Category: Connect

The relationship between addiction and emotional anguish — primarily anxiety and depression — is well known. When we look for root causes of addiction, we inevitably ask why so many people are suffering. Here I reflect a bit, and link to a mind-blowing video, on suffering and evolution.

Why is it so hard? Why is there so much suffering, in the world, in ourselves? That question comes up all the time, especially among us addicts (recovered or not). We’re not the only ones. We just tried to find a way out through the back door. The proportion of people in the Western World (e.g., the US) who suffer from anxiety and/or depression (and related conditions) is astronomical. And for today’s young people it seems to be getting worse, though that conclusion is conflated with changes in the way people communicate with each other and with mental health professionals.

One simple answer is that we evolved from physical matter to become the unfathomably sensitive and intelligent creatures we are. And evolution doesn’t concern itself with suffering. In fact suffering (struggle, loss, and death) is a big part of what drives it.

This question, always cycling though my dialogues with people in this community and others in my life, came back to me a few days ago when I received a long, detailed email from someone I don’t know, someone who has struggled on and off with addiction throughout his life. He told me of his childhood traumas and hardships, and of the brutal treatment received by his parents in an internment camp during World War II who, as a result, were never able to give him what he needed as a child. He sees himself as someone who has to struggle and persevere just to get through each day, fending off anxiety, depression, hopelessness, and meaninglessness — you know, the usual quartet of background singers.

What could I say to him? Advice? Meditation…sure, but he’s tried that and it hasn’t worked for him. Therapy? Tried that too. In a nutshell, there was nothing at all I could say to help him. I recalled my own explosive introduction to utter, fundamental helplessness, an experience on ayahuasca that I tried to convey to you in this post. Accepting one’s helplessness might be a way toward struggling less, or even giving up the struggle, and just living in the present, accepting the ebb and flow of forces that sometimes bring happiness but undoubtedly bring suffering and lead, inevitably, to loss and death. And certainly these forces are intermingled with the disconnection, competition, and often cruelty that we face from other humans who are, when you stop and think about it, just as caught up in their own struggles to survive from day to day and hold onto a bit of happiness.

You just want to scream: it’s so unfair!

But there are other ways to think about it. Fairness is a construction we learn at around age five, and it has absolutely nothing to do with the natural universe. It’s just a social norm, a code for resolving petty rivalries. It’s no more relevant to nature than tea ceremonies or Facebook.

In fact, we are lucky as hell to be here at all. And suffering is just part of the process that brought us here and that continues to give us the chance to evolve and, hopefully, to grow more intelligent, compassionate, and beautiful.

I’m in San Francisco now, mainly to spend time with my father, who just turned ninety. He’s had a rapid but luckily temporary decline in cognitive function. He’s doing better. I’m going home soon. On my way here, I bought a book called Dancing with Elephants. It’s about how to be present, engaged, and even happy in the face of terminal illness, oncoming dementia, and — you guessed it — the inevitability of death. Yeah, cheery stuff. But it’s written by a guy with Huntington’s Disease, a guy who is presently in the process of losing everything, his body and his mind. And he’s talking about connecting and accepting and loving. He’s nowhere close to despair. I’m only partway through and I can’t yet recommend it confidently, but take a look if you like. There are certainly gems of wisdom in the book, and even the fact that this guy can think this way and write this way is astonishing and uplifting.

Anyway, I have nothing more to say on the subject of suffering. But I want you to watch this video, especially if you’ve not seen it before. I recently rediscovered it, and I think it is wonderful. There is so much in it, complexity and symmetry, perspective, and a vastly comprehensive view of who and what we are. But there’s also a simple message: evolution isn’t easy, suffering and death are always with us, but there is tremendous beauty in how we got here and where we might continue to go.

 

 

…by Hanna Pickard…

Hanna is one of several addiction researchers who wrote commentaries about my book and my theory of addiction. Here she explains how we can view addiction as guided by choice without the extra baggage of blame, shame, and stigma. Following are segments of her revised commentary, which can be seen in full here.

Hanna and I have discussed her viewpoint in detail, and we are largely in agreement. However, she sees me as rejecting a “choice” model of addiction. I don’t agree with that. I think that addicts do have choices, but they are not simple choices. They are difficult, effortful choices to struggle against years of habit formation and the conditioning that goes with it — especially since habitual behaviours become wired in our brains, at least for a while. This makes choice difficult — but certainly not impossible.

Despite our disagreement about what I think of choice, Hanna’s essay makes some excellent points. Here’s what she has to say —

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Drug use and drug addiction are severely stigmatised around the world. Cross-cultural studies suggest that social disapproval of addiction is greater than social disapproval of a range of highly stigmatised conditions, including leprosy, HIV, homelessness, dirtiness, neglect of children, and a criminal record for burglary… Our common language also expresses stigma: people who use drugs are “junkies”, mothers who use drugs are “crack moms”, and abstinence is called “getting clean” — implying, of course, that when people use drugs they are dirty…

Why are drug users and addicts subjected to stigma and harsh treatment? No doubt a full explanation depends on a variety of complicated historical, socio-political and economic forces. But…we must also recognise how much these attitudes and policies resonate with the moral model of addiction which was dominant in the first half of the Twentieth Century.

The moral model of addiction has two distinctive features. First, it views drug use as a choice, even for addicts. Second, it adopts a critical moral stance against this choice. Addicts are considered people of bad character with antisocial values: selfish and lazy, they supposedly value pleasure, idleness and escape above all else, and are willing to pursue these at any cost to themselves or others. In contemporary Western culture, we typically hold people responsible for actions if they have a choice and so could do otherwise, and we excuse people from responsibility if they don’t. Because the moral model of addiction sees drug use as a choice, it views addicts as responsible — deserving of the stigma and harsh treatment they in fact receive.

For those who recoil from the attitudes embodied in the moral model, the disease model of addiction can appear by contrast to offer a desperately needed [alternative]. “When addiction specialists say that addiction is a disease, they mean that drug use has become involuntary.” According to the disease model, addiction is a chronic, relapsing neurobiological disease characterised by compulsive use despite negative consequences. Repeated drug use is supposed to change the brain so as to render the desire for drugs irresistible: the disease model maintains that addicts literally cannot help using drugs and have no choice over consumption.

I agree with Lewis that addiction is not a disease — at least given the typical meaning and implications of that concept. And I believe Lewis is correct to emphasise the central importance of a sense of agency, empowerment, and personal growth and self-understanding, in overcoming addiction. But I do not agree [with Lewis] that we must reject a choice model of addiction.

There are two straightforward reasons why. The first is that the evidence is ever-increasing that, however hard it is for addicts to control their use, and however important it is for others to recognize and respect this struggle, addicts…have choice over their consumption in many circumstances. To briefly review some of this evidence: Anecdotal and first-person reports abound of addicts (including those with a DSM-based diagnosis of dependence) going “cold turkey”. Large-scale epidemiological studies demonstrate that the majority of addicts “mature out” without clinical intervention in their late twenties and early thirties, as the responsibilities and opportunities of adulthood…increase. Experimental studies show that, when offered a choice between taking drugs or receiving money then and there in the laboratory setting, addicts will frequently choose money over drugs. Finally, since Bruce Alexander’s seminal experiment “Rat Park” first intimated that something similar might be true of rats, animal research on addiction has convincingly demonstrated that…cocaine-addicted rats will…forego cocaine and choose alternative goods, such as saccharin or same-sex snuggling, if available. In short, the evidence is strong that drug use in addiction is not involuntary: addicts are responsive to incentives and so have choice and a degree of control over their consumption in a great many circumstances.

The second reason to maintain a choice model of addiction is that the process of overcoming addiction through a sense of agency, empowerment, and personal growth and self-understanding — a process that Lewis describes in The Biology of Desire with great care and acuity — itself presupposes that addicts have choice and a degree of control. Agency needs to exist to be mobilized: you can only decide to quit and do what it takes to stop using and change how you live and the kind of person you are if you have some choice and control over your use and your identity.

Recall that the moral model of addiction has two features. It views drug use as a choice. And it adopts a critical moral stance against this choice. Because of the evidence [just reviewed], I believe we must accept the first feature. But that does not mean we must also accept the second. Just as addicts have choices with respect to drug use, we have choices with respect to how we respond to people who use drugs.

Marc Lewis has diagnosed a genuine dilemma: the disease model is neither credible in the face of the evidence nor helpful in so far as it disempowers addicts; but…a choice model invites blame and stigma by attributing agency and responsibility to addicts. In response, he has opted to distance himself from both. But that is an unstable position… We must accept a choice model of addiction – although [we also] need to contextualise choices and understand the variety of ways control, agency, and so too responsibility, may be reduced in addiction.

However, accepting a choice model of addiction incurs a moral burden… Choice models of addiction ought…to be paired with a practice of [questioning] our own attitudes towards addiction alongside a commitment to working for social justice. [It is possible to distinguish] our concept of responsibility from our concept of blame.

Suppose we begin by asking a direct question to challenge the moral model: What precisely is supposed to be wrong with using drugs? Throughout human history, drugs have been used as means to achieve a host of valuable ends, including (1) improved social interaction; (2) facilitated mating and sex; (3) heightened cognitive performance; (4) facilitated recovery and coping with stress; (5) self-medication for negative emotions, psychological distress and other mental health problems and symptoms; (6) sensory curiosity – expanded experiential horizon; and, finally, (7) euphoria and hedonia – in other words, pleasure. Drugs make us feel good, provide relief from suffering, and help us do various things we want to do better. [It] is difficult to see what could possibly be wrong with using drugs in and of itself. Suppose now we ask a further direct question: When use escalates to the point of addiction, who is to be held responsible for the ensuing negative consequences? According to the moral model, it is addicts themselves, who are not only responsible but [blameworthy], as they are considered to be fundamentally people of bad character with antisocial values… As an advocate of a choice model of addiction, I do not of course deny that some responsibility — but, crucially, responsibility as distinct from blame — lies with addicts themselves… The point I wish to emphasise however is that, in placing blame squarely on addicts or their disease, both models are united in enabling us to keep the focus of our attention away from ourselves and our society, avoiding the question of whether we, as a society, also collectively bear some responsibility for drug use and addiction and their consequent harms.

Do we collectively bear such responsibility? …A disproportionate number of addicts come from underprivileged socioeconomic backgrounds, have suffered from childhood abuse and adversity, struggle with mental health problems, and are members of minority ethnic groups or other groups subjected to prejudice and discrimination. They may experience extreme psychological distress alongside a host of mental health problems apart from their addiction, feel a lack of psychosocial integration, and are at a socioeconomic disadvantage such that they have severely limited opportunities. These circumstances are central to understanding addiction in many contexts. Put crudely, the reason is simply that drugs offer a way of coping with stress, pain, and some of the worst of life’s miseries, when there is little possibility for genuine hope or improvement… In such circumstances, whatever harms accrue from using drugs must be weighed against whatever harms accrue from not using them. For this reason, the explanation of addiction and its associated negative consequences must lie in no small part with the psycho-socio-economic circumstances that cause such suffering and limit opportunities. And the existence of these circumstances is a feature of our society for which we must all collectively take some responsibility.

Both the moral and the disease model of addiction can therefore be seen to function as a psychological defense — protecting us from focussing our attention on the existence of these circumstances and their role in explaining drug use and addiction, thereby keeping consciousness of our own collective responsibility for these facts at bay. Perhaps one reason, then, why we blame and stigmatise addicts for their choices is that it is more comfortable than facing up to aspects of our society which make drugs — whatever their costs — such a good option for many of our already vulnerable and disadvantaged members.

Note: Hanna will be talking about drugs and addiction on Radio 4 on Wednesday, 12 July, at 20:45 BST. (After that date, the broadcast will be available for download here.)

 

…by Matt Robert…

We interrupt this broadcast for an important announcement from the fake news channel.  If you haven’t already heard, you are a worthless piece of shit who doesn’t have any business having a happy life, so you should just give up, say fuck it and use. You should just give up and settle for less, because this isn’t gonna get any better. Besides, nobody will know…or care.

Sound familiar?

One of the Trumpocalypse’s unintended contributions to the rational world was the reminder that not everything we hear on the news is real. Neither is everything we hear in our heads — especially the automatic negative thoughts blaring from our own fake news channel.

In some fake news stories of foreign origin the English is not quite right. In many of them, regardless of origin, the reasoning is not too solid. Likewise, sometimes the reasoning on our own fake news channel is a bit off: “So what if you got a degree in literature? You don’t know shit.”

Remember the fake news story about Hillary Clinton running a child pornography ring out of a pizzeria in NY city? And the guy who got a gun and drove hundreds of miles to the pizzeria to “save the children”? We too often act on the ridiculous messages that our fake news channel is sending us.

I’ve noticed that, when I was an in-patient or in a treatment program, the fake news network stopped broadcasting, or at least I couldn’t pick it up. I was always puzzled that whenever I was in treatment, I’d do great. Just being there sharpened my awareness. When I came out I’d go along great for a while and then tank. One likely reason: my fake news sources were back in action, broadcasting loud and clear.

So what to do? Well, you can’t change something if you don’t know what it is–and our fake news channel may always be there. Get to know yours — there may be more than one. My most popular channel is on the Self-Blame and Praise-Hater network.  “This just in: Everything bad that happens is your fault, and you don’t deserve any credit for a job well-done. And now a word from our sponsor: You suck.” I specifically and mindfully practice noticing when these subtle yet insidious rebroadcasts emerge unbidden.

Fake news triggers urges, and vice versa. The satellite feed for the lead story originated long ago and far away — for some of us the stories started in early childhood.  The stories can be as incessant as muzak playing over and over in your head. We have to change the channel to stay ahead of it…to stay in front of the fuck-its. Because when do the fuck-its happen? When terrorists demand action, now — no time to stop and think — or else.

Fake news is now not only a meme but an apt tag for the harmful diatribes that go off in our heads and often drive our behavior. But if we can recognize them, we can label them, and if we can label them, we can stop listening. If we can slow down enough to classify the news as real or fake, then, if it’s fake, we can turn down the volume — all the way down.

What are some things people do to change the channel on their fake news? Please let us know.

 

 

As neuroscience explodes with new ideas, new technologies, and new findings, ordinary people have a hard time absorbing the information that emerges. We are learning more details about networks in the cortex responsible for different kinds of thinking, reflecting, observing, and we know about regions lying beneath the cortex responsible for emotion and motivation. What are we supposed to do with this knowledge? Why is it so hard to integrate into our daily lives?

I think the main reason is that our thinking and feeling, our personalities, and consciousness itself are so immediate, so personal, that we can’t entertain the idea that they emerge from electrochemical pulses among a bunch of cells. Our experience is so intricate, nuanced, and private — it’s difficult to imagine that it comes from a remarkable bodily organ. This paradox has been a real problem for philosophers ever since the time of the Greeks. It was made famous by Descartes, who said there must be some part of us that does not come from our bodies: this was termed “mind-body dualism.”

What’s that got to do with addiction? you might ask. The thing is, most of us continue to see addiction as a personal problem, a nastiness that comes from our inner being, a reflection of the dark places we’ve been and the dark things we’ve thought and done. The dishonesty that often comes with addiction (the lying, stealing, etc) feels like an incontrovertible personal failure, unforgiveable (at some level) because…well because shouldn’t I be a better person?

The darkness, confusion, tragedy and destruction do belong to us. There’s no denying it. But they also belong to a brain that is an organ of our bodies. The brain functions according to the codes built into it over millions of years of evolution, most critically: attempt to minimize suffering and maximize relief. Stave off deprivation. And it puts those requirements above other goals, like obeying social conventions. This brain of yours has been adjusting to whatever has happened to you every single day since (and before) your birth. And some of what’s happened to you has no doubt been frightening, uncontrollable, and perhaps deeply traumatic.

Through all this your brain continues to adapt.

To accept that our thoughts and actions really do arise from our brains does not get rid of personal responsibility — that’s not what I’m trying to say. But it can be a crucial step in understanding that the things we do that we’d rather not do aren’t simple choices between right and wrong. They arise from a sequence of developmental adaptations in an organ that does its best to keep us going in a hugely challenging world.

To accept that your addictive impulses come from your brain opens an avenue to self-forgiveness. But remember: brains have developed incredible capacities to think, plan, and reason about consequences. Self-control is one of the brain’s crowning achievements. And since addiction leads irrevocably to suffering, maybe you can work with your brain, sort of as a partner, to make your life a lot happier than it is.

 

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P.S.  Thanks for the comments so far, guys. I love this community. Meanwhile, I wanted to share a link to a work-in-progress dramatization (a theatre piece) of a very serious gambling problem, especially in the UK and Australia. The problem is the deployment of rapid-fire electronic gambling machines called Fixed Odds Betting Terminals — a new generation of machines that can take enormous amounts of money in a very brief time. These things are destroying lives as quickly as any drug. Take a look at this.

By the way, the title “Crack Cocaine” is a misnomer — they plan to change it soon.

 

 

 

 

I’ve written about the benefits of stretching your sense of yourself outward, freeing it from the repetitive, stagnant “now” of addiction, extending it all the way from a distant but familiar past to a wished-for future. But how can we turn this abstract idea into an exercise, a therapeutic method, for recovery, for whatever you want to call the next stage?

I’ve been thinking vaguely about a workshop I’m to give in Australia this July. So I ask myself: what on earth do I have to offer front-line workers in addiction? What can I suggest that’s concrete enough to help real people struggling with addiction in the here and now? Well an idea finally came to me while I was meditating this morning. I do sometimes get good ideas while meditating. I’m no expert meditator by the way, and I know you’re not really supposed to be thinking things through. But sometimes new perspectives just appear, and I value them.

So here it is:

What if, either alone, maybe in a guided meditation context, or maybe in psychotherapy with an expert, what if the cravings, the fondness, the attraction of getting high kind of slid down a slide of time, from the present to the past. After all, those cravings don’t really belong in the present tense, that’s not their home. They come from long ago. From the dark oppressive helplessness that followed something awful, some period of abuse or chaos. They come from a depression that started when you were a teen. Well, didn’t they? I know mine did. And they show up in the present, in the now, in the “should I or not?” of today, as stubborn visitors. They continue to visit you in the present. Like unwelcome guests, they don’t leave when it’s time for them to go, even though they’re taking up half the house.

So imagine the whole continuum of your life as though it were a slide or a slope. Let those desires slide backward in time, and follow them, observe them, see where they land in the past, see where they really belong, like an observer on an archeological expedition. When I try that exercise, I get a rush of self-compassion and self-understanding, and, as a bonus, present-tense cravings pack their belongings and clear out.

It’s like an overcast sky when the clouds start to part and little bits of sun filter through. And then you realize there’s a whole blue sky waiting on the other side of the clouds.*

Then continue the metaphor: imagine the slope of your life continuing upward, rising, unfurling, as it opens into the future. That future really is different from the past — and the present. This is not an abstraction. It’s a completely different place, a place you’ve never been to, but a place that sends tendrils of possibility, rays of hope, back to you, now, in the present, where you’re sitting wondering about and yearning toward freedom and change.

Maybe a better image is that of a cone…maybe an ice-cream cone. After all, there’s only so much mileage you get from a shoe horn. Maybe picture an ice-cream cone and let all the slush gravitate to the bottom, which invariably starts to leak. So the goo leaks out the soggy bottom, and what’s left on top is…I don’t know, the good stuff, the untasted flavours? The chocolate sprinkles?

Maybe a snow-cone?

I can’t quite find the right image. Any ideas would be appreciated. It would be nice to develop this metaphor so that I could actually talk about it, elaborate it, teach it. Here’s another image that might work better, because you can see the “bad stuff” emitting downward and out the bottom while the “good stuff,” the possible future, radiates from the mouth of the cone.

Try it and see what you think. For me, this is unfinished business, a rough draft. But I’m sure there’s a palpable feeling to letting the present-tense sludge slide back into the past, where it really belongs, and then…then, I don’t know, the sky’s the limit.

 

 

*I got this metaphor from “Andy,” the guide for the Headspace meditation app. I think Headspace is fabulous. Try it!