Author: Marc

Hi people.

I’m sorry I’ve been so out of touch. There isn’t one particular reason, but several things have conspired to keep me busy. The last actual post was a cut-and-paste from Arne, a reader, on August 25^th, and the last one I wrote myself was on August 17^th. Both posts got a LOT of comments: each became a real dialogue among readers, and that was a delight in itself. Not only that, but new people stumbling on this blog have complimented us on the depth and diversity of our perspectives. So, congratulations to us! Anyway, I got caught up in this sea of comments, followed leads, bought books, etc, and all that kept me busy for a while.

I also finally started my interviews. I’ve been talking with a subset of the people who responded to my request (on this blog) to use their life stories of addiction and (mostly) recovery, for my next book. I must have gotten between 100 and 150 responses to that request, and if you were among them, I’m very thankful to you. I tried to get back to everyone who offered a peak into their private lives – not something I take for granted. If I somehow missed you, please accept my apology: My inbox was completely flooded for a few months.

Everyone who responded shared some aspect of their life with me, all by email, and some also with a follow-up phone call. People shared anything from a rough sketch to a cluster of searing details. Some were almost novella-length. Others were teasers, eliciting curiosity or enchantment. Some struck me as warnings to anyone listening. Others were more like cries for help. I found these accounts to be moving, inspiring, and/or agonizing, each in its own way. So here’s the problem: For my book I can only use four or five of these stories, fleshed out as biographies. More than that and the book would lose its coherence. Now what do I do with the rest? It would be such a waste to ignore them.

Here’s a solution: A memoir repository.

I want to invite everyone who has shared some aspect of your life as an addict, recovered or not, to post your story on this website. And anyone else who wants to join in would be welcome as well. It doesn’t matter whether you’ve contacted me personally or not. My web-designer and I will create a unique page where people can post their stories directly. They will not be edited by me or anyone else. My only demand is that you think before you post. Don’t post details that you might not want to be public. (But if you change your mind later, you can ask me to delete your post and perhaps make up a new one.) What I envision is a repository of addiction memoirs, anywhere from a paragraph to several chapters in length, sitting in their own special place on the Internet. They will be available for anyone who might be looking for inspiration, wisdom, or warning, or parallels with their own troubling experiences, or maybe a few moments of recognition, a sense of commonality, or a spot of hope in an ominous future.

Please don’t send your stories to me now. I’ll let you know when the posting page is ready, and I’ll make sure and announce the details on how to post your story directly. Also, if you have comments about this new feature, or other ideas to share, please send them as comments on this post rather than as emails.

Next post, I’m going to share what I’m getting from the in-depth interviews I’ve already conducted. I’m learning so much more about addiction than I thought I knew, from the astounding details of other people’s lives. You’ll see what’s been keeping me busy.

Marc,

I’ve been working on a drug education video series for a client who works mostly with classrooms of 5th-8th graders, and stumbled on your blog while doing research. It’s been extremely valuable to me in getting my head around addiction and the action of drugs in the brain. The challenge has been how to translate that into information that might help insulate a kid from going down that path when drugs are encountered.

Do we focus on kids never trying drugs, or on preparing them to stay away from “abuse” rather than “use”?

My question about addiction is perhaps most what I see as a non-drug-addict (as you rightly elucidate, there are plenty of my behaviors that mirror those of addicts, but I don’t have any addictions to drugs) who is working in the space between kids and drugs. One thing I haven’t read here in your blog or the resulting comments is a sort of social prism. Thinking of myself as a youngster, the feeling of getting out of my body or being in some ecstatic space was extremely important. I dabbled in various hallucingens mostly, but I think because I had enough other experiences of joy that I saw them as interesting but not essential. If anything, I feared drugs because the resultant come-down deprived me temporarily of access to the more natural experiences of authenticity I treasured.

I think of Ben in the video you link to up there. Sure, he had no overt trauma, but he grew up in what seemed one of those imprisoning and somewhat dulling strata of UK society…loving family, but perhaps not much room for connection to anything other than a row house and a job? Isn’t there a trauma in culture? In growing up in a civilization or particular society that requires a certain kind of adaptation — an adaptation that many of us are unable to make, whether biologically or, if you bend that way, spiritually? I think of the kid in Into the Wild…it wasn’t drugs for him, but he needed something out of his life that his sweet upbringing couldn’t provide.

Drugs for many might provide the only experience of ecstasy they’re likely to have…and who are we to ask them to prefer a long life of frustration and being an upstanding citizen to a few fleeting moments of feeling truly alive? What are we alive for, exactly? To execute our biological and social functions? I think these discussions of being and the brain are extremely fascinating, and I think a lot of work is being done lately to understand how brain networks affect behavior and health, but I feel like there’s a big gap here as we individualize and anatomize too much around addiction and think less of the more philosophical question of our purpose here.

For non-traumatized kids, what do we offer them as a culture that makes resisting drugs an appealing choice? Fear of ending up like Ben obviously isn’t enough. What’s the positive path we give them to choose? If we value euphoria, or even just wellbeing, as a culture, does our current system work?  How available is the state of wellbeing in ordinary life? Or are drugs the best way to get there; and that’s how they get so deeply into our brains?

I started reading your book and couldn’t help feeling that there was more to your drug use than the obvious trauma. Not only were people mean to you and you felt loss leaving home, but it seemed that drugs gave you a path to the sublime that was missing in your surroundings. Your lyrical writing in those passages certainly attests to a sense of doors being opened…maybe the lack of major psychic pain you allude to was also the lack of venues in your social situation to access joy or hope?

I often think about this when working with kids at risk. Are we really telling youth to work at McDonald’s (if they can even get a job there) and be upright citizens for the minimal sense of satisfaction and safety that comes with that choice — rather than choosing either the visceral thrill and sense of joyful community of being in a gang, or the (temporary) euphoria and wellbeing that come with drug use?

I am finally caught up! My inbox is clear for the first time since October. I have no classes to teach until after January. I just completed a draft outline for my next book (at 4:30 AM, somewhat hungover). And I’m now starting to communicate with the many people who sent me amazing stories.

There is actually nothing I’d rather be doing than this “research” into others’ addiction stories. I’m pretty much certain that addicts are the most interesting people on the planet.

Oh yeah, and I finished that disease/choice/self-medication set of posts I promised. Phew.

So, now, on to other things.

…………………………….

People often ask me how I quit drugs (roughly 30 years ago, with only minor blips since). So here’s a recent email exchange (lightly edited) in which I try to spell it out. Like others, this reader thought that the passage describing how I quit was too fast and loose. Maybe it was.

> From: “Donna” [not her real name]
> To: marc@memoirsofanaddictedbrain.com
> Sent: Tuesday, 24 July, 2012 2:53:06 PM

> Message: Hi Marc,
…….

> I just finished your book last night–I could hardly put it down. I
> was fascinated with the subjective descriptions of your experiences
> with drugs and how they manifested biologically in the brain. As I
> read I became rather depressed, however–learning about the brain’s
> loss of plasticity, and the feedback loops created by addiction made me
> feel rather hopeless. I was eager to get to the part where you talked
> about how you finally stopped doing drugs, despite having “hit
> bottom” many times.
>
> I have to say that your “NO” mandala was a big letdown. I’m sure I’m
> not the first nor the last to say that. It made me think of Nancy
> Reagan and the whole 1980s Just Say No campaign and here’s your brain
> on drugs–a fried egg. I really don’t understand. How did this work
> for you? How was it “different” from the other times you were filled
> with self-loathing, got your shit together, and ended up clean for a
> period of years? I wasn’t really looking at your memoir as a
> self-help book–I wanted to learn about the neuroscience of addiction,
> and I did learn a lot. But I also couldn’t help thinking about how
> you escaped, and what I could learn from that and how I could apply it
> to my own life. Sadly, I just don’t get it. Given the changes to your
> brain, what happened to enable you to overcome what was essentially a
> biological process?
>

> Best,
>

Hi Donna,

I’m happy to reply to this kind of mail…especially when your question is so clear and credible. Yes, others have expressed similar disappointment in the ending of my book. Let me try to explain how I quit.

First, there were never any periods of more than a few months, more often a few days or at best a few weeks, of being clean in the previous three or four years. So this time was obviously hugely different. How did it work? I’m really not sure. Basically, I reported what happened. The details are accurate. I didn’t have an instruction manual, so I can’t really say what was going on or precisely what I did that time that unlocked a new door.

But here, I’ll try. I had recently endured two particularly shitty events. My girlfriend left me, which broke my heart, and my friends found me, semi-comatose,  on a toilet seat in a public building with a needle sticking out of my arm, which was intensely shame-inducing. I think by then I had built up a lot of rage, not just self-contempt and all that but real rage — toward drugs, I could say, or toward what seemed to be a force or a malevolent spirit, or maybe something like the Greek Orchestra idea of a “fate” that keeps fucking up the protagonist’s chance of getting out of hell. Something pivoted on that particular day, the day I wrote “NO” on a piece of paper, decorated it with the trimmings of a mandala, and stuck it up on my wall. The rage seemed to pivot around and focus on this external entity, rather than on me for a change. And that was a big change. I remember feeling: you have no right! I deserve to live! You can’t do this to me!

That was how it started. There was also the small matter of saying to myself “never again” — rather than never again for at least 2 years, or never again injecting, or other half-assed self-promises. I truly at that moment didn’t want to EVER do it again.

And I just kept going on like that, day after day, telling myself NO fifty times a day….then less and less as the days went by. By the second or third week, I thought it might be really working, but I didn’t know for sure until about two months had gone by. And during all that time, the horror of my recent life kept returning to me in vivid images, and I kept telling myself: I don’t WANT to go there again. This is ME speaking: I DON’T WANT TO. Of course the withdrawal symptoms and the depression and all that were shitty for a week or two, but even within a few days, there were rays of light. Maybe even that first day.

Things like that happen. Big life changes can turn on a dime. How can that be, you may ask, given all the “wiring” that’s already taken place? For one thing, the brain hasn’t lost all its plasticity from addiction. Not at all. It’s just that addiction takes hold through several really fierce feedback loops that continue to gobble up plasticity on a day-to-day basis. I mean the loop of wanting-getting-losing-craving, and also the loop of using/lying/sneaking and shame, which greatly increases psychic pain and makes you want relief at any price. In both cases, there is a massive interaction between dopamine uptake, cue salience, and the potency of desire……that just cuts through the available options — the plasticity — as if there WERE no other options.

I guess another idea is that, while I was building up this elaborate addict network (I mean synaptically), I was also building up an elaborate non-addict network. I never stopped trying. I still wanted to be a regular person with a good life. I went to see a variety of therapists. I remember one who wouldn’t even talk to me (a psychologist, in fact) because he said I was too far gone. In fact, none of them helped much, but it meant (at least to me) that I was trying. Meanwhile, I was applying to jobs in mental health agencies, and getting some, and I was still aiming to get back into school. All that equals a whole OTHER synaptic network. Maybe the pivot point for me had to do with connecting a day-to-day/hour-to-hour sense of self with that second network, long enough for it to “take”…and start sucking up its own helpings of dopamine (I WANT this).

Also, I have no idea if I’d have stayed clean IF I didn’t get accepted into grad school a few months later. I’d like to think so, but I just don’t know.

Since then, I’ve had a number of flirtations with drugs, I sometimes drink too much, but I have never gone back to the hell I lived in before that day.

So there you have it.

And don’t be depressed. Loss of plasticity is relative. There’s plenty left over. Read Norman Doidge’s book if you want to think more about the immense degree of plasticity that’s available, even well into our later years.

Cheers,
Marc

Last post I reviewed a study showing powerful correlations between traumatic experiences in childhood and adolescence and addictive behaviours in adulthood. Although several readers found significant holes in the research, the study maintains a fair bit of respectability, and besides, if we look at our own lives, I think we often see clear connections between personal hardships and addiction. This sort of “anecdotal” evidence, subjective and biased though it may be, is often the strongest reason, deep down, for accepting (or rejecting) the self-medication model.

The self-medication model portrays addictive behaviours as attempts to diminish the feelings of anxiety, loss, shame, and loneliness left in trauma’s wake. For me, the connection is too obvious for words. I was lonely, depressed, and constantly on the lookout for personal attacks while at boarding school as a teenager. Within a year of leaving, I had shot enough heroin to end up unconscious in a bathtub, appearing to my friends to be dead. I don’t for a moment doubt the connection between these episodes of my life. And I say that, not as a scientist, but as a regular person, trying to make sense of my life.

I recently spoke with a reader who has serious problems with alcohol, but only when things go wrong in her personal life. Eleven months of the year she has no craving, no attraction to alcohol. She doesn’t even have to be on guard because there’s no urge to get drunk. However, when her (now, thankfully, ex) husband became verbally and physically abusive, when her custody of her child was being challenged, when she had to go and live with her parents because the matrimonial home was a torture chamber….those were the times she drank to excess. Emphasis on excess. How can you be an “addict” only when things get tough, and then become a non-addict when life goes back to normal? The disease model simply can’t explain that sort of pattern, whereas the self-medication model predicts it. Threat and anxiety lead her to take alcohol, which makes it easier for her to bear.

But there are problems with the self-medication model that need to be addressed.

First, although trauma may lead to addiction, it isn’t necessary — addiction does not have to be preceded by trauma. Some people fall into addiction without any evident history of trauma. Instead, other factors, such as peer pressure or simple exposure, might be sufficient. Check out the video recommended by Steve Matthews as a prime example.

Second, we know that self-medication doesn’t work very well. The things we take or do to diminish bad feelings actually increase them in the long run, or even in the not-so-long run. Maybe we’re not very good doctors. We prescribe for ourselves treatments that do more harm than good. Or they work for a little while — a month, a week, an evening — and then we get hit by the after-effects. Our dopamine-powered beam of attention cares only about the immediate, not the long run. Pretty short-sighted for a doctor.

These iatrogenic (more harm than good) effects don’t actually conflict with the theme of self-medication. If you’ve ever tried prescription antidepressants (SSRIs) or painkillers for legitimate reasons, you know that many medications produce iatrogenic effects. These drugs often lead to dependency and an uncomfortable period of withdrawal. But the fact that self-medication often makes matters worse leads us to another question: Is the trauma we are “medicating” produced by the medication itself? That’s about as vicious a circle as I can imagine, and it challenges the very idea that trauma causes addiction — rather than the other way around, as pointed out recently by Conor (in a comment following my last post).

So let’s imagine a causal story that goes completely opposite to that proposed by the self-medication model.

As I noted above, some people start down the road to addiction without having lived through serious trauma. But even given a certain amount of trauma in childhood/adolescence, one’s PTSD or depression might be under control. When I first tried heroin, I wasn’t terrifically happy but I wasn’t in great psychic pain, relatively speaking. Then I stumbled on a substance that made me feel terrifically happy. Enter the choice model: I want to do that again, because it’s more valuable to me than any alternative. After a while, the substance or activity is a presence in one’s life. And that presence takes on increasing value: it’s sorely missed when it’s gone. Now the source of my anxiety wasn’t so much my historical injuries (e.g., my mother’s depression, my stint at boarding school).  Rather it was my present fear of going without dope, and wanting it badly, and not being able to stop thinking about it. Now we’ve got at least two of the most common outcomes of trauma – loss and anxiety – both caused by present drug-taking rather than historical events.

Then along comes outcome number 3: shame. The loss of self-control – whether due to dirty underwear at age 4 or slavering desperation to get high at age 24 – is contemptible. That’s how others see it, so that’s how we see it. The result is shame, and guess what? Shame is one of the most common residues of trauma.

From an article in The Fix, on 25 Sept 2011, comes the following:

Of all the ACEs (adverse childhood experiences) that muck up one’s life, “’the one with the slight edge, by 15% over the others, was chronic recurrent humiliation, what we termed as emotional abuse,’ says Dr. Vincent Felitti, one of the directors of the study.” Shame is one of the few emotions that is directly, viscerally painful. Now, combine the loss you feel after running out or stopping, with the anxiety you get from craving what you can’t seem to get, with the shame that comes from your lack of self-control, and you’ve got a feast of negative emotions. The need for self-medication is now at its peak — indicating that the addiction itself is the trauma.

The vicious circle — connecting addiction to psychic pain leading to further addiction – may well be the causal engine we’ve been searching for. But self-medication is only one part of this cycle: it doesn’t work all that well as an explanation that connects traumatic life events to a special, intrinsic need for self-soothing. What it really shows, as suggested by Nik, is that, for some period of time, we believe that there’s one thing in the world that can make us feel better.

Of the three models of addiction, self-medication works best for me. As long as we acknowledge that trauma is an ongoing progression with its roots in our childhood but its branches still growing, still advancing, sometimes wildly, out of control, with each addictive act.