Author: Marc

I just got a piece published in Newsweek! This makes me happy, to be sure. But if you see the paper version, the headline they picked does NOT appeal to me:  “My Kool Acid Test”. Hmmm….not my choice, but I couldn’t talk them out of it. Oh well, it’s Newsweek, and I’m a shameless publicity hound these days…

Here’s the link to the online edition. Below I’m going to paste in the UNABRIDGED text. Although I was after a story-line that focuses on the sixties, I think the “then and now” aspect is really interesting. And though they cut this part for the publication, check out the contrast between Ecstasy, today’s favourite party drug, and LSD, our drug of choice 40 years ago.

 

I’m a neuroscientist, I try and understand how the brain works, but I take a special interest in how it doesn’t work when people take drugs. That interest arose from memories of my own troubled youth: I used to be one of those people. For most of my late teens and twenties I ingested every drug I could find, and I became seriously addicted to hard drugs for part of that time. Now I try to make sense of those years, by exploring how different drugs modify brain function and how those modifications can become so terribly attractive. The drugs we find appealing reveal much about who we are; yet their effects remain mysterious, almost unknowable, until we look at the brain and its own intrinsic chemistry.

My drug-taking adventures began in the late sixties – when the world seemed wide open, waiting to reveal its wonders. I had just arrived in Berkeley, California, and my newfound friends and I were spellbound by the mind-expanding potential of LSD. But the world has changed since then, and the drugs we take today, including SSRIs and ecstasy, send our brains in a very different direction, toward comfort rather than freedom. The irony is that both these pathways begin with one very special molecule: a neurotransmitter called serotonin.

LSD (lysergic acid diethylamide) goes to work in the brain by blocking serotonin receptors, the gateways that allow serotonin into our neurons. As a result, serotonin molecules flowing from our brain stem have nowhere to go and nothing to do. Serotonin’s job is to reduce the firing rate of neurons that get too excited because of the volume or intensity of incoming information. That’s how it calms synaptic traffic, modulates extremes, regulates and supervises the brain. Serotonin filters out unwanted noise, and normal brains rely on that. So, by blocking serotonin, LSD allows information to flow through the brain unchecked. It opens up the floodgates – what Huxley called the “Doors of Perception” – and that’s just what it felt like the first time I took it.

My first acid trip was both wonderful and terrifying. I was in a friend’s apartment, among a rag-tag assortment of hippie types, and I swallowed a little purple pill during a prolonged Monopoly game. About 45 minutes later, the room started to disintegrate. I had to stop playing; I could no longer read the numbers on the dice. The dice, the plaster walls, the chattering voices, the facial hair of my compatriots – each perceptual gestalt broke apart into its constituent details, moving, changing, swirling, arranging themselves into patterns of geometric beauty or turgid ugliness. My senses and thoughts were out of control, and the world rushed in relentlessly.

LSD was invented by Albert Hofmann in the 30s, but its psychedelic properties were not apparent until he tried it on himself, in 1943, and thought he was going mad. For a couple of decades, psychiatric researchers tried  to treat disorders ranging from schizophrenia to alcoholism with LSD. The CIA and US military got into the act in the 50s and 60s, with the hope of manipulating potential informers or instilling mass confusion in enemy troops. But the effects of LSD remained elusive and unpredictable. It was deemed more trouble than it was worth in government circles, but it found its true calling as the emblem of a generation intent on change. For my friends and I, LSD was revered as a key that could unlock human perception and redefine human potential. So I took acid at least once a week and watched the grain of the sidewalk separate into rainbow fragments, gazed at the canopy of a redwood forest devolving into geometric scribbles, or tossed in the surf of my own cognition as it swelled in profundity. I wanted to open up my senses, strip off my mental armor, and let reality enter. And I didn’t give up for several years, until acid finally became routine, and I got drawn toward darker adventures with addictive drugs, heroin among them.

Still, for those few years from 1968 to 1972 , acid seemed the leading edge of a culture bent on charting new territory. “The times they are a changin’” chanted Dylan, and the world seemed rich with  possibilities. As far as my friends and I were concerned, LSD, mescaline, and psilocybin – all compounds that torpedoed serotonin – made that world accessible. Move over, serotonin. Safety is out. Infinity is in. So we popped our pills and wandered the frontiers of inner space. At least until the drug wore off and our serotonin molecules flowed huffily back into place.

In the last ten years, serotonin has again been the target of a culture-wide chemical invasion, but the new drugs shift human experience in the opposite direction. SSRIs (selective serotonin reuptake inhibitors) — like paroxetine (Paxil) and fluoxetine (Prozac) — are used to treat depression, anxiety, PTSD, OCD, and undefined feelings of ickiness. Instead of getting rid of serotonin, these drugs block the reabsorption process, so that serotonin keeps piling up in the synapses. The result: an extra-thick blanket of serotonin that filters out the intrusions of anguish and anxiety, making our inner worlds secure. Instead of turning on, tuning in, and dropping out, they help us turn off, tune out, and drop in – into a solipsistic safety zone, protected from too much reality.

Unlike the psychiatric researchers of the 50s and 60s, today’s psychopharmacologists are pleased with their progress. Every year or two, new and perhaps improved SSRIs are dumped into the waiting hands of millions of needy patients. (By 2007, antidepressants were the most pescribed drugs in the U.S., according to the Center for Disease Control.) But what do these new molecules tell us about our culture, about how we perceive our world? Apparently, now is not a time of exuberant exploration, but a time to hunker down and play it safe. The world seems too upsetting to wander in search of new adventures, too dangerous to explore beyond our own front porch. Instead of letting the world in, with all its uncertainties, we try to keep it out. And a barricade of serotonin makes that possible.

Even the recreational drugs of today’s youth point the weather vane of serotonin toward comfort rather than freedom. Ecstasy (MDMA) increases serotonin in the synapses, like a hyped-up antidepressant, making the world feel cozy. And while it’s true that most people don’t take serotonergic drugs, either from their doctor or their dealer, it’s no accident that those who do are resonating to a cultural theme much different from the optimistic vision of the sixties: Life is dangerous, protect yourself, or at least make yourself comfortable.

The drugs we take, the drugs we create, offer an idealized antidote to the cravings of our times. LSD was born from our craving for freedom. SSRIs reflect our need for security. Molecular makeovers never quite get us there, but they can show us where we are and where we’ve been.

 

 

 

 

Several posts ago I started a discussion of “the pivot point” — the moment when we give in to our cravings and dive for the drugs or the booze. I emphasized a few things about this event, many of which resonated with readers’ experiences — in fact many of which came from readers:

-it can begin with a change in your internal dialogue, like my humming to myself in the rat lab, when you already know, without full consciousness, that you’re going to do it

-at the final moment, it feels like you are throwing off control, not just surrender but also triumph

-there is often a feeling of great relief, abandon, or escape from suffocating self-control — one reader called it the sense of free fall

We then discussed the pivot point in more detail, getting into the psychology of ego fatigue and the underlying brain dynamics: the weakening of the will as the anterior cingulate cortex (ACC) runs out of fuel, and the final snapping of the branch. The dialogue concluded with the notion of an 11th commandment: Avoid Temptation. Because you can’t inhibit your impulses, actively, for a very long time. Your brain can’t take the strain.

In this post I want to go a step further and explore the relief that comes at the pivot point. There is still an untapped mystery here. Sure, you’ve been craving, and now you allow yourself to get the thing you’ve been craving. Dopamine feels like desperate desire when the goal is out of reach. But it feels like a headlong rush when you’re suddenly “allowed” to go get it. That’s a part of the relief.

Yet there’s a lot more to it. During periods of self-restraint, there can be an ongoing struggle that often takes the form of an internal dialogue: Don’t do it. No, just stop. But it would be so nice… Stop thinking about it. But I want… Shut up! Just stop! And it can get quite a bit more vicious than that: Stop, you self-indulgent baby. But it’s just one last time. That’s what you always say, you hopeless cretin. So? Everyone’s got their problems. You don’t deserve sympathy.  But I’m so depressed…  No wonder you disgust people. Etc, etc. If you’ve ever heard a (usually unspoken) dialogue  like this, going on in your head, then you’ve probably gotten to the point of saying “Fuck it.” And you know that the relief you get is not only from the drug/drink, or the anticipation of the drug/drink. It’s also the blissful shutting off of that nasty voice of self-rebuke.

Think about it this way: When are you more likely to yell at your kid? When she is playing safely in the playground, or when she’s wandering out into the street? When your kid is approaching an oncoming truck, or a cliff edge, is when you lose it and scream: Stop! Go back! I told you NEVER to do that!

So what’s going on in the brain during this state? Picture your ACC, sitting near the top of the brain, trying to keep control, but finding it slipping, slipping. Two floors down there’s the amygdala, the organ of emotional colouring. As your ACC starts losing it, your amygdala begins to panic. Not only because of the longterm suffering you’re about to contract, but also because the internal “parent-like” voice is getting more and more harsh, nasty, and punitive.

With the ACC losing control and the amygdala responding with waves of anxiety, the two voices in your head, the childish self and the scolding parent, become more desperate, and more desperately at odds with each other. There is no consensus on where internal voices are generated in the brain, but we do know that anger is associated with the left prefrontal cortex (PFC) and fear with the right. The left PFC, being involved in planning, logic, and making sense, has also been associated with moral judgment. The right PFC is more “childish” — it develops rapidly in infancy, before the left — and it’s more closely connected with raw emotion. In fact, some neuroscientists claim that an important job of the left PFC is to regulate the right. That often means inhibiting impulses. So now you’re losing control, the amygdala is blaring anxiety, and the “childish” right hemisphere is being suffocated by the moral authority of the left.  This is no picnic. It’s a major family argument in the privacy of your own brain!

And then comes the pivot point. The ACC is finally too “fatigued” to keep controlling impulses. So here’s what I think happens next:

Without the ACC to help keep the ship on course, the left-based punitive “voice” loses its authority. The right PFC is suddenly free to take the emotional path of least resistance. Left-hemisphere reasoning now switches over to become allied with its old friend, the ventral striatum (the engine of goal-pursuit), which has silently toppled the ACC in terms of cortical supremacy. In fact the whole frontal brain becomes unified behind one exalted goal: LET’S GET HIGH. And the left PFC does its part by planning (its specialty) — how to get it, how to pay for it, how to hide it. The amygdala is suddenly passing along waves of excitement rather than anxiety, and you are cruising, rudderless, in a tide of pure intention.

This kind of brain modelling needs to be verified by research, and we’re just starting to acquire the tools to go there. For example, recent research (in a related model) shows that, when the inner voice of restraint is coming from brain regions that represent other people (not oneself), we stop listening, and we stop acting responsibly.

So there it is: a (speculative) brain-based model of the relief that comes from escaping self-restraint. But I’m not recommending it! (Don’t try this at home, kids.) That relief is real, both psychologically and neurologically, but it is a temporary flash of positive emotion at the start of a long dive into negative emotion. This is part of the siren song, the fool’s gold, of substance use. It doesn’t last long, and it leaves you empty and gasping when it’s gone.

I know this post is a little dense. I wanted to get these ideas down before leaving for the US book tour — in less than two days. But please post your comments or questions, I’ll check in while I’m on the road, and I hope to unpack some of these themes in the near future.

 

 

 

 

Why the new book image on the homepage?

My book is going south. It just got published in Australia/New Zealand, and on March 6th it will be released in the US. The cover you see now is the US version. The Australian version, which features my addicted brain as a moth-infested lightbulb, can be seen on the “Buy” page. Who is that fellow, and what’s his problem?!

Interviews and reviews are gearing up again. I’m starting to get calls from reporters, columnists, reviewers, and producers for radio and TV shows, and I’m going on a US book tour in two weeks. All very exciting…and weird. I’ll keep you posted as to the reception.

Meanwhile, if you’ve got anything to say about the book (and it doesn’t have to all be positive), please consider writing a “customer review” for Amazon.com (not Amazon.ca). That will help spread the buzz southward.

 

Hi All. I just got back from a week in the French Alps. I know: poor me. But I spent the first day trying to snow-board, and fell on my ass with bone-jarring impact about once a minute. And I thought I was past the suicidal thing…

But while I was away, my US publicist sent me the link to a New York Post article, for which I was interviewed by phone in depth the week before. Most newspaper and magazine coverage of the book has been pretty good, despite various factual errors. But this article had some of my words and convictions turned completely upside down. For example:

Along with many other leaders in the field, Lewis believes that the recovery model needs an overhaul, that addiction should be treated as manageable disease, akin to HIV, rather than a curable one.

I don’t think of addiction as a disease at all. Sure, the disease metaphor resonates with aspects of addiction. But whenever I’m asked (as I was this time), I describe addiction as a form of learning. It’s a kind of learning that’s vastly accelerated and self-reinforcing. But it’s not a disease. And I would never, in my wildest dreams, compare addiction to HIV — there is NO VIRUS at work here.

But I don’t blame this columnist for trying to fit addiction into a familiar mould. The gist of her article was about inadequacies in the 12-step approach, and we were in synch on many points. In fact, her aim was to find a simple answer to a complex question. What the hell is addiction and how do we “cure” it?

My book and my other writings highlight the commonalities among addictions and among addicts. I emphasize a “common pathway” of addiction in the neurochemistry of dopamine, the role of the ventral striatum in craving, and the sculpting of synaptic pathways (in the orbitofrontal cortex) that imbue drug, drink, or whatever it is with value. Other neuroscientists also believe in a common pathway for all addictions. Along with ego fatigue, and a few other well-documented findings, these neuropsychological realities reveal something universal about addiction.  So a lot of my message is that we share the same brain — with its characteristic frailties — and when we fall, we fall down the same rabbit hole, and share the same challenges when we try to climb out.

And yet…what I have learned, not only from the addiction literature but from you, dear readers, is that people recover in vastly different ways.

First come the statistics. About 5% of alcoholics stop for good on their own every year  (see this opinionated but fascinating review). The rate of spontaneous recovery appears to be far higher for narcotics addicts (see the recent book by Gene Heyman. Though I disagree with some of Heyman’s arguments, his statistics on spontaneous recovery are informative.) Second, harm reduction really works: many people don’t stop using but they slow down or clean up enough to stop destroying themselves — another natural process of healing. Third, comments on this blog clearly demonstrate that, as difficult as it is to ignore craving, many of us manage to resist it or outsmart it until it becomes manageable, on our own, or with friends, or with family, or with our partners, or in the care of recovery programs (12-step based or not), or in therapeutic communities, or with private therapists, or, or, or…

I’m continuously blown away by how much diversity there is in how people get by and get out.

So what do I tell journalists who want to know the answer ? Yes, brain characteristics are fundamentally relevant to the addiction process. Yes, finding a “common pathway” in the neuroscience of addiction is critical, both for addicts and for those involved in helping them. But no, there is no common pathway to recovery. Some of us take comfort in following rules. Others abhor them. Some of us need to feel cared for before we can stop. Others need to feel more independent. And there are all those shades of grey, those mixtures and variants, among them. We are each individuals, with unique experiences, capacities, affinities, and aversions, and our creativity is probably the most important element in our recovery.

That doesn’t sound at all like a disease.

 

 

 

 

 

 

 

 

Last post, I emphasized an assumption of incompleteness as the foundation of craving. This feeling was referred to by readers as a hole, or pothole, or just plain lacking something. There is a lot to that, for those of us who put things (like booze or drugs) into us, in order to fill us up. But recent comments from readers struggling with anorexia or bulimia should make us think about craving more broadly. For some people there’s a compelling need to get rid of something.

What’s the common denominator?

As mentioned time and time again: relief from suffering, and I still think this translates to feeling complete. To be protected against suffering you have to be complete. For some that means filling holes, for others it means getting rid of excess. Either way, we want to make ourselves ideal, coherent, whole, and thus safe from suffering.

Let’s start with those of us who need to put something into ourselves.

This is not the time to review Freud in detail, but a hundred years of psychodynamic (e.g., post-Freudian) theory point to the infant’s need for milk or food, and the relief it provides, as the primal experience of taking something inside ourselves – something we need in order to be okay. One psychodynamic theorist, Melanie Klein, thought that young children experience a profound longing, which she called “envy,” for the mother’s breast or the mother herself. The infant seemed to know, beyond any doubt, that he or she needed something outside the self, in order to be complete. Maybe the first few times you got high, or drunk, or laid, you were reminded of how that works.

But what about those of us who need to get rid of something? There may be a feeling that we are too much, too dirty, too big, too fat, too needy, too greedy. I think even those of us who tend to shoot for more rather than less can identify that feeling. We want to trim ourselves so that we can be pure. Clean and nice. Maybe the common denominator is something really simple, like feeling “good,” which translates to lovable in cuddly mammals like ourselves.

Psychologists try to measure craving, or desire, using verbal information. For example, Hofmann, Baumeister, and colleagues (2011) got 200 people to participate in an experiment in which they were beeped at random times throughout the day and asked to record whether they were presently experiencing a desire…among other things. To make a long story short, participants reported at least one current desire on 50% of the occasions they were beeped. “On average, desires were actively resisted on 42% of occasions and enacted on 48% of occasions.” Well, I’m not sure that puts us much further ahead. Desire is a fact of life,  and a lot of desires have to be inhibited. That psychological datum fails the Grandmother Test: my grandmother could have told me that.

Which is why I turn to neuroscience: the biological basis of mind. I recently heard a very succinct account of what dopamine does in the striatum. It decreases “noise”. There are always a number of competing motor plans — plans of action — vying for enactment. That’s the normal noise in the system. What dopamine does is to inhibit the weaker plans and disinhibit (augment) the strongest of the competing plans. It’s a biological mechanism, sort of like focusing your eyes. So what dopamine does in the striatum is to narrow the field of potential actions, from many down to one. And that’s the basis of craving: a narrowing of focus and motivation to one thing and one thing only.

How could it be so simple?

A “cue” in psychologese means a reminder, an association. According to the research, drug and alcohol cues (like clinking ice cubes or round yellow pills) immediately increase dopamine flow for addicts, drawing our attention to those cues and away from other things. Thus the “plan” to acquire the thing being cued (the drug or drink) is strengthened. Then internal cues — remembering, wishing, imagining — join whatever cue came first, and each of those mental cues also increases dopamine flow to the striatum. From a trickle to a torrent. So, before long, there really is only one plan of action, one intention, one goal, that feels worthwhile. And whether or not it’s forbidden, it overtakes the prefrontal cortex with its urgency: the need to get the one thing that will make us feel complete. Or get rid of the one thing that makes us feel incomplete.

That’s how brain science makes addiction make sense. Craving…addiction…an aberration, according to the ideals of our society. But a very natural process for a part of our brain whose job it is to motivate us to make things better.