Category: Connect

Hi all. I’m finally back in the Netherlands. This is the first time I’ve ever travelled ar0und the world, and I have two things to report.

1. It is indeed round, or else a lot of people have gone to a lot of trouble creating a first-rate illusion.

2. The jet-lag seems to average out symmetrically, so that I’m actually sleeping at night again.

I have another post coming up soon, but I just want to thank all of you who have replied to my request for contributions to my next book. Many of you have sent me fascinating tidbits — little glimpses of lives that have gone off the rails with addiction, and often gotten back on one way or another. So there’s a lot of material for me to sort through. I’ve responded to some of you. For those I’ve neglected so far, please be patient. I’ll get to you in another week or two.

Meanwhile, I’m just grateful, not only that you’re out there and that you have amazing stories to tell, but also for the courage and creativity embodied in these real-life adventures, and your willingness to share them with me and my readers.

Also, I want to welcome new readers to this blog. My time in Australia was very fruitful. I got in touch with a lot of people in the addiction community, there and in the US in the last few weeks, and I think quite a few of you have tuned into this blog (judging by the spike in numbers I see on Google Analytics).

Okay, enough blather. More posts coming up very soon.

Best,

Marc

Hello people. This is not a post but a request. I just got the go-ahead from my agent to begin work on a new book. Here’s the plan —

Three or four intimate biographies, of people who have had serious struggles with drugs and/or alcohol, who have become addicted, by one definition or another, and who have tried and perhaps succeeded in recovering — even if it didn’t last for good. These life stories will be the backbone of the book. I plan to connect each story to one of the major outlooks, or camps, that try to understand how addiction works: the disease camp, the “choice” camp, and the “self-medication” model, all which have some power to describe addiction, but none of which explains it completely successfully — in my view. I will use science (neuroscience and psychological science, maybe genetics, maybe treatment and prevention science) to take a deeper look at what’s going on in each of these addiction journeys, and I’ll pull it all together with an approach and an explanation that I think works the best.

I need volunteers! I have already talked to a few of you in some detail about your life stories, but I need to talk to others. Would you consider letting me write the story of your life? Of course, you don’t have to tell me everything. I don’t want to “reveal” what you don’t want to be revealed. But I do need detail. I need to know what it’s been like, what it has felt like, where you have been, where you are now, and where you think you’re going. Most of all, I need to know the facts and the feelings as only you can describe them.

Most if not all interviewing would be done via Skype or phone — at my expense of course.

I do NOT have to use your name. That’s a choice you can make, but it is not at all necessary or even very useful for the book I’m planning. Pseudonyms will be fine. And, I hope it goes without saying, I would never reveal your name, or any details attached to your name, to anyone, in any circumstances, without your express (and written) permission. I’m still a clinical psychologist (one of my hats) and I’m still bound by professional ethics. Not to mention personal ethics.

Please consider this request, and if you’d like to talk with me about it, drop me a line. It’s best to use the “contact” form that is embedded in this website. Just click on the Contact tab at the top of this page.

Thanks for any replies, suggestions, or questions,

–Marc

My last post was about neurodiversity, and it brought up some great discussion! Now I want to bring all this back to addiction.

I’m at this Writers’ Festival in Sydney Australia, extremely jet-lagged, flogging my book, doing radio interviews a couple of times a day, and the same question keeps coming up: Is addiction genetic? I mean, do you think you became an addict because of the way you were made? Not everyone is vulnerable to addiction, right? So there’s got to be something in the basic brain plan that makes you that way. Right?

I don’t think so.

There is simply no gene or combination of genes that is linked with addiction as a trait. That doesn’t mean that genes are not part of the enormously complex causal bouquet that does result in addiction. But the genes that are correlated with addiction are genes for traits like impulsivity. And even these correlations are often weak or inconsistent. Some traits – impulsivity, maybe neuroticism, maybe low frustration tolerance – do help describe an individual who will, when things get tough, tend toward addiction more than the next guy. But impulsivity also puts you “at risk” for bungee jumping. And nobody is saying that bungee jumping is genetic.

A lot of people are doing good research on genetic factors that predispose toward addiction, and I’m not saying this work is irrelevant. But so far, the result seems to be a lot of small pieces of a very large puzzle. So let’s go back to impulsivity, where the water is clearer.

Impulsivity, the opposite of inhibitory control, is known to be correlated with inherited (genetic) factors. And the lynchpin of this correlation is believed to be brain mechanics. Well, what else could it be? So a recent study, which claims to be the largest of its kind ever conducted, looked at the brain activation patterns underlying impulse control in early adolescence. The researchers identified multiple brain networks involved in impulse control…which of course means they’re involved with its opposite – impulsivity. But each network was associated with a different style or type of impulsivity. Moreover, activation in one of these networks correlated with early drug or alcohol use, while activation in a different network correlated with ADHD symptoms. Already this shows that an individual’s particular brand of impulsivity (and the hardware underlying it) lends itself to a different constellation of problems.

Of most interest, the pattern associated with early drug use (reduced activation in the lateral OFC) was not a result of drug-taking but a predisposing factor. Does that mean we are beginning to discover the neural recipe for addiction? No! It means that a particular style of impulsivity predisposes teens to experiment with drugs or alcohol. It probably predisposes them to experiment with a lot of other things, including sex, travel, maybe graffiti, maybe tree-climbing, and quite possibly bungee jumping. And notably, this particular brain pattern was not linked to any genetic variant. Again, not surprising. These are the brains of kids who have already grown up in their own particular environments, and brains rewire themselves with experience. These brain patterns were not preformed in the womb. So genetic links, which are often insubstantial to begin with, have to step aside to make room for the role of experience – no matter what.

In a nutshell: Genetic links? Yes. Genetic determinism? Not at all. The relations between genes and brain structures help – among many other factors – to build personality dispositions. They do not build addiction. Addiction is an outcome, a result of a particular set of life experiences, a learned pattern of thought and behaviour. There are many brands of misfortune, both inside and outside our bodies, that can move us toward this outcome.

Yesterday I was interviewed with another author in front of 200 people, and he and I were encouraged to take off from the questions and start our own conversation. I met this guy in the lobby, a half hour earlier. His name is Lemon Andersen – um yeah, his first name is Lemon – and he’s this short, slender, cool looking poet dude from Brooklyn, with a Hispanic accent that makes him even more cool. His style of oral performance is related to “slam poetry,” he’s been mentored by Spike Lee, and he won a Tony in his mid-twenties. Now he’s in his mid-thirties. His parents met at a methadone clinic in Brooklyn. They were both long-term junkies, and they both died of AIDS.

Lemon has never taken drugs. He sold them, to get by in an impoverished housing project, but he never took them himself.

We were in the same session because we both had a lot of addiction in our past lives. But when I first met this guy, I wondered if there’d be any rapport. The Beat poet and the dowdy professor? As it turned out, we practically fell in love with each other on-stage. Maybe because we’ve both struggled to get away from drugs. Maybe because we’ve both found a calling that helped keep us sane. Do you know why Lemon has never touched drugs? Because he was afraid to. Simple as that. With all that genetics working against him – so you might think – he took a different path. His own path.

That’s what we all do, whatever it is we’re made of and wherever it is we come from. Masters of our fate? No. But we create our own masterpiece – ourselves – from the multidimensional palette of genes and environment.

In a recent post I brought up the age-old debate as to whether addiction is a disease or not. In response, Alese raised the bigger issue of neurodiversity. Many scientists believe that a certain amount of individual diversity is built into human behaviour, because it provides an evolutionary advantage for all of us. It may be that our social groupings work best when a small percentage of us are highly detail oriented (autism spectrum), a small percentage are fearlessly aggressive, some tend toward extreme caution. And perhaps some are born with the tendency to seek immediate rewards over long-term gains – those most at-risk for addiction.

This built-in diversity in psychological styles would have to be based on diversity in brain plans. And this neurodiversity would then be considered a survival benefit for the species. That would mean that the psychological syndromes we like to classify as disorders or diseases don’t fit those categories. Not at all. (Even if they don’t make life pleasant for those who “have” them.) Instead, they may be outcomes of adapative variations in the human genome.

When I was in Toronto last month, Jim Kennedy (a highly-renowned research psychiatrist at CAMH) told me an amazing story over dinner. It concerned some research in which he’d participated, examining ADHD (attention deficit hyperactivity disorder), genetics, and migration. I’ll make that long story short:

ADHD is a disorder, if not a disease. Right? Not right? It depends on your perspective. According to Dr. Kennedy, the study of genetically pure (no intermarriage) native populations in the Americas reveals a fascinating pattern of geographically distributed genetics. A gene variant related to ADHD (a certain number of repeats in the part of the DNA linked to dopamine metabolism) shows up at a very low rate in native groups living in northern Canada: 2-3%. The incidence of this variant increases, to something like 10-20% in native groups living in the southern U.S. In Central America, incidence of this variant increases up to 50%, and it exceeds 50% in parts of South America.

What could this possibly mean? Does sunburn cause a genetic predisposition to ADHD?!

According to accepted theory, the Americas were first settled by migration waves from Asia, across a land bridge connecting Siberia with Alaska, at least 12,000 years ago and possibly much earlier. That bridge has since disappeared. This model implies a gateway for migration, starting in northwestern North America and moving south, over many thousands of years.

But why would there be a greater hereditary risk for ADHD as the original settlers of America moved south? ADHD describes a syndrome in which people are more distractible, their attention wanders off target (which means it goes to new targets), and they are more attracted to novelty than to routine. In North American and European classrooms, this is bad news. You’re supposed to be facing the board, listening to the teacher, and doing your assigned work. If a certain proportion of people don’t do this, if they have a “problem” with their attention, and if this problem is related to distinct neural mechanisms AND to genetic predispositions, then the problem gets classed as a mental disorder or disease.

But if this “problem” only arises in certain social contexts – if it can be an advantage in other contexts – then the disease label starts to peel off. Imagine that you are a North American native, it’s 10-15,000 years ago, you live somewhere in northern Canada, and there is nowhere nearby to buy a Gortex jacket or even long underwear. It’s awfully cold for many months of the year. But you happen to have a predispositon to wander off into the woods, peak over the next hill, and to lose attention to the normal duties of hunting and trapping. One fine day, while on your explorations, you look over the crest of a hill and find a long valley extending off to the south. The lands north of you are already settled, so they’re not very interesting to explore. But this valley to the south is completely uninhabited. You let the elders know, and within a generation half your tribe is living there. Your children have a greater likelihood of having the same attraction to novelty, the same low tolerance for routine. After all, they carry many of your genes. When they grow up, they are also more likely to discover greener pastures, and  your descendants  will continue to migrate southward.

By this process, the genetic makeup that confers an attraction to novelty and a disdain for routine will become correlated with geography. Tribes — or groups within tribes — who have a higher proportion of that genetic variant will be more likely to migrate, and will show up further and further south. Thus, a certain genetic pattern is linked to a certain pattern of migration. In fact, it is the adaptiveness of this pattern that EXPLAINS the migration.

Today, in North America and Europe, we associate that genetic pattern with ADHD – a “disorder”. But for those aboriginal people, it facilitated adaptive waves of migration, moving them further and further away from the frozen North and opening up new possibilities for hunting, farming, and building civilizations.

Conclusion: the psychological qualities of a genetic distinction can’t be defined or labeled in a vacuum. The advantages or disadvantages of that distinction can only be described in context.

Research points to genetic patterns that are correlated with addiction. I’ll get into that topic next post. For now, I want to leave you with the thought that addiction may arise from a predisposition that’s not unhealthy or bad in itself. Its goodness or badness may depend entirely on what our society values and on where and how it fits in.

Hi all. A number of you have asked if I could post that talk I gave at CAMH (“the scene of the crime”) on the evening of March 27th. Here’s my talk, converted into a PDF file and annotated for “easy reading”. Still X-rated of course. Enjoy…