Category: Connect

Or at least they agree that the point is worth considering. Their review of my book is quite positive. Laura Miller, a senior writer for Salon, got most of it right, and she didn’t shy away from the details. Way better than a kick in the head.

A couple of relevant quotes:

One of those neuroscientists is Marc Lewis, a psychologist and former addict himself, also the author of a new book “The Biology of Desire: Why Addiction is Not a Disease.” Lewis’s argument is actually fairly simple: The disease theory, and the science sometimes used to support it, fail to take into account the plasticity of the human brain. Of course, “the brain changes with addiction,” he writes. “But the way it changes has to do with learning and development — not disease.” All significant and repeated experiences change the brain; adaptability and habit are the brain’s secret weapons. The changes wrought by addiction are not, however, permanent, and while they are dangerous, they’re not abnormal. Through a combination of a difficult emotional history, bad luck and the ordinary operations of the brain itself, an addict is someone whose brain has been transformed, but also someone who can be pushed further along the road toward healthy development…

One size does not fit all, and there’s a growing body of evidence that empowering addicts, rather than insisting that they embrace their powerlessness and the impossibility of ever fully shedding their addiction, can be a road to health as well. If addiction is a form of learning gone tragically wrong, it is also possible that it can be unlearned, that the brain’s native changeability can be set back on track. “Addicts aren’t diseased,” Lewis writes, “and they don’t need medical intervention in order to change their lives. What they need is sensitive, intelligent social scaffolding to hold the pieces of their imagined future in place — while they reach toward it.”

…by Matt Robert…

When I was finally ready to stop, I began the ignominious journey of failing at rehab after rehab. My resolve to stay clean was firm, but I often struggled with aspects of treatment. One of the most baffling things to me was how people were told to refer to themselves in meetings. “Joe– alcoholic/addict.” It never sat right with me. But virtually no one in the programs would sit down and explain it to me. Why should someone refer to themselves as the very thing they were trying not to be? I had to go to 3 or 4 meetings a day in residential treatment, and I noticed that this repeated, retrograde self-disclosure had unintended effects. When people were called to the phone, they often stumbled and said, “Hello, this is Jim– alcoholic.”

Early on I stopped adhering to this meeting routine. It made me feel worse, not better. I had no illusions about my problem and did not harbor the fantasy that I would be able to use again in safety. But the self-naming routine made me feel resistance, not acceptance. Sometimes, when it was my turn in the in-house meetings, I made something up:

“Hi, I’m Matt. Chemical Recycling Dump.”

“Matt, Emotional Disaster Area.”

“Matt, Seething Cauldron of Broken Dreams and Missed Opportunites.”

It had never occurred to me that there were so many sarcastic, unsympathetic ways to refer to addicts. I started sifting through the alphabet for the day’s meeting moniker, (Altruistic, Atheist Addictoholic, Benevolent Bipolar Boozebag, etc….). I had to keep a sense of humor in all this. Otherwise, I was lost.

Finally, I began to piece together the reasoning behind the practice: by calling myself an addict it meant I was gradually accepting it, “faking it till you make it,” at least until my sobriety started to stick. This practice was supposed to keep my awareness on the problem— to keep it fresh, keep it green, keep it up front— to be a part of the community, and the fellowship, and not alone.

I could see the benefit of repeating the label as a pseudo-reality check when someone is in denial that there is a problem, when they’re still in the subacute phase of early recovery. But after we move deeper into recovery, I couldn’t see the point anymore. It was counterintuitive and, for me, counterproductive. By self-identifying, I was reinforcing my connection to a negative behavior that I was trying to replace with something positive. I realize this doesn’t happen for everyone who attends 12-Step meetings. I still attend AA/NA meetings, but because of the personalities, not the principles. It’s the people who I identify with. My principles are fine, otherwise my sobriety wouldn’t be. The most important thing about meetings is to find ones that we like— where we can relate to someone’s story, where we feel better when we leave than when we walked in. Meetings that make us want to stay clean.

I facilitate a group at an inpatient program for homeless women waiting to be placed in sober living situations. I’m there to tell them about SMART Recovery as another option, but my goal is not to push any particular agenda or approach. It’s to get them to go to meetings. Any meetings. We have an open discussion around that, which starts to resemble a SMART meeting. When I first started going , we collectively agreed on a way for everyone to introduce themselves. I would explain the skewed logic of labeling, and suggest that during introductions you could say your name, something about who you are or are working toward (not what you are trying not to be), and an adjective about how you are feeling that night. A similar approach is portrayed in the documentary The Anonymous People and is powerful and compelling: “My name’s Sue…and I’m a person in longterm recovery (…or early recovery…or trying to stay clean).” “I’m Jill, a mother of 4 who likes rock climbing. Tonight, I’m feeling hopeful.”

By the time we get around the room, everyone knows a little more about each other and where they are at emotionally that night. It often makes for a deeper, more meaningful discussion. People learn things about each other.

Sometimes there are longtime AA members in the meeting who are resistant to this different way of self-introduction, just as I was resistant to the traditional AA self-introduction practice. I try to encourage them to remain open-minded (something also stressed in the Big Book). Try everything that seems to help, and accept suggestions. Because we never know where or when that opportunity, that moment of clarity, that motivational window will appear, and we don’t want to miss it.

…by Matt Robert…

Wouldn’t it be nice if we never had to think about our addiction ever again? I posted about 10 months ago on the benefits of mindfulness in recovery. One of the points was that mindfulness informs all cognitive-behavioral approaches: it’s important to pay attention to what you’re telling yourself, and that takes practice. Practice as in mindfulness practice. Mindfulness practice helps us recognize old thoughts, feelings, and habit patterns that can lead us down the road to relapse. It keeps us on track so that we can stop, redirect and avoid those patterns. To notice and arrest a state that many call “prelapse.”

Prelapse is that state where your addicted brain is trying to juke you like a sly basketball player, fool you with cognitive card tricks, and swindle you out of your sobriety. It’s where your mind will tell you skiing might be a healthy idea to distract and reward yourself, even though it’s at the resort where you always got high in the past. It tells you to take the old route home from work, where your favorite liquor store used to beckon your car into its parking lot. It gets you to tell yourself “Pot is okay. It never triggered me in the past. I’ll just have one hit.”

There are many mindfulness methods other than meditation, the one everybody associates with mindfulness. One of the things I like about SMART Recovery meetings is that people are encouraged to find what works for them, and that varies from person to person. SMART groups allow us to self-reflect on our situation and get creative with our recovery. We all have to find our own techniques.

For example, one group member used a mindfulness bell on his iPhone that would go off at random intervals. When it rang, it reminded him to look at what he was doing— and thinking. For instance, if his brain was in the default mode Marc has described, or was engaging in negative self-talk, he could catch himself, redirect his thoughts, pay attention to what he was doing, and change it. He could modify his thoughts and behavior right at that moment—the present moment— and thus better train his brain to respond differently. He could start to modify old habit patterns into new ones. This strategy embodies mindfulness without meditation.

An animated acronym worked for another member. When he noticed himself feeling triggered and wanting to use, he pictured an “escape pod” with the acronym POD painted on the side. The initials stand for Pause (when you feel yourself getting drawn in by a triggering emotion); Observe (what you’re feeling, what you are telling yourself), and Do something different (different from the habitual reaction, to start breaking the habit pattern). The “O” for “observe” launched a mindful state that came about in midstride, without having to sit still with eyes closed. The technique didn’t work right away, but eventually he got better at it and his slips diminished. In other words, he got good at being mindful when he needed to be.

From vague malaise to intense compulsion, you can’t change your behavior until you change your mind.  That’s why mindfulness practices are so important in recovery. Listening and sharing in meetings, noticing the bright colors of spring again, catching ourselves in negative self-talk, being reminded of relevant anecdotes or pithy slogans that have personal meaning. All these are mindfulness, not just sitting on a cushion chanting mantras.

There is a saying many psychologists dislike and recovery groups promote, “What’s the definition of insanity? Doing the same thing over and over and expecting different results.” It may not be an apt definition for insanity, but it certainly is for addiction. And if we don’t remain mindful, the opportunities around us can pass us by, and we’re more likely to end up stuck in the pitfalls we ignore. When I finally began to recover, I became more open to everything. I started to let go of the past and expectations, and came back to my real self. Practice helps me continue to avoid prelapse, and pay attention and notice change—particularly when it is headed in the wrong direction.

Hello people. I’m writing this using a voice recognition app — and then editing the result. Which is pretty strange after all these years using my fingertips. I had a torn tendon in my shoulder repaired last week, and for the next 5 weeks I will have to keep my right arm in a sling. What a drag! At least I’m learning to e-nun-ci-ate more clearly. The most frequent turn of phrase in our household is “What?!” This could help.

For today I just want to draw your attention to the new look of my website. The title, understanding addiction, is clearly what we’re trying to do here. The subtitle, linking brain, behavior, and biography is meant to highlight the importance of integrating viewpoints across these radically different modes of inquiry.

Perspectives on addiction from psychological research, neuroscientific data, and biographical accounts (including addiction memoirs and stories) are so different that it seems we are describing unique phenomena or different species. But there is just one phenomenon we need to grapple with, and our understanding of that thing will be greatly enriched and articulated by unifying these perspectives.

You probably agree with me or you wouldn’t be reading this. And I don’t need to preach to the converted. Rather, I want to highlight the importance of combining perspectives for newcomers — former and recovering addicts, their families, and writers, scientists, and treatment providers. Because it just isn’t done enough. It’s hardly done at all! How often do you think addiction memoirs are read by addiction neuroscientists? How often do people mesmerized by stories of addiction and recovery delve into the brain processes going on at the very same time as those stories are unfolding? Not interested? Too complicated? Psychologists sometimes dip gingerly into each of the other two spheres, but they often don’t use what they learn to design more meaningful studies.

Noted exceptions are Gabor Maté (no, not gay bar message, not game board Maytag, not Gameboy anything!!! This voice recognition software is hilarious…I mean, at least it’s trying) and more recently Carl Hart. It can be done. It’s not all that difficult. The trick is to realize that we are describing the same human being going through the same immensely difficult and powerful transformation and to recognize that this person’s brain, mind, subjective experience, and behaviour all reflect it, though in very different ways.

I also want to encourage my readers to send your stories for me to post on the Guest Memoirs page. It’s still there. Do your part! Let’s keep reading, thinking, and telling our stories — and listening to each other.

You’ve heard of the blind men and the elephant? Each man describes what he gleans from touching a different part of the animal, but it takes all of them together to get a sense of what an elephant is. So I’ll end with a sentence from Wikipedia I got by clicking “blind+men+elephant”

At various times the parable has provided insight into the relativism, opaqueness or inexpressible nature of truth, the behavior of experts in fields where there is a deficit or inaccessibility of information, the need for communication, and respect for different perspectives.

That pretty much says it all.

If you weren’t completely sold on the bicycle analogy. Try this one. The point is the same, and it’s not complicated: addiction is a mental habit, it grows, stabilizes, and gets difficult to reverse. But it’s not permanent. It can be reversed — with practice. Unfortunately, the good habits that replace it may not be permanent either.

Mental habits become stable and resilient, hard to switch out of, when they are practiced repeatedly. That’s the case with piano lessons, pizza night, bicycling, and heroin. (I don’t distinguish “cognitive” habits from motor habits like bicycling — they’re all grounded in the same brain.) It’s possible to switch out of one mental habit and settle into another incompatible habit; that’s all well and good. Except that you might switch back into the old habit if you’re not careful. Because the synaptic configuration that held that pattern in place isn’t gone. It’s just been “deactivated.” Synaptic patterns take a long time to fade — through a process known as synaptic pruning. And the only way that’s going to happen is if other habits are practiced in their place.

Until that occurs, you’ve got these two habitual mental frames, let’s call them drug-wanting and drug-shunning. I recently referred to them as “two you’s.” They’re incompatible. One disappears when the other takes over. And it’s not hard to switch from one to the other — either by accident or on purpose.

So here’s another example: the Necker cube. (I don’t know who Necker was….maybe the guy who discovered this cool optical illusion.)

Take a look at it:

Pretty, isn’t it? Now try seeing the face that includes the lower left corner as the outer face — the face facing you. Easy enough, right? Just stare for awhile. Get used to it. Then imagine a different orientation: imagine that that face is actually at the back, and the front face is the one pointing up and rightward (and including the top rightmost corner) rather than down and leftward. Can you do it? It might take a while, but if you blink a few times and/or move your head around, you should get it. But it’s delicate — like early recovery. Blink again…and your former interpretation might spring back to mind, making the second interpretation highly effortful once more.

Of course these two “interpretations” of the structure of the cube are incompatible. They can’t coexist.  Just like the you who eagerly anticipates getting high can’t exist at the same time as the you who is in control, centered, and connected to the future. These two you’s are incompatible! But they can switch. So watch out!

Now take a look at this diagram:

This represents, in a very simple way, that each version of the Necker cube can be represented by the same group of neurons. Here there are only six neurons involved — obviously an unrealistic number. But line (b) is showing us that a different pattern of activation on the same set of neurons projects a different interpretation of the cube.

Now imagine that you have one (much larger!) group of neurons representing the two interpretations you have of your drug of choice: let’s say cocaine-good and cocaine-bad are the two versions. A different pattern of activation on that same macroset of neurons will produce one or the other version. And the two versions can easily switch, as the activation of the neurons shifts, due to….well, due to the way you’re feeling, the way you’re thinking, how much you slept last night, whether or not your dealer just called, whether you had a coke dream recently, whether you just got a raise at work…or lost your job. I’m sure you know what I’m saying.

In some ways addiction is very complicated. But in other ways, it’s pretty simple. Mental habits can be considered, reflected on, worked with, played with….and they can ultimately be controlled — with practice — though perhaps not entirely.