Author: Marc

We are about to launch a “Guest Memoirs” page, as promised. Here is a description of the project, including details, benefits and risks, and the procedure for publishing your memoir.

Anyone who wishes can share the story of their addiction/recovery with other readers of this blog as well as members of the general public who will soon be able to find it via Google.  The only requirement I ask is that the stories be “true” to the best of your recollections. The length can be anywhere from a paragraph to a couple of chapters. Please feel free to post an anecdote or two, or else notes on an interesting period of your addiction or recovery. You don’t have to tell your whole life story!!!

There will be a comment section at the end of each published memoir, allowing others to reply, reflect, ask questions, or whatever. I will not be editing the memoirs or the comments. I will take a brief glance at each memoir received, mostly to get a sense that it’s appropriate for this feature, before publishing it. However, beware: anybody can write anything in the comment section, so if you have a thin skin, you might want to give this a miss. But I expect very few comments to be offensive. And…if you receive comments that are truly nasty, just alert me by email and I’ll remove them.

I may also comment, and if I do, one of the things I’ll try to do (especially if requested) is to supply a little neuroscience information that might complement your memoir.

I expect that it will do many of us a lot of good to see where others have been. The main thing to keep in mind is that there are a lot of lonely, confused people struggling with their addictions. Just being able to see what others have gone through, and how they have managed to survive and improve their lives (e.g., recover, in part or in full), will be of great benefit to these people. Just knowing that they are not the only ones who have felt what they’ve felt and suffered what they’ve suffered can be a healing process. Rays of light are always encouraged. For those of us who are not in such dire straits, it is always interesting to compare notes!

Your memoir will be anonymous unless you choose to include a name or pseudonym. That’s your choice. So here’s the format I request:

Title (if you like, or just note “untitled” which is fine too).

Name or pseudonym, only if desired.

Keywords: If possibly, please supply 3-5 keywords, so if we ever get around to it we can index the entries for easier organization and access. I think these should include the name of the thing you are or have been addicted to (e..g, opiates, alcohol, stimulants, sex, gambling, eating, or even more specific terms like “”cocaine” or “heroin” — and, of course, multiple addictions are welcomed 🙂 Also include specific programs or treatment approaches that are highlighted in your memoir, such as Narcotics Anonymous, mindfulness meditation, methadone, or whatever. The rest I leave up to you. Perhaps include keywords indicating important features that have been associated with your addiction, such as “lying” or “stealing” or “dealing” or “hospitalization” or whatever.

The memoir: Put the text of the memoir in the email, NOT an attachment. Please do not use special characters. Normal characters like quote marks usually come through fine.

REQUEST:  Will a few of you please send me something in the next week. That way we can launch the memoir page with actual material, which will look a lot better than just a lot of white space.

All emails to me — the memoir itself and any questions you may have — can be sent via the “Contact” box, which you can access via the button at the top of this page. Or else mail to marc@memoirsofanaddictedbrain.com.

You probably didn’t think it was possible. How could this be? It’s scandalous! Providing opioids for the very people who are trying so desperately to get off them. But since this is Week 2 of our be-nice-to-12-step extravaganza, let me tell you the story.

In the comments following my last post, Elizabeth told us of a study (Coan and colleagues, 2006) showing that hand-holding can diminish people’s response to threat. Unfortunately the link only takes you to a brief summary of the study. I went back and read the full version, and this is what happened.

Fifteen women who reported high quality marriages were put into an fMRI scanner, with their husbands and the experimenter remaining outside in the room. The women were shown cues on a screen several seconds before an electric shock was possibly administered to their ankle by an electrode. These electrical zaps are generally only slightly painful (in psychological experiments). But the cue on the screen, coming a few seconds earlier, is bound to make one anxious. Especially because it announces that a shock may come, but it may not. In other words, the subject is in a state of uncertainty and anxiety, waiting to see if the shock will come or not.

This experimentally-induced state of threat or anxiety is, of course, meant to simulate real-life stress. And I think that’s fair enough. Let’s get specific about opiate addicts. Will I be okay? Will I be able to restrain myself today? Or will things get so shitty that I’ll fall off the wagon — again? And if I do, there will be hell to pay when I get home…etc, etc, etc. We all know the drill. Being an opiate addict in recovery is being in a state of anxiety or stress — for much of the time — and the only relief may be…a shot of heroin (or pills, or whatever) OR a visit to your local NA group. That makes you feel better too. That’s why you go.

Little did we know that the group makes you feel better for the same reason (at the cellular level) as a shot of heroin.

Some very prominent emotion scientists have theorized that opioids (made inside our brains) are at the root of human attachment. Mother’s milk is rich with opioid molecules. In other words, nature found a surefire way to soothe the baby with its mother’s milk, using the same chemical formula that’s responsible for the soothing feeling of heroin. Jaak Panksepp theorizes that all social attachment is based on the release of opioids within the brain. Here’s a quote from him, referring to his early attempts to publish this work, cited in a very nice review for the non-scientist:

“When we first tried to publish our paper on the role of opioids in social attachment in three species, we submitted it to Science,” he said. When he asked the editor [why the paper was rejected, he was told], “‘We decided it was too hot to handle. If love and attachment ride on the same system as narcotic addiction, that’s too scary…’ ”

The review goes on to show how parents also get opioids from their kids. They feel great gobs of love and mush because their own brains produce a glut of opiods just at the sight of those sweet little faces. But let’s get back to Coan and colleagues’ experiment.

When the woman in the scanner was holding her husband’s hand, through a little hole in the side of the machine, many brain regions involved in stress or negative emotion showed reduced activation. On some trials, the hand she held was not her husband’s but that of the experimenter, a friendly male stranger. Even on those trials, many of the same brain regions showed reduced activation. Now here’s the kicker: The brain regions that got calmed down by hand-holding (including regions of the ventral ACC, ventral prefrontal cortex, striatum, and insula) are the same brain regions that have a high density of opioid receptors! The authors speculate (and I think it’s very likely) that opioid release is what causes the deactivation of these emotional hot spots. The subjects also reported less unpleasantness when they were holding hands while anticipating the shock. And, get this, the reduction in unpleasantness was correlated with the reduction in brain activity in these hot spots.

Thanks for the opioids, dear.

Elizabeth said in her comment that she heard a lecture by the same researcher, reporting that some of the same neural calming effect was found when the person’s partner was just in the same room with them, never mind hand-holding. So you don’t need to hold someone’s hand to get opioid soothing. You just need someone who cares for you to be in the same room.

In a recent debate on this blog, I argued that a supportive group like NA makes sense as a primary treatment for addiction–not a secondary one. Certainly members of NA or AA see their group experience — with or without hand-holding — to be the most powerful antidote to their feelings of anxiety, stress, loneliness, and all the other negative variants that can lead to relapse. Now we can point to a very concrete, biological mechanism responsible for the soothing function of the group: when you are in close contact with people who care about you (even a little), your own brain releases opioids. And, in a sense, those opioids replace the opioids you’d otherwise be buying on the street.

A final word: this is not some cheap trick the brain is playing on you. Internal opioids are not like methadone maintenance. Opioids have been nature’s way of soothing our pain and our stress, for tens of millions of years of evolution! That’s why we need them. That’s why we like them. NA, and other forms of intimate group experience, help us to get them from our connections to other humans (something we’ve perhaps forgotten how to do) rather than the guy on the street corner.

That’s what nature intended.

I see a lot of comments rolling in on my recent post. That really makes my day. Or night, in this case: it’s currently just after 4 AM. Can’t sleep.

I had an amazing two days in England just now, visiting people who work in one way or another with addiction. My first evening there, spent in Oxford, was with two Australian philosophers who’ve received a large grant to study the identity issues of addicts. Lovely people, but I did not learn much from them. In all fairness, they have just begun to analyze the first wave of data in a multi-year study. Still, I recall JLK’s contention that a high level of abstraction sometimes seems to miss the boat when it comes to addiction.

So let’s get down and dirty.

The following evening I met Peter, who has recently posted comments on this blog. I won’t tell his story – it’s his to tell – but after a three-hour train ride to the north of England, I’m received by a large, smiling man, who lives in a small house that seems to be tilting on its foundations, together with a very large dog and a quiet friendly woman, his partner.

But we didn’t go to his home first. On the long drive through rush-hour traffic I told Peter I’d never been to a 12-step meeting. Hint hint. Would you like to got to one tonight, he asked? Indeed I would. He said we’d be a few minutes late but it didn’t matter. We were on our way to a meeting of one of about 30 NA (Narcotics Anonymous) groups in the region.

We walked in the door of a modern, nondescript building, and approached a group of about 30 or 40 people sitting in chairs in a large ragged circle. Many looked up at Peter as we approached, nodding or smiling. He seemed the granddaddy of the group. He’d been clean and sober for over ten years, a state many of the others could barely imagine. I felt their love and their respect for him. And they looked over at me, some with flickering smiles: who is this diminutive, academic looking fellow, never before seen in these parts? What’s his story? I heard them thinking.

So we sat down at the outskirts of the group and just listened. Through very strong accents from the north of England, their stories found their way into my brain and my heart. These people, mostly men, looked like they’d been through the ringer. Their faces were hard, their endurance carved in the creases around their eyes and the grim holding pattern of mouth and jaw. But there was a softness here too. They listened to each other’s miseries with real caring, with a kind of empathy that doesn’t run out, because if there’d been any limit to it, it would have run out ages ago. Later, I asked Peter what was the approximate range of clean time for the people there that night. He said: mostly under a year or so, some a few months, some a few weeks, some just a few days. I could recognize the last group from their constant sniffling and jerky movements. Everyone there was a heroin addict.

With all my negative presentiments about the 12-step program, I found myself shifting like a boat with no keel. There was something intrinsically good here. And I knew what it was: that old thing variously called friendship, warmth, brotherhood, support, caring. These people cared for each other, and given the degree of their helplessness, what better treatment could you want? That’s why they kept coming back. Their stories were sad, of course they were, full of bitter irony and gut-wrenching failure, self-rebuke, hopelessness tinged with a bit of hope. But there was always a smile there too. Maybe not until the last sentence, at which point the person might look up, his face finally relaxing into a crooked grin, as if to say, I know you know that I probably won’t make it, at least not for good, at least not this time, but you know, I might…

On the way back to Peter’s crooked house, I asked him how many of the people sitting there tonight would stay clean…for a good long time, maybe barring the occasional relapse. He thought for a moment and then said: maybe 30%.

He also explained what some people mean by being a “true addict” – a phrase we’ve recently argued about on this blog. From the perspective of NA or AA, being a true addict means that you could not, simply could not, after trying everything under the sun and the moon, time after time, year after year, could not stop. So these groups were really the only thing left. And sometimes they worked. But even if they didn’t, they probably made life bearable. Peter felt that the “true addict” polemic did more harm than good, magnifying differences rather than commonalities. But at least now I knew what it meant. And I was damn glad I didn’t fit that bill.

I asked Peter a lot of questions that night, and I’ll just mention one more. I asked: why the dogma? Why do some 12-steppers insist that this is the only way…when we all know it’s not the only way? He thought about that one for a while. Then he said something like this: When you’ve been trying that long and failing that long and then, finally, something works, you don’t look around and compute the statistics. You tell everyone who will listen: This is what works. This is the only thing that works. The unspoken part remains “for me.”

We had a bit of a blow-out in the comment section two posts ago. John (JLK) wrote a comment in which he made several claims about what addiction “really” is and provided a very specific recipe for how it should be treated. He also said he didn’t think I qualified as a “true” addict:

Your method of quitting has always sounded too good to be true for me. You also are able to drink on a regular basis. While it is true it takes all kinds there are also a lot of similarities in the stories I have heard… and I must admit I have not heard one remotely like yours…

To put it plainly I am still not convinced you were a true addict but possibly driven by other psychological problems. First you were a “binger” and second you were able to quit the hard stuff too easily.

Two commenters, Alese and Nik, took John to task on these and other points. I stayed out of it, though it’s true his comment did piss me off, and I had to decide to hold my tongue.

Now, in retrospect, I have a few points to add:

First, I don’t think John meant to offend. His very recent comment, about walking on eggshells, suggests that he has his own style of what to express and what NOT to hold back. I feel badly that you may have been stung by some of these replies, John, but I also think that they expressed important and valid counter-arguments to your claims. I also think you walked right into this, by challenging just about everything on your radar, without much thought about how readers, including me, would react.

Nik disputed some of your claims very convincingly. I won’t reiterate that here. But the upshot is that many of us feel there are many ways to BE addicted and many ways to recover….So, maybe, counter to the theme of my last post, there IS a fair bit of diversity in people’s experiences during addiction and recovery. But I guess what inflamed most was how you took experiences such as mine and passed judgement on them without seeming to care how I interpreted my own experiences. Most people, but (ex?) addicts especially, are pretty sensitive to that sort of thing: if you’re going to try to understand what I’ve been through, ask me, don’t tell me.

The funny part is: why should I  be so proud of the “addict” label that I resent you for challenging it — as if you’ve ripped away my favourite shirt or something. But here are a few more concrete issues:

–many addicts are involved in “binge” style using. It’s really pretty common, among alcoholics too. I was talking to some addiction specialists last night who report that binge drinking among teens is rapidly on the rise in many Western countries, leading to increasing reports of death and brain damage. The main issues are: how often, how much harm, and how much control does one have? Call it binging or not, but I was very close to killing myself. When you alternately shoot Demerol and coke, every 20 minutes or so, a minor miscalculation can kill you easily, because you are balancing a massive dose of an opiate with a massive dose of a psychostimulant. This was one of the last episodes of using I report in my book — and I think it was one of my last times ever. Anyway, don’t imagine that this was child’s play, a point that’s not so much insulting as it is inaccurate.

-although my story has some unique features, it’s not all that unique. I did not quit easily. I had tried to quit many many times, and by now I was completely desperate. On this particular day, it worked. But that’s just a small part of the story. I’ve recently talked in depth with two heroin addicts, both of whom can point to a last day: the last day they used — after which they just stopped. So much desperation, disgust, and horror had built up, they just couldn’t keep going. So we shouldn’t confuse the “ease” of “just saying No” with the long, grinding build-up that makes that moment possible. And by the way, “spontaneous recovery” is much more common than recovery through any particular form of treatment, including certainly the 12-step approach. That’s a fact.

-John and I may agree on one thing: that compulsivity is a huge part of addiction. Different parts of the striatum are responsible for different aspect of addiction. The ventral striatum becomes highly sensitive to addictive cues and shifts attention to the drug/booze target. That’s impulsivity. The dorsal striatum is in charge of directing a stream of behaviour, step by step, toward that target. Compulsivity is the inability to turn off that stream of behaviour, as exemplified in OCD and compulsive gambling. Dopamine fuels both striatal functions — wanting and doing. And guess what: when Parkinson’s patients are given  dopamine-enhancing drugs, their tendency toward compulsive gambling goes way up! A central issue in understanding addiction is: how and when does the impulsive aspect give way to or get replaced by the compulsive aspect? We need to learn more about this.

-and finally, yes, I’m able to drink alcohol without a massive landslide in self-control. So are a lot of other ex-addicts. This issue is not definitional — it’s a matter of individual diversity. Many ex-alcoholics can smoke, some can’t, some ex-junkies can drink, some can’t. For some former addicts, smoking pot is a minor diversion after giving up more toxic substances, for others it’s the top of the slippery slope. What bothers me is the tendency to set up these formulas and imagine that they apply to everyone: if you drink then you either never were or still are an addict. All these “formulas” have millions of exceptions. And something that hit-and-miss isn’t really a formula at all.

Okay, let’s bury the hatchet and keep on talking. We really can learn a lot from listening to each other — and that’s not just a warm-and-fuzzy motto: it’s a reality.

As mentioned, I’ve started interviewing a subset of the people who responded to my request for biographical material. These people offered to share the stories of their lives as addicts. Most have recovered. Some are still in process. The point is that this is a rare gift. It gives me a unique and potent data set for my next book – intimate accounts of what it’s like to be addicted and then to try, and fail, and try, and eventually (hopefully) succeed in getting on with one’s life. I haven’t gotten all that far with the book. The proposal has been blessed by my agent. My sample chapter is sitting in his inbox. I’ll discover its fate soon enough.

Meanwhile, I want to tell you what I’m starting to learn from these interviews – even this early in the game.

First, you should know that they take place by Skype or phone – sometimes I see the person I’m talking to and sometimes I have to use my imagination. They seem to last an hour to an hour and a half, and they are full of painful memories – usually memories that have been rehashed many times over, while people try to make sense of them. Now they’ve got someone else rehashing them with them. Sometimes I feel like a dentist, drilling until I strike a new vein of distress or at least discomfort, and I know it must hurt, but we’ve got to get to these details if the book is to be as compelling as I want it to be. I know it hurts partly because I’ve been to similar places, and my memories of the bad times don’t seem to fade much. And I know it because I can get goose-bumps up and down my arms or tears in my eyes. So much suffering! It bowls me over. And so much loneliness – the isolation of being locked in your addiction with everyone you care about eyeing you from the outside.

But I often come away from these interviews uplifted and optimistic, rather than depressed. Because just about everyone I’ve talked to – no, everyone I’ve talked to – has mounted a campaign against his or her addiction and eventually won, or at least formed a truce. And that takes the best of a person: courage, dedication, forebearance, creativity, and plain common sense. I’ve said it before: addicts (ex or still struggling) are some of my favourite people.

I’m learning a lot from the interviews. But here I want to share just one thing that’s struck me repeatedly.

The lives of the people I’m interviewing – and probably the lives of most addicts – have an hourglass shape to them. They start out unique: each person begins with his or her own specific culture, family environment, level of education, personality, social network, personal secrets, and all the rest. But then, when addiction takes hold, these lives start to look exactly the same. Regardless of whether it’s cocaine, opiates, alcohol, or even food, that wide range of individual differences shrinks to a narrow tube – the middle of the hourglass. What I mean is that people’s addictions have this fundamental commonality: the initial discovery that whatever it is helps with anxiety or depression, it feels golden, and then with time it becomes irresistible, then it’s no longer much fun, and then it becomes the source of new anxieties and more depression, as the desperation, the cover-up, the way we turn our back on other people, the way we turn our back on our own selves…. seem to be the main ingredients of everyone’s addiction. Then people make whatever attempts they make to get better, to get past it. (I’m not fond of the term “recovery” because that implies going backward, to something you once were.) And usually, eventually, after ten or a hundred tries, they make it. Then they start to live their own lives once more, and here’s where the hourglass starts to bulge out again, in its bottom half. Now individuality, creativity, and uniqueness get relaunched, without that yoke restricting them, and the hollow tube of mindless repetition fans out to a million possible ways to live your life.

That’s what I’ve learned so far. Tell me your thoughts. Have you also experienced the commonality of addiction, or do you see it another way? There may be massive exceptions to the pattern I seem to be noticing. And stay tuned. I plan to share a lot more as the book proceeds and I get caught up in trying to match these life profiles to the brain events going on below the surface. That will require me to go back to the neuroscience of addiction and do more homework, to try to figure out how it is that the features of the brain are necessary for understanding the features of addiction.