Author: Marc

Hi people. I wanted to write one last post before leaving for India. (tomorrow!!!) So here’s something that’s been on my mind a lot lately. We have discussed many ways of seeing addiction and recovery in terms of choice. We mostly agree that, if using or abstaining is a choice, it’s a very unusual kind of choice. It is often irrational, it changes over time, it becomes more pressing (or less pressing) as the moment of action approaches, it is highly dependent on biases and motivational undercurrents, etc, etc. If it’s a choice, it’s not the kind of choice you make when you decide what movie to watch or what you’re going to make for dinner.

Or is it?

Here are a couple of quotes from a paper about intentions, by a philosopher named Marc Slors (Philosophical Psychology, 2013).

[T]here is considerable evidence against the causal efficacy of proximal (short-term) conscious intentions… [my italics]

Libet, Haggard, and others…showed that simple conscious motor intentions occur only after the unconscious neural onset of actions.

Um, what?! Slors reviews studies (both behavioural and neural) that show that people’s actions are not determined by their preceding intentions. In other words, our actions happen without our intentions, or despite our intentions, or preceding our (imagined) intentions…all the time! Not only when we “impulsively” or “compulsively” reach for the bottle or the phone to get high. If you believe the results of this research (and I don’t see how you can avoid it), it makes your head spin. It blows a big hole in the idea of “free will.” And yet free will is a fundamental assumption we make all the time. To imagine that free will doesn’t exist is almost blasphemy. Yet it makes addiction a lot easier to understand…

A classic experiment demonstrating the irrelevance of “choice” or “intention” would be this. Subjects are asked to make a simple choice, with very little consequence for anything. For example, they might choose whether to press the button showing the red circle or else the one showing the green square. Once they’ve made the choice and seen the result, they are asked about it. Did you choose which button to press? When did you make the choice? Without fail, people report that they made the choice from a moment or two to several seconds before they pressed the button. But in fact, the likelihood of pressing one button or the other was strongly determined before that time. It was already predicted by cues (words, images) given to them (without their noticing) before they (think they) made the choice. For example, cues like the pairing of pleasant pictures with the colour green (or with squares) and unpleasant pictures with the colour red (or circles). Other studies have found that brain activation patterns strongly predict the choices people make, before they themselves have any conscious idea of what they are about to choose.

Here’s another quote from Slors:

In this experiment…thoughts are “inserted” into the heads of people just prior to their being coerced, unbeknownst to them, to perform an action that matches the thought. In such cases, people turn out…to think that their action was caused by their thought.

Well I find this stuff completely astounding. So, whether I make fish or chicken tonight will not depend on my thoughts just before “making the choice.” I’ll think it will, but it actually won’t. Rather, it will depend on unconscious processes already at work. These will probably include how I feel about the last few meals I’ve made, how I think my wife and kids will respond to soy sauce, etc. But I won’t be conscious of any of that. I’ll think I’m simply making a free choice.

So, immediate intentions (called “proximal intentions”) really don’t have much effect on our actions. But that’s not the end of the story. Long-term intentions (called “distal intentions”) do have an impact on our actions. A very strong impact. For example, I’ll be flying to India tomorrow. That action will have nothing to do with any choice I make between now and then. That action was determined by what I decided several months ago. I decided I wanted to go on this trip and I bought myself a ticket — which took an hour of fussing online. Get the point? Free will isn’t dead…but it works in a very particular way.

I’ve written various posts and comments about the fact that addicts have an especially hard time making good choices because the immediate goal (e.g., getting high) overtakes the whole motivational system (the striatum) and overwrites the value of long-term goals — like having a bank account and staying out of jail. But it turns out that this is just a more extreme version of a very general issue: immediate choices are illusory — they are already determined by the value you have attached to something. The fact that you just love cocaine, and you’ve devoted about a billion synapses to fondling it mentally, is going to determine whether you get high tonight — not the choice you make in the next two hours.

What I’m getting to is this. If we recognize that short-term, proximal choices are weak, meaningless or illusory — if we recognize that only long-term, distal choices actually determine our actions — then the only way to quit being an addict is to plan ahead. The only way to stop is in advance of the moment. This may not be big news to some of you. We already know (don’t we?) that you have to get rid of all the booze in the house if you want to make sure not to drink later on. And we know (don’t we?) the value of rules, like “I will never drive home on Yonge Street after work, because that would take me right by the liquor store.” Or telling your buddy, Joe, that the next time he calls you you’re going to call the police — because you have to make sure, in advance, that you will never speak to him again. Or joining a group. Or telling your doctor, look, Doc, I have a problem… Or maybe just emailing him or her. That would just take a moment. You could do it right now. That’s a version of “sneaking up on choice” (recent post), because you can do it without thinking about it intently (this time, anyway).

Rules and plans are not only important for choosing to quit. They are almost the only things that work. (Mindfulness is great too, surely, but then you also have to plan to meditate regularly.) Proximal intentions don’t matter. By the time you are getting close to the point of action, the dye is already cast. Setting up intentions in advance is called “self-programming” by Slors, and I think that’s a great name for it. You are indeed programming your own future, by changing contingencies, determining circumstances, setting up non-negotiable outcomes. You are programming your life, and your brain, and your environment,  your unconscious as well as your conscious mind, by intending and planning what’s going to happen.

Now that’s free will. Use it wisely!

 

P.S. I will be giving your regards to the Dalai Lama. Seriously. Enough of you have asked me to do that…I figure the feeling comes from all of us. After all, the dude must be pretty interested in addiction to have a five-day meeting on the subject.

 

 

 

 

 

 

 

 

 

Hi again. Well, I started writing. What a relief! I’ll say more about that in a sec, but to make it slightly relevant to this blog, let me tell you what I just learned about “choice.” Last post there was a great dialogue about the “choice” model of addiction. I ended my post arguing that the choices addicts make are highly irrational, based on biases and attractions already inscribed in the brain. Thus….we need to think about making choices in a new way, a way that has nothing to do with logic.

So writing is an intentional act, right? Sitting down to write something, whether a book or an email, is a choice people make. It’s clearly not a disease, it doesn’t happen unconsciously, and it involves deliberation, planning, and so forth.

In that way, writing is something like the decision to take a drug or a drink. And it’s also something like the decision to quit — choosing not to take a drug or drink. (though it’s always harder to choose not to do something than to do something — because the goal is not right there in front of you)

My choice to sit down and write involved a great deal of anxiety, self-scolding, reflection, and many many attempts before I actually pulled it off. Sound familiar?

I had to sneak up on myself. And that’s very often the way addicts manage to quit. I had to wait until I wasn’t concentrating. It was too difficult to sit down and force myself to write, to stare myself in the face. Rather, I was en route to doing something else, making dinner or something, when I stopped at my computer and wrote a few sentences on the fly. Very little deliberation, actually, in the moment of doing it.

But that was enough. An hour later I stopped by my computer and started to revise the….ONE PARAGRAPH. There’s already one paragraph on the screen! I wrote that. And it’s not too bad. Paragraph 2 flowed from paragraph 1, as you’d hope, and since then it’s been easier and easier.

So here was a deliberate and important (to me) choice that changed the direction of my life, the way I spend my time. And I had to be clever, resourceful, sneaky (toward myself), not staring myself in the face — in order to make it. The parallels with quitting are obvious. And the choice to take drugs is not unlike the choice to quit, in that it can happen on the fly, without really focusing on what you’re doing.

The coolest thing I noticed is how the activity of writing grew on itself. Once I had one paragraph on the screen, I felt that I could do it. I felt that I was finally moving. Then the second paragraph was so much easier. And thirty years ago, my second week of recovery was a lot easier than my first.

By the way, this is all about the emergence of self-trust, a topic we discussed in some detail several posts ago.

To say that addiction is a choice is to say very little. The same goes for recovery. Choices come in many shapes and sizes. The crucial thing to remember about making choices is that they usually involve a mixture of deliberate intention, situational factors, unconscious processes (like biases), emotional readiness, and momentum — that sense of moving forward. Some choices, including the choice to quit drugs, depend a lot on momentum. Which is why it’s so hard to get started, and why it’s so useful to sneak up on yourself, don’t think too much, just do it, then let nature take its course (with a little help).

 

 

 

Hi all. I’ve been low on energy for a couple of weeks, which is why I haven’t posted anything. Actually, depressed is the word. I have this whole world of opportunity waiting for me — a visit with the Dalai Lama! And yet I’m completely nonfunctional. I’ve been trying to start Book 2 for over a month, and it just seems like too much effort. At the same time, Isabel is highly stressed at work, and she brings it home with her (of course), so we argue more, which depletes my energy further.

The working title for my new book is: The Biology of Desire: Why Addiction is Not a Disease. You probably know my stance on that one. But the problem is: how to frame it in the current debate? The way I see it, most of the medical community, most if not all of the psychiatric community, most of the treatment community, and most of the scientists who study addiction (either behaviorally or neurally) do in fact see addiction as a disease. Nora Volkow, the head of NIDA (one of the nine branches of NIH) describes addiction as a disease every chance she gets. A chronic brain disease. So it’s important to refute that definition — if in fact it’s wrong. But the trouble is, you then get bogged down in this dichotomy: that if addiction is not a disease, it must be a choice.

The current spokesperson for that position is Carl Hart. Here’s the latest: a write-up and video, care of the New York Times.

Hart brings crack addicts into the clinic, they stay there for awhile, and they are offered crack to smoke on a regular basis. But they are also offered a certain amount of money each time they forego the crack. And often they make that choice: they take the money instead. Sometimes for as little as $5, and almost always when offered $20. In other words, addicts can choose not to partake of a highly addictive substance if they have alternative choices that are attractive. Hart deserves the credit he’s been getting for this research. He is showing that addiction is not a result of some property of a drug; it is the result of some property of the environment, namely the absence of opportunities to get rewards elsewhere. Hart compares his crack addicts to the poor, young, black, marginalized men he grew up with. He argues, very convincingly, that there were no other rewards (e.g., financial stability, steady interpersonal relationships, respectable jobs) available to them. So they chose to get high. According to Hart, it was a rational choice, given the available options.

And by the way, Hart talks about the impact of environmental impoverishment on rats too. He reviews the famous “Rat Park” studies by Bruce Alexander, which I have written about elsewhere. Here is Alexander’s own commentary on what he found out about addiction and environment.

But I don’t agree that addiction is a rational choice. Just yesterday I got an email from a meth addict who’s in big trouble. Someone I don’t know. I had answered a desperate query from this person a couple of months ago, then again a couple of days ago, saying there wasn’t much I could do to help. Then I got this email yesterday:

I am unsure of what to do or where to turn next. I tried rehab once for a few days before my body became toxic and I ended up in the hospital for a week. It was only after I tried quitting that i fell ill close to death with a high fever,failing kidneys and toxemia. Now three years later I am that much more addicted and afraid that this is what will kill me ,and it wont be long. I dont know what I am more afraid of, being sick physically and dying or  staying high, falling apart mentally ,and for things to never change. Maybe this is how it was meant to be? In which case life isnt worth living and my children might be better off without me. I wish there was an antidote.

That doesn’t sound like rational choice. And I get emails like that, more or less, once every week or two.

I want to get into this debate, but where? The problem with the “choice” approach is that it completely ignores the brain. It relies on economic reasoning, not biological reasoning. But we are our biology, Our brains are not computers. They are inscribed with biases, attractions, associations, and habitual pathways of thought. Their fundamental modality is emotion — attraction and repulsion — not logic. And they really do change with addiction (as with other forms of learning). The evidence is indisputable. So, do we have to ignore the brain to oppose the disease model?

I don’t think so. I want to talk about “choice” as a highly irrational mechanism. And there’s lots of research to back that up. See Kahneman’s recent book, for example. In fact, research shows that people think that they’ve made a deliberate choice after their brains have already decided what to do. Much of this literature is quite technical, but here’s an example. I want to model addiction as a biased choice, a choice that is not inevitable but is highly probable, given the attractions that are already engraved in our synapses.

I’ve got the book mapped out, of course. I just need the momentum to get over the hump of page one. But writing this post helps. Maybe today’s the day.

In comments following a recent post, many of you saw addiction and religion as different versions of a similar enslavement. Then last post we talked about the terrifying loss of meaning at the finish line. But today I want to show that these parallel prisons arise from the same fundamental longing — one that’s almost noble in character.

In your comments, many of you wrote that religion, like addiction, can be viewed as an extreme form of attachment, with all the bells and whistles: the narrowing of attention and emotion to a small range of rewards, rigid adherence to methods for getting more of what you need and rejecting anything that gets in the way, blind commitment to something that satisfies your needs, at least in part, and attempting to put all your needs into that basket and neglecting whatever doesn’t fit.

And then we got to the fear of meaninglessness that confronts the addict contemplating abstinence.

Well it seems that this implosion of meaninglessness is just as terrifying for a deeply religious person who no longer can believe in his/her religion (e.g., in God)  as it is for the addict staring into a life of total abstinence. James Joyce and Graham Greene wrote fine novels about the malignant anxiety facing priests who could no longer believe. And about their nihilistic attempts to keep going through the motions, living off the remains of a dying addiction to God.

For both the believer and the addict, that loss of meaning is terrifying. It’s a loss of everything that filled one’s thoughts, dreams, and hopes. In fact, I’d say it’s much more about loss than it is about meaning per se.

So what is it that we so greatly fear losing?

There’s a flip side to this ungainly partnership of religion and addiction. What we want so badly, and what both religion and addiction appear to offer, is a sense of connection that binds our lonely little selves to something else, something bigger, something that offers certainty in a world that is beyond control. This longing for connection and “ongoingness” is pretty fundamental. So much so that it embeds itself in the neural circuits responsible for desire and goal-pursuit — yes, the infamous striatum (including the nucleus accumbens) that I’ve referred to so often. We wish, and we seek, and we crave, and we long for that thing we seem to be missing, because our brains are made for seeking what we don’t have.

In the talk he’s preparing for the Dalai Lama, Kent Berridge emphasizes something very important about the brain. The neural machinery of desire is this rather extensive network of  brain matter — literally, it includes a large area in the middle of the brain, and its tentacles reach into the brain stem, the amygdala, and the prefrontal cortex — that’s a lot of territory. Whereas the neural machinery of pleasure is this little hunk of tissue about a square centimeter in size (e.g., a part of the ventral pallidum). In other words, desire is much more important than pleasure, when measured in terms of neural real estate. That’s how central it must be to our survival as a species. (And so, no, I wouldn’t call it “The Beast,” in the parlance of Rational Recovery.)

So it goes. We are built for wishing, for wanting, for craving. And the fact that what we sometimes crave is a sense of connection is why so many of us turn to religion, or addiction, or both. But the wish itself is not an evil thing. It’s a very human thing. It even seems noble, or courageous. It expresses a need we know intimately in ourselves and that brings out our compassion for the vulnerability we see in others.

We can respect the religious person, and we can respect the addict, not for the way they live their lives, but for appropriating the machinery of desire for the pursuit of connection. Not money, not power, not even pleasure — the paltry goals of everyday life — but something very special.

No one expresses that longing better than Eddie Vedder in this song. (Warning: you probably have to be extremely weird to like this song as much as I do). Here’s the first verse:

And I wished for so long… cannot stay.
All the precious moments… cannot stay.
It’s not like wings have fallen… cannot stay.
But I feel something’s missing… cannot say.

 

 

Hi all. I recently got an email from Jeff Skinner, a member of this blog community, who came up with the following synopsis. To me, this brief statement (lightly edited) perfectly sums up the existential trap that awaits the addict facing recovery, like some lurking monster that you simply cannot sneak past. You have to face it head-on.

A high functioning addict has many degrees of freedom [i.e., choices] in handling the proverbial monkey. The addict can take a night off from drinking or drugging (or fooding or gambling). He/she can take a week off. He/she can reduce intake temporarily, even for long periods. What doesn’t change is that the meaning of existence is measured relative to the next time. This kind of freedom certainly produces tensions, sometimes big ones, but they can be tolerated.

The crisis comes when “the next time” is moved out to infinity (abstinence). Now life becomes existentially meaningless. This causes an unbearable anxiety/panic — one that can only be alleviated by taking, or at least scheduling — [or at least imagining] — the next drink or drug.

I have thought about this problem many times, and I still do. But I think Jeff expressed it with unusual clarity. He and I are both interested in your comments and will respond to them…

I’ve written a lot about the battle between craving and self-control, as have others. I’ve pointed out the neurophysiological events that stack the deck: the role of dopamine in narrowing attention and boosting desire, the resultant “delay discounting” that makes it so hard to think outside the moment, the nonstarter of “ego depletion” — a fuel tank that reads EMPTY before you get to the top of the hill, and the growth of synaptic networks (in cortex and limbic system) that colonize your psychological world with too many associations, action tendencies, and feelings related to the thing you want so badly, so often.

But I’ve never quite figured out how to capture the loss of meaning that stares you down when you think about quitting — FOR GOOD. For sure it’s about the accumulated synaptic restructuring (network pattern) that has strangled half your forebrain like some crabgrass invasion. It’s about the weakening and dissolution of the other synapses — the ones you might have used if activation didn’t keep returning to the more familiar circuits. It’s about all the goals your striatum forgot how to strive for, or even notice, over those years of seeking one thing above everything else. I can explain it in brain terms fairly well. But what’s hard to put into words is the feeling — the deadly vertigo, the whoosh of the void suddenly opening right in front of you, as you contemplate giving it up FOR GOOD.

How can life possibly be meaningful without IT? — when it’s been the foundation of meaning, the hallmark of value — for such a long time? And not just “meaning” in the abstract, but the sense of being taken care of, however perverse that is; the sense of where you belong in the world; the sense of who you are; the sense of what it is you do…

How do you overcome that ultimate challenge? How do you cross that gulf? I guess the answer is to start building up other networks of meaning and value, before you’re able to quit, maybe even before you can seriously try. Or at least at the same time. (For me, returning to graduate school was a big deal.)

But what if you don’t know where to find another source of meaning? What if you don’t know where to start? What if there’s just nothing else in your world, because you have no resources, no real friends, you’ve burned up all your other opportunities? What if you look out at the universe and all you see is a featureless horizon?

 

When the degrees of freedom shift from some to none, when there are no other choices, when you pack up your home, sell your furniture, and drop off the key, there’d better be at least one other place to go. Or you’re probably not going to make it very far.