25 in all. There’s a fire crackling in the middle of the room, its smoke rising to a chimney hole in the shadows high above. The shaman sits on a stool behind a little table, covered by fabrics and totems of various sorts, somewhere behind the fire. There are candles here and there, but the chamber is mostly dark. An assistant, sitting next to the shaman, prepares the brew, stirring a large flask of brown liquid. The shaman pours a certain amount in a cup, then beckons the next person to come and drink.

One by one, each of us goes forward and sits down on a small stool just in front of the shaman’s table. Now it’s my turn. The silence rushes in. I can barely see the man’s face, but I sense his smile, the twinkle in his eye as he looks directly at me. He hands me an earthenware mug, and I drink the nasty tasting liquid in two gulps. I thank him by touching his hand. Then I sit back down, and the next person takes my place.

By the time the last person is done, the ones who went first are beginning to make noises. Little sighs, or gasps, perhaps a low chuckle…or a fart.  The person I came with (I’ll just say “my companion”) is on the sleeping bag next to mine. Nobody is going home tonight. We will lie down and sleep when the time comes. For now, we look at each other and raise our hands in a “cheers” gesture, smiling. Happy landing.

The wave of sounds makes its way around the chamber until — I feel the changes starting to happen in my own body and in the implicit motion and blending edges that begin to distort my field of vision. It’s been about 40 minutes since my drink. I’m excited, hugely intrigued, and terrified.

Then everything starts to change very rapidly: my perception, my thinking process, and my bodily awareness. The patterns on the prints on the far wall start to extend out into the room. Soon it’s difficult to tell which lines and whorls are painted on fabric and which are insinuating themselves in the air all around me. Tiny noises are magnified; sounds ricochet through an echo chamber.

Magic rushes in from all sides. Visual perception becomes vastly distorted: space fills with interlocking mosaics, people’s faces mutate, shifting identities, growing halos. The candle beams are fiber optic cables fraying like cotton scorched by flame. And so on and so on. I’ve tried to put the psychedelic experience into words several times. See my “Memoirs” for example. It’s not easy, but you can find many attempts at such descriptions on the net. So let’s cut to the chase.

This stuff is coming on very much like LSD. But it’s stronger. It’s happening too fast. I am overwhelmed. I wish I could turn the volume down but it keeps going up. The visual hallucinations are now so thick that I can barely see what’s actual. The wall is an arbitrary layer in a thicket of planes. As to the doors, I simply can’t find them.

This becomes a real problem when I have to go to the toilet. I’m now lying on the floor, on my side, and I can’t get up. I have no sense of balance. And I have to shit. And suddenly I realize that the urgency of the shitting, about which I’ve been warned, is right here, right now, and I have no clue what to do about it. I can’t ask for help, because I can’t find anyone in this fog of patterns. And I don’t think I can speak. I know I can’t stand up. And I don’t know which direction to crawl in.

So here comes the shit. It’s relentless, and there’s not a thing I can do about it.

Now I’m lying on the floor, somewhere, and there’s shit in my pants. I can’t figure out how much shit, but it feels like a giant mound. I imagine it has already covered the sleeping bag of one of my neighbours, though this turned out not to be true. There’s a very clear voice in my head. It’s my voice, and it’s remarkably sharp, considering my predicament. The voice says: this is an engineering problem. I have all this shit in my pants and I can’t get up or move.

I found out later that I had lain on the floor saying “oh fuck, oh fuck” several times a minute. For several hours! But what I experienced subjectively was different. I experienced PURE HELPLESSNESS. Yet there was a calmness in it. This helplessness was the ground floor of an architecture I’d lived in all my life. I can’t give you a clearer sense of what I mean except by repeating these words: paralyzed, shit, can’t see, can’t walk, can’t ask for help…and then I started getting cold. Really really cold. But there was nothing I could do about that either, since any movement (e.g., creeping toward the fire) had become much too challenging.

We were all instructed not to interfere with each other’s “trips” unless we deemed that someone was in great distress or in actual danger. (And in those cases, the assistants always seemed to get there quickly.) It was thought best to let people go through their suffering and learn what they needed to learn from it — without interruption. So, for three or four hours, I lay there and considered what pure helplessness was like. I had not experienced it since (presumably) my infancy. There was a lot to catch up on. I felt the helplessness through every part of my body and mind. I prodded it from every mental angle. I thought about it. I felt it. And I remembered it.

We know (intellectually) that we come from helplessness in infancy and return to it in old age or on our death-beds if we don’t live that long. But how can we actually live with that knowledge? How can we just be here, knowing that we could lose everything at any time? And someday we will? How can we endure this condition? And then…what other condition is there? With the plant soothing and guiding me at the deepest level, I experienced (vividly, like I was there) what it was like for my ancestors, tens and hundreds of thousands of years ago, to not be able to get warm. To be freezing cold, with no fire anywhere. I felt the ultimate fragility of all animate beings. I experienced helplessness as pure reality.

And I kept asking myself, and asking the plant who seemed a living presence, who could endure this? And the answer came when I listened to my breathing and asked (as I often still do in meditation) who is doing this breathing? This body. That’s who.

I remembered what it was like to be a small child and depend entirely on someone else to help me out of problems I could not solve. And with that came the most brutal and most enlightening realization: tonight, every time I considered calling out for help, I stopped myself, because I didn’t want to bother anyone, and because I was ashamed. I heard my voice coil into these self-effacing, euphemistic pleas: if it wouldn’t be too much trouble…if you wouldn’t mind… In fact I could not imagine that someone (like a parent) might just want to help me. I could not trust.

Which neatly explained the two years of bullying and despair I’d forced myself to endure at boarding school as a teenager (before I got seriously into drugs). I could have asked my parents to get me the hell out of there. But I didn’t. Now, for the first time, I understood why.

All these insights came with a kind of intense grace or beauty despite their awfulness. The ayahuasca was unsparing, determined, but also somehow generous and loving, like a planetary caregiver.

Help came, finally, when the hallucinations abated enough for me to recognize familiar faces. Like the face of my companion and the shaman — both looking concerned. I called to them. They hoisted me up, gently, pretty much carried me to the washroom, and hosed me down in the shower. There was no warm water. I was colder than I’d ever imagined being. But they got me clean. And I had brought clean clothes. They helped me stagger back to my spot, and before too long I was almost okay. I lay down on my sleeping bag and, once the whispers faded, finally slept.

That recognition of pure helplessness hasn’t gone away completely, and it’s been a few years now. Sometimes it’s distant, sometimes (for example when meditating), it’s right there, a cosmic slap in the face. And at each of these times, during each of these replays of that first dreadful realization, I understand something about myself I’d never understood before that night. Even after ten years of twice-a-week psychotherapy in my thirties. I understand that (until quite recently) I have lived my life in denial of my helplessness — and in denial of the lack of trust that makes it so sad. My thinking skills, my determination, my obsessiveness, my drive to succeed (20+ years as a professor is no picnic) — all were weapons against helplessness. In the service of self-control.

And so was my drug-taking — because drugs are a way to deny helplessness. Drugs allow you to change things, to change how you feel. Drugs were a way to take control of my mood — my anxiety, depression, shame, fear…to vanquish them. If only for a while.

My conclusion is simple: Can taking psychedelics help us understand our addictions? Yes, but it might not be an easy ride.

My four subsequent ayahuasca trips (three in South America) weren’t nearly as difficult as that first one. And I was able to make it to the toilet each time — though sometimes at a run. Why did I ever take it again? Because I wanted to experience other facets of this strange substance and the tradition it came from. And I did. I experienced cohesion, love for those around me, beauty so intense that it made me cry, and something else I’d never felt before: pure, unfettered gratitude, gushing outward into the universe. Gratitude for something I can’t explain. I mention this because I don’t want to leave you with the impression that psychedelics can only be valuable for the pain they release. They can also be valuable for connecting us with the goodness inside and outside ourselves.

That might be another important way to help people move beyond their addictions. But more on that another time.

 

Since the discovery of LSD’s mind-blowing properties (in the 1940s-50s) there have been several waves of research, clinical trials, and of course “recreational” tripping with LSD and its close cousins, mescaline and psilocybin (magic mushrooms). The interest and excitement of the scientific community was pretty much squelched in the US by legislation making LSD strictly illegal, a policy that continues to this day. But more enlightened countries have resumed research on LSD and psilocybin. These substances are of great interest because of their (probable) clinical value in fighting depression, chronic pain, chronic anxiety, fear of death, and — you guessed it — addiction, especially alcoholism. Take a look at this intriguing documentary trailer. Meanwhile, recreational use has continued over the decades, trending and receding in different countries at different times.

We are also finally beginning to understand LSD’s impact on the brain. A recent, multi-layered study showed that “under [LSD], regions once segregated spoke to one another.” In other words, psychedelics open lines of communication between neural regions that normally stay hived off from each other, doing their own (quasi-independent) thing. We don’t really know how this affects cognition, but participants who showed the greatest increase in cross-brain synchrony also reported greater “ego dissolution.” That makes sense. According to the lead researcher, David Nutt, “The drug can be seen as reversing the more restricted thinking we develop from infancy to adulthood…” Nutt concluded that LSD “could pull the brain out of thought patterns seen in depression and addiction.” (quotes and paraphrasing from this article). Here’s a slightly more technical but excellent review of the study.

What’s most interesting here for addiction? Well, for one thing, David Nutt has long functioned as a lead adviser to the UK government on drug policy (the equivalent of a drug czar in the US?) And he was the lead author of the study! Nutt is no nut. He’s smart, influential, highly respected as a scientist, and progressive in his views and advice about drug use. So if David Nutt is cool about exploring how acid disintegrates neural barriers, then you know that psychedelics are no longer being sneered at or ignored by scientists, that they’re being recognized as potent tools for revamping thought and perception, essentially breaking neural habits — if only for a few hours.

So what’s the word on the street? Well you’ve probably heard of ayahuasca, and if you haven’t you should really google it. You can start here, or start with Wikipedia. Ayahuasca (or its underlying molecule, DMT) is the psychedelic of the present age. Many young people know about it, some have taken it, and the reports of users are (as usual) controversial. Some have had a bad trip, some have been duped by fake shamans, but the majority have huge respect for this natural herbal brew. Many feel it has been transformative in their lives. Shamans in South America have used ayahuasca for centuries to help treat ailments of the mind or the spirit, and it is also regarded by today’s youth as “healing.” Yet for many ayahuasca drinkers, there is nothing overt that needs to be healed. For them, ayahuasca is an opportunity to learn deep lessons about who they are and how they connect to the world.

Many with addictions have gone to ayahuasca for help. And the renowned addiction expert, Gabor Maté, has become one of its strongest advocates. Maté is convinced that ayahuasca is the most direct and effective way for addicts to uncover and come to accept the pain and confusion they’ve kept inside and which perpetuates the emptiness and anxiety that locks in their addiction. He also sees it as a gateway to an uncluttered, even blissful, sense of the universe — which sounds like the kind of universe you’d choose not to damp down with heroin. Maté emphasizes the importance of taking ayahuasca in a tradition-based ceremony with an experienced shaman. He has set up various supervised ayahuasca retreats, first in Canada (specifically targeted to the addict community in Vancouver) and now (that it’s been banned in Canada) in Central America.

I don’t consider myself an addict anymore, but I still have addictive tendencies, ruminative thoughts, sporadic depression, and an attraction to alcohol (within the bounds of social drinking) to help ease my discomfort with myself. So I didn’t take ayahuasca to treat an addiction. Rather, I took it because I wanted to experience its power and potential — with some hopes that it would help free me of lingering anxieties and depression (not without some hard work — as Maté also emphasizes). I had taken a lot of LSD and related drugs when I was young, in the 60s and 70s. I think these experiences were useful to me in various ways, but they certainly didn’t smooth out all the rough edges. I suppose my last acid trip was some time in my thirties. Then I stopped. Been there, done that. But what’s all the fuss about ayahuasca? Is it really different in some fundamental way? I wanted to find out.

There are ayahuasca ceremonies in Europe every year, most if not all supervised by experienced shamans and their assistants. I’ve now taken ayahuasca five times (in five years) and I doubt I’ll ever take it again. It’s just too much for this old brain. Ayahuasca isn’t exactly fun. It can be disturbing, it can be hard work (just to endure), it can make you shit your guts out and puke violently (politely called purging). But it can also be wonderful, enlightening, and (I think) constructive in a big way — if done in the right circumstances with the right follow-up.

I’m out of space here, so I’ll tell you about my own experience in my next post. Coming soon.

Meanwhile, warning! If this little introduction makes you want to run out and try ayahuasca, do not even consider doing it without a knowledgeable, experienced shaman or other guide. You don’t do this in your high-rise apartment one night, or at parties. And you don’t do it alone. Oh and if you find a proper ceremony to attend and feel you’re ready, make sure to bring an extra pair of undies.

 

 

 

 

 

 

 

Since retiring from the university about a month ago, my “career” seems to be better defined than ever. I’m a science writer and a speaker. And because I get invited to write articles and give talks, I’m obliged to continue to update my understanding of my field, which happens to be addiction.

And things keep changing. In the realm of neuroscience, there is more attention to neuroplasticity, more attention to cellular changes and the molecules involved, new findings in genetics, epigenetics, the biological sequels of early trauma, and so much more. In the treatment realm, harm reduction and decriminalization have become centre stage, there is increasing opposition to court-ordered attendance at 12-step groups, and the glaring discrepancy between the brain disease model and 12-step methods continues to…well, glare. At the interface between science and treatment, there’s new thinking about the benefits of psychedelics, new research on how meditation changes the brain, investigation of smartphone apps that might help control urges, and increasing precision in the debate between the disease model and the learning model — as both sides advance their weaponry.

I want to do a few posts that identify and explore these new directions.

To start, let’s go back to the fundamental question of definition. If addiction isn’t a disease, then what is it? As you can imagine, I get asked this a lot.

My first reaction is to call addiction a habit of mind. But what on earth does that mean? Calling it a habit of mind at least avoids having to choose to focus on cognition, emotion, or behaviour: rather, all three are on the table. Which respects the finding that cognition, emotion, and behaviour can’t be clearly differentiated in brain structure or function. They overlap entirely.

But what do I mean by habit? It’s an old word, a colloquial word…how much traction can we get from such an everyday term?

To explore that question, let me tell you how scientists define a habit. And for that, we need to take a brief tour of complexity theory. According to complexity theory, a habit is a stable state in a complex system — a system composed of many interacting parts. Complex systems — such as ecosystems, societies, cultures, family dynamics, flocks of birds, herds of cattle, individual minds, individual bodies, and certainly individual brains — are made up of components (birds in a flock, family members at the dinner table, plants and animals in an ecosystem) that continue to influence each other. As a result, the relations between them continue to change, which means that the whole system (e.g., the family, the flock, the body, the mind) can continue to alter its form. Change is intrinsic; it doesn’t come from outside the system. Change means change in the interaction patterns, the relationship of the components, not the components themselves.

Your sister makes a caustic remark at the dinner table, then your mother puts down her fork, and then your father gets silent and distant, and then Aunt Jenny starts to criticize your sister. So the shape or form of the family dynamic changes, all by itself, with no particular push from the outside world.

But if complex systems can change so easily, why do they tend to fall into the same familiar patterns time after time? In fact, stable, recurrent patterns — or “habits” — are fundamental to all complex systems. They are called attractors, because they literally “attract” the system. The flock of birds continues to fall into its characteristic V shape, family arguments always devolve into a familiar but infuriating script, and individual minds fall into familiar concerns or interpretations (e.g., “nobody really understands me!” or “I’m just so cool”) every hour of every day. Attractors aren’t necessarily attractive!

When we talk about people’s minds, what do we generally call these attractors — these habits of mind? Well, if they last only a few hours, we can call them moods. But if they recur week after week, month after month, year after year, we can call them personality patterns. Personality patterns (or traits) emerge more and more predictably during childhood and adolescence. (Of course, most people have several and can even be seen switching from one to another — e.g., grumpiness to guilt — as circumstances shift.) These patterns recur, they get reinforced, they set synaptic connections into particular configurations (or recurring synaptic configurations set them, depending on how you look at it), and they stabilize. In fact they become incredibly stable. Traits consolidate with development and they perpetuate themselves, becoming  “stuck” over the lifespan.

Complex systems naturally fall into habits. Otherwise, they would waste a lot of energy trying and discarding different patterns, different forms. That’s called chaos, and nature doesn’t like chaos. Complex systems fall apart if they can’t cohere into patterns. In fact, a large-scale pattern actually maintains the interaction of its parts in a very particular (and energy-efficient) configuration, which recreates the large-scale pattern again and again. So the (global) pattern and the (local) interactions literally cause each other (called circular causality). That’s what makes habits so resilient. That’s why it’s so hard to achieve deep, lasting change through psychotherapy. Hard, but not impossible.

What does this have to do with addiction? As I see it, personality traits or habits include what we might consider mental health problems. Such as: depression, anxiety disorder, overdependency, paranoia, obsessive-compulsive disorder, aggressive or antisocial personality style, etc, etc. All those patterns emerge and stabilize over development (even if they get a boost from genetics). They usually become stuck by early adulthood, they cause a lot of misery, and they are hard (but not impossible) to change. Addiction is just another such pattern.

So addiction isn’t really different from other mental health issues: it’s a sticky, long-lasting habit in the development of the self. And when you look at how complex systems work, how they get stuck, you see that addiction is actually natural. It’s not some kind of aberration. (Of course that doesn’t mean it’s good!)

Addiction is a habit in a very real sense. It’s a self-perpetuating way of thinking, a self-cohering set of beliefs, a self-reinforcing progression of emotions (desire-excitement-disappointment), and a limited (stuck) behavioural repertoire. Addiction is a habit of mind.