Category: Connect

Hi my lovelies! I want to wish you a very very good and in fact wonderfully happy and even exemplary new year!

We flew into Amsterdam this morning. No sleep last night. The scary thing, after trying to bid the van-taxi driver down below his 200-euro fixation, was cruising along the freeway, wife and kids asleep in the back, waiting for the day to start. By 8:15 I was getting worried that the sun wouldn’t rise till late January. But the sky did lighten by about 8:30, and we got to Arnhem by 9:00.

And everything here is just the same as it was five months ago. The house is here, the key was still under the flowerpot, the car woke up once I remembered to depress the clutch while starting it. The next-door neighbor gave me a big hug when I knocked on his door. My friend, the woman down the street, nearly burst into tears when I showed up. Julian’s 8-year-old friend came by, just now, with his mother, to drop off an oversize postcard that read “Welkom T’huis” — Welcome Home. And even the guy at the nearby SPAR store was happy to see me this afternoon — he beamed that sweet openness that you just don’t see in big cities in North America. Not that Arnhem is a big city. And when I left with my bag of groceries, it was of course raining in the grey, soggy streets.

The weather in L.A. was fantastic, but I’ll take the people in Arnhem any day.

I know I’ve been talking about finishing my book ad nauseam. But it really is finished AS OF YESTERDAY!!! I wrote “THE END” at the bottom, a couple of days ago, and I’ve been picking away at edits since then. While Isabel took care of all social and child-related responsibilities, I sat on various friends’ and relatives’ sofas and wrestled with so many meticulous decisions, such as…: Should I refer to the amygdala or just the dorsal striatum in the chapter about Johnny, who nearly drank himself to death before quitting? Should I include “hair on the bathroom floor” — or is that overkill? — and just go with “clumps of hair in her hairbrush” when describing Alice’s descent into anorexia? Should I call the neural network that churns out DESIRE the “motivational core” or the “motivational engine” in this paragraph? Many of these edits were triggered by the thousands of comments/suggestions along the side of the page, from my editors and from Matt Robert and his partner, Cathy, who noticed everything that needed noticing… But I had to ruminate about each one before I was satisfied.

Have I mentioned the parallels between OCD and addiction?

But it’s all done. Edits x 3 throughout most of it, and a final chapter that actually comes to a conclusion, rather than ending with the ubiquitous but lame “……more to come…..”

So I’m high on fatigue — little dreamies sauntering in from the corners while I’m trying to sleep this afternoon — happy to be back here, really glad that the book is done — at least until the page proofs are sent back to me — and not even curious about what I’ll be doing next.

The book will be out in May. And my only request is, simply, BUY IT!

So here’s the resolution that occurred to me.

The problem was that the learning curve that describes addiction onset is often unusually steep — what I’ve called accelerated learning. But the biographies I include in the book, and other tales of addiction sent my way, sometimes show a gradual onset — a period of coasting before substance use takes off. And sometimes there are plateaus, or even remissions, when our addictions may live underground. We might hear them stirring late at night, but they don’t always rise up and send us on another cliff-hanging romp with self-imposed torture.

So I wanted to come up with a description of addictive learning that allows for accelerated learning but also gradual onsets and plateaus. The following is a (slightly edited) passage from the final draft of the second-last chapter, sent to my publisher this morning. It’s not particularly new or amazing, but I think it covers the issue. And serious thanks to you guys for the suggestions and insights you posted or emailed to me. They helped me think it through.

Brain changes naturally settle into brain habits — which lock in mental habits. And the experiences that get repeated most often, most reliably, and that actually change synapses rather than just passing through town, are those that are emotionally compelling. Most important, combining strong motivation — such as desire — with frequent repetition changes the rate of learning. It speeds up the feedback cycle between experience and brain change. This kind of accelerated learning is bound to boost the entrenchment of long-term habits, for several reasons:

• because desire focuses attention like nothing else, and attention is the springboard to learning.
• because addiction offers highly desired rewards that disappear before long, thus priming the desire pump repeatedly.
• because a feedback loop that cycles faster will generate more of whatever it generates, thus accelerating its rate further. This is the well-known snowball effect.
• because any growth process that is speeded up enough will outrun its competitors. Since synapses fade and disappear when they are no longer in use, and since addictions are pursued at the expense of other goals, addictive habits come to usurp habits incongruent with addiction — like caution, integrity, and empathy.

The onset of addiction doesn’t always looks like an accelerated learning curve. The biographies of Brian and Donna show us that people can take drugs for a long time before they become addicted. Brian’s use of stimulants and Donna’s use of opiates had little motivational thrust for that initial period. Brian was trying to remain awake and alert so he could accomplish work goals, and Donna was taking Vicodin for pain long before she took it for pleasure. Nevertheless, both Brian and Donna reached a turning point, at which the learning curve must have risen steeply. For Donna, this occurred more than once, since there were periods of calm between her drug-stealing storms. The learning spiral would have first quickened, showing a snowball effect in behavior and a cascade of neural changes, when Donna and Brian began to pursue drugs for the feelings they provided, not as a means to an end — when desire kicked in and their quest for drugs overrode their other goals, including the wish to avoid big risks. That’s when their lives started to unravel.

Because the onset of addiction must include one or more phases of accelerated learning, but can also simmer for long periods, I’ve settled on the phrase “deep learning.” This is meant to cover the overall profile of addictive learning, including periods of rapid change and periods of coasting (or even periods of abstinence — “remission” in medical parlance). Note that this profile corresponds with models that view the onset of addiction as a series of stages or steps.

That said, I want to wish you all a calm, happy, warm, peaceful holiday. May we all be free of our demons and let the holiday maelstrom of emotions pass without harm.

Two posts ago I sent you a few paragraphs from the introduction to my new book. In that draft I said:

This book makes the case that addiction results from the motivated repetition of certain thoughts and behaviors until they become self-perpetuating habits. Thus, addiction develops, and it can develop quickly, through a process I call accelerated learning.

I woke up at 5:30 today and couldn’t get back to sleep because I realized that this portrayal is flawed. Of the five people whose biographies I include in the book, two of them make it very clear that addiction can have a slow or  delayed onset. The man I call Brian was using coke and then methamphetamine for about two years before he became really addicted. At first he just wanted to stay awake and energetic. But then he slid deeply into addiction, to the point of smoking meth every few hours and missing many nights of sleep in a row. The woman I call Donna was on Vicodan for a year to treat back pain caused by a bicycle injury. Only then did she start doubling her dose and liking how it felt. She ended up forging prescriptions and stealing pills from just about everyone she knew. It blew apart her marriage and her life.

Both these people eventually recovered, as most addicts do. The point is, though, that the learning spiral leading to addiction need not cycle quickly. At least not at first.

So I lay there till the alarm went off, thinking, okay, what the hell is it? What makes it different from other learning trajectories — other bad habits? The phrase “overlearning” popped into my head from undergrad psychology. Here’s the definition — which highlights extended practice that results in “escalated persistence of the learning over time.” But that was an idea that faded with the decades, because it simply described the use (especially in classroom settings) of a greater number of learning trials to get a longer period of retention. Not all that interesting after all. Unless you bring in the power of motivation and start thinking about dopamine.

So how am I going to resolve this? As mentioned last post, I am still doing final edits. But I have to figure out a concise description of the psychological process leading to addiction, a particular twist to the more general mechanism of learning, or the book will have a big hole in it. It’s there in the stories. It’s there in the neurobiological details. I think I show very clearly that drug addiction is no different from falling (deeply) in love — both in its psychology and its biology — or from behavioral addictions, etc. Still… I have to find that phrase.

By the time the alarm went off, I was pretty set on “deep learning.” As long as that’s fully explained, I think it works. And it will be fully explained, if it isn’t already. So now I have to make a new set of revisions.

I know some people get addicted very quickly, once they’ve found their substance (or activity) of choice. But that’s not universal — or mandatory. I want to explore this in some detail next post.

Now back to the grindstone.

Hi all. This is ridiculous. I’ve been back from South America for a month and have not yet returned to blogging. I haven’t even responded to many of the comments and sweet sentiments following the last post. Though I have skimmed through most of the dialogue and debate — with interest.

I have so much to share with you, but it will still have to wait a bit longer.

Having two publishers (one American, one Canadian) means having two editors. They each have very different specialties, and I have to edit the whole manuscript twice, once for each of them. This has been a burden, but also a blessing. They are both really good!! And the book will be that much better due to their excellent skills. That is, if I ever finish the edits and get a final manuscript into them in time for the publication date.

I’ve also received amazing help with some chapters from Matt Robert, a frequent visitor to this blog, and his partner, Cathy. Matt is a SMART facilitator and he knows the addiction field inside-out. Their help has been particularly useful for thinking about the historical context of the addiction field, current debate on many issues, and the implications of my framework for recovery.

Some day soon, it will all be done.

To provide a little content before I publish this, I’m inserting several (slightly revised) paragraphs from the second last chapter — the wrap-up chapter. Here’s a cool way to think about desire, which is, after all, the most prominent word in the title.

Why desire?

The potency of desire — which we can call an emotion or a motivational state — deserves a lot of respect, as does the neural terrain bequeathed to it by evolution. Focus on your mental state when taking a bite of pasta (or anything else). Notice where your attention is directed while you are eating. While the food is approaching your mouth, en route from your plate, at least some of your attention is likely to be focused on the food. For now, attention is linked with the goal of getting the food where it’s going. And you are feeling desire, at least at some level. Desire and attention converge into one beam. But as soon as the food is in your mouth, your attention goes elsewhere: back to the conversation or to the book you’re reading or the show you’re watching. The amount of attention you pay to the taste of that mouthful is a drop in the bucket compared to the amount you paid to getting it there.

So, perhaps sadly, maybe ironically, pleasure is a small part of the common experience of eating, even when you’re eating something delicious. Desire and expectancy make up most of the experience: the approach is by far the main act. But this disproportionate relationship makes perfect sense. The evolutionary requirement to focus on pleasure is almost nil. Once the food is in your mouth, it’s a done deal. But if you weren’t deeply engaged, focused, attentive, and determined to achieve the food-in-mouth goal, your survivability would be a poor bet.

This is of course the same with all other highly motivating goals. Like, for example, getting drugs, booze, cigarettes, money, or sex. I get into the brain mechanics a bit in the book, but the gist is this: the brain regions devoted to desire occupy far more volume and are far more complex than the roughly cubic centimeter responsible for pleasure.

The biology of desire not only helps us understand addiction; it helps us understand why addiction is not a disease. Why it is, rather, an unfortunate outcome of a normal neural mechanism that evolved because it was useful.

I hope that was a tasty tidbit, and I promise more soon!

Hi you people! I haven’t forgotten about you. In fact I really miss you. This blog community has been like a second family to me, and I’ve gotten a lot of warmth and a lot of learning from communicating with you.

As I mentioned last summer, I’ve moved to L.A. with my family — temporarily. And I’ve spent the last two months feverishly trying to finish my new book: The Biology of Desire: Why Addiction is Not a Disease. That’s why I haven’t been posting.

I have to get a full draft to my publishers by tomorrow, then I’ll be off traveling again (this time to South America!) for two weeks. Then I think I’ll be able to start regular posting again.

For now, I’ll copy the first few paragraphs of the book. It’s still only a draft, and the argument will be old news to those of you who have followed this blog. But it’s the best summary I can give you of what I’ve been thinking and writing about.

“Public attention has been riveted by the harm addicts cause themselves and those around them. More in the last few years than ever before. And the way we view addiction is changing, molting, and perhaps advancing at the same time. We’ve begun to separate our ideas about addiction from assumptions about moral failings. We’re less likely to dismiss addicts as simply indulgent, spineless, lacking in willpower. It becomes harder to relegate addiction to the down-and-outers, the gaunt-faced youths who shuffle toward our cars at traffic lights. We see that addiction can spring up in anyone’s backyard. It attacks our politicians, our entertainers, our relatives, and often ourselves. It’s become ubiquitous, expectable, like air pollution and cancer.

To explain addiction seems more important than ever before. And the first explanation that occurs to most people is that addiction is a disease. What else but a disease could strike anyone at any time, robbing them of their wellbeing, their self-control, and even their lives? There is indisputable evidence for physiological changes with addiction. Research over the last 20 years reveals distinct alterations in brain structure and function that parallel substance abuse. This seems to clinch the definition of addiction as a disease — a physical disease. And it gives us hope, or at least forebearance; because the notion is sensible, comforting in its own way, and part of our shared reality. If addiction is a disease, then it should have a cause, a time course, and possibly a cure, or at least agreed-on methods of treatment. Which means we can hand it over to the professionals and follow their directions.

But is addiction really a disease?

This book makes the case that addiction results from the motivated repetition of certain thoughts and behaviors until they become self-perpetuating habits. Thus, addiction develops, and it can develop quickly, through a process I call accelerated learning. A close look at the brain tells us why this occurs: because the neural circuitry of desire governs many other brain functions, so that highly attractive goals will be pursued repeatedly, and that repetition (not drugs, booze, or gambling) will change the brain’s wiring. As with other entrenched habits, this developmental process is underpinned by a neurochemical feedback loop that’s present in all normal brains but now spirals more quickly than usual because of the allure (and repeated pursuit) of particular goals. There’s mounting evidence that addiction arises from the same neural hardware that binds children to their parents and lovers to each other. And it builds on the same cognitive mechanisms that permit humans to seek goals selectively and to pursue symbols — goals that stand for something. Addiction is unquestionably destructive, yet it is also uncannily normal: an inevitable feature of the basic human design. That’s what makes it so difficult to grasp — societally, philosophically, scientifically, and clinically.

I believe that the disease idea is wrong, and that its wrongness is compounded by a biased view of the neural data — and by scientists’ habit of ignoring the personal. It’s an idea that can be replaced, not by shunning the biology of addiction but by examining it more closely, and then connecting it back to lived experience. Medical researchers are correct that the brain changes with addiction. But the way it changes has to do with learning and development — not disease. Addiction can therefore be seen as a developmental cascade, often foreshadowed by difficulties in childhood, always accelerated by the narrowing of perspective with recurrent cycles of acquisition and loss. Like other developmental outcomes, addiction isn’t easy to reverse, because it’s based on the restructuring of the brain. Like other developmental outcomes, it arises from neural plasticity, but its net effect is a reduction of further plasticity, at least for awhile. Addiction is a habit, which, like other habits, gets a major boost from the suspension of self-control. Addiction is definitely bad news for the addict and all those within range. But the severe consequences of addiction don’t make it a disease, any more than the consequences of violence make violence a disease, or the consequences of racism make racism a disease, or the folly of loving thy neighbour’s wife make infidelity a disease. What they make it is a very bad habit.

Although this book uses scientific findings to build its case, it works through the testimony of ordinary people. I relate detailed biographical narratives of five very different people, each struggling with addiction, as the scaffolding on which brain science is introduced and interpreted.Through these stories, I show what it’s like and how it feels when addiction takes hold, while explaining the neural changes underlying it. There’s no doubt that these changes mark a difficult passage in personality development. But I conclude each chapter on a positive note, following my contributors through their addictions to their growth beyond it — a phase often termed “recovery.” And I provide the neuroscientific facts and concepts to help us understand how they get there. Most addicts end up quitting: uniquely and inventively, through effort and insight. Thus quitting is best seen as further development, not recovery from a disease.”

Sayonara! More soon….