Category: Connect

If you happen to click here and listen to B. B. King sing “The Thrill is Gone,” you might notice that he does not look happy. Nor does he sound happy. And he’s sweating. A lot! He says he’s free, but I somehow doubt it.

What happens when the thrill is gone? That’s a central question for addiction, as most of us know first-hand. In fact, what if the thrill was never there to begin with…?

I said I’d report to you on everything I learned at the conference on behavioral addictions in Budapest last month. First I reported on the common denominator, OCD-type states in brain and behaviour, then I tried to specify the key difference between substance and behavioral addictions, then came Elizabeth’s guest post comparing food and drug addiction, and now here’s Part 4: the genetics of thrill-seeking.

On day 2 of the conference, once my brain was seriously sweating, I met the guy who coined the term Reward Deficiency Syndrome (RDS). His name is Kenneth Blum, and he’s a smallish wiry guy, very intense, seemingly dour, but flashing the occasional dry smile. Here’s his hypothesis:

When we take drugs, or do whatever it is we’re addicted to, the brain systems that “light up” include dopamine circuits in the striatum and its neighbours. No surprise there. Blum lists half a dozen dopamine receptors that get in on the act. But the lead role goes to the D2 receptor — which controls the amount of dopamine available to synapses all over the frontal cortex and striatum. The D2 receptor is involved in attention, motor control, motivation….lots of pretty important stuff. Here’s a detailed description. So what happens when the D2 receptor population isn’t quite normal (e.g., too many or too few)? What happens is that you are more likely to suffer from a whole host of things, including OCD, ADHD, schizophrenia, and — you guessed it: addiction. Addiction to drugs, booze, gambling — that receptor has a lot of connections with the underworld of our psyches.

The problem is that the gene that’s responsible for growing D2 receptors, while we’re in the womb, has got different variants (like many genes), and one of those variants (allele A1) causes an overall reduction in the number of D2 receptors. There’s lots of evidence that addiction runs in families, and I’ve usually been reluctant to pin it all on genetics. Why? Because most scientists agree that there’s no single gene or cluster of genes that causes addiction; genetic predictors of addiction usually depend on personality factors, like impulsivity; and there is so much in behaviour and experience that can bridge generations — for example, you hardly need a genetic boost if your dad is an angry drunk and your mom is seriously depressed. But Blum cites some pretty convincing research showing that addictions shared across generations (like father, like son) correspond with this nasty dopamine allele. It shows up in more than one generation!  That is to say the allele gets passed down, along with the silverware and the porcelain figures nobody wants.

In a nutshell, some people have fewer D2 receptors, like maybe 40% fewer in some brain areas like the nucleus accumbens. So these people are not as excited about reaching their goals. Their whole “reward system” is relatively flat. Life is not as much of a buzz for them as it is for most people. As with B. B. King, the thrill is gone. In fact, maybe it was never there at all.

If you have the wrong allele of the DRD2 gene, and fewer D2 receptors, and therefore you have RDS, how are you going to get the thrills those around you seem to get? Well, drugs (including alcohol), gambling, and other super-fun stuff might be the most effective way. These “rewards” are hyper-exciting for most people. For you, who are chronically under-excited, they might be the only way to feel really engaged with life. At least until you get addicted, which seems like a step backward.

That’s the story, according to Blum. That’s what he talked about in his talk, and that’s what we argued about in the lobby for an hour. Reward deficiency leads you to seek out the biggest bang for your buck. Which makes sense, because everyone wants to feel the excitement that dopamine bestows when something special is about to happen. When I was a kid, about age eight or so, I remember making a disturbing discovery. Almost all the fun I had in life seemed to come with looking forward to things, whether a chocolate bar or a birthday present. Once the desired event was actually happening, it wasn’t as much fun anymore. (I was a weird kid, no doubt.) But for most people, a lot of pleasure comes from anticipation, from approach, and that’s what gets muted with RDS.

By the way, I’m actually working with a guy named Arnt Schellekens here in the Netherlands. He and his team are investigating low dopamine levels as a gateway to alcoholism. So this research direction is pretty close to home.

Despite its appeal, there are some serious problems with the RDS model. I’ll name just two. We know from dozens of studies that drug or alcohol use itself leads to a reduction in dopamine receptor density, or at least dopamine receptor activation, because those receptors tend to burn out or become desensitized when we keep bombarding them with fun stuff. Now that’s getting closer to B. B. King’s complaint: The thrill was there for awhile, but now it’s gone. Sound familiar? The question remains: is your dopamine landscape more determined by your genes or by how you use them? Problem #2 is that teenagers as a group are often described in terms of reward deficiency syndrome.  Teens can be seen as under-stimulated, probably because the reorganization of the nervous system in adolescence is pretty disorganized. A disorganized reorganization! That would mean that teenage thrill-seeking is not only natural, it’s inevitable, and it serves an important emotional function. Unfortunately, dangerous drugs are often part of the picnic. In other words, genetic contributions to addiction may simply be dwarfed by a tidal wave of thrill-seeking that comes with adolescence.

The jury is still out when it comes to genetic influences on addiction. Few addiction researchers doubt that such influences exist, but their exact mechanisms aren’t well understood. Blum and his colleagues are still chasing down the RDS model, and trying to connect it to other influential models, like Berridge’s incentive sensitization model.  There’s a lot to be learned, and I admire researchers like Blum and Schellekens, who keep opening new doors to find out what’s behind them.

By  Elizabeth from the blog….

I am very pleased to present a guest post, created by Elizabeth, who has been a member of this blog community for at least a year. Thanks, Elizabeth, for your contributions until now, and especially for this fascinating post–

The present “obesity epidemic” has given rise to public concern about the level of refined sugars, especially high-fructose corn syrup, in the North American diet.  While we can all agree that an excess amount of sugar is probably not good for anyone, more controversial questions about the “addictive nature” of such sugar intake have also emerged.  Public policy measures to curb access to this “addictive substance” (see NYC soda ban) are designed with intentions to prevent individuals from developing a “sugar dependency” and hopefully curb the rising rates of obesity.  But, is overconsumption of these sweet and calorie-dense foods really reflective of a widespread “addiction” to sugar?  Perhaps there is some truth to the matter, and perhaps we can understand this phenomenon better by looking at studies of drug intake.

Several years back, researcher Roy Wise argued that drug intake could be viewed as an “ingestive behavior.” He noted that animals who were limited to short periods of drug access at regular times throughout the day show signs of “regulated drug intake” to maintain a steady blood serum drug level similar to “regulated food intake” to maintain energy balance.  When the self-administration studies were halted, these animals displayed little, if any, signs of withdrawal.  Thus, they were probably not really addicted or dependent on the drug at all.

So what could make this regulated intake spiral out of control?

Marc has provided a wealth of information regarding the predictors of drug addiction, including the effects of stress, low feelings of self-worth, and the need to compensate by “self-medicating.”   I won’t belabor these points.  What is interesting to me is that these factors seem to aid the development of “addiction-like” drug intake in animals — when the self-administering rodents escalate their use over time, pursue the drug in the face of punishment, and show physiological withdrawal symptoms. In other words, when they seem to become addicted.

So, additional factors — beyond drug availability — may be necessary to make the “ingestion” of drugs more “addiction-like.”  Does this mean that the ingestion of foods can also be normal, versus addictive, depending on external factors?

Indeed, stress and negative self-worth also play major roles in the development of eating disordered behavior (e.g., excessive caloric restriction, binge food intake, purging, etc..).  Food and drug rewards act on the same neurotransmitter systems, so disruptions in reward circuitry can confer drug addiction and, likewise perhaps, change the meaning of food. Get this: If you want to get an animal to REALLY want to take a drug, you can deprive it of food.  This suggests that dysregulated food intake cross-sensitizes with dysregulated drug intake (kind of like how abuse of one substance can lead to abuse of another). Basically, since the brain interprets the value of both food and drug rewards through similar circuits, alterations in these circuits can cause EXCESSIVE pursuit of both.  The brain is saying “hey, I’m deprived of some necessary sustenance…give me more!  The next time I get that reward, it’s going to be REALLY reinforcing, so I will seek it harder and make SURE I get all I can!”  So, the next time drugs are encountered, we binge on them.  The next time we get access to a sweet treat, we are likely to binge on that as well.  In fact, there is a striking comorbidity between binge food intake and drug abuse.

What this means is that there can be addiction-like components to both binge eating and drug taking.  The super-sensitivity to both rewards appears to be greatly influenced by the individual’s history:  Have there been significant life stressors?  Has the individual been deprived? (Think of those with eating disorders who have excessively restricted their caloric intake in order to look or feel thin.) These factors come together to promote a sort of “super-craving” — for food, drugs, or both.

I’m not sure that these factors are widespread enough to completely explain the obesity epidemic, but they sure help put it in context.

Those first puffs of pot were so rich, so sweet, so…promising. And that first hit of smack. Granted the needle stuff was a little rough, but can anything that feels this good actually be…um, bad?

One of the most universal characteristics of drug use is the chimeric quality that’s almost always present, especially the first couple of times. (And by the way, just so you know, “chimeric” is a real word: “relating to, derived from, or being a genetic chimera or its genetic material <a chimeric cat> <chimeric genes>” from Merriam-Webster.com.)

Well it should be clear that I have nothing of substance to write about tonight. But I’ll share this bit of fluff.

A few posts ago  I commended Bhagavan Das to you. I called him: “that wise / spiritual / contemplative / meditative dude with a huge beard.” This was in relation to the problem of self-control.

Well apparently he’s not so wonderful after all. In fact, self-control seems to be way down on his list of attributes. I recently learned that B.D. can be a real shit. One of my most effective double-agents had this to say:

“He can be quite magnetic, but you might be shocked by reading and viewing some clips/articles here:  http://karmageddonthemovie.com/”

If you click on this link you will find yet another mirage: a guy who came across as wise and spiritual, but who looks, on closer inspection, to be a bit of a self-serving, devious shadow puppet. Someone who is not even close to what he appears to be.

Ah well, so it goes. Perceptions are by their nature misleading, and maybe the only way you ever get to know the reality of something is to be smacked in the face repeatedly with the stupidity you showed by missing it up until then.

Happy Easter.

A few people commented on my last post that addiction was not the same as OCD. I agree: they overlap, but they’re certainly not synonymous. What I’ve been ruminating about is a related matter: the implication that substance addictions and behavioral addictions are the same. No, I don’t think they’re the same either. I called them cousins, not twins.

There are important things to say about differences in brain mechanisms and other physiological matters. I’m not going to deal with these much here, but the main point is this: Substances such as drugs and alcohol “talk to the brain in its own language,” as I say somewhere in my book. What they provide for the user is immediate, even intimate, in that they directly alter what’s going on in your synapses — the physical medium through which you experience…everything! Their effect does not need to be mediated by actions or events. They affect the brain directly. The implications are huge, but greatest among them is the certainty they provide. Without the middlemen of actions and events to pick up some of the slack, you can be pretty sure you’ll get what you paid for.

In this post I’m going to look more closely at what it is you get — what I got — by examining my own experiences. In doing so, I hope to pinpoint what I think is unique about substance addiction.

My addiction was mostly to opiates, though I also had a great fondness for cocaine at times. And though that was 31 years in the past, I managed to revisit my addiction about two years ago. I don’t often talk about this, but I don’t hide it either. In fact I wrote an essay about my partial re-addiction,  published in Toronto Life (one of the most popular life/culture/news magazines in Canada), and that essay is available for all to see on this website.  I had been through some pretty serious back surgery, and I was in a lot of pain for about 6 months. Which meant 6 months of painkillers. Which meant I got to experience the joys of QUITTING all over again.

It wasn’t nearly as bad as it was the last time. I hadn’t broken any laws and I hadn’t compromised my life. But it was…a potent reminder of what it’s like to have a substance play an unduly prominent role in one’s psychological life, and the step-down I went through with my doctor was a reminder of the ferocity of withdrawal symptoms — this time properly managed, thank goodness.

In any case, my memories remain pretty fresh.

Being a substance addict always meant the same thing to me. It meant putting a huge amount of value in a thing or things. Pills, for example. The substance was hard currency. You could save it up, you could collect it at the back of your drawer. You could sit up at night and count it. I don’t suppose you can do that with internet addiction or sex addiction, though I could be wrong. But for me, the substance, the thing itself, the currency, had enormous symbolic value — as currencies generally do. And the value was that I could cash it in for a feeling any time I wanted.

Most important, the exchange rate was pretty reliable, given a certain amount of slippage — inflation — due to tolerance. So this currency gave me instant and predictable access to a feeling, just by putting something inside my body. Unlike gambling, where you have to be lucky, or like food addiction, where what you feel is a complex blend between calories, flavour, and your distance to the nearest Seven-Eleven, drugs gave me reliable access to a warm feeling that itself was (at least partly) symbolic. A symbol of a symbol? Sounds complicated. In fact it was very simple. The warm feeling was a version of some fundamental state of calm, contentment, peace… But it was really just a version. It was a nice feeling, but not quite the real thing.

Certainly other addictive rewards are symbolic: winning at cards, beating on-line opponents, having sex with…let’s not even go there. So I don’t think that’s the main difference between substance and behavioral addictions. The main thing, for me anyway, was that I had possession of these things, these pills. That gave me total control of the cascade of symbols and feelings that I had become attached to. Substances are….there. They’re objects, in three dimensions, solid, liquid, or even gas, I suppose, if you count nitrous oxide. You can hold them in your hand and take them when you want to. (Until they run out, of course.)

And what that means, dear friends, as I’m sure most of you know, is that you don’t have to get good feelings from other people or other activities. You don’t have to get good feelings from being at one with yourself, from loving yourself. You have this direct access to good feelings — sitting in your drawer. That gives you control. And control is the one thing we simply don’t have with other people, or with life in general. In fact the opposite of control is helplessness, and I believe that helplessness is the fundamental state we spend most of our time and energy trying to get away from. Brain-altering substances are just a little more efficient than anything else — at turning our backs on our helplessness.

I think that the bottom-line value of all addictive acts is that they give us access to feelings that are not accessible without them. I think that must be true of gambling and sex and the internet and crack, speed, booze, and everything else. But behavioral addictions don’t affect your brain directly. They require you at least to DO something — which involves more work, more symbolism, more uncertainty. Substance addictions simply require you to open your mouth, your nose, or your veins.

I said I’d use the next few posts to share what I learned at a recent conference on behavioral addictions. I should emphasize that the conference, held in Budapest, was billed as the the First International Conference on Behavioral Addictions. The idea that gambling, hypersexualized behavior, eating disorders (including obesity), and internet addictions are in fact addictions is quite new, and even today there are many professionals, policy-makers, and researchers who bristle at the thought.

Think for a moment about the implications. If the medical world accepts, say, internet addiction and eating problems as addictions, requiring treatment, then insurance companies in the U.S. will go bust within weeks. Not that they don’t deserve it. If internet use is an addiction, then how do parents and teachers moderate kids’ internet use? Almost nobody would claim that internet use should be forbidden, yet, if it’s addictive, then shouldn’t it be tightly controlled? These are just a few of the problems society will face when behavioral addictions are acknowledged as addictions.

I say this as if the matter is resolved. Well, it is for me. I saw enough evidence in those two days at the conference to convince me, beyond a doubt, that behavioral addictions not only resemble substance addictions in “real life” but also arise from the same brain processes.

The most convincing parallels between substance and behavior addictions start by recognizing their common denominator: compulsion. When gambling is considered an addiction, it’s called compulsive gambling. Eating disorders including binging and bulemia are often discussed as compulsive. The same goes for sex addiction and a few other things. Then we cross the line into substances. Smokers smoke compulsively, alcoholics drink compulsively, and as for drug addiction,the National Institute on Drug Abuse defines it as characterized by “compulsive drug seeking and use.” In my last few posts, I’ve described a set of stages in the onset of addiction (and addictive acts), and the final stage is compulsion. So, if we are seeing evidence of a common denominator underlying both substance and behavioral addictions, both in people’s behavior and in their brain mechanisms, then the defense rests.

Interestingly, the most fundamental behavioral addictions are the individual actions people perform repeatedly when they suffer from OCD (obsessive-compulsive disorder). When you wash your hands or check the stove 50 – 100 times a day, that’s a behavioral addiction! So a number of speakers at the conference directly compared the behavioral and neural portrait of OCD with both/either drug and/or behavioral addictions.

Naomi Fineberg, a well-recognized researcher in this area, sees OCD as the archetypical compulsive disorder: People with OCD can’t inhibit impulses, they show low cognitive flexibility, and narrow, limited goals. She uses a button-pressing task in which the “reward” is turning off a mild electric shock. After training on the task, the reward is withdrawn. From that time on, pressing the button accomplishes exactly nothing. Yet compulsives keep on pressing the button. Ordinary people do not. Compulsives report that they keep on pressing simply because they feel the “urge” to do so. Sound familiar? Sound like addiction? She concludes that OCD is not about repeating a behavior to get a reward — nothing good is anticipated. Rather, actions are performed to avoid “punishment” — the negative consequences of not doing something. And the negative consequence may simply be the build-up of anxiety. I’d say it’s very much the same with addiction.

Dr. Fineberg also talked about her neuroscience research. OCD “patients” (I hate that term, but that’s what they call them) and stimulant (e.g., coke and meth) addicts show a host of similarities in the scanner. The ventral regions of the prefrontal cortex (such as the orbitofrontal cortex) are where emotional meaning grows and solidifies over time, and these regions show reduced connections with more dorsal areas involved in self-control. So the brain becomes less capable of exerting self-control.

Giacomo Grassi, from the University of Florence, talked about OCD and addiction as caused by “reward dysfunction” — a condition that starts out with anxiety but ends up as a behavior problem, becoming “addicted to compulsion” as he calls it. Dr. Grassi’s brain scan images showed that OCD patients have higher activation of the amygdala (the centre for emotional conditioning) and lower activation of the nucleus accumbens (or ventral striatum — the brain centre for motivated reward-seeking) — a pattern repeatedly shown in addicts as well. He also demonstrated a shift in activation from the nucleus accumbens to the dorsal striatum as compulsions set in, just as I discussed two posts ago as the final stage of addiction.

So we could say that OCD is the pure form — the grand-daddy syndrome — in which people fall into loops that are no longer rewarding, just difficult to turn off. Substance addictions and behavioral addictions are two derivatives or variants of that form. Two lines of descendants — its offspring. Substance addictions and behavioral addictions look the same, sound the same, smell the same — common sense suggests that they are, at least, very close cousins.