Author: Marc

What a great conference!!! PINC (People, Ideas, Nature, Creativity) is like a Dutchified version of TED, and the main theme seems to be creativity — that’s what the “C” stands for — and what creativity looks like across disciplines including: science and its societal relevance, art and design, food, philosophy, and a few others. It was beautifully executed, as would be expected given the price tag of  €900/seat for non-speakers — the timing and lights, stage design, headphones with spontaneous translation of the Dutch talks (about half), sound quality, music…yes music!…and dance! The day opened with a pair of tap-dancers who were just excellent, and it ended with a 13-year old boy playing Brahms and something else on piano, at a level that easily matched adult solo concert performers. He was shockingly good. And in between, all these 20-minute talks…

The talks were so good that I felt quite insecure about mine. So I snuck out during coffee breaks and lunch to revise and upgrade my slides. Then, at the end of each break, they played a recording of an oom-pah-pah band..which actually got louder by the minute, in order to herd people back in. Pretty progressive, don’t you think? Rather than flashing the lights and hollering. Boisterous happy music at swelling volume to get people to stop chatting and sit down. That’s the sort of creativity that characterized the whole thing.

How do I give a sense of the diversity of the talks? Well, one was by an American living in Antartica to study penguins and another was by a Swiss biologist who had camped out with bears for 3 months in Alaska. Then there was the harder science stuff — but mixed with liveliness and humor and surprises. For example, a pair of guys who came on like comedians — Mikael from Finland and Roman from Switzerland — Laurel and Hardy? They stood on either side of a tippy blackboard, took turns with the chalk, and showed how the curve describing the success and failure of political figures (high rise, low dip, then slow rise and plateau, or not) was mathematically identical to that describing the rise and fall (and hopefully rise again) of marriages. (By the way, that corresponds perfectly to a neurochemical model, by which the first year of a romantic relationship is all about the rise and then fall of dopamine, as the “reward” gets more “predictable” — to be followed by an attachment relationship based on endogenous opioids. Must publish that some day, though it’s probably been done.) Then, my favourite, a condensed history of the Corduroy Appreciation Club in NYC.  The speaker was dry and pedantic (a spoof, as it turned out)  and revealed many interesting factoids, including the significance of meeting dates. The annual meeting is always held on November 11, as the date so nicely symbolizes the very essence of corduroy (11.11). Of course the big one was held in 2011. The secret handshake, that involves interlacing but parallel fingers. There was even video footage of one member being dragged out by (hooded) security guards for a major infringement of the society’s policies: he was only wearing two pieces of corduroy — not three, as required for the annual meeting. The silly bugger: I mean, adding a corduroy tie would have been sufficient. Other talks included one session on baking bread in Africa and one on how to fold paper so as to create amazingly detailed works of art, such as the Escher-like staircase you see here. The angle of the light turns out to be all important.

Then there was me, talking about addiction, self-destruction, ego fatigue, and the absence of self-trust. I felt like a bit of a downer, but I tried (and got away with) a few jokes. Examples?  One about my ambivalence about the publicity I’ve gotten here in Holland — like bringing the boys to school and having the other parents smile and nod at me: Oh, you’re the drug addict! Saw you on TV last night. Chuckle. People seemed to appreciate the talk. Lots of nice compliments afterward. The Dutch really like honesty — one reason why I really like the Dutch. I’ll see if I can figure out how to post the talk. But maybe TED will be more polished. I can only hope.

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

 

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

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

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

There are two psychological phenomena that help explain it.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

Hello! It’s been awhile. This is vacation time in the Netherlands. The kids are out of school for two weeks and we’re trying to do family-type things. I know, it’s a strange time to vacate, but the weather here is so spotty, this might be one of the few periods likely to get some sun and warmth.

So I thought! Last Saturday we rented a boat. A very large boat (11.5 meters/ about 38 feet) with cabins below deck and all that, and the four of us set off from a town called Sneek (pronounced Snake). Well named, because the waterways leading out of the harbour were so incredibly narrow and sinewy that we got lost before we ever got to the main canal. Ended up in some cul-de-sac where an irate man with a house on the water kept waving us away. That’s because we kept almost ramming his house, which was very close to the shore. We were trying to make a U-turn in a narrow spot — just about impossible, especially because I had not yet discovered the “bow-thrusters” among the many Dutch-named switches on the instrument panel. When he finally realized that we didn’t understand a word he was saying, he started again in English: “Practice!” he yelled. “Go on the lake and practice!”  Yes, yes, an obvious suggestion. If only we could find the lake.

Anyway, we had a lot of fun. Isabel and I mostly sitting up on the top deck sharing a big steering wheel, watching the cows and sheep going by, and the boys down below, playing cards, with occasional sojourns to the upper deck to help steer. As I am constantly reminded, seven-year-olds don’t want to watch; they want to do. But it was cold out! Polar winds blowing through us except when we were huddled under this massive flapping plastic tarp. Oh well, it was still great, and we didn’t hit a thing in four days. Well maybe just a few tiny bumps. Tiny!

Isabel and I are going to drive over to France in a couple of days. It’s only a few hours, and it’s worth it just for the food. But meanwhile I have two talks to prepare, and one of them is a TED talk. Yes, TED! I was invited to join this TEDx event held at my university, and I’m getting pretty jazzed about it. The theme of the conference is “trust,” so naturally my talk will be about trust and addiction.

At first, I wasn’t sure how to approach this topic. You can’t trust an addict, right? How do you know an addict is lying? Because his lips are moving… Hah hah. No, wait a minute, how about…addicts can’t trust the treatment community? We know that people are almost always let down by their experiences in rehab, whether in- or out-patient, and so much of the treatment world is dominated by 12-step philosophy, which is certainly not for everyone (right, Persephone?), and a 30-day stint of treatment is about as useful as a bath during a dust storm, and the revolving door of addicts coming in and out is closely matched by that of the treatment staff, who come and go at an alarming rate themselves, and most of whom really don’t have the knowledge or the credentials to help people in serious trouble. The general public can’t trust addicts, addicts can’t trust public institutions..etc, etc… Could that work?

But is seemed a bit superficial, a bit too obvious, no real bite to it. And then, about two weeks ago, it hit me: The main issue with trust and addiction is that addicts can’t trust themselves. Of course! You can’t trust yourself to take care of yourself. Because, when you tell yourself you’re going to stop, or at least slow down, or at least stop injecting, or whatever it is, and swear up and down that this time is the LAST time, and it will NOT happen again….you end up betraying yourself. Time and time again. Why would you trust yourself after you’ve let yourself down 50 or 500 times?! But it’s worse than that: you hardly even have a self to trust. You (or I) lose the sense of a grown-up conscientious self that can soothe you, hold you, get you through the rough times, tell you that it’s just craving and it will not last forever… That self is so damned hard to find after a while that you stop believing it exists. No, you can’t trust yourself. (And surely, as a consequence, no one else can trust you either.) So who/what do you end up trusting? Your addiction, of course! You trust that a hit of smack or a bottle of vodka or a few grams of coke or yet another roller-coaster ride of sex or gambling or that bowl of chocolate ice-cream or even the glazed eye of your computer screen will make you feel better. At least for a while. And it might. For a while. We put our trust in the thing we’re addicted to…because there is no one and nothing else to trust. And of course, of course, each time we do that, we lose even more ground with our self. The ability to trust ourself takes yet another soul-crushing hit. Vicious circle. And how.

This TED talk thing makes me nervous. I have to stand on a stage in front of 1,200 people, knowing that every move I make, every sound I utter, will appear on computer screens all over the world and become inscribed in the holy scrolls of YouTube for time immemorial. With no notes! No powerpoint slides at my fingertips to remind me of what I’m trying to say. Not even a podium to hide behind. Scary!

But I think I have a good talk. I’m going to present two psychological phenomena that make it particularly hard for addicts to trust themselves: ego fatigue (see previous posts) and delay discounting (the tendency to place way too much value on immediate rewards, at the expense of long-terms gains….like, oh, keeping your marriage or your job intact — a result of that dopamine/craving wave). I’ve got it down in my head, why these phenomena stack the deck against us. And why that makes it just so hard to quit. I’ve practiced it in the car. And once in front of Isabel. It’s going to be good.

And I’m going to practice it with you. Next post. Stay tuned.

If you happen to click here and listen to B. B. King sing “The Thrill is Gone,” you might notice that he does not look happy. Nor does he sound happy. And he’s sweating. A lot! He says he’s free, but I somehow doubt it.

What happens when the thrill is gone? That’s a central question for addiction, as most of us know first-hand. In fact, what if the thrill was never there to begin with…?

I said I’d report to you on everything I learned at the conference on behavioral addictions in Budapest last month. First I reported on the common denominator, OCD-type states in brain and behaviour, then I tried to specify the key difference between substance and behavioral addictions, then came Elizabeth’s guest post comparing food and drug addiction, and now here’s Part 4: the genetics of thrill-seeking.

On day 2 of the conference, once my brain was seriously sweating, I met the guy who coined the term Reward Deficiency Syndrome (RDS). His name is Kenneth Blum, and he’s a smallish wiry guy, very intense, seemingly dour, but flashing the occasional dry smile. Here’s his hypothesis:

When we take drugs, or do whatever it is we’re addicted to, the brain systems that “light up” include dopamine circuits in the striatum and its neighbours. No surprise there. Blum lists half a dozen dopamine receptors that get in on the act. But the lead role goes to the D2 receptor — which controls the amount of dopamine available to synapses all over the frontal cortex and striatum. The D2 receptor is involved in attention, motor control, motivation….lots of pretty important stuff. Here’s a detailed description. So what happens when the D2 receptor population isn’t quite normal (e.g., too many or too few)? What happens is that you are more likely to suffer from a whole host of things, including OCD, ADHD, schizophrenia, and — you guessed it: addiction. Addiction to drugs, booze, gambling — that receptor has a lot of connections with the underworld of our psyches.

The problem is that the gene that’s responsible for growing D2 receptors, while we’re in the womb, has got different variants (like many genes), and one of those variants (allele A1) causes an overall reduction in the number of D2 receptors. There’s lots of evidence that addiction runs in families, and I’ve usually been reluctant to pin it all on genetics. Why? Because most scientists agree that there’s no single gene or cluster of genes that causes addiction; genetic predictors of addiction usually depend on personality factors, like impulsivity; and there is so much in behaviour and experience that can bridge generations — for example, you hardly need a genetic boost if your dad is an angry drunk and your mom is seriously depressed. But Blum cites some pretty convincing research showing that addictions shared across generations (like father, like son) correspond with this nasty dopamine allele. It shows up in more than one generation!  That is to say the allele gets passed down, along with the silverware and the porcelain figures nobody wants.

In a nutshell, some people have fewer D2 receptors, like maybe 40% fewer in some brain areas like the nucleus accumbens. So these people are not as excited about reaching their goals. Their whole “reward system” is relatively flat. Life is not as much of a buzz for them as it is for most people. As with B. B. King, the thrill is gone. In fact, maybe it was never there at all.

If you have the wrong allele of the DRD2 gene, and fewer D2 receptors, and therefore you have RDS, how are you going to get the thrills those around you seem to get? Well, drugs (including alcohol), gambling, and other super-fun stuff might be the most effective way. These “rewards” are hyper-exciting for most people. For you, who are chronically under-excited, they might be the only way to feel really engaged with life. At least until you get addicted, which seems like a step backward.

That’s the story, according to Blum. That’s what he talked about in his talk, and that’s what we argued about in the lobby for an hour. Reward deficiency leads you to seek out the biggest bang for your buck. Which makes sense, because everyone wants to feel the excitement that dopamine bestows when something special is about to happen. When I was a kid, about age eight or so, I remember making a disturbing discovery. Almost all the fun I had in life seemed to come with looking forward to things, whether a chocolate bar or a birthday present. Once the desired event was actually happening, it wasn’t as much fun anymore. (I was a weird kid, no doubt.) But for most people, a lot of pleasure comes from anticipation, from approach, and that’s what gets muted with RDS.

By the way, I’m actually working with a guy named Arnt Schellekens here in the Netherlands. He and his team are investigating low dopamine levels as a gateway to alcoholism. So this research direction is pretty close to home.

Despite its appeal, there are some serious problems with the RDS model. I’ll name just two. We know from dozens of studies that drug or alcohol use itself leads to a reduction in dopamine receptor density, or at least dopamine receptor activation, because those receptors tend to burn out or become desensitized when we keep bombarding them with fun stuff. Now that’s getting closer to B. B. King’s complaint: The thrill was there for awhile, but now it’s gone. Sound familiar? The question remains: is your dopamine landscape more determined by your genes or by how you use them? Problem #2 is that teenagers as a group are often described in terms of reward deficiency syndrome.  Teens can be seen as under-stimulated, probably because the reorganization of the nervous system in adolescence is pretty disorganized. A disorganized reorganization! That would mean that teenage thrill-seeking is not only natural, it’s inevitable, and it serves an important emotional function. Unfortunately, dangerous drugs are often part of the picnic. In other words, genetic contributions to addiction may simply be dwarfed by a tidal wave of thrill-seeking that comes with adolescence.

The jury is still out when it comes to genetic influences on addiction. Few addiction researchers doubt that such influences exist, but their exact mechanisms aren’t well understood. Blum and his colleagues are still chasing down the RDS model, and trying to connect it to other influential models, like Berridge’s incentive sensitization model.  There’s a lot to be learned, and I admire researchers like Blum and Schellekens, who keep opening new doors to find out what’s behind them.

By  Elizabeth from the blog….

I am very pleased to present a guest post, created by Elizabeth, who has been a member of this blog community for at least a year. Thanks, Elizabeth, for your contributions until now, and especially for this fascinating post–

The present “obesity epidemic” has given rise to public concern about the level of refined sugars, especially high-fructose corn syrup, in the North American diet.  While we can all agree that an excess amount of sugar is probably not good for anyone, more controversial questions about the “addictive nature” of such sugar intake have also emerged.  Public policy measures to curb access to this “addictive substance” (see NYC soda ban) are designed with intentions to prevent individuals from developing a “sugar dependency” and hopefully curb the rising rates of obesity.  But, is overconsumption of these sweet and calorie-dense foods really reflective of a widespread “addiction” to sugar?  Perhaps there is some truth to the matter, and perhaps we can understand this phenomenon better by looking at studies of drug intake.

Several years back, researcher Roy Wise argued that drug intake could be viewed as an “ingestive behavior.” He noted that animals who were limited to short periods of drug access at regular times throughout the day show signs of “regulated drug intake” to maintain a steady blood serum drug level similar to “regulated food intake” to maintain energy balance.  When the self-administration studies were halted, these animals displayed little, if any, signs of withdrawal.  Thus, they were probably not really addicted or dependent on the drug at all.

So what could make this regulated intake spiral out of control?

Marc has provided a wealth of information regarding the predictors of drug addiction, including the effects of stress, low feelings of self-worth, and the need to compensate by “self-medicating.”   I won’t belabor these points.  What is interesting to me is that these factors seem to aid the development of “addiction-like” drug intake in animals — when the self-administering rodents escalate their use over time, pursue the drug in the face of punishment, and show physiological withdrawal symptoms. In other words, when they seem to become addicted.

So, additional factors — beyond drug availability — may be necessary to make the “ingestion” of drugs more “addiction-like.”  Does this mean that the ingestion of foods can also be normal, versus addictive, depending on external factors?

Indeed, stress and negative self-worth also play major roles in the development of eating disordered behavior (e.g., excessive caloric restriction, binge food intake, purging, etc..).  Food and drug rewards act on the same neurotransmitter systems, so disruptions in reward circuitry can confer drug addiction and, likewise perhaps, change the meaning of food. Get this: If you want to get an animal to REALLY want to take a drug, you can deprive it of food.  This suggests that dysregulated food intake cross-sensitizes with dysregulated drug intake (kind of like how abuse of one substance can lead to abuse of another). Basically, since the brain interprets the value of both food and drug rewards through similar circuits, alterations in these circuits can cause EXCESSIVE pursuit of both.  The brain is saying “hey, I’m deprived of some necessary sustenance…give me more!  The next time I get that reward, it’s going to be REALLY reinforcing, so I will seek it harder and make SURE I get all I can!”  So, the next time drugs are encountered, we binge on them.  The next time we get access to a sweet treat, we are likely to binge on that as well.  In fact, there is a striking comorbidity between binge food intake and drug abuse.

What this means is that there can be addiction-like components to both binge eating and drug taking.  The super-sensitivity to both rewards appears to be greatly influenced by the individual’s history:  Have there been significant life stressors?  Has the individual been deprived? (Think of those with eating disorders who have excessively restricted their caloric intake in order to look or feel thin.) These factors come together to promote a sort of “super-craving” — for food, drugs, or both.

I’m not sure that these factors are widespread enough to completely explain the obesity epidemic, but they sure help put it in context.