Category: Connect

This video was sent to me by Shaun Shelly, a frequent contributor to this blog. It conveys how a well-practiced “mind set” can end up being so much more than a momentary wrong turn. It can be an inescapable ride on a vehicle that’s about to crash. And it can have a vast nonverbal dimension that is entirely  invisible. Like an iceberg, most of its mass is probably below the surface.

I’m talking about addiction, of course. We want to understand how we can shift from one “you” to the other “you.” That was the theme of my post a couple of weeks ago. But the craving self is so thoroughly sculpted in brain tissue, so overpowering in the moment, that it’s difficult if not impossible to just shift out of it. We want to turn it off like a buzzing light bulb, and we keep flicking the switch, and nothing happens. You can’t switch it off because it is a stable, learned pattern that arises in mind and brain whenever drugs or booze are present.

Okay, so watch the video, then we’ll talk. (The creator, whose name sounds like “Destin,” comes across pretty manic, but don’t let that stop you.)

Destin has learned a pattern of motor responses triggered by the sensory information that comes from getting on and riding a bike. As have most of us. The trouble is….it’s the wrong pattern for his particular bike. Every time he tries to ride, the sensory information (feel of the handle bars, changes in the visual field with motion, tilting of the bike with gravity) triggers his well-learned motor response pattern — without his say-so. Even his intense cognitive efforts can’t change it: “Knowledge is not understanding.”

But it’s the “wrong” pattern. So he continues to fall.

There are a few places we can go with this.

(We could consider his weird bike to be analogous to addiction…..In which case we’d say it took him a long time to  get addicted — and once he got it, he found it hard to unlearn. He finally manages it 6 minutes into the clip.)

But let’s keep it simple. Let’s imagine that the way he learned to ride a normal bike all those years is like learning an addictive mental habit. It became ingrained. When he wanted to shuck that habit, he couldn’t. It was too well learned.

For Destin and for addicts, the ingrained habit comes to life in a matter of moments. The cues for the bike rider are the sensory inputs I mentioned above. For the addict as well, sensory inputs can be hazardous. That’s why you don’t drive past the liquor store or chat on the phone with your former dope partner if you’re serious about staying abstinent. But addicts don’t need to experience that inflow of sensory information. All they have to do is bring the image to mind. Remember how great it felt, fondle that memory, taste it, and then the craving explodes to the surface.

We could consider how anxiety itself amplifies the cascade that leads to the fall for Destin — how the first glimmer of imbalance is enough to propel the motor movements that will rapidly defeat him. Not much different from addiction at all. To paraphrase Frank Herbert’s Dune, anxiety is the mind-killer.

What holds the pattern so firmly in place for the bike rider is the urgency of turning the handlebars to offset the first hint of imbalance. That urgency is the middleman that sends the messages to the muscles…turn the handlebars this way, which is sure to complete the disaster. For addicts, what holds the pattern in place is also urgency — but it’s entirely mental, not physical (except in the case of physical withdrawal symptoms). The addict doesn’t need physical uncertainty to propel the wrong moves, just emotional uncertainly, which accelerates to urgency, which rapidly calls up habitual responses: I want it, yes, I really do, just this one time, I deserve it, I’m going to do it, and it’ll be all right.

In addiction, the urgency, craving, desire, whatever you want to call it, is the psychological product of dopamine flooding particular synapses in the striatum. But I’ve told that story elsewhere. For now, what’s most important is that, once the habitual pattern arises on each occasion, two things happen:

1. We are lost, at least this time around, we’re going to fall — unless we’re really clever and we’ve already been practicing bail-out techniques.
2. The pattern, having overtaken our nervous system yet again, is reinforced in our synapses, and thus more likely to arise in the future.

There’s one more point that I hope you’ve noticed: Destin finally did learn to take control of his riding pattern, to rid himself of the habitual response set that led inevitably to a crash. But it took practice! Five minutes a day, for eight months! The moral is simple: well-learned brain algorithms need not be permanent. You can change them, especially if they’re not working for you. But it takes time and it takes practice.

…by Matt Robert, with Marc Lewis…

In this guest post, Matt, a regular contributor to this blog, takes a close look at the paradox of being in the moment. Is that a good thing — as meditation teachers counsel us? Or is it a sink-hole in time — a stagnant swamp where addiction can take root and grow? Matt’s fascinating exploration of the relation between addiction and time triggered my authorial outpourings…so I couldn’t resist adding a few sentences.

“Being in the present moment” is nowadays touted as the goal of our attitude as well as our behavior. And in fact, it’s often a very motivating state of being for people — to be fully engaged, maybe in the “flow” of being creative, active, kind, or compassionate. There is nothing there but one’s focus and the activity itself. It can take us beyond the difficulties of life to a better place — as long as it lasts — for ourselves and everyone else.

But here’s the problem with addiction. It keeps us in the present moment alright. Frozen in the present moment, locked in. We choose that route to go beyond our difficulties and move on with life, and yet we end up stuck…chained to the present moment. It’s like a funnel winnowing down our awareness to a single point, to the exclusion of everything else, and then everything else eventually falls away like chaff. And all that’s left is the next hit, the next drink, the next high…

So what is different between these two ways of being “in the moment”? In the first case, the flow of the activity connects me to the past and the future versions of myself — who I was, who I am, and who I’m striving to be. As I engage in some social or creative activity, I am connected to my different selves. This doesn’t mean that I’m thinking about the past and future at any given moment. Rather, it means there are no barriers between past, present and future. The sense of flow is a sense of being in the present but also a larger sense of moving through life, in a continuous or seamless way. In my past, there is this little person trying to please his mother, and the teenager striving to be different, and all the other persona making up my life. And in the present there is this addictions worker, facilitating recovery meetings. But there is also the person in the future, perhaps running his own program, or sailing a boat in the Carribean. This makes me a person with an impetus to go forward, even if for the moment that means getting and staying sober.

But in the other kind of “in the moment” — the ball and chain variety — there is no connection to our future self. The present is just recycling, never changing, concerned only with the immediate goal — which is to get more of whatever it is we seem to need. Whirlpools continue to “flow” in a sense. But they never get anywhere.

In the authentic kind of “in the moment,” our engagement is linked to who we are now and also who we could be. There is a continuity of experience. We might actually develop a talent for the activity we’re enjoying just now. It can move from being a hobby to being a commitment. We may become accomplished musicians, or social workers, or gardeners. This idea (which Marc also discusses) helps me incorporate my experience with my evaluation of that experience. I can become objective without losing the feeling of being subjective, in the moment. And I can do that however my process of recovery — of living my life — continues to unfold. It helps make sense of it all.

When people say “Be in the present moment” they mean that the present moment is all we have, and we need to cherish it as such. But in active addiction, it’s all we’re ever gonna have. A land of vanishing opportunity. At one point, I wanted it that way, and it was a comfort, a relief. Not to look at or worry about the future.

But that’s not me anymore, because I’ve accepted the fact that change is inevitable — and resistance is futile.

When I said I wanted to move further into the psychology of addiction, I didn’t mean I was about to forget the brain. The subtleties of your thoughts and the cellular activities of your brain might seem like different planets, impossible to gaze at simultaneously. Yet both are going on at exactly the same time in exactly the same place.

Addiction is usually characterized by two psychological states: craving and loss of control. But when we look very closely at the flow of time leading to each occasion of using (or drinking, or whatever it is), there seems to be a blurring of the two. Giving in (loss of control) starts to look like a well-worn path, initiated by craving. Can we reconceptualize the relationship between craving and giving in? So that it makes sense? — at least more sense than the notion of falling through a trap door that was bolted shut? What if craving and surrendering are not two processes but one? Just a single time-line, a building momentum, leading from a state of determined abstinence to a headlong plunge?

Imagine that you can be two different people. That’s not such an absurd idea. It’s been around in psychoanalysis for a century, and even the cognitive science of the last three decades finds it reasonable. Not multiple personalities, but something subtler. The you that screams for vengeance when your favourite player gets tripped from behind and the you that turns off the TV and tucks your kid into bed can easily be seen as two distinct yous. So let’s imagine that the you who anticipates how wonderful it will feel to get high is simply a different you than the one that knows that’s insanely stupid.

Of course this isn’t an original idea in addiction studies. Twelve-step fellowships continue to broadcast warnings that your addiction is waiting to get you, doing push-ups in the parking lot, and even the more contemporary cognitive-motivational tactics of SMART Recovery might counsel you to ignore the addict voice — as though it weren’t your own voice at all.

So let’s think about the two yous differently, by aligning the psychology of wanting versus abstaining with two distinct brain states. That’s not difficult. When we anticipate getting high with excitement and attraction, the striatum, which is the part of the brain that initiates goal pursuit and powers it with desire, is strongly connected to the orbitofrontal cortex (OFC), a region of the prefrontal cortex on the border of the “limbic system” that encodes the value of things — good things like a friend’s smile and bad things like sour milk. The striatum and OFC are quickly linked (an “orbitostriatal” bond is formed) in anticipation of a valued outcome, and that’s when you become the child, yearning, anticipating, and falling forward into the treasure trove at your feet.

But what happened to self-control? A much smarter part of the brain — called the dorsolateral prefrontal cortex — often oversees the impulses generated by your striatum. The dorsolateral PFC is where judgments are formed by comparing possible outcomes and making conscious decisions. We can call the dorsolateral PFC the “bridge of the ship.” Its job is to steer.

But addiction and other impulsive acts are accompanied by a “loss in functional connectivity” between the orbitostriatal alliance and the bridge of the neural ship. A loss of connectivity simply means that activity (measured by an fMRI brain scan) in one region becomes less correlated with activity in the other region. This disconnect is exactly what is observed in addiction. When pictures of drug paraphernalia are flashed on a screen, addicts show a surge of activity in the orbitostriatal region and reduced activity in the dorsolateral PFC. Some studies show this disconnect to become more severe with the length of the addiction. Other studies show the same disconnect when “normal” people surrender to tempting (but dumb) impulses. The disconnect is real. And when it happens, you become the unfettered, unconstrained child.

Craving is simply desiring what feels attractive, and surrender is the natural order of things when desire is unconstrained.

So you get high, you start drinking, you click on a tried-and-true porn site or you call that forbidden phone number. An hour later you are bored and you know you didn’t get what you wanted. Two hours later the regrets pile up like unanswered mail. Three hours later (if it takes that long) the child’s excitement is replaced by self-reproach, recrimination, and perhaps a determined commitment to never do it again. You are no longer thinking or feeling the way you were a short time ago; your values have locked in again. And your brain is no longer functioning the way it was functioning a short time ago. The orbitofrontal cortex (occupied now with something like sour milk) is reconnected with the dorsolateral PFC, its overseer. Because desire is now just a memory, an empty husk. With desire slaked, no matter how unsatisfactorily, your brain changes back again. It’s just the way it works.

Let’s say you’d been abstinent for weeks, maybe months. How could you have done something so stupid? Again?!

The answer is simple: it was a different you.

Hi all. I’ve taken a little break from blogging. The final send-off of my book manuscript gave me a chance to catch up with email, reading, and some other writing projects. I even sneaked in a novel. It’s called The Humans, by Matt Haig. I picked it up at an airport bookstore on my way to Budapest, where I gave a talk at the International Conference on Behavioral Addictions. Beautiful city, great conference, and a really engaging novel: it’s about an alien who comes to earth on a mission to kill a math professor whose discovery threatens the entire universe. Humans might now acquire the technological capabilities to wreak havoc on a cosmic scale. But against his better judgement, he actually learns to like us, and before long he wants to be one of us. Sweet, funny, and often wise.

Anyway, I’ve thought about where I want to go next in blogging. I want to move on. Through this blog and my writing, I’ve arrived at a place in my own understanding of addiction which I think covers the basics, so to speak: the neural, psychological, and experiential elements that converge in addiction. I’ve shared all this with you: the neuropsychological basis of craving, the cycle of seeking and losing that accelerates learning, the narrowing window of desire and attention and its biological foundation in the dopamine system, the critical importance of self-narrative, of connecting desire with a self-defined future rather than remaining stuck in the present. And all the rest of it.

This leaves me with the sense of having built a good solid foundation for a model that makes addiction comprehensible without shovelling it into a pat category — like disease, or choice for that matter — and filing it away for the experts to dissect.

But there’s a lot farther to go. I want to build more floors onto this model. I want to make it as big, comprehensive, articulate, balanced, and realistic as possible, using the tools I know: psychology, neuroscience, others’ experience, and my own self-honesty.

I think the next level has to do with the way we talk to ourselves — the running dialogue or monologue through which we organize our thoughts and orchestrate our feelings. The hells and heavens we create for ourselves in imagination and reality. We all know that drugs and other addictive substances and acts can have tremendous appeal, or they can feel like relentless attackers. We sometimes pursue them even while we revile them, and sometimes we shun them even when they call to us in their sweetest voices. Our ruminations, our internal rebellions against real and imagined authorities, our construction of plans, limits, goals, and rules all have a great deal to do with whether, when, and how we pursue these angel-demon entities. Whether we remain addicted or break free.

I think these psychological processes are critically important for understanding addiction in a more detailed, more intimate, and more realistic way. And I think we can access them, bring them into the daylight of examination, and work with them — in ourselves, our loved ones, or our clients — in order to gain mastery over addiction.

So that’s where I want to go and I want to bring you with me. We learn a lot from each other. We’ve graduated from Kindergarten; now let’s move on.

Those of you who remember record players probably recall the infamous “broken record” — which kept repeating the same sounds over and over. Maybe that’s me, but I thought I’d share a few more words of thanks. I finally finished editing the copy-edited manuscript of my book, a horrific chore that took three weeks, nearly full time. Now the book is really, really, really finished — entirely in the hands of the publishers And my last task was to compose the dedication, which goes at the front, and the Acknowledgements, which go at the end. Here they are…

Dedication

For the members of my blog community, who have generously shared their experiences and insights, and for the five who trusted me to tell their stories here.

Acknowledgements

After writing a book about my own passage through addiction, I needed to learn what my experiences had in common with those of others. So I began a regular blog that attracted a bright, boisterous, and empathic community populated by former and recovering addicts. The many comments following my posts and the guest posts contributed by members provided a wealth of insights and information that I could not have hoped to find elsewhere. I want to thank each and every one of the people who’ve engaged in this conversation with me. You inspired me to write the present book, and you helped me understand addiction well enough to feel I could make a worthwhile contribution.

The five former addicts whose stories I tell deserve the gratitude of everyone attempting to comprehend addiction by combining private experience with other forms of knowledge. The people who volunteered for this project donated many hours to respond to my questions, and they did so with unstinting energy and honesty, dredging up details from experiences they might have preferred to forget. When wearing my interviewer’s hat, I often felt like a dentist drilling deeply, painfully, until I unearthed every chunk of my respondent’s past. They bore up bravely, shining the beam of self-examination wherever I asked them to look. I am deeply grateful.

Lisa Kaufman, my editor at PublicAffairs, helped me upgrade my understanding of the rehab world, past and present, until I’d acquired the perspective I needed to portray it sensitively and accurately. But I’m most grateful to Lisa for encouraging me to follow the implications of my own model from theoretical abstractions to concrete directions for practice. She convinced me that, for many readers, that’s where the book had to land. And she was right.

Tim Rostron, my editor at Doubleday Canada, has now been my writing guru through two books, and I continue to celebrate my good fortune. Tim’s mastery of the deep and subtle currents of English and his dedication to transparency and flow have nursed my growth from scientist to writer.

I benefited hugely from the seasoned perspective of two unpaid editors, Matt Robert and Cathy O’Connor. As a pioneer in the rehab community and a sparkling commentator on current trends, Matt took me behind the scenes of the rehab/recovery world. He read most if not all of these chapters, showed me what I was missing in both form and substance, and helped me smooth out terms and concepts that might otherwise get caught in the reader’s throat. Cathy generously dipped into her editorial talents to guide me through the no-man’s-land between what I thought I was explaining clearly and what readers were likely to grasp. There were jagged craters everywhere, most in places I would not have checked. Cathy pointed them out with patience and precision and helped me figure out how to fill them. I am so very grateful to both of you.

Other treatment experts came to my aid. I am particularly indebted to Shaun Shelly, who kept pace with every conceptual step I took, in the book and in the blog, and harvested examples to help support our shared understanding of addiction. And my thanks to Peter Sheath, who spearheaded the Birmingham Model described in the last chapter and infected me with the courage, creativity, and optimism he has brought to the treatment world. [Both of these men have been frequent contributors to this blog.]

My most generous and dependable editor remains Isabela Granic, my partner for eighteen years. Your steady supply of gist was the mortar by which my details could cohere and settle. You continued pointing me toward what I’m good at and reminding me of its worth. And you stoked the fires whenever I got discouraged or just tired. This book could not have existed without you.

Finally, Ruben and Julian, thank you for letting me work all those hours when I should have been playing with you. Ruben, thanks for adjusting my chair. Julian, thanks for the cuddles. I’ll try to make it up to you both now that the book is finished.

To Matt, Shaun, Peter, my five interviewees, and all the rest of you — Thank You!