Category: Connect

Following that invitation to meet with the Dalai Lama, I’ve been looking more into Buddhism and studies that link it with neuroscience – and with addiction. In one recent article, I learned that mindfulness/meditation (let’s call it MM) changes the brain in one important way. From the treatment community, we also know that MM helps people recover from addiction. Research has been sparse so far, but there are good results with respect to smoking. So my question is this: if we know that MM changes the brain in such and such a way, and if we know that it helps reduce addiction, will we come to understand what neural processes are at the core of addiction?

An important brain region has been identified in many labs in the last few years. It’s called the Default Mode Network. This area (which includes the posterior cingulate and medial PFC) “lights up” when we are daydreaming, self-reflecting, imagining our selves in past or future situations, or imagining interactions with other people. In other words, the default mode is where we go when we are going with the flow and thinking in an undirected way about ourselves. Most interesting is that the default mode network turns off when we become focused on a task. When we have to do something novel or challenging, we leave the default mode and enter a focused mode, supported by very different brain regions, including the dACC – a region I’ve discussed as critical for self-control.

This particular article shows that MM changes activity in the Default Mode Network – a finding supported by other studies. The more you meditate or practice mindfulness, the more likely you are to activate the “focused” brain regions and turn off the default mode, especially when you’re required to pay attention. This article also claims that the reason MM helps people recover from addiction is because addicted individuals have too much activation of the default mode network. In other words, the images, cues, plans, ideas, associations, etc, that come to your mind when you’re addicted are more like daydreaming than focusing. You are using a brain region that DOES NOT solve problems but maintains a habitual sense of who you are.

I found just two articles that show that addicts have more activation in the Default Mode Network than other people – not a huge number of studies so far, but still… One of these showed that the default mode network is highly activated in heroin addicts, and this activation does not go down when they’ve had a dose of methadone. So whether you’re high or not, this is home base.

I’ve usually considered addiction as being too focused. After all, craving – the main ingredient of addiction – means having one goal and only one goal consistently at the centre of your attention. But it’s also true that there’s something very unfocused about addiction. Your thoughts are following such familiar ruts, without conscious guidance, and your sense of yourself is habitual rather than flexible. Oh wouldn’t it be nice if…..here I go again…not too surprising….well I don’t have to quit this week….could wait till things get less stressful, etc, etc. So maybe that unfocused state is where the addictive plan starts to form. Look at this snatch from John’s Guest Memoir:

Resting after the first set [of exercises]; I do something I should not do: I trace with my finger along a raised vein on the back of my forearm, slowly, gently, slightly, thinly smiling — the blood’s rushing to my head already anyway — tap on that one good spot a couple times, and now here comes the idea. Ohhhh… and oh fuck that reminds me of the dream I had last night.

That pretty much typifies the default mode…not paying attention, letting your thoughts go, which includes letting them go to places where they really should not go.

So, if addictive behaviour arises from a brain network that supports habitual, undirected thoughts, and if MM helps bring focus and clarity to one’s thinking, by deactivating that network, then it wouldn’t be surprising that MM is an important tool for recovery. And this kind of research, which is starting to grow exponentially, teaches us critical lessons about how treatment can tackle addiction – right in the middle of our brains.

For you Australians who’ve just come to visit this site, thanks for your interest! I’ve taken about a three-week break from blogging, but I’ll post again very soon. Meanwhile, you might want to catch up with some of the topics we’ve tossed back and forth on the blog. We’ve had some excellent dialogues, but will be moving on to new territory. Also, check out the Guest Memoirs page, and feel free to send me yours if you feel like contributing.

The site was first launched as publicity for my book. But now the blog has taken on a life of its own. Our main topic is addiction, obviously, and recovery, and the variety of paths to recovery. But there’s also a science undercurrent, and I try to touch on a neuroscience perspective in most of my posts. The neuroscience of addiction is a key interest of mine (having been both an addict and a neuroscientist), and the blog has been invaluable for me to link it up with real life.

So…..welcome!

For all readers, Happy New Year!!! I’m looking forward to more posts and more of the in-depth dialogues we’ve had in the past. More soon…

Last week I was trying to think like a Buddhist, in preparation… I thought about the self-reinforcing nature of “attachment” (à la Buddhism) and the self-reinforcing nature of addiction (which we all know about from our, ahem, independent research). What Buddhists describe as the lynchpin of human suffering, the one thing that keeps us mired in our attachments, unable to free ourselves, is exactly the same thing that keeps us addicted. The culprit is craving and its relentless progression to grasping.

The cycle of human attachment is represented in Buddhism by a wheel that keeps on turning. First comes emptiness or loss, then we see something attractive outside ourselves that promises to fill that loss, then we crave — a state we all know and love. Craving seems to be a universal form of anxiety, focused on a goal rather than a threat. So we crave and crave, and here comes the clincher: the next thing we do is grasp — reach for it. That’s what keeps the whole wheel spinning, like a merry-go-round you can’t stop. Grasping of course leads to getting. Getting leads to more attachment. Attachment leads to more emptiness and loss, because the thing we’ve attached ourselves to is never enough to fill the void. And so we’re embarked on the next revolution of the wheel — searching for something outside ourselves.

The parallels with addiction are so obvious, I won’t bother to list them. I guess the only thing that’s special about addiction is that we keep grasping for the same thing again and again. There are good neural reasons for that — reasons the Buddhists may not have appreciated. Each cycle of craving, grasping, and loss leaves its trace on the synaptic architecture of our brain. The synapses that represent the addictive substance or behaviour, the getting or doing it, and the expected relief become increasingly reinforced each time they are activated. “What fires together wires together.”

As far as I know, Buddhist common sense recommends breaking the cycle between craving and grasping. Is it possible to remain in a state of craving without going after it — the thing you so badly want? Of course it’s possible, but it ain’t easy.

A paper published by Kuhn, Gevers, and Brass (2009, Journal of Neurophysiology) reports on a neat experiment. These guys measured electrical activity in the area of the dorsal anterior cingulate cortex (the dACC: the region responsible for effortful self-control), using brain wave signatures called event-related potentials. On most trials, the subjects were instructed to press one or two buttons in response to a pattern on the screen (called the “instructed Go” condition). But on some trials they were told not press the button (to withhold the action, called “instructed NoGo”). And on other trials, they were free to press or not press, according to their own whims (called “free Go” and “free NoGo”). Given this design, the researchers were able to compare the level of brain activity (in the region of the dACC) between instructed actions, free actions, instructed non-actions, and free non-actions.

The point is that instructed non-actions (“instructed NoGo’s”) are exactly what we face when we tell ourselves NOT to grasp, not to go for another drink, another bite, another pill or whatever. When you hold in mind the “instruction” not to do something, and you successfully obey your own instruction, then you’ve broken the cycle, at least for now. You’ve refrained from doing something you were just about to do: that’s craving without grasping.

The diagram showing the results of the experiment gives voltage values for different brain regions in each of the four conditions. In the second row, the “N2” tells the whole story. The N2 is considered a measure of self-control, and the N2 shows the maximum voltage (blue colour, because the voltage is negative rather than positive) in the “instructed NoGo” condition, not the “instructed Go” condition or either of the “free” conditions. So your brain, and specifically your dACC, is working hardest when it’s trying to refrain from doing something — harder than when it’s trying to do something. In Buddhist terms, it’s a lot easier to grasp than to refrain from grasping. And if you’ve been following my previous posts, you know where that self-restraint can lead: ego fatigue! Your dACC can’t take the strain and sooner or later gives up.

So here’s an instance where neuroscience and Buddhism tell us complementary aspects of the same story. Neuroscience tells us how hard it is to intentionally refrain from something you’re about to do. Buddhism tells us: Yes, it’s hard, but do it anyway! And you’ll be glad you did… That makes sense to me. If you can let yourself crave without grasping, even a few times, then you start to break down that automatic progression — that compelling momentum — that keeps the wheel going round and round. And after a while craving itself begins to diminish, because it’s got nowhere to go.

My family and I are going back to Toronto for two weeks to meet up with friends and family. So I may take a break from blogging — unless something really interesting comes along. Meanwhile, Happy Holidays to all of you! And thanks again for your warm good wishes last week — That’s the best present I could have wished for.

So I’m having this relatively uneventful week, doing a bit of homework for my Dutch lessons, preparing for a class I’ll be teaching next term, defrosting the freezer, debating with a publisher as to why she should accept my next book, driving the kids to soccer and always arriving late, though no one seems to care, and wondering during my few un-busy moments what I’m actually doing with my life. Do I seriously think there’s more I can contribute to the addiction literature – besides blogging, which I love? Or should I hang up my spurs and take up growing tulips?

When all of a sudden I spy an email from the Mind and Life Institute, a group started by the Dalai Lama and a few other notables, whose mission is to identify links between the contemplative arts (e.g., Buddhist meditation) and neuroscience. I figured it was a generic invitation to their yearly conference. I went a few years ago, and it was actually great. Each day I woke up early, did a lot of yoga, ate a lot of vegetables, and spent many hours with my eyes closed, making infinitesimal progress toward enlightenment but getting pretty relaxed.

No, it wasn’t that. It was a letter, addressed to me. I had to read it twice to believe it. It was an invitation to spend five days with the Dalai Lama at his residence in Dharamsala, all expenses paid. I would be one of fewer than ten scientists or scholars or addiction specialists, and we would be meeting with him throughout the five days to discuss craving and addiction. The Dalai Lama remains deeply interested in societal problems, especially those that might be addressed from both Buddhist and scientific perspectives. According to the letter, he sees addiction as a major source of suffering in today’s world. I have to agree with him there.

So…yeah…I’m blinking rapidly and checking the address to make sure it’s not a hoax. They “very much hope you are able to join us for this special conference …” and would I please let them know as soon as possible. So I thought about it – for approximately 2 ½ seconds. I would give my left arm, maybe my right arm, to meet this man and talk about addiction with him and a few other folks. I’d go just for the ride. Just to be in his presence. Besides, Dharamsala isn’t Rotterdam. It’s halfway up the Himalayas. It’s a beautiful place according to the pictures.  Just to be there would be an amazing trip, but to talk with this precious man about, let’s face it, my favourite subject. Yes, I accept!!!

I don’t know why I’m telling you all this. I guess just to share the most exciting moment in my life for the last couple of years. But this opportunity also brings to mind something I’ve thought about for awhile. When I argue my usual position, that addiction is not a disease, I often get a lot of flack. In particular, the disease advocates often argue that addiction must be a disease because it changes the brain, often irrevocably. And I argue back that I think addiction is an extreme form of normality, because normal learning also changes the brain, often irrevocably, especially when the learning concerns goals or intentions that are highly emotionally charged, such as falling in love, having a child, religious conversion, and, well, developing a serious fondness for coke, smack or booze. I haven’t yet been able to make my argument as articulate and convincing as I’d like to. In a recent post on a science blog, I tried to put it as succinctly as possible. And dozens of comments came back – most of which were not in agreement. So I’d counter that, if drug addiction was a disease, then so would gambling and other serious behavioural addictions be diseases, not to mention a passionate affair with the man or woman next door, and so on and so forth.

But how’s this for cutting to the chase: Just about everyone describes addiction as a continuous state of craving that can only be relieved by acquiring/doing the thing you crave. Whatever is going on in the brain, the psychology of it is pretty straightforward. So if I were a Buddhist, I’d probably say: hey, that’s human existence for you. Human existence is characterized by longing, by craving…and then being propelled by the craving into grasping – which means going after the thing you crave and getting it. Which always lets you down, since material things never satisfy the emptiness that’s at the core of craving. Which is why Buddhists recommend that you do some serious meditating and thereby give up your attachments. When that starts to happen, then you can watch yourself being in a state of craving without going to the next step, grasping. You can just watch it, see it for what it is, and let it go.

(Which may be why a lot of people find meditation extremely helpful for recovery.)

I wonder if the Dalai Lama will see addiction in a similar way. I suspect that he, of all people, will see it as an extreme form of attachment, which of course generates craving, which is why addicts suffer so much – until we’re able to watch the cravings come and go. I doubt I’d have to convince him than addiction is not a disease; it’s a highly focused state of longing – for something that glitters but isn’t even close to gold.

(Another reminder: Check out the Guest Memoir page, linked above. We’ve gotten a couple of new ones, and they’re really gripping. Please comment if you’ve got anything at all to add, or send us your own memoir.)

In the last two posts – one by Persephone and one by me – we talked about the possibility that 12-step treatment offers a “static” rather than “developmental” approach to recovery. Persephone argued that certain features of 12-step practice kept the addict or alcoholic in a frozen state of heightened anxiety, much like PTSD. My last post was an attempt to extend and articulate some of Persephone’s points. I was really taken with the similarities between her idea of “static recovery” and PTSD, and I provided information about traumatic memory maintenance in support.

But today I want to take a different approach – and I think it provides a real reconciliation between the pro and con positions on 12-step recovery. The point I want to make is that any and all recovery has to be developmental in nature. Pure stasis simply cannot correspond with recovery.

The term neuroplasticity has been bandied around a lot. Norman Doidge seems to think he invented the concept, or at least brought it into the limelight, but it’s been around for ages. Dr. Eric Kandel of Columbia shared a Nobel Prize in 2000, reflecting decades of research on how the brain changes when learning occurs. In a nutshell, Kandel showed that the connections among neurons – synapses – must change physically if memories are to be formed. He showed this at a molecular level, validating Hebb’s famous insight from the 40s: What fires together wires together. Well all the neural change that takes place when we learn and remember things is really just neuroplasticity.

Neuroplasticity is strongly amplified when people are highly motivated to change, probably because of the strong emotions that come into play and focus one’s attention. In her wonderful book, Barbara Arrowsmith-Young describes the many cognitive exercises she devised for herself, in order to overcome her very severe learning disabilities. They worked. She went from a high-school student who could not comprehend history, who even had a hard time understanding simple sentences, to a writer and teacher who has set up roughly 70 schools for learning-disabled children in North America. Barbara, whom I met in Australia last year, has a delightful phrase for neuroplasticity dedicated to replacing bad habits with good ones.

What fires together wires together, and what fires apart wires apart!

(I don’t actually know the origin of this phrase, but I like it.)

In 1993, Mogliner and colleagues looked at the brains of people who had been plagued with webbed fingers. That means that some of their fingers could not operate separately – they functioned in total unison. After surgery was performed to allow the fingers to move independently, these authors looked at changes in the (somatosensory) cortex. What they found was that the synaptic wiring of neurons in the corresponding brain regions had changed substantially, just weeks after people started to control their fingers independently.

The parallel with addiction seems striking. You “learned” your addiction through neuroplasticity, which is how you learn everything. You maintained your addiction because you lost some of that plasticity. As if your fingers had become attached together, you could no longer separate your desire for wellbeing from your desire for drugs, booze, or whatever. Then, if you did indeed recover, whether in AA, NA, or standing naked on the 33^rd floor balcony of the Chicago Sheraton in February, that means you got your neuroplasticity back. Your brain started changing again – perhaps radically. You started to separate one set of desires from another and to act on them independently. And just as in Mogliner’s study, your brain began to regrow its synaptic patterns – to allow the change to take place, to hold onto the change, and thereby to permit a new degree of personal freedom.

The take-home message is simple: All recovery is developmental. Without developmental change in mind and brain, you would stay exactly the way you are.