Category: Connect

A LOT of you replied to my brief ramblings on Harm Reduction. Some of you see it as almost poisonous — a kind of quicksand making it more difficult to quit using. Others see it as a valuable perspective for helping people “where they are,” without imposing conditions or restrictions. Some of you see it as an expression of kindness, others as short-sighted or even lazy, and some note that it does more good for the society at large than for addicts trying to recover. It’s good for all of us to be aware of this diversity of opinions.

I don’t think I can help provide unity, but here are a few more impressions I got from that conference.

I mentioned in one reply, last post, how struck I was by a speaker who looked like he was about to collapse right there on the podium. A slender young man who spoke in a halting voice, sometimes unable to find his words. He talked of being a young gay man from a traditional Chinese family. He was rejected by his family and peers with such vehemence that he ended up wandering around Toronto like a stray puppy, looking for anyone he could follow home. Not surprisingly, sex was part of that equation, and, apparently not uncommonly, so was crystal meth. Clean needles and condoms were the furthest thing from his mind. Until he got sick. Now, HIV-positive and who knows what else, he stood there, quavering, clearing his throat, telling this group of strangers all about his shameful deeds. And everybody’s heart went out to him. There wasn’t one person in the room who didn’t wish they’d gotten to him first, not to put a halt to his experimentation but to help him survive it. When he told us he’d been clean for almost four years, the room erupted in waves of applause. But it didn’t seem he’d be a poster-child for HR or anything else for very much longer.

From that moment it was clear to me that harm reduction and abstinence were not opposing goals. And I was sold. I don’t think you can fully buy into harm reduction until you stare straight into the totality of harm.

Karen, a syringe program coordinator talked with me for awhile. Big heart, yes. Weird ideas? Maybe not.

“All I want to do is house them,” she said, “give them somewhere they want to go back to. You want to make it cozy for them, help them furnish it, make it their safe place.”

You’d think that might make it more comfortable for addicts to keep on using. But that wasn’t her view.

“When that happens,” she said,  “their using levels out and the risk-taking all but disappears. They stop sharing any equipment, they stick to one dealer, they tend not to use in groups, and the quantity goes down: crystal meth, Dilaudid, old-style oxycontin, you name it.”

Okay, you might wonder, but don’t you try to get them to stop? Apparently it’s hard to do both at the same time.

“If clients fail to stop using something they said they’d stop using, then I never bring it up again,” Karen said.  “You never shame people, because shame is the hardest emotion, in my opinion. Kindness — that’s what you give them. You thank them for coming in.”

Others felt that way too. One heavily tattooed man who looked like he could bench-press his Harley told me, in the mildest voice: “The client is the boss. I’ll plan whatever you want…and at any point you want to change it, we’ll change it. Because it’s their life, not my expectations, that matter.”

I never stopped wondering whether this was precisely the right approach. But I became convinced it was a lot better than nothing for seriously down-and-out users. If you met them with restrictions, rules, shame or disapproval, they would simply disappear. Disappearing was one thing they were particularly good at. That and destroying themselves.

My talk was well received. Almost everyone there wanted to understand how addiction works, and the neurobiology was a lot of what they were missing. But policy is not my thing. And all the biology I could offer seemed a pale wand to wave at the pain that surfaced in that room.

I left feeling that harm reduction was a desperate response to a desperate situation, bound to help those who needed it most.

P.S. Check out this recent discussion forum in the New York Times. See if you can tell the good guys from the bad guys.

Hi you guys!!!!! Okay, I give up. I was seriously considering ending the blog, at least for a while. It’s time consuming! Especially trying to reply to your thoughtful and heart-felt comments. (I know I don’t have to, but I usually just feel like it.) I have two courses to teach in the next four months, and then there’s that book that’s supposed to be completed by June. Although my publishers may be somewhat flexible, I do want to finish by June. It’s a hot topic now. It may not be so hot in a couple of years.

The fact is, I miss you. I miss my blog, which means I miss communicating with you, my readers. It feels like a chunk removed from my life. And although there are a lot of other things I can attend to, I have learned a tremendous amount from this blog. About addiction and treatment and recovery and suffering and courage and being human and hurting deep down and soothing that hurt…and finding other ways to soothe it, other ways to feel. I don’t want to lose that incomparable source of knowledge, wisdom, compassion…whatever it is. I continue to study, write, and give talks about addiction and recovery. I’d better keep learning what I can about how it works. But beyond that, I just want to stay in touch. Whether you’re a frequent commenter or a hovering spook, I’ve become attached. You’re a second family to me.

So…New Year’s Resolution: I’ll try to keep my posts shorter — each one doesn’t have to be an award-winning essay — and just send you tidbits of stuff that seem new and important to me and that you might appreciate learning about too. Since I seem to be a blogging addict, I can at least try some form of harm reduction.

So here’s the connection. Last week I went to Toronto to give a keynote talk at the annual conference of the Ontario Harm Reduction Distribution Program.   What an eye-opener! I thought I knew something about harm reduction. That’s when nice people try to keep addicts alive and relatively healthy until they can quit, right? Not exactly. Here’s a cool radio piece about a harm reduction initiative in Amsterdam: supplying beer to serious alcoholics as partial payment for cleaning up the park they trashed the night before.  Maybe this tells an important part of the story.

Well yes, harm reduction includes all that. But it’s also an entirely different approach to addiction, maybe you’d even call it a distinct philosophy. It doesn’t seem to have much to do with abstinence, for a start. Well, here’s how it came across to me. There were a couple of hundred people at this conference, and they make their living caring about people who most of society would prefer to write off. They seem to have unusually big hearts, and weird ideas to go with them. For example, teaching methamphetamine addicts to inject safely. How can you inject meth safely? The few times I shot meth, back in my chaotic twenties, I had no doubt that I was playing with death. One woman, a harm-reducer from London, Ontario, said, during her presentation: “We’ve distributed two million, one hundred and something thousand syringes this year. And we’re very proud of that.” Proud? I was shell-shocked. Proud? And when I passed the registration desk on day one, I was asked to try on the tourniquet. Arm-band, you mean, right? Isn’t it a nice navy blue color? And see how snugly it fits….velcro, you know.

I happened to be with my 25-year-old daughter that day. Still, as instructed, I pulled the thing around my upper arm, and sure enough those nearly-forgotten habits popped up to the surface of my consciousness, just as my veins popped up to the surface of my forearm. Besides being incredibly embarrassed in front of my daughter, who knows something of my history, I was simply grossed out. I haven’t shot drugs for over thirty years. Like is this some clever version of a registration tag, a door prize, or what? I couldn’t do it. Not that they were offering anything to go with it. But…it’s been too long. It was just yucck.

In keeping with my Resolution, I’ll end here. More on the conference, and some very interesting individuals I met there, next post.

Meanwhile, welcome back. And thanks for sticking around.

Over the last year, I’ve explored the terrain between meaning and dogma, choice and compulsion, I’ve taken you with me to Dharamsala, found surprising convergences between Buddhist philosophy and dopamine metabolism, pondered the application of mindfulness to treatment. But the theme I seem to land on most is the search for an alternative to the disease model of addiction — a way to understand addiction that does not pit disease against choice, or self-medication against self-indulgence.  So for this final post of the year, I want to bring this discussion to some sort of close. Not a final answer: no way. But a plateau where it’s possible to set up  camp and rest a bit before delving further into the wilderness of this almost intractable problem we’ve all lived with one way or another.

Because I’m feeling stuffed, indulgent and lazy, as I hope you are too this Christmas day, I’ll just copy and paste a few paragraphs from the first chapter of the book I’m working on. It’s just a draft at this point, more revision to be done, but I think this captures the kernel of what I want my book to say:

“Among the opponents of the disease model, almost no one has fought fire with fire and tackled the neuroscience behind it. Most of those arguing against the disease model, like the general public, are spellbound, if not paralyzed, by the notion of “brain change.” … It’s almost as if students of addiction make a choice: either admit the brain is a really important organ, in which case addiction is a brain disease, or put the brain back in the closet, in which case you can go on talking about choice, environmental factors, social anthropology, and all the rest of it.

This strikes me as exceptionally odd. Surely the brain that underlies addiction is the same brain that we use to perceive and respond to our environments, make choices, and reflect on the benefits of being high — in context. So it seems extremely likely that the brain is fundamental to addiction, whether we construe addiction as a disease, a choice, or a self-medication strategy.

The fact is: brains change. They’re supposed to. These days it’s called neuroplasticity. Brain change is the fundamental mechanism by which infants grow into toddlers who grow into children who grow into adults. Brain change underlies the transformations in thinking and feeling that characterize early adolescence. (By some estimates, the prefrontal cortex loses 30,000 synapses per second during this period.) Brain change is necessary for perspective-taking and language acquisition in early childhood, and for falling in love, with a partner or with one’s children, later in life. And for learning to play a musical instrument or appreciate opera. Brains have to change for learning to take place. Without physical changes in brain matter, learning is impossible. Synapses appear and self-perpetuate or weaken and dissipate. These processes alter the communication patterns between brain regions and build unique configurations of synapses (synaptic networks) that represent knowledge, familiarity, and memory itself. The relation between learning and brain change has been studied for more than 100 years, it was reasonably well understood by the 1940s, and the search for specific cellular mechanisms of learning continues to point to new levels and mechanisms of change. Whether repairing the damage caused by a minor stroke or altering emotional processes in the wake of trauma, neuroplasticity is at the top of the brain’s resumé.

Proponents of the disease model argue that addiction changes the brain. And they’re right: it does. But the brain is designed to change. It’s primary functions — to think, feel, remember, and act — are served by structural transformations at every level, from gene expression to the size and shape of the cortex itself. The premise that brain change equals brain disease is so ill-founded, it’s hard to know exactly where to start chopping.

A new model of addiction and a plan for the book

This book makes the case that addiction results from accelerated learning — the acquisition of thought patterns that rapidly self-perpetuate because of the brain’s tendency to become sensitized to highly attractive rewards. I see this as a developmental process, accelerated by a neurochemical feedback loop that’s particular to strong attractions. Like other developmental outcomes, addiction isn’t easy to reverse, because it’s based on synaptic restructuring. Like other developmental outcomes, it arises from neural plasticity and uses it up at the same time. 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…

This book shows why the disease model is wrong — and how that wrongness is maintained by a biased view of the neural data. Then it shows how we can replace the disease model, not by shunning the biology of addiction but by examining it more closely. Rather than throw the brain out with the bathwater, as some anti-disease crusaders have attempted, I examine brain changes under a microscope that integrates depth and detail. And I show them to be developmental changes in an organ designed to restructure itself. I show how common neurodevelopmental processes yield uncommon results when we become attached to a narrow set of goals that squeeze out the competition….

I show how addiction arises through neural changes that constitute development, not disease — changes that nevertheless conspire to make it increasingly hard to quit. And I show how recovery is achieved when addicts continue to develop, by strengthening new connections among desire, self-regard, and self-control.”

So, stay tuned. The book, to be released in 2014, will spell out this meta-perspective through the telling of biographical accounts, slices of the incredible life stories some of you have shared with me — or who still might talk with me when I finally catch up enough to email, skype, and/or call you. And I’ll connect these stories to the science of brain change in a way that I hope will be accessible, persuasive, and un-put-downable as they say on back covers.

But as far as this blog goes, I think I’ll give this debate a rest — and move on to other things. We all need a break.

With that in mind, Happy Holidays, Happy New Year, get some rest, some peace, some refreshment, and some fun. Thanks for going the distance with me this year…and I promise to be staring at you from your inbox, once again, in 2014.

Hi people. It’s been awhile. I left off with some brief descriptions of the Dialogue and summaries/links for two great talks. Now I want to tell you something about Nora Volkow’s presentation and, more interestingly, the chat we had afterward.

I have been running to keep up with myself for at least a month, and now I’m finally able to slow down, relax, and post something. I’m in Toronto for a week. I came to give a couple of talks, see family and friends, and just hang out. Isabel and I have literally been playing tag team to accommodate travel and children. I’m away, she’s at home with the kids, she’s away, I’m at home with the kids. We’ve spent only 4 days in the same place for over a month! She was returning from the US last Thursday, the day I left for Toronto. We were in the Arnhem train station at the same time but texting, trying to meet up, when we must have walked right past each other. By the time we connected, I was in the train and she was getting in a taxi. Funny and a bit sad.

Ok, Nora Volkow, head of NIDA (National Institute on Drug Abuse).  She’s often been a voice in my head when I’ve argued against the disease model of addiction in my writing and blogging. Why? Because she is one of the most eloquent and knowledgeable proponents of the disease approach, she is a powerful force in the worlds of research funding and policy-making, and because she’s a highly respected researcher. Who better to argue with, at least in my head?

She gave her presentation on day 3 of the dialogue. Here’s the link to the talk itself and here’s Shaun’s summary. She focused mostly on the blunting of dopamine reactivity in the brains of addicts, resulting both in the reduced “rewardingness” of drugs and a reduced capacity for cognitive control. A lot of people liked her talk. She’s a great speaker: passionate but clear, with well-defined logical connections between data and interpretation. His Holiness looked like he enjoyed her presence, and Richie Davidson seemed enraptured. I liked her talk too. However…

I was listening for a rethink or even a mild qualification of her well-know contention that addiction is a chronic brain disease. But it wasn’t there. She continues to see addiction as resulting from the “damage” caused by repeated drug use. And she uses that word “damage” insistently, even though the measures available for assessing brain changes generally show them to be reversible (e.g., grey matter density changes). Two things have bothered me about this position for quite some time: (1) it makes drug addiction a completely separate animal from all other addictions (e.g., gambling, sex, food), despite evidence of overlapping or identical brain changes; (2) it places the cause of addiction squarely in the molecular action of the substance itself, something Nora emphasized repeatedly, ignoring the crucial lessons of Rat Park and subsequent research on environmental determinants.

Ok, so she’s Nora Volkow, she’s a pillar of the medical establishment (NIH), and she finds it valid and convenient to classify dysfunction as disease. So what’s my problem? Maybe it was in reaction to a comment she made later that day that my blood boiled over (gently of course). During a discussion period she proposed to debate whether addiction is “a disease of the brain or a disease of the mind.” She was so sure of herself. I looked around the circle of fellow presenters and organizers. Doesn’t anyone else question whether it’s even a disease?

So during the final hour of the final session (Day 5, morning, following Sarah Bowen’s talk) I picked up the microphone and waved it around for a good 20 minutes before I got my chance. The clock was ticking toward the end of the session. Only a few minutes left. I waved the microphone a bit more frantically, and Richie Davidson, the moderator of that session, gave me the last few minutes before lunch. I was nervous. I’d been aware of my heart pounding most unprofessionally. I didn’t want to defy the great Nora or piss off my newfound colleagues. The proceedings so far had been quite lovey dovey, almost devoid of serious academic debate. I didn’t want to breach that policy. Yet it seemed cowardly to sit back. I thought of you guys and some of the heated comments you’ve made about the disease model — how the logic never quite spoke to you, or how it left you feeling boxed and helpless.

So I said my bit. (Most of you have heard it before.) Maybe addiction isn’t a disease at all…given that recovery seems to derive from self-reflection, concentration, and effortful revision of one’s perceptions and goals, given that brain change is essential to all learning processes, and given that radical synaptic restructuring is the rule at developmental transitions (e.g., adolescence). And if addiction isn’t a disease, then perhaps it is best treated, not by the medical profession, but by programs of the type that Sarah Bowen had just described so beautifully — based on mindfulness and other methods of revamping our responses to our own cravings.

Nora did not look particularly pleased with my comment. But Sarah did. Richie I couldn’t read. Then, as people got up and milled around, preparing for lunch, I sampled the vibes as much as I could. And concluded that some were glad to have an opposing perspective on the table, a few were not, and most didn’t much care.

Since Nora was among the last to leave the room, I walked over to her and asked her what she thought of my comment. Surely she’s been confronted with opposition to the disease model. And sure enough she had a string of arguments already loaded and ready to fire. Here they are:

• Not all diseases show up as major bodily disruptions. Some are far more subtle.
• Calling something a disease doesn’t mean that it can’t be helped by psychosocial interventions. Even cancer recovery can be aided by mindfulness (to improve the mood and the self-care practices of patients).
• Drugs damage brain tissue. For example, cocaine has been shown to directly damage the brains of rats, and by extension, probably humans, as does alcohol.
• But beyond the damage issue, when something doesn’t work the way it should, we call it a disease. That’s how the word is used — that’s how language works.
• Calling addiction a disease mitigates massive volumes of stigma and guilt, and it deflects blame from those who’ve fallen prey to addiction.
• Arguing definitions is futile. Call it anything you want. The point is to get help for people who need it. And if we don’t treat addiction as a disease, it won’t be treated at all.

I could argue with most of these points, I thought. For one thing, I just don’t believe that most drugs cause brain damage, except in cases of extreme quantities and other critical factors, such as the impact of vitamin deficiency in Korsakoff’s syndrome, impure or toxic concoctions, overdose, etc, etc. And if you don’t believe me, look at the articulate prose of someone like David Carr (the New York Times journalist who smoked a ton of crack and drank a ton of booze over many years, then wrote The Night of the Gun). And sex addiction, gambling, and the other behavioral addictions aren’t likely to cause brain damage either. And in a country where the government is not in the business of helping people in dire need of help (including the poor, the sick, the old, the young, single parents, victims of accidents, abused women and children…the list goes on), perhaps the disease definition is the best avenue for getting help for low-functioning addicts. But that’s politics, not science, and it’s politics that fits one country, not the world at large.

As (my now friend) Kent Berridge tried to convince me later, we shouldn’t have to accept one definition or the other — both might be accurate for different individuals, stages, or circumstances. Yet the working (sub)title of my current book is “…why addiction is not a disease.” So I’ve got quite a stake in the argument. I don’t want to get bogged down in a useless war of words, and I certainly don’t want to spend my efforts trying to dismiss a “straw man” — a contrived version of my intellectual opponent that’s easy to refute because it’s exaggerated or fraudulent. And Nora wasn’t interested in further debate just now. That was clear — and lunch was calling.

But I’ll end by saying that, if my scientific beefs about the disease model turn out to be valid, something fundamental has to change in the way we label, understand, and treat addiction. Because it’s not just a war of words. After reading thousands of comments and emails from ex- or recovering addicts, I’m convinced that calling addiction a disease is not only inaccurate; it’s harmful. It’s harmful because it replaces one stigma with another. People don’t often boast about their incurable diseases — they are nothing to be proud of. And a sense of responsibility probably doesn’t do much to combat most diseases, but it’s a crucial part of the arsenal for combating addiction. To put it differently, those who have fought addiction and won — really won — hardly see themselves as lacking responsibility. Nor are they keen to walk on egg-shells for the rest of their lives, lest the latent virus erupt once more. For them, for us, there are more satisfying ways to define ourselves than “My name is Joe and I’m an alcoholic.” Most of the recovered addicts I’ve talked to would rather see themselves, not as in remission, but as free. Maybe better than ever.

I got back yesterday around noon. What a relief it was to be home! India is overwhelming in so many ways, with poverty and raw need topping the list. To get back to this calm, orderly place was a reprieve and a pleasure, tinged with guilt at leaving all that suffering behind.

For anyone just tuning in now, I was at a week-long “dialogue” with the Dalai Lama on the theme of “Desire, craving, and addiction.” I was one of eight presenters, each of whom gave a talk to His Holiness (as he is called) and to the surrounding experts, monks, movie stars and what have you. All the talks are posted here. My talk is here. I want to tell you about two of the talks I found most fascinating and most relevant for people struggling with addiction.

The first was by Matthieu Ricard. This guy is amazing, He’s a Frenchman turned Buddhist monk for the last 20 years or so. He has a shaven head, glasses, and eyes that are kind and beaming with intelligence. And he’s humorous, human, and incredibly knowledgable at the same time. He just finished a thousand-page (!) book on altruism, he’s very close to His Holiness and sees him often, he’s participated in studies of brain states related to meditation, and he says his favourite thing to do is retreat to his retreat in the Himalayas — where he meditates all day long and essentially alone (there are a few other monks around, but they don’t talk to each other). Yet he spends most of his time running the Karuna-Shechen organization, which has established roughly 140 projects aimed at improving the lives of children in Tibet, Nepal and India. Please check out his talk.  Or, if you don’t have time at the moment, here’s a summary:

Matthieu talked about the elements of Buddhism and general mindfulness (including but not limited to meditation) that can be of practical use to recovering addicts — or addicts who are trying to quit. He talks about the roots of suffering in our determined, unshakable view of ourselves as the center of the universe. That’s the primary delusion. And it requires us to be constantly protecting, improving, and caring for this self — this selfish self. In fact we’re willing to give up our freedom and control, just to continue to feed this self with drugs, booze, or whatever we think will protect it.

Matthieu recognizes the fundamental importance of craving in addiction. Craving and attachment. Here are his three suggestions for getting on top of it:

1. Apply a direct antidote: Find a mental state that is incompatible with craving. That is, focus and/or meditate on the unattractive qualities of the thing you’re addicted to. For example, focus on freedom, which is directly incompatible with the out-of-controlness provided by the addictive substance. Or maybe focus on the anxiety that accompanies withdrawal and on how that anxiety creeps in, even while we’re high and supposed to be having fun.

2. Examine the nature of craving itself: The fact that you’re craving doesn’t mean that’s all there is going on in you. Since you are aware of your craving, there must be a part of you that is outside the craving, looking in. By continuing to experience this awareness, through mindfulness or simply reflection, that part of you — the part that is outside the craving — will continue to grow. While you are looking at the craving, you will notice that, yes, it’s strong, but it is just a feeling, it comes and goes, there is nothing permanent of concrete about it. So you don’t have to obey it after all.

3. Use craving as a catalyst: This may be the most difficult, says Matthieu, but it can work for some people. There is a feeling of strong clarity that comes with the onset of craving. Stay with that feeling. It is a version of your energy, your wish for betterment. Go with that momentum in a direction that’s opposite to what we normally do. Use it to strive for betterment rather than relief. Easier said than done, he admits. So are the other two suggestions. But they can work.

Matthieu concludes that the cumulative nature of addiction, building on itself over time, means you can’t stop on a dime. It took time to build up this habit. It will take time, and effort, to overcome it. But how do you find the motivation to change? This is a tough one. He says: look for it in the way you’d look for inspiration. You try different environments, find different people to talk with. He even talks about the role of neuroplasticity in shaping both the habit and its undoing. It’s good to listen to him talk. His humility comes out in recognizing that these ideas are not directly translatable into clinical methods. Yet they are strong ideas, and that gap is waiting to be filled. That’s where Sarah Bowen comes in.

She was the last speaker of the week, and she and I agreed that we liked being the bookends — the conference starting with me and ending with her. My talk mostly posed the problem, hers, the solution. Without the need of concepts such as disease or brain hijacking to thoroughly address addiction and recovery.

Sarah Bowen is focused and rational. A good listener and a sharp thinker. She’s attractive, 30-something, and nothing resembling a Buddhist monk (or nun). She’s a clinical scientist devoted to the development of Mindfulness Based Relapse Prevention (MBRP), the first and only treatment approach that is built around mindfulness training. Sarah inherited this nascent program from her mentor, Alan Marlatt. But she is taking it to new heights, I think, and conducting well-controlled outcome studies to prove it. Here is Sarah’s talk. And here’s my summary:

MBRP is modeled on Jon Kabat-Zinn’s very effective programs for stress reduction, recovery from depression, and coping with chronic pain. This is where East meets West with a bang, generating success after success where Western psychiatry was left flailing. The program Sarah has developed uses group process (and the sense of companionship it entails) to take addicts through orderly steps of training in mindfulness, awareness, and self-compassion. This link is intended for clinicians but it provides MP3 instructions on each of the steps. Very helpful! The goal is not to get rid of craving but to be aware of it, understand it, see through it, and move beyond it. As a bonus prize, people who go through the program actually report a reduction in the intensity of craving as well as a drop (or cessation)  in substance use. And these outcome statistics are gathered through well-controlled, scientifically valid studies.

Skills for tuning your attention, letting craving come and go, relaxing in response to stress, and talking to yourself in a more compassionate way are methodically developed through a series of exercises, performed by each individual in the group context (over an eight-week period) and guided by a moderator who is already advanced in her own mindfulness practice. A compelling example is “urge-surfing,” a mind-set that allows you to coexist with your cravings in an almost playful way, moment by moment, while staying upright. Then these skills are systematically brought to bear on life outside the treatment setting — so they can be accessed when it counts most, when you’re home alone at night or whenever and wherever you’re at your most vulnerable. I can’t provide more detail in this summary, but I urge you to check out the talk. Not only does MBRP translate Matthieu’s ideas into concrete practices, but it is shown to be far more effective than other treatment approaches — even for people who have bottomed out in their lifestyle or…their lack of a lifestyle. When asked to suggest a treatment course for addicts, this is the program I’d feel most confident recommending — if only it were available more widely. Maybe some day it will be.

That’s enough for this very long post. I have more to tell. I didn’t even get to the neuroscience presentations, nor the string of objections Nora Volkow voiced in response to my (you guessed it) contention that addiction is NOT a disease. Nor the singular perspective offered by the Dalai Lama himself. Coming soon…