Category: Connect

Finally got a wi-fi connection. Better get this posted quickly before I lose it!

Written yesterday evening: I’m pretty tired so I’ll try to make this brief. Today was day 1 of the conference. This morning there were various introductory remarks. Then, just after a vegetarian lunch, I was to be the first speaker. I was to be in the “hot seat,” next to him, for two hours — 1.00 to 3.00 PM — powerpoint presentation on the screen, words stuck in my throat, talking to him. Not to the audience but to him. Gaaaaggghhhhhhh!!!!!

Yes, I was a bit nervous. I had sat in that room for three hours already, with 2-300 other people in seats arranged around our inner sanctum of easy chairs, with his chair (and the hot seat, the one next to it) at the front. About 60 Westerners (some very famous) from the Mind & Life Institute plus donors — the folks who made it all happen. Plus a hundred or so Buddhist monks, plus various people from all over the world who’d managed to get invited for various reasons.

The security was tight. Every person who crossed from “the temple” to “the residence” had to show a passport, a visa, fill out a detailed form, have everything in our pockets checked, and then undergo a full body search. Once you got to the other side, you knew you were some place unique, reserved, protected.

(And by the way, these folks have good reason to be vigilant. The Chinese have not been very friendly toward the Dalai Lama. They seem to hate him, and that plus any whacko who’d like to get famous shooting a good guy…well, that’s why they’re careful.)

But once you enter the conference room, you are in another world. The main thing is the energy. Before His Holiness (HH) arrived, the air was thick with anticipation, hope, affection, excitement, admiration. The Dalai Lama, whatever you might think of him, has a lot of people who love him. He IS special. And when he came out and greeted everyone — and I mean everyone — with waves and nods and hand holding — you got a sense of what was so special about him. He was cheerful, penetrating, personal, warm, sincere, exuding both gravity and humour — if you can imagine all that in one man.

My talk was pretty much what you’ve already heard on this blog. Insert: my talk posted here. Thank you, Shaun! In a nutshell, I did good. I got a lot of hugs and handshakes and big thank-yous from the team and audience members afterword. And a few riveting looks, wry smiles, and some friendly pats from him during the process.

Written this evening: There is a live webcast of the remaining days of the conference, and then the whole thing will be archived on the Mind & Life website, viewable, soon. Sorry, but the wi-fi connection here has been extremely intermittent. Anyway, there are three more days of talks about “desire, craving, and addiction” and I especially urge you to tune into Kent Berridge’s talk. Kent spoke this morning — Day 2 — and I just had dinner with him in some funky Tibetan cafe — lovely guy. I know, he looks about 14 years old. But he’s got an amazing head on his shoulders. INSERT: Here is the link to Kent’s talk. All other sessions can be accessed by going to YouTube and searching for “mind life craving desire addiction”. The full program can be accessed at  http://www.mindandlife.org/dialogues/upcoming-conferences/ml27/ The PDF is towards the bottom of the page, and also creates summaries of the various presentations. (Thanks, Shaun, for this information.)

 

Feeling happy here today, a bit star-struck but holding my own. Nora Volkow just arrived this afternoon. So she’s missed Kent’s talk and mine, which is unfortunate. But it was cool sitting next to her and passing the mike back and forth during the discussion periods. She seemed just like the firebrand I’d expected. A small, lithe woman with a LOT of self-confidence. A great scientist, no doubt, but also someone with strong opinions and no hesitation in expressing them and backing them up with the latest data.  She still sees addiction as “hijacking the brain.” So her basic stance has not changed over the years. I’ll hear her talk tomorrow morning, and you can easily catch it live-streamed at the above links.

And then there’s Richie Davidson, smiling and schmoozing, moderating and guiding things, being knowledgeable but at the same time rather sweet. And a few other people I’d never heard of before the meeting in June — people I’m really growing fond of.

I’ll tell you more about the viewpoints expressed and debated among Buddhists and Westerners next post. And by the way, I talked about you, my “blog community” quite a bit yesterday. You’re my data base now, my compass — not to mention where I send my letters from overnight camp.

 

 

Hi people. I wanted to write one last post before leaving for India. (tomorrow!!!) So here’s something that’s been on my mind a lot lately. We have discussed many ways of seeing addiction and recovery in terms of choice. We mostly agree that, if using or abstaining is a choice, it’s a very unusual kind of choice. It is often irrational, it changes over time, it becomes more pressing (or less pressing) as the moment of action approaches, it is highly dependent on biases and motivational undercurrents, etc, etc. If it’s a choice, it’s not the kind of choice you make when you decide what movie to watch or what you’re going to make for dinner.

Or is it?

Here are a couple of quotes from a paper about intentions, by a philosopher named Marc Slors (Philosophical Psychology, 2013).

[T]here is considerable evidence against the causal efficacy of proximal (short-term) conscious intentions… [my italics]

Libet, Haggard, and others…showed that simple conscious motor intentions occur only after the unconscious neural onset of actions.

Um, what?! Slors reviews studies (both behavioural and neural) that show that people’s actions are not determined by their preceding intentions. In other words, our actions happen without our intentions, or despite our intentions, or preceding our (imagined) intentions…all the time! Not only when we “impulsively” or “compulsively” reach for the bottle or the phone to get high. If you believe the results of this research (and I don’t see how you can avoid it), it makes your head spin. It blows a big hole in the idea of “free will.” And yet free will is a fundamental assumption we make all the time. To imagine that free will doesn’t exist is almost blasphemy. Yet it makes addiction a lot easier to understand…

A classic experiment demonstrating the irrelevance of “choice” or “intention” would be this. Subjects are asked to make a simple choice, with very little consequence for anything. For example, they might choose whether to press the button showing the red circle or else the one showing the green square. Once they’ve made the choice and seen the result, they are asked about it. Did you choose which button to press? When did you make the choice? Without fail, people report that they made the choice from a moment or two to several seconds before they pressed the button. But in fact, the likelihood of pressing one button or the other was strongly determined before that time. It was already predicted by cues (words, images) given to them (without their noticing) before they (think they) made the choice. For example, cues like the pairing of pleasant pictures with the colour green (or with squares) and unpleasant pictures with the colour red (or circles). Other studies have found that brain activation patterns strongly predict the choices people make, before they themselves have any conscious idea of what they are about to choose.

Here’s another quote from Slors:

In this experiment…thoughts are “inserted” into the heads of people just prior to their being coerced, unbeknownst to them, to perform an action that matches the thought. In such cases, people turn out…to think that their action was caused by their thought.

Well I find this stuff completely astounding. So, whether I make fish or chicken tonight will not depend on my thoughts just before “making the choice.” I’ll think it will, but it actually won’t. Rather, it will depend on unconscious processes already at work. These will probably include how I feel about the last few meals I’ve made, how I think my wife and kids will respond to soy sauce, etc. But I won’t be conscious of any of that. I’ll think I’m simply making a free choice.

So, immediate intentions (called “proximal intentions”) really don’t have much effect on our actions. But that’s not the end of the story. Long-term intentions (called “distal intentions”) do have an impact on our actions. A very strong impact. For example, I’ll be flying to India tomorrow. That action will have nothing to do with any choice I make between now and then. That action was determined by what I decided several months ago. I decided I wanted to go on this trip and I bought myself a ticket — which took an hour of fussing online. Get the point? Free will isn’t dead…but it works in a very particular way.

I’ve written various posts and comments about the fact that addicts have an especially hard time making good choices because the immediate goal (e.g., getting high) overtakes the whole motivational system (the striatum) and overwrites the value of long-term goals — like having a bank account and staying out of jail. But it turns out that this is just a more extreme version of a very general issue: immediate choices are illusory — they are already determined by the value you have attached to something. The fact that you just love cocaine, and you’ve devoted about a billion synapses to fondling it mentally, is going to determine whether you get high tonight — not the choice you make in the next two hours.

What I’m getting to is this. If we recognize that short-term, proximal choices are weak, meaningless or illusory — if we recognize that only long-term, distal choices actually determine our actions — then the only way to quit being an addict is to plan ahead. The only way to stop is in advance of the moment. This may not be big news to some of you. We already know (don’t we?) that you have to get rid of all the booze in the house if you want to make sure not to drink later on. And we know (don’t we?) the value of rules, like “I will never drive home on Yonge Street after work, because that would take me right by the liquor store.” Or telling your buddy, Joe, that the next time he calls you you’re going to call the police — because you have to make sure, in advance, that you will never speak to him again. Or joining a group. Or telling your doctor, look, Doc, I have a problem… Or maybe just emailing him or her. That would just take a moment. You could do it right now. That’s a version of “sneaking up on choice” (recent post), because you can do it without thinking about it intently (this time, anyway).

Rules and plans are not only important for choosing to quit. They are almost the only things that work. (Mindfulness is great too, surely, but then you also have to plan to meditate regularly.) Proximal intentions don’t matter. By the time you are getting close to the point of action, the dye is already cast. Setting up intentions in advance is called “self-programming” by Slors, and I think that’s a great name for it. You are indeed programming your own future, by changing contingencies, determining circumstances, setting up non-negotiable outcomes. You are programming your life, and your brain, and your environment,  your unconscious as well as your conscious mind, by intending and planning what’s going to happen.

Now that’s free will. Use it wisely!

 

P.S. I will be giving your regards to the Dalai Lama. Seriously. Enough of you have asked me to do that…I figure the feeling comes from all of us. After all, the dude must be pretty interested in addiction to have a five-day meeting on the subject.

 

 

 

 

 

 

 

 

 

Rather than one of our typical mind-bending dialogues, here’s some very practical information. If you are actively or recently addicted, live in the U.S., and are low on funds, this may be of use. I see it as getting the most out of the “disease model”. Thanks to Ram Meyyappan for offering to post this to our community.

Drug Addiction and Social Security Disability Benefits

Drug addiction can wreak havoc on an individual’s life and can often prevent an individual from working. What many people do not understand is that drug addiction is actually considered to be a disability by the Social Security Administration (SSA). If you are struggling with drug addiction or drug addiction recovery, you may be able to qualify for Social Security Disability benefits.

Qualifying for Social Security Disability Benefits with a Drug Addiction

It is important to note that even though the side effects of drug abuse can prevent an individual from performing gainful work activity, addiction alone is not enough to qualify a person for Social Security Disability benefits. If, however, the addiction results in other medical conditions, you can qualify for disability benefits due to the resulting conditions. According to the Social Security Blue Book (SSA’s manual on conditions that qualify for benefits), you can qualify for Social Security Disability benefits due to drug addiction if the drug addiction results in one or more of the following:

• Organic mental disorders, which will be evaluated under Section 12.02 of the Blue Book.
• Depressive syndrome, which will be evaluated under Section 12.04 of the Blue Book.
• Anxiety disorders, which will be evaluated under Section 12.06 of the Blue Book.
• Personality disorders, which will be evaluated under Section 12.08 of the Blue Book.
• Peripheral neuropathies, which will be evaluated under Section 11.14 of the Blue Book.
• Liver damage, which will be evaluated under Section 5.05 of the Blue Book.
• Gastritis, which will be evaluated under Section 5.00 of the Blue Book.
• Pancreatitis, which will be evaluated under Section 5.08 of the Blue Book.
• Seizures, which will be evaluated under Sections 11.02 or 11.03 of the Blue Book.

For more information on qualifying for benefits with a drug addiction, visit: http://www.disability-benefits-help.org/disabling-conditions/drug-addiction-and-social-security-disability

Applying for Social Security Disability Benefits with a Drug Addiction

You can apply for Social Security Disability benefits online (http://www.ssa.gov/pgm/disability.htm) or in person at your local Social Security office. When applying for benefits due to drug addiction, you will want to explain to the Social Security Administration how your drug addiction has resulted in one of the qualifying conditions in the Social Security Blue Book. For example, if your drug addiction has resulted in an irreversible personality disorder, you will want to provide the SSA with evidence documenting that you have been diagnosed with the associated personality disorder and proof of treatment. This means providing copies of your clinical records and treatment history.

The Technical Criteria for Social Security Disability Benefits

In addition to proving that you are disabled according to the SSA’s criteria when you apply for disability benefits, you will also need to prove that you meet the technical criteria. If you are applying for SSDI benefits, this means proving that you have earned enough work credits to qualify for the program. The SSA will determine if you have enough work credits to qualify when they pull your work history. For each year that you have worked, you will earn a maximum of four work credits. Depending on your age, a certain number of work credits will be needed to qualify for the SSDI program.

If you do not have enough work credits to qualify for SSDI benefits, you may still be able to qualify for SSI benefits. SSI is a needs-based program. In addition to meeting the SSA’s disability criteria, you must also meet the program’s financial criteria. As of 2013, in order to qualify for SSI benefits you cannot earn more than $760 per month as an individual or $1,060 per month as a couple. Your household assets must also not exceed $2,000 as an individual or $3,000 as a couple.

For more information on SSDI and SSI, visit: http://www.ssa.gov/disability/

Appealing a Denial of Benefits

You will receive notice regarding the SSA’s decision of your disability claim within three to six months of the date of your application. If the SSA decides to deny your application, you have 60 days from the date of the denial notice to file an appeal. The first stage of appeals is a Request for Reconsideration. It takes approximately two to six months to complete this appeal. Unfortunately, most appeals are denied at this level. You have the best chance of overturning the SSA’s denial of your benefits during the second stage of the appeal process, the disability hearing. During the disability hearing you will have the chance to present evidence to an Administrative Law Judge (ALJ) and explain why you need disability benefits. It is in your best interest to hire a disability attorney or advocate prior to attending the disability hearing.

Article by Ram Meyyappan
Social Security Disability Help

Hi again. Well, I started writing. What a relief! I’ll say more about that in a sec, but to make it slightly relevant to this blog, let me tell you what I just learned about “choice.” Last post there was a great dialogue about the “choice” model of addiction. I ended my post arguing that the choices addicts make are highly irrational, based on biases and attractions already inscribed in the brain. Thus….we need to think about making choices in a new way, a way that has nothing to do with logic.

So writing is an intentional act, right? Sitting down to write something, whether a book or an email, is a choice people make. It’s clearly not a disease, it doesn’t happen unconsciously, and it involves deliberation, planning, and so forth.

In that way, writing is something like the decision to take a drug or a drink. And it’s also something like the decision to quit — choosing not to take a drug or drink. (though it’s always harder to choose not to do something than to do something — because the goal is not right there in front of you)

My choice to sit down and write involved a great deal of anxiety, self-scolding, reflection, and many many attempts before I actually pulled it off. Sound familiar?

I had to sneak up on myself. And that’s very often the way addicts manage to quit. I had to wait until I wasn’t concentrating. It was too difficult to sit down and force myself to write, to stare myself in the face. Rather, I was en route to doing something else, making dinner or something, when I stopped at my computer and wrote a few sentences on the fly. Very little deliberation, actually, in the moment of doing it.

But that was enough. An hour later I stopped by my computer and started to revise the….ONE PARAGRAPH. There’s already one paragraph on the screen! I wrote that. And it’s not too bad. Paragraph 2 flowed from paragraph 1, as you’d hope, and since then it’s been easier and easier.

So here was a deliberate and important (to me) choice that changed the direction of my life, the way I spend my time. And I had to be clever, resourceful, sneaky (toward myself), not staring myself in the face — in order to make it. The parallels with quitting are obvious. And the choice to take drugs is not unlike the choice to quit, in that it can happen on the fly, without really focusing on what you’re doing.

The coolest thing I noticed is how the activity of writing grew on itself. Once I had one paragraph on the screen, I felt that I could do it. I felt that I was finally moving. Then the second paragraph was so much easier. And thirty years ago, my second week of recovery was a lot easier than my first.

By the way, this is all about the emergence of self-trust, a topic we discussed in some detail several posts ago.

To say that addiction is a choice is to say very little. The same goes for recovery. Choices come in many shapes and sizes. The crucial thing to remember about making choices is that they usually involve a mixture of deliberate intention, situational factors, unconscious processes (like biases), emotional readiness, and momentum — that sense of moving forward. Some choices, including the choice to quit drugs, depend a lot on momentum. Which is why it’s so hard to get started, and why it’s so useful to sneak up on yourself, don’t think too much, just do it, then let nature take its course (with a little help).

 

 

 

Hi all. I’ve been low on energy for a couple of weeks, which is why I haven’t posted anything. Actually, depressed is the word. I have this whole world of opportunity waiting for me — a visit with the Dalai Lama! And yet I’m completely nonfunctional. I’ve been trying to start Book 2 for over a month, and it just seems like too much effort. At the same time, Isabel is highly stressed at work, and she brings it home with her (of course), so we argue more, which depletes my energy further.

The working title for my new book is: The Biology of Desire: Why Addiction is Not a Disease. You probably know my stance on that one. But the problem is: how to frame it in the current debate? The way I see it, most of the medical community, most if not all of the psychiatric community, most of the treatment community, and most of the scientists who study addiction (either behaviorally or neurally) do in fact see addiction as a disease. Nora Volkow, the head of NIDA (one of the nine branches of NIH) describes addiction as a disease every chance she gets. A chronic brain disease. So it’s important to refute that definition — if in fact it’s wrong. But the trouble is, you then get bogged down in this dichotomy: that if addiction is not a disease, it must be a choice.

The current spokesperson for that position is Carl Hart. Here’s the latest: a write-up and video, care of the New York Times.

Hart brings crack addicts into the clinic, they stay there for awhile, and they are offered crack to smoke on a regular basis. But they are also offered a certain amount of money each time they forego the crack. And often they make that choice: they take the money instead. Sometimes for as little as $5, and almost always when offered $20. In other words, addicts can choose not to partake of a highly addictive substance if they have alternative choices that are attractive. Hart deserves the credit he’s been getting for this research. He is showing that addiction is not a result of some property of a drug; it is the result of some property of the environment, namely the absence of opportunities to get rewards elsewhere. Hart compares his crack addicts to the poor, young, black, marginalized men he grew up with. He argues, very convincingly, that there were no other rewards (e.g., financial stability, steady interpersonal relationships, respectable jobs) available to them. So they chose to get high. According to Hart, it was a rational choice, given the available options.

And by the way, Hart talks about the impact of environmental impoverishment on rats too. He reviews the famous “Rat Park” studies by Bruce Alexander, which I have written about elsewhere. Here is Alexander’s own commentary on what he found out about addiction and environment.

But I don’t agree that addiction is a rational choice. Just yesterday I got an email from a meth addict who’s in big trouble. Someone I don’t know. I had answered a desperate query from this person a couple of months ago, then again a couple of days ago, saying there wasn’t much I could do to help. Then I got this email yesterday:

I am unsure of what to do or where to turn next. I tried rehab once for a few days before my body became toxic and I ended up in the hospital for a week. It was only after I tried quitting that i fell ill close to death with a high fever,failing kidneys and toxemia. Now three years later I am that much more addicted and afraid that this is what will kill me ,and it wont be long. I dont know what I am more afraid of, being sick physically and dying or  staying high, falling apart mentally ,and for things to never change. Maybe this is how it was meant to be? In which case life isnt worth living and my children might be better off without me. I wish there was an antidote.

That doesn’t sound like rational choice. And I get emails like that, more or less, once every week or two.

I want to get into this debate, but where? The problem with the “choice” approach is that it completely ignores the brain. It relies on economic reasoning, not biological reasoning. But we are our biology, Our brains are not computers. They are inscribed with biases, attractions, associations, and habitual pathways of thought. Their fundamental modality is emotion — attraction and repulsion — not logic. And they really do change with addiction (as with other forms of learning). The evidence is indisputable. So, do we have to ignore the brain to oppose the disease model?

I don’t think so. I want to talk about “choice” as a highly irrational mechanism. And there’s lots of research to back that up. See Kahneman’s recent book, for example. In fact, research shows that people think that they’ve made a deliberate choice after their brains have already decided what to do. Much of this literature is quite technical, but here’s an example. I want to model addiction as a biased choice, a choice that is not inevitable but is highly probable, given the attractions that are already engraved in our synapses.

I’ve got the book mapped out, of course. I just need the momentum to get over the hump of page one. But writing this post helps. Maybe today’s the day.