Author: Marc

Whenever I take a couple of weeks between postings I start to feel home-sick for my blog. I miss you guys. I miss having something to say to you — something that’s at least a bit thought-provoking and interesting — and I miss your comments. Whether lengthy and rich with content or brief musings, reactions on the fly, your comments engage me, teach me something, or remind me of things I’ve thought about, insufficiently, or simply touch me with some shared emotion, maybe a recognition of past or present feelings and struggles of my own. And of course, after all this time, I’m getting to know many of you, becoming familiar with your personal style of questioning or arguing, extending or contextualizing, trying on ideas, accepting, rejecting, fitting, refitting – one way or another joining me in a deep exploration of addiction and trying to understand its massive reverberations in our lives.

But I’ve started teaching this term, and the last two weeks have been something of a blizzard: reading, preparing slides, lecturing to 200-plus undergraduates at a time, and then coming home to my own kids, still only six but starting to ask big questions. From a teaming mass of unnervingly young, stylishly dressed, device-laden, Dutch-speaking, half-interested (on average) post-teens to my own little haven of unnervingly witty six-year-olds with ever-changing constellations of teeth (new and old).

But now here’s a free couple of hours, and I’m ready to serve the first course of something I’ve been cooking up for awhile.

In my recent posts I outlined four stages leading from unguided daydreaming to the ironclad compulsion to get or do the thing you’re addicted to. Here are the steps in summary:

		Mind	Brain
Daydreaming	||	Thoughts flowing freely without direction	Default mode network: including posterior cingulate and medial PFC
Impulse	||	Switch to attractive image of addictive goal and urge to pursue it	Amygdala (AMG), ventral striatum, VTA (motivation-targeted dopamine/DA)
Goal-seeking	||	Rapidly-growing anticipation, concrete action plan forming, driven by craving	Orbitofrontal cortex, ACC, ventral striatum, VTA, AMG, hippocampus
Compulsion	||	Shift from anticipation of reward / relief to urgent need to act at once	OFC and v.s. deactivation; dorsal striatum, AMG, DA from substantia nigra/motor loop

 

Note that the brain column is pretty skeletal. Most (but not all) of these brain bits have been fleshed out in earlier posts and/or the book. Also note that I’ve skipped any step labeled “cognitive control attempts” — because I think these evolve in stages as the addictive urge evolves, with or without success.

So here’s the question: what is the time scale? How fast do we move through these steps, from the first fluttering of addictive images, interrupting our innocent fantasies, to a lurching momentum — gotta have it, gotta do it?

And the answer is: there is more than one scale. I count at least three different time scales for moving through steps 1 to 4.

A lot of natural phenomena have a property called self-similarity. That means that the same pattern gets repeated at different scales — whether in time or in space. Examples include the geometrical motif in the fronds of a fern, the curvature of beaches within bays within inlets that give shape to a shoreline, and the clustering of nests within communities within societies. Those natural forms show similar patterns at different scales — in space — from small to large. But we see the same kind of thing in time: for example, the back-and-forth cycles of advance-retreat in a conversation or argument can also be seen in the large-scale progression of a relationship: when one or both partners oscillate between confidence and surrender over weeks or months. And ocean waves break in dramatic clusters, leaving periods of relative calm, while the small wavelets within them follow the same rhythmic pattern of interspersed bunches. Maybe you’ve heard of fractals — patterns within patterns within patterns: where you see the same geometrical images at very different scales, all expressions of some common theme, some common structural principle.

Well this is all a bit dense, isn’t it? And what does it have to do with addiction…and the brain…and the way our lives unfold over time?

It’s going to take another post or two to flesh this out, but here’s where I’m going with it.

In addiction, we see this pattern: attraction leading to craving, leading to pursuit, leading to…a brief period of pleasure or relief, followed by more attraction and craving. In other words, wanting leading to getting, leading finally to loss or emptiness, which leads once more to wanting. For example: craving booze, drugs, or food, leading to binging, leading to saturation or tolerance, and then loss or maybe even withdrawal symptoms, then running out of the substance or the money to get it, leading to more emptiness, more craving. And this kind of cycling is fairly well recognized in the addiction field. A prominent review of addiction neuroscience has this to say:

Three major components of the addiction cycle have been identified — binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation (craving) — and incorporate the constructs of impulsivity and compulsivity…

But the first amazing thing is that this pattern, this cycle, can be seen at different time scales.

The slow scale tracks our hero as he or she develops a fondness for some substance or activity, leading to repeated experimentation, leading to a period of more intense experimentation, greater amounts, more potent concoctions (beer to vodka?  painkillers to heroin?) as the fondness turns into strong desire turns into addiction. Self-control is easy to come by in the first month or two; but a couple of years later, once you’ve gone all the way, self-control is a plastic bag you’re chasing in strong wind.

The fast scale tracks our hero as he or she wakes up one Saturday morning, lies in bed daydreaming, suddenly gets hit with vivid images of doing it, tries to chase them away, fails, starts to crave, starts to plan, lifts up the phone and starts dialing…so that by early afternoon he or she is pacing frantically, waiting for Mr. Dealer to pick up the phone.

It’s the same sequence! The same sequence of psychological states, and — here’s the second amazing thing — the same sequence of brain stages. With one difference. The slow scale traces the development of addiction, the development of that unholy love affair, and the gradual brain changes that support it. The fast scale traces (the microdevelopment of) an addictive episode, or, we could say, the activation of the addiction on one particular Saturday morning.

And what about the brain changes? At the fast scale, the wiring pattern of your brain isn’t changing; that’s already set. Rather, the wired-up brain regions become activated — in roughly the same order they got wired up — and that happens fast! Because you are the proud owner of a set of biological connections, giving rise to a familiar cascade of feelings and actions, that took years to develop. At the slow scale, what fired together time and time again ended up wiring together. Remember Hebb’s Law? And now, what got wired together over months and years quickly starts to fire together — over seconds and minutes. Enjoy the ride: that downhill cascade that takes just an hour or two, and that’s self-similar to the developmental cascade that took years to complete.

As for a third scale, stay tuned.

My next post, coming much quicker than this one, I hope, will flesh all this out in detail. I think I finally get it, and I’m serving it up all month.

 

This morning I woke up before the rest of my family. We’re in a hotel in Switzerland, on a ski holiday. Switzerland isn’t that far from our home in Holland, but I know that I’m a lucky guy. My life has improved substantially since sitting in a cell in Thunder Bay, Ontario, waiting to get bailed out (after raiding a pharmacy with a motion detector). So I snuck out of the room, trying not to wake anybody else. But of course one kid started coughing and the other went to pee, by which time Isabel was frowning at me in her first moments of wakefulness. Was I being too noisy?

Anyway, I’m feeling a bit disoriented. Vacations are nice, but I find it hard to just….um….relax. So I get to the lobby and boot up my computer and the first thing I read is a comment on one of the memoirs, by “jaqueline” (about 15 comments down this page).  Now suddenly I’m not bored anymore, or preoccupied with petty things like wondering when the grandparents will come down for breakfast and whether I’m supposed to get back to the room to help the kids dress. Suddenly I’m with this person in the freezing cold – cold attacking her body from the outside and her soul from the inside – trying to figure out what she can sell to get a bit of heroin. Her mother offers to get her a hotel room but refuses to give her any money. And she thinks: what good is a hotel room without drugs?

I remember that feeling so clearly. Viscerally. Even though it’s been a long time for me. The need for drugs that attaches itself to you so thoroughly that every movement of your body, even turning over in bed, feels like you’re pulling against a second skin. There’s this dark sticky second skin that’s stretched around you, irritated, pulling away patches of your own skin with every move you make. I’m here. I want drugs. What are you going to do about it?

That old expression, “monkey on your back,” isn’t far off. But it feels bigger than a monkey and so much darker. And there’s really nothing else to do. That’s the point: there’s only one thing to do and no other action has any point to it.

So you lurch out into the cold of early morning or late night, seeking, searching, there’s got to be a way. There’s got to be a sequence of steps. If I can only figure out where the path starts, I know, I just know, that there will be drugs at the far end.

That’s called compulsion. The drive to act, to do something, without thought or reason.

I promised last post to continue the model of addictive behaviour I was working on.  I’ve been reading more neuroscience papers, and there is a final state in the sequence of states I outlined. A final stage that I think is applicable to most people and most addictions: When addiction tightens its grasp, impulse turns to compulsion, and that’s when you just can’t stop – or so it seems.

There’s a distinct neurobiological change when this happens. I have focused a lot of attention on the ventral striatum or nucleus accumbens. That’s where attraction and focus suddenly converge to create the impulse to go after the thing you crave. But the striatum has another whole subsystem within it, higher up in the brain, which we can call the dorsal striatum. When impulsive drug-seeking behaviour turns to compulsive drug-seeking behaviour, it’s the dorsal striatum that gets activated. This is a definite change in how the brain processes cues – and when I say cues I mean the thoughts, memories, withdrawal symptoms, or reminders out there in the world that call your attention to the thing you’re addicted to. Now, the action sequence, the set of steps, the behavioural response, whatever you want to call it, is suddenly resonating, vibrating with life. You are plunged into action, forced into action by the wiring of your dorsal striatum. Much like Pavlov’s dog, who starts to salivate when he hears the bell. There’s nothing to think about, no more reflection on whether it’s worth it or not. You just have to act. Which means: you just have to get some.

I’ll say more about compulsive addictive behaviour next post. For many experts in addiction neuroscience, compulsive drug-seeking is the definition of addiction, and it’s worth our attention. For now, I feel a bit compelled to get this post up. (I’ll probably revise it more later). Jaqueline’s story, so resonant with Janet’s memoir and so searing a reminder of my own crazy drug days, got my fingers going until this post was done.

Now I’ll go see what’s up with the family.

 

 

In my last post I explored the role of the default mode network in addiction. One conclusion was that addicts’ brains activate the default mode network more than the brains of nonaddicts.

This brought us to a paradox. Actually two paradoxes. (My wife hates it when I pun, but a pair o’ ducks already sounds like two… Ok, ignore that and we’ll proceed.) The default mode network (a set of 6-8 brain regions that often become synchronized) corresponds with daydreaming, nondirected thinking, going with the flow, imagining oneself in the past and/or future, etc.

Paradox 1: Isn’t it good to be in the default mode? Isn’t that the foundation of creativity or at least relaxed self-reflection? (well expressed by Persephone in a comment on the last post)

Paradox 2: Addiction is characterized by craving, which means highly focused attention on a single goal. I want to get some…..now! This focused state corresponds with an entirely different network of brain structures (including the dACC) — those involved in intense, planful activity, or homing in on a problem that needs to be resolved.

So how do we reconcile the “positives” of the default mode network, and the “negatives” of the task-focused network, in order to arrive at a coherent model of addictive behaviour?

And while we consider this, let’s reflect on Shaun’s lovely metaphor, also from comments on the last post:

I have always described addictive behaviour as walking through a field of tall grass. We tread a path and we become “programmed” to walk this path. We return to this path every time we feel “lost”.

Getting lost in tall grass might correspond with the unguided thinking of the default mode. But once we’re truly lost in our fantasies, we return to a single well-worn path.

My former student, Professor Rebecca Todd, suggested something similar, but in more concrete terms. Falling into an addictive act should be seen as a micro-developmental process. That means it isn’t a single event; it develops, but it develops in micro time — in seconds or minutes. Duh. Why didn’t I think of that? Almost every emotional phenomenon is best seen as a micro-developmental process — a cascade (love that word) that takes a few seconds, minutes, or even hours to unfold. Thank you, Rebecca! (I like to think I taught her to be brilliant, but maybe she just came that way.)

So here’s the beginning of a micro-developmental model that puts these ideas together:

Step 1: fantasizing. You are in the default mode. Your thoughts are running wild and free.

Step 2: Impulse. This is exactly the state from which impulsive behaviour can easily spring. Because it’s…thoughtless. Free-floating fantasies lead to images of drugs, booze, sex, food, or whatever it is that attracts you. And off you go!

Scientists have very good evidence of the link between impulsivity and drug-taking. The following is from an article by Dalley, Everitt, and Robbins, 2011:

Impulsivity is the tendency to act prematurely without foresight…. One form of impulsivity depends on the temporal discounting of reward [which means going after immediate rewards, even at the expense of long-term consequences], another on….response disinhibition [what it sounds like: just do it!]. Impulsivity is commonly associated with addiction to drugs from different pharmacological classes…

Step 3: Focused attention driven by desire. The third step is that tightly focused preoccupation with the soon-to-be (I hope, I wish) reward. Now brain activation patterns have switched over completely, from the nondirected to the directed, from the default mode to the highly-focused, task-oriented mode (which, in the case of addiction, must include hyperactivation of the nucleus accumbens / ventral striatum, spiking on dopamine). Now all your energies are directed at solving the problem: getting it and doing it — plus subsidiary problems like paying for it, lying about, and hiding it.

I believe there is a fourth step, compulsion, which is not the same thing as impulse (though they are related). More about that next post.  I also believe there are different strategies for trying to stop the cascade, depending on which step you’re in. I’d love to hear your ideas about that.

 

Finally, here’s Bhagavan Das, that wise / spiritual / contemplative / meditative dude with a huge beard, talking to us from a recent documentary:

You’ve got to realize one thing: you need to tame your wild and crazy mind. Your mind has a very very bad habit, which we call self-cherishing.

That may be where all the trouble starts: the free-ranging fantasies of the default mode converge on the wish to improve the way you feel.

 

 

 

 

 

 

 

Following that invitation to meet with the Dalai Lama, I’ve been looking more into Buddhism and studies that link it with neuroscience – and with addiction. In one recent article, I learned that mindfulness/meditation (let’s call it MM) changes the brain in one important way. From the treatment community, we also know that MM helps people recover from addiction. Research has been sparse so far, but there are good results with respect to smoking. So my question is this: if we know that MM changes the brain in such and such a way, and if we know that it helps reduce addiction, will we come to understand what neural processes are at the core of addiction?

An important brain region has been identified in many labs in the last few years. It’s called the Default Mode Network. This area (which includes the posterior cingulate and medial PFC) “lights up” when we are daydreaming, self-reflecting, imagining our selves in past or future situations, or imagining interactions with other people. In other words, the default mode is where we go when we are going with the flow and thinking in an undirected way about ourselves. Most interesting is that the default mode network turns off when we become focused on a task. When we have to do something novel or challenging, we leave the default mode and enter a focused mode, supported by very different brain regions, including the dACC – a region I’ve discussed as critical for self-control.

This particular article shows that MM changes activity in the Default Mode Network – a finding supported by other studies. The more you meditate or practice mindfulness, the more likely you are to activate the “focused” brain regions and turn off the default mode, especially when you’re required to pay attention. This article also claims that the reason MM helps people recover from addiction is because addicted individuals have too much activation of the default mode network. In other words, the images, cues, plans, ideas, associations, etc, that come to your mind when you’re addicted are more like daydreaming than focusing. You are using a brain region that DOES NOT solve problems but maintains a habitual sense of who you are.

I found just two articles that show that addicts have more activation in the Default Mode Network than other people – not a huge number of studies so far, but still… One of these showed that the default mode network is highly activated in heroin addicts, and this activation does not go down when they’ve had a dose of methadone. So whether you’re high or not, this is home base.

I’ve usually considered addiction as being too focused. After all, craving – the main ingredient of addiction – means having one goal and only one goal consistently at the centre of your attention. But it’s also true that there’s something very unfocused about addiction. Your thoughts are following such familiar ruts, without conscious guidance, and your sense of yourself is habitual rather than flexible. Oh wouldn’t it be nice if…..here I go again…not too surprising….well I don’t have to quit this week….could wait till things get less stressful, etc, etc. So maybe that unfocused state is where the addictive plan starts to form. Look at this snatch from John’s Guest Memoir:

Resting after the first set [of exercises]; I do something I should not do: I trace with my finger along a raised vein on the back of my forearm, slowly, gently, slightly, thinly smiling — the blood’s rushing to my head already anyway — tap on that one good spot a couple times, and now here comes the idea. Ohhhh… and oh fuck that reminds me of the dream I had last night.

That pretty much typifies the default mode…not paying attention, letting your thoughts go, which includes letting them go to places where they really should not go.

So, if addictive behaviour arises from a brain network that supports habitual, undirected thoughts, and if MM helps bring focus and clarity to one’s thinking, by deactivating that network, then it wouldn’t be surprising that MM is an important tool for recovery. And this kind of research, which is starting to grow exponentially, teaches us critical lessons about how treatment can tackle addiction – right in the middle of our brains.

For you Australians who’ve just come to visit this site, thanks for your interest! I’ve taken about a three-week break from blogging, but I’ll post again very soon. Meanwhile, you might want to catch up with some of the topics we’ve tossed back and forth on the blog. We’ve had some excellent dialogues, but will be moving on to new territory. Also, check out the Guest Memoirs page, and feel free to send me yours if you feel like contributing.

The site was first launched as publicity for my book. But now the blog has taken on a life of its own. Our main topic is addiction, obviously, and recovery, and the variety of paths to recovery. But there’s also a science undercurrent, and I try to touch on a neuroscience perspective in most of my posts. The neuroscience of addiction is a key interest of mine (having been both an addict and a neuroscientist), and the blog has been invaluable for me to link it up with real life.

So…..welcome!

For all readers, Happy New Year!!! I’m looking forward to more posts and more of the in-depth dialogues we’ve had in the past. More soon…