Author: Marc

My last post was about neurodiversity, and it brought up some great discussion! Now I want to bring all this back to addiction.

I’m at this Writers’ Festival in Sydney Australia, extremely jet-lagged, flogging my book, doing radio interviews a couple of times a day, and the same question keeps coming up: Is addiction genetic? I mean, do you think you became an addict because of the way you were made? Not everyone is vulnerable to addiction, right? So there’s got to be something in the basic brain plan that makes you that way. Right?

I don’t think so.

There is simply no gene or combination of genes that is linked with addiction as a trait. That doesn’t mean that genes are not part of the enormously complex causal bouquet that does result in addiction. But the genes that are correlated with addiction are genes for traits like impulsivity. And even these correlations are often weak or inconsistent. Some traits – impulsivity, maybe neuroticism, maybe low frustration tolerance – do help describe an individual who will, when things get tough, tend toward addiction more than the next guy. But impulsivity also puts you “at risk” for bungee jumping. And nobody is saying that bungee jumping is genetic.

A lot of people are doing good research on genetic factors that predispose toward addiction, and I’m not saying this work is irrelevant. But so far, the result seems to be a lot of small pieces of a very large puzzle. So let’s go back to impulsivity, where the water is clearer.

Impulsivity, the opposite of inhibitory control, is known to be correlated with inherited (genetic) factors. And the lynchpin of this correlation is believed to be brain mechanics. Well, what else could it be? So a recent study, which claims to be the largest of its kind ever conducted, looked at the brain activation patterns underlying impulse control in early adolescence. The researchers identified multiple brain networks involved in impulse control…which of course means they’re involved with its opposite – impulsivity. But each network was associated with a different style or type of impulsivity. Moreover, activation in one of these networks correlated with early drug or alcohol use, while activation in a different network correlated with ADHD symptoms. Already this shows that an individual’s particular brand of impulsivity (and the hardware underlying it) lends itself to a different constellation of problems.

Of most interest, the pattern associated with early drug use (reduced activation in the lateral OFC) was not a result of drug-taking but a predisposing factor. Does that mean we are beginning to discover the neural recipe for addiction? No! It means that a particular style of impulsivity predisposes teens to experiment with drugs or alcohol. It probably predisposes them to experiment with a lot of other things, including sex, travel, maybe graffiti, maybe tree-climbing, and quite possibly bungee jumping. And notably, this particular brain pattern was not linked to any genetic variant. Again, not surprising. These are the brains of kids who have already grown up in their own particular environments, and brains rewire themselves with experience. These brain patterns were not preformed in the womb. So genetic links, which are often insubstantial to begin with, have to step aside to make room for the role of experience – no matter what.

In a nutshell: Genetic links? Yes. Genetic determinism? Not at all. The relations between genes and brain structures help – among many other factors – to build personality dispositions. They do not build addiction. Addiction is an outcome, a result of a particular set of life experiences, a learned pattern of thought and behaviour. There are many brands of misfortune, both inside and outside our bodies, that can move us toward this outcome.

Yesterday I was interviewed with another author in front of 200 people, and he and I were encouraged to take off from the questions and start our own conversation. I met this guy in the lobby, a half hour earlier. His name is Lemon Andersen – um yeah, his first name is Lemon – and he’s this short, slender, cool looking poet dude from Brooklyn, with a Hispanic accent that makes him even more cool. His style of oral performance is related to “slam poetry,” he’s been mentored by Spike Lee, and he won a Tony in his mid-twenties. Now he’s in his mid-thirties. His parents met at a methadone clinic in Brooklyn. They were both long-term junkies, and they both died of AIDS.

Lemon has never taken drugs. He sold them, to get by in an impoverished housing project, but he never took them himself.

We were in the same session because we both had a lot of addiction in our past lives. But when I first met this guy, I wondered if there’d be any rapport. The Beat poet and the dowdy professor? As it turned out, we practically fell in love with each other on-stage. Maybe because we’ve both struggled to get away from drugs. Maybe because we’ve both found a calling that helped keep us sane. Do you know why Lemon has never touched drugs? Because he was afraid to. Simple as that. With all that genetics working against him – so you might think – he took a different path. His own path.

That’s what we all do, whatever it is we’re made of and wherever it is we come from. Masters of our fate? No. But we create our own masterpiece – ourselves – from the multidimensional palette of genes and environment.

In a recent post I brought up the age-old debate as to whether addiction is a disease or not. In response, Alese raised the bigger issue of neurodiversity. Many scientists believe that a certain amount of individual diversity is built into human behaviour, because it provides an evolutionary advantage for all of us. It may be that our social groupings work best when a small percentage of us are highly detail oriented (autism spectrum), a small percentage are fearlessly aggressive, some tend toward extreme caution. And perhaps some are born with the tendency to seek immediate rewards over long-term gains – those most at-risk for addiction.

This built-in diversity in psychological styles would have to be based on diversity in brain plans. And this neurodiversity would then be considered a survival benefit for the species. That would mean that the psychological syndromes we like to classify as disorders or diseases don’t fit those categories. Not at all. (Even if they don’t make life pleasant for those who “have” them.) Instead, they may be outcomes of adapative variations in the human genome.

When I was in Toronto last month, Jim Kennedy (a highly-renowned research psychiatrist at CAMH) told me an amazing story over dinner. It concerned some research in which he’d participated, examining ADHD (attention deficit hyperactivity disorder), genetics, and migration. I’ll make that long story short:

ADHD is a disorder, if not a disease. Right? Not right? It depends on your perspective. According to Dr. Kennedy, the study of genetically pure (no intermarriage) native populations in the Americas reveals a fascinating pattern of geographically distributed genetics. A gene variant related to ADHD (a certain number of repeats in the part of the DNA linked to dopamine metabolism) shows up at a very low rate in native groups living in northern Canada: 2-3%. The incidence of this variant increases, to something like 10-20% in native groups living in the southern U.S. In Central America, incidence of this variant increases up to 50%, and it exceeds 50% in parts of South America.

What could this possibly mean? Does sunburn cause a genetic predisposition to ADHD?!

According to accepted theory, the Americas were first settled by migration waves from Asia, across a land bridge connecting Siberia with Alaska, at least 12,000 years ago and possibly much earlier. That bridge has since disappeared. This model implies a gateway for migration, starting in northwestern North America and moving south, over many thousands of years.

But why would there be a greater hereditary risk for ADHD as the original settlers of America moved south? ADHD describes a syndrome in which people are more distractible, their attention wanders off target (which means it goes to new targets), and they are more attracted to novelty than to routine. In North American and European classrooms, this is bad news. You’re supposed to be facing the board, listening to the teacher, and doing your assigned work. If a certain proportion of people don’t do this, if they have a “problem” with their attention, and if this problem is related to distinct neural mechanisms AND to genetic predispositions, then the problem gets classed as a mental disorder or disease.

But if this “problem” only arises in certain social contexts – if it can be an advantage in other contexts – then the disease label starts to peel off. Imagine that you are a North American native, it’s 10-15,000 years ago, you live somewhere in northern Canada, and there is nowhere nearby to buy a Gortex jacket or even long underwear. It’s awfully cold for many months of the year. But you happen to have a predispositon to wander off into the woods, peak over the next hill, and to lose attention to the normal duties of hunting and trapping. One fine day, while on your explorations, you look over the crest of a hill and find a long valley extending off to the south. The lands north of you are already settled, so they’re not very interesting to explore. But this valley to the south is completely uninhabited. You let the elders know, and within a generation half your tribe is living there. Your children have a greater likelihood of having the same attraction to novelty, the same low tolerance for routine. After all, they carry many of your genes. When they grow up, they are also more likely to discover greener pastures, and  your descendants  will continue to migrate southward.

By this process, the genetic makeup that confers an attraction to novelty and a disdain for routine will become correlated with geography. Tribes — or groups within tribes — who have a higher proportion of that genetic variant will be more likely to migrate, and will show up further and further south. Thus, a certain genetic pattern is linked to a certain pattern of migration. In fact, it is the adaptiveness of this pattern that EXPLAINS the migration.

Today, in North America and Europe, we associate that genetic pattern with ADHD – a “disorder”. But for those aboriginal people, it facilitated adaptive waves of migration, moving them further and further away from the frozen North and opening up new possibilities for hunting, farming, and building civilizations.

Conclusion: the psychological qualities of a genetic distinction can’t be defined or labeled in a vacuum. The advantages or disadvantages of that distinction can only be described in context.

Research points to genetic patterns that are correlated with addiction. I’ll get into that topic next post. For now, I want to leave you with the thought that addiction may arise from a predisposition that’s not unhealthy or bad in itself. Its goodness or badness may depend entirely on what our society values and on where and how it fits in.

Hi all. A number of you have asked if I could post that talk I gave at CAMH (“the scene of the crime”) on the evening of March 27th. Here’s my talk, converted into a PDF file and annotated for “easy reading”. Still X-rated of course. Enjoy…

Hi again. I’ve been back home in the Netherlands for exactly two weeks, and there has been so little time for anything…so I have not posted anything. Lots of course work to catch up on. One new class started last week, and I had to prepare my lectures…with eye-catching Powerpoint animation, jokes that might seem funny to 21-year old Dutch students, and oh yeah, all that neuroanatomy that had gotten slightly rusty… I was a bit nervous. There were 300 of them sitting there chatting while I was standing at the podium clearing my throat. English is their second language, one they had to learn in high school. And Neuropsychology 101 isn’t intrinsically entertaining to everyone. The text book was dry, so was my throat, and how was I going to say anything comprehensible and interesting enough to get their attention off their cell phones?!

It didn’t go badly after all. I really got into talking about the brain. I pranced around the stage, pointing to different spots on my head and extolling the marvels of this self-organizing system of rapidly emerging subnetworks, that are the physical basis of all experience, a system that is designed to be underdesigned (because we need to learn almost everything we know — and that requires massive reorganization), and I’m talking about 20 billion or so cortical neurons, ladies and gentlemen, dames en herren, with 1,000 or more connections. EACH!  That’s at least 20 trillion nodes, each node affected by complex concoctions of neurotransmitters, which tune them, just so, influencing how much information gets through, what kind of information gets through, and how we FEEL about that information…

Someone (I think Joseph Ledoux) boldly said: You ARE your synapses. That shifting configuration of tiny electrochemical connections: that’s YOU!

They were happy and smiling at the end. A good sign, I thought, except maybe they just liked watching me stride about tapping myself on the head. I had to wonder what was getting through to them.

I wondered the same thing, a week and a half ago, while participating in an hour-long talk show, via Skype. It’s called The Agenda with Steve Paiken, and a lot of Canadians watch it. So I was a bit nervous that night too. Behind me the camera picked up vague shapes in a dark, messy living room — watching it afterward, I thought I looked like a resident in some unlit chamber of hell, compared to the bright faces in the studio in Toronto.  But the real problem was that one of the three other guests was an MD, a psychiatrist, named Peter Selby — a guy who does both research and clinical work — at this psychiatric/addiction institute in Toronto. CAMH, it’s called, I mentioned it in my last post. And he, like many of his colleagues, really sees addiction as a disease. But I don’t. So we argued about it. It was all quite civilized, but we weren’t seeing eye to eye. And yet he had some good points.

Politics and pontification aside, am I really so sure that addiction is NOT a disease? This is a topic that I’ve gotten into before, but not in much depth. I know how to talk the talk. I’m used to arguing cleverly that the “disease concept” of addiction is really just a metaphor, and a sloppy one at that. It can be useful. It helps us refrain from beating ourselves up if we think we’ve got a disease. But maybe it robs us of the sense that we can overcome it through our courage and our creativity — something you can hardly do with a real disease. I have some good sound bites… like: if addiction is a disease, then you must CONTRACT it at some point, and then you HAVE it, and then you GET treatment, and if the treatment works, then you’re CURED. And if it doesn’t, you have the disease until you die. I can talk like that, and I can smugly conclude that those are NOT the characteristic features of addiction. But now I’m not so sure, and I wonder if I’m the one being too superficial, too mentally lazy, to give this matter the attention it deserves.

Because Selby was right about one thing: “disease” is not such a simple black-and-white concept. Take Type 2 diabetes. You don’t catch it or otherwise contract it. Rather, it grows — it’s really a developmental disorder that comes about when people make bad choices about what they eat. Or live in unhealthy environments. And it’s not something you try to cure, it’s something you try to treat. The same could be said for quite a few “medical” diseases. Like high blood pressure? Like colitis or irritable bowel syndrome? Like carpal tunnel syndrome? When I’m on an anti-disease rant, I often fall back on the argument that brains change with development, they change with experience, they’re supposed to change: learning changes the brain, addiction is a kind of learning, it’s highly accelerated, it’s very focused, but it’s still a process of learning. So I’m thinking, diabetes, colitis….do they change the structure of your body too? Well, of course they do. And yet your body isn’t supposed to change in those ways. Aha! I’ve clinched the argument. Except that I have this intrusive thought: brain changes that come about with addiction are NOT so natural after all. Sure, the brain — especially the cortex and limbic system — is designed for its mutability. It’s supposed to be able to change with learning. But it’s not supposed to change so much that you can’t secrete dopamine in the ventral striatum without focusing on your drug or drink or sexual obsession or food obsession of choice. That’s a pretty fucked up brain, even if it got that way through a “natural” “developmental” process. So…is the outcome of addiction really distinguishable from what we call a disease?

I’m not going to go further with this tonight. But what do you guys think? Please share your ideas before I share more of mine. Yet we all have to try to leave our politics at the door before we get into this. Because the 12-step versus do-it-yourself versus the self-medication approach versus the “choice” position — all those territorial disputes take our attention away from the fundamental issue, the thing we really need to focus on. Which is: what is addiction? What is it really?

Hello people! It feels good to be back in touch with you….as though you are my long-lost family. I have posted some comments, haphazardly, in response to recent comments of yours. For anyone still waiting for a reply from me, I’m sorry. I’ll be home in three more days and I will catch up soon. Or if I miss you and you want to hear from me, just nudge me with a note from the “contact” page.

This trip has been amazing: stressful, tiring, but also satisfying. I’ve stopped in a lot of cities, done a lot of interviews, a few readings, a few talks, written a couple of pieces while waiting at airports, and schmoozed with a lot of people, both media types and scientist types – addiction scientists – and even a few ex- or wish-they-were-ex- addicts. They are – we are – everywhere.

For example, last night, after I finished talking to an audience of about 200 people (scientists/practitioners and “normal” people), one young woman comes up to me while I’m packing up my laptop, and says unsurprising things, like “…really interesting talk. I do research on rats…self-administration of nicotine…test for increased activity in cholinergic neurons…etc, etc.” After a short pause, she continues, “I have a problem, too. I guess you’d call it an addiction,” and she looks down shyly. Then she looks up and our eyes lock and I recognize her as someone just like me, a much younger female version, but there she is, divulging her struggles to a stranger. Struggles with an eating disorder, a self-destructive compulsion, and I notice how thin her hand is after it’s just shaken mine. I look at her more closely and see her anxiety, all wrapped up in her skinny body, I notice the openness in her face, and I instantly like her: she’s got the courage and dedication to fight addiction and study it at the same time. I admire her, feel for her, and hope that she will win in the end.

Last night’s talk was the climax of my trip. It was held in the main auditorium of the main psychiatric institute in Toronto, called CAMH, Centre for Addiction and Mental Health. I always thought that was a weird name, as if they’re dispensing addiction and/or mental health – take your choice. Anyway, the posters advertised Marc Lewis, no title, with my face next to a big picture of the book, and in huge letters: Memoirs of an Addicted Brain. Three TV cameras were being set up when I entered the auditorium. I was pretty nervous. But once I started speaking, and once I started to focus in on the faces of the audience members – interested, intelligent, and engaged, with friendly expressions, no hint of the suspicion or judgement I’d half-expected – once I got going, I lost my nervousness and the words started to flow.

When I was done people clapped and clapped, and I felt like a star. But even at that proud moment I was very much aware, as I had been all day, that I was standing in the building where I’d done my research, my rat research, for my Bachelor’s (undergrad) thesis, some 34 years ago. And this was the place where I first got serious about stealing drugs.

The halls and the stairwells still looked familiar, and when my host pulled out his master key, on the way back from the auditorium, I vividly recalled the days when I’d had my own master key…and used it to go from office to office, lab to lab, late at night, after I’d finished with my rats…looking for drugs. And finding them! Or else grabbing a prescription pad off someone’s desk, ready for a little art work, imitating doctors’ classic messy handwriting, working in those Latin symbols, so I could bounce into a pharmacy later that night, coughing as convincingly as possible, and find my way to a bottle of Hycodan or Tussionex.

So I was a little nervous all day yesterday, not only about doing my biggest public lecture of the tour, not only about doing it on TV (yikes!), but about being recognized or found out somehow. I kept imagining that some old researcher would come walking down the hall toward me and his eyebrows would suddenly shoot up in surprise, then drop down in an angry scowl. So you’re the one! You’re the guy who stole all the morphine. You’re the reason the supply kept dwindling through the winter of 1978. Caught you!

Actually, the morphine came from the basement of the Psychology building, a few blocks away. But I’d scoop out a gram or two (we’re talking pure morphine sulfate, powder, in a couple of jars the size of peanut butter jars) and bring it with me to the CAMH building (then called the Clarke Institute). And I’d take a little break, somewhere around rat #15, when things were getting really boring – except for the wave of excitement building in my stomach – and I’d take my precious powder, mix it with water in a small plastic vial, shake it, strain it, load it into a syringe, and shoot it into my arm in a tiny locked room, with only the rats to judge me.

I did this for almost a year. And of course I always wondered when I’d get caught. When would someone notice something, either here or in the Psych building? When would someone blow the whistle on this addict disguised as a psychology student?

I finally did get busted, about a year later, but not here in this building. I had left, intact, with degree in hand, and the shit didn’t hit the fan until graduate school in another city, when I began to steal from doctors’ offices, not from the cupboards of an underground lab. So only a few people around here could ever have known about the other me, the real me.

Tonight in my talk, I was both the person I was then and the person I am now, a weird hybrid – drug addict and neuroscientist – standing up at the podium, talking about how my book might be able to help people get a better handle on addiction. You take the uncompromising cookie-cutter of neural findings and sprinkle liberally with the complexities of real life, everyday life, captured in a memoir. Then you can get to addiction from both angles at the same time and you can make a little more sense of it than either perspective on its own. I talked about addiction as a developmental process, a self-perpetuating preference turned compulsion, a creeping, encroaching synaptic network overtaking the orbitofrontal cortex and striatum, crowding out other synapses that represented other goals (like friendship, success at school, or even just pizza and beer). I showed a picture of ivy proliferating from a few tendrils to a bushy mass.

And I talked about you! I talked about my blog, and all the people I’ve met through it. I talked about the guts it takes to fight something as insidious as addiction. I talked about ego fatigue and I tried to paint a picture of how hard we work, we addicts, to outsmart our impulses. Just try holding your arm straight out to the side, I told them. No problem…..for the first five minutes. But try it for an hour. Try it hour after hour, day after day. I sang your praises, dear readers. I cheered for you. I told them: contrary to popular belief, rather than being lazy, or weak, or self-indulgent, addicts work way harder than most people. Because they are determined to say NO to an overwhelming compulsion or desire, to overcome ego fatigue, to outsmart their cravings by changing something fundamental about how they view themselves, how they attend to the world, how they talk to themselves. They are the bravest people I know.

I told them how much I have learned from the people who write into my blog: about addiction, about recovery, and about the far reaches of imagination, courage, and determination – the strategies and eventual victories we achieve through hard work – so that we can feel decent, normal, better than normal, proud of ourselves…the way I felt tonight.

Thank you for that.