Category: Connect

Hi again. I’ve been back home in the Netherlands for exactly two weeks, and there has been so little time for anything…so I have not posted anything. Lots of course work to catch up on. One new class started last week, and I had to prepare my lectures…with eye-catching Powerpoint animation, jokes that might seem funny to 21-year old Dutch students, and oh yeah, all that neuroanatomy that had gotten slightly rusty… I was a bit nervous. There were 300 of them sitting there chatting while I was standing at the podium clearing my throat. English is their second language, one they had to learn in high school. And Neuropsychology 101 isn’t intrinsically entertaining to everyone. The text book was dry, so was my throat, and how was I going to say anything comprehensible and interesting enough to get their attention off their cell phones?!

It didn’t go badly after all. I really got into talking about the brain. I pranced around the stage, pointing to different spots on my head and extolling the marvels of this self-organizing system of rapidly emerging subnetworks, that are the physical basis of all experience, a system that is designed to be underdesigned (because we need to learn almost everything we know — and that requires massive reorganization), and I’m talking about 20 billion or so cortical neurons, ladies and gentlemen, dames en herren, with 1,000 or more connections. EACH!  That’s at least 20 trillion nodes, each node affected by complex concoctions of neurotransmitters, which tune them, just so, influencing how much information gets through, what kind of information gets through, and how we FEEL about that information…

Someone (I think Joseph Ledoux) boldly said: You ARE your synapses. That shifting configuration of tiny electrochemical connections: that’s YOU!

They were happy and smiling at the end. A good sign, I thought, except maybe they just liked watching me stride about tapping myself on the head. I had to wonder what was getting through to them.

I wondered the same thing, a week and a half ago, while participating in an hour-long talk show, via Skype. It’s called The Agenda with Steve Paiken, and a lot of Canadians watch it. So I was a bit nervous that night too. Behind me the camera picked up vague shapes in a dark, messy living room — watching it afterward, I thought I looked like a resident in some unlit chamber of hell, compared to the bright faces in the studio in Toronto.  But the real problem was that one of the three other guests was an MD, a psychiatrist, named Peter Selby — a guy who does both research and clinical work — at this psychiatric/addiction institute in Toronto. CAMH, it’s called, I mentioned it in my last post. And he, like many of his colleagues, really sees addiction as a disease. But I don’t. So we argued about it. It was all quite civilized, but we weren’t seeing eye to eye. And yet he had some good points.

Politics and pontification aside, am I really so sure that addiction is NOT a disease? This is a topic that I’ve gotten into before, but not in much depth. I know how to talk the talk. I’m used to arguing cleverly that the “disease concept” of addiction is really just a metaphor, and a sloppy one at that. It can be useful. It helps us refrain from beating ourselves up if we think we’ve got a disease. But maybe it robs us of the sense that we can overcome it through our courage and our creativity — something you can hardly do with a real disease. I have some good sound bites… like: if addiction is a disease, then you must CONTRACT it at some point, and then you HAVE it, and then you GET treatment, and if the treatment works, then you’re CURED. And if it doesn’t, you have the disease until you die. I can talk like that, and I can smugly conclude that those are NOT the characteristic features of addiction. But now I’m not so sure, and I wonder if I’m the one being too superficial, too mentally lazy, to give this matter the attention it deserves.

Because Selby was right about one thing: “disease” is not such a simple black-and-white concept. Take Type 2 diabetes. You don’t catch it or otherwise contract it. Rather, it grows — it’s really a developmental disorder that comes about when people make bad choices about what they eat. Or live in unhealthy environments. And it’s not something you try to cure, it’s something you try to treat. The same could be said for quite a few “medical” diseases. Like high blood pressure? Like colitis or irritable bowel syndrome? Like carpal tunnel syndrome? When I’m on an anti-disease rant, I often fall back on the argument that brains change with development, they change with experience, they’re supposed to change: learning changes the brain, addiction is a kind of learning, it’s highly accelerated, it’s very focused, but it’s still a process of learning. So I’m thinking, diabetes, colitis….do they change the structure of your body too? Well, of course they do. And yet your body isn’t supposed to change in those ways. Aha! I’ve clinched the argument. Except that I have this intrusive thought: brain changes that come about with addiction are NOT so natural after all. Sure, the brain — especially the cortex and limbic system — is designed for its mutability. It’s supposed to be able to change with learning. But it’s not supposed to change so much that you can’t secrete dopamine in the ventral striatum without focusing on your drug or drink or sexual obsession or food obsession of choice. That’s a pretty fucked up brain, even if it got that way through a “natural” “developmental” process. So…is the outcome of addiction really distinguishable from what we call a disease?

I’m not going to go further with this tonight. But what do you guys think? Please share your ideas before I share more of mine. Yet we all have to try to leave our politics at the door before we get into this. Because the 12-step versus do-it-yourself versus the self-medication approach versus the “choice” position — all those territorial disputes take our attention away from the fundamental issue, the thing we really need to focus on. Which is: what is addiction? What is it really?

Hello people! It feels good to be back in touch with you….as though you are my long-lost family. I have posted some comments, haphazardly, in response to recent comments of yours. For anyone still waiting for a reply from me, I’m sorry. I’ll be home in three more days and I will catch up soon. Or if I miss you and you want to hear from me, just nudge me with a note from the “contact” page.

This trip has been amazing: stressful, tiring, but also satisfying. I’ve stopped in a lot of cities, done a lot of interviews, a few readings, a few talks, written a couple of pieces while waiting at airports, and schmoozed with a lot of people, both media types and scientist types – addiction scientists – and even a few ex- or wish-they-were-ex- addicts. They are – we are – everywhere.

For example, last night, after I finished talking to an audience of about 200 people (scientists/practitioners and “normal” people), one young woman comes up to me while I’m packing up my laptop, and says unsurprising things, like “…really interesting talk. I do research on rats…self-administration of nicotine…test for increased activity in cholinergic neurons…etc, etc.” After a short pause, she continues, “I have a problem, too. I guess you’d call it an addiction,” and she looks down shyly. Then she looks up and our eyes lock and I recognize her as someone just like me, a much younger female version, but there she is, divulging her struggles to a stranger. Struggles with an eating disorder, a self-destructive compulsion, and I notice how thin her hand is after it’s just shaken mine. I look at her more closely and see her anxiety, all wrapped up in her skinny body, I notice the openness in her face, and I instantly like her: she’s got the courage and dedication to fight addiction and study it at the same time. I admire her, feel for her, and hope that she will win in the end.

Last night’s talk was the climax of my trip. It was held in the main auditorium of the main psychiatric institute in Toronto, called CAMH, Centre for Addiction and Mental Health. I always thought that was a weird name, as if they’re dispensing addiction and/or mental health – take your choice. Anyway, the posters advertised Marc Lewis, no title, with my face next to a big picture of the book, and in huge letters: Memoirs of an Addicted Brain. Three TV cameras were being set up when I entered the auditorium. I was pretty nervous. But once I started speaking, and once I started to focus in on the faces of the audience members – interested, intelligent, and engaged, with friendly expressions, no hint of the suspicion or judgement I’d half-expected – once I got going, I lost my nervousness and the words started to flow.

When I was done people clapped and clapped, and I felt like a star. But even at that proud moment I was very much aware, as I had been all day, that I was standing in the building where I’d done my research, my rat research, for my Bachelor’s (undergrad) thesis, some 34 years ago. And this was the place where I first got serious about stealing drugs.

The halls and the stairwells still looked familiar, and when my host pulled out his master key, on the way back from the auditorium, I vividly recalled the days when I’d had my own master key…and used it to go from office to office, lab to lab, late at night, after I’d finished with my rats…looking for drugs. And finding them! Or else grabbing a prescription pad off someone’s desk, ready for a little art work, imitating doctors’ classic messy handwriting, working in those Latin symbols, so I could bounce into a pharmacy later that night, coughing as convincingly as possible, and find my way to a bottle of Hycodan or Tussionex.

So I was a little nervous all day yesterday, not only about doing my biggest public lecture of the tour, not only about doing it on TV (yikes!), but about being recognized or found out somehow. I kept imagining that some old researcher would come walking down the hall toward me and his eyebrows would suddenly shoot up in surprise, then drop down in an angry scowl. So you’re the one! You’re the guy who stole all the morphine. You’re the reason the supply kept dwindling through the winter of 1978. Caught you!

Actually, the morphine came from the basement of the Psychology building, a few blocks away. But I’d scoop out a gram or two (we’re talking pure morphine sulfate, powder, in a couple of jars the size of peanut butter jars) and bring it with me to the CAMH building (then called the Clarke Institute). And I’d take a little break, somewhere around rat #15, when things were getting really boring – except for the wave of excitement building in my stomach – and I’d take my precious powder, mix it with water in a small plastic vial, shake it, strain it, load it into a syringe, and shoot it into my arm in a tiny locked room, with only the rats to judge me.

I did this for almost a year. And of course I always wondered when I’d get caught. When would someone notice something, either here or in the Psych building? When would someone blow the whistle on this addict disguised as a psychology student?

I finally did get busted, about a year later, but not here in this building. I had left, intact, with degree in hand, and the shit didn’t hit the fan until graduate school in another city, when I began to steal from doctors’ offices, not from the cupboards of an underground lab. So only a few people around here could ever have known about the other me, the real me.

Tonight in my talk, I was both the person I was then and the person I am now, a weird hybrid – drug addict and neuroscientist – standing up at the podium, talking about how my book might be able to help people get a better handle on addiction. You take the uncompromising cookie-cutter of neural findings and sprinkle liberally with the complexities of real life, everyday life, captured in a memoir. Then you can get to addiction from both angles at the same time and you can make a little more sense of it than either perspective on its own. I talked about addiction as a developmental process, a self-perpetuating preference turned compulsion, a creeping, encroaching synaptic network overtaking the orbitofrontal cortex and striatum, crowding out other synapses that represented other goals (like friendship, success at school, or even just pizza and beer). I showed a picture of ivy proliferating from a few tendrils to a bushy mass.

And I talked about you! I talked about my blog, and all the people I’ve met through it. I talked about the guts it takes to fight something as insidious as addiction. I talked about ego fatigue and I tried to paint a picture of how hard we work, we addicts, to outsmart our impulses. Just try holding your arm straight out to the side, I told them. No problem…..for the first five minutes. But try it for an hour. Try it hour after hour, day after day. I sang your praises, dear readers. I cheered for you. I told them: contrary to popular belief, rather than being lazy, or weak, or self-indulgent, addicts work way harder than most people. Because they are determined to say NO to an overwhelming compulsion or desire, to overcome ego fatigue, to outsmart their cravings by changing something fundamental about how they view themselves, how they attend to the world, how they talk to themselves. They are the bravest people I know.

I told them how much I have learned from the people who write into my blog: about addiction, about recovery, and about the far reaches of imagination, courage, and determination – the strategies and eventual victories we achieve through hard work – so that we can feel decent, normal, better than normal, proud of ourselves…the way I felt tonight.

Thank you for that.

I just got a piece published in Newsweek! This makes me happy, to be sure. But if you see the paper version, the headline they picked does NOT appeal to me:  “My Kool Acid Test”. Hmmm….not my choice, but I couldn’t talk them out of it. Oh well, it’s Newsweek, and I’m a shameless publicity hound these days…

Here’s the link to the online edition. Below I’m going to paste in the UNABRIDGED text. Although I was after a story-line that focuses on the sixties, I think the “then and now” aspect is really interesting. And though they cut this part for the publication, check out the contrast between Ecstasy, today’s favourite party drug, and LSD, our drug of choice 40 years ago.

 

I’m a neuroscientist, I try and understand how the brain works, but I take a special interest in how it doesn’t work when people take drugs. That interest arose from memories of my own troubled youth: I used to be one of those people. For most of my late teens and twenties I ingested every drug I could find, and I became seriously addicted to hard drugs for part of that time. Now I try to make sense of those years, by exploring how different drugs modify brain function and how those modifications can become so terribly attractive. The drugs we find appealing reveal much about who we are; yet their effects remain mysterious, almost unknowable, until we look at the brain and its own intrinsic chemistry.

My drug-taking adventures began in the late sixties – when the world seemed wide open, waiting to reveal its wonders. I had just arrived in Berkeley, California, and my newfound friends and I were spellbound by the mind-expanding potential of LSD. But the world has changed since then, and the drugs we take today, including SSRIs and ecstasy, send our brains in a very different direction, toward comfort rather than freedom. The irony is that both these pathways begin with one very special molecule: a neurotransmitter called serotonin.

LSD (lysergic acid diethylamide) goes to work in the brain by blocking serotonin receptors, the gateways that allow serotonin into our neurons. As a result, serotonin molecules flowing from our brain stem have nowhere to go and nothing to do. Serotonin’s job is to reduce the firing rate of neurons that get too excited because of the volume or intensity of incoming information. That’s how it calms synaptic traffic, modulates extremes, regulates and supervises the brain. Serotonin filters out unwanted noise, and normal brains rely on that. So, by blocking serotonin, LSD allows information to flow through the brain unchecked. It opens up the floodgates – what Huxley called the “Doors of Perception” – and that’s just what it felt like the first time I took it.

My first acid trip was both wonderful and terrifying. I was in a friend’s apartment, among a rag-tag assortment of hippie types, and I swallowed a little purple pill during a prolonged Monopoly game. About 45 minutes later, the room started to disintegrate. I had to stop playing; I could no longer read the numbers on the dice. The dice, the plaster walls, the chattering voices, the facial hair of my compatriots – each perceptual gestalt broke apart into its constituent details, moving, changing, swirling, arranging themselves into patterns of geometric beauty or turgid ugliness. My senses and thoughts were out of control, and the world rushed in relentlessly.

LSD was invented by Albert Hofmann in the 30s, but its psychedelic properties were not apparent until he tried it on himself, in 1943, and thought he was going mad. For a couple of decades, psychiatric researchers tried  to treat disorders ranging from schizophrenia to alcoholism with LSD. The CIA and US military got into the act in the 50s and 60s, with the hope of manipulating potential informers or instilling mass confusion in enemy troops. But the effects of LSD remained elusive and unpredictable. It was deemed more trouble than it was worth in government circles, but it found its true calling as the emblem of a generation intent on change. For my friends and I, LSD was revered as a key that could unlock human perception and redefine human potential. So I took acid at least once a week and watched the grain of the sidewalk separate into rainbow fragments, gazed at the canopy of a redwood forest devolving into geometric scribbles, or tossed in the surf of my own cognition as it swelled in profundity. I wanted to open up my senses, strip off my mental armor, and let reality enter. And I didn’t give up for several years, until acid finally became routine, and I got drawn toward darker adventures with addictive drugs, heroin among them.

Still, for those few years from 1968 to 1972 , acid seemed the leading edge of a culture bent on charting new territory. “The times they are a changin’” chanted Dylan, and the world seemed rich with  possibilities. As far as my friends and I were concerned, LSD, mescaline, and psilocybin – all compounds that torpedoed serotonin – made that world accessible. Move over, serotonin. Safety is out. Infinity is in. So we popped our pills and wandered the frontiers of inner space. At least until the drug wore off and our serotonin molecules flowed huffily back into place.

In the last ten years, serotonin has again been the target of a culture-wide chemical invasion, but the new drugs shift human experience in the opposite direction. SSRIs (selective serotonin reuptake inhibitors) — like paroxetine (Paxil) and fluoxetine (Prozac) — are used to treat depression, anxiety, PTSD, OCD, and undefined feelings of ickiness. Instead of getting rid of serotonin, these drugs block the reabsorption process, so that serotonin keeps piling up in the synapses. The result: an extra-thick blanket of serotonin that filters out the intrusions of anguish and anxiety, making our inner worlds secure. Instead of turning on, tuning in, and dropping out, they help us turn off, tune out, and drop in – into a solipsistic safety zone, protected from too much reality.

Unlike the psychiatric researchers of the 50s and 60s, today’s psychopharmacologists are pleased with their progress. Every year or two, new and perhaps improved SSRIs are dumped into the waiting hands of millions of needy patients. (By 2007, antidepressants were the most pescribed drugs in the U.S., according to the Center for Disease Control.) But what do these new molecules tell us about our culture, about how we perceive our world? Apparently, now is not a time of exuberant exploration, but a time to hunker down and play it safe. The world seems too upsetting to wander in search of new adventures, too dangerous to explore beyond our own front porch. Instead of letting the world in, with all its uncertainties, we try to keep it out. And a barricade of serotonin makes that possible.

Even the recreational drugs of today’s youth point the weather vane of serotonin toward comfort rather than freedom. Ecstasy (MDMA) increases serotonin in the synapses, like a hyped-up antidepressant, making the world feel cozy. And while it’s true that most people don’t take serotonergic drugs, either from their doctor or their dealer, it’s no accident that those who do are resonating to a cultural theme much different from the optimistic vision of the sixties: Life is dangerous, protect yourself, or at least make yourself comfortable.

The drugs we take, the drugs we create, offer an idealized antidote to the cravings of our times. LSD was born from our craving for freedom. SSRIs reflect our need for security. Molecular makeovers never quite get us there, but they can show us where we are and where we’ve been.

 

 

 

 

Several posts ago I started a discussion of “the pivot point” — the moment when we give in to our cravings and dive for the drugs or the booze. I emphasized a few things about this event, many of which resonated with readers’ experiences — in fact many of which came from readers:

-it can begin with a change in your internal dialogue, like my humming to myself in the rat lab, when you already know, without full consciousness, that you’re going to do it

-at the final moment, it feels like you are throwing off control, not just surrender but also triumph

-there is often a feeling of great relief, abandon, or escape from suffocating self-control — one reader called it the sense of free fall

We then discussed the pivot point in more detail, getting into the psychology of ego fatigue and the underlying brain dynamics: the weakening of the will as the anterior cingulate cortex (ACC) runs out of fuel, and the final snapping of the branch. The dialogue concluded with the notion of an 11th commandment: Avoid Temptation. Because you can’t inhibit your impulses, actively, for a very long time. Your brain can’t take the strain.

In this post I want to go a step further and explore the relief that comes at the pivot point. There is still an untapped mystery here. Sure, you’ve been craving, and now you allow yourself to get the thing you’ve been craving. Dopamine feels like desperate desire when the goal is out of reach. But it feels like a headlong rush when you’re suddenly “allowed” to go get it. That’s a part of the relief.

Yet there’s a lot more to it. During periods of self-restraint, there can be an ongoing struggle that often takes the form of an internal dialogue: Don’t do it. No, just stop. But it would be so nice… Stop thinking about it. But I want… Shut up! Just stop! And it can get quite a bit more vicious than that: Stop, you self-indulgent baby. But it’s just one last time. That’s what you always say, you hopeless cretin. So? Everyone’s got their problems. You don’t deserve sympathy.  But I’m so depressed…  No wonder you disgust people. Etc, etc. If you’ve ever heard a (usually unspoken) dialogue  like this, going on in your head, then you’ve probably gotten to the point of saying “Fuck it.” And you know that the relief you get is not only from the drug/drink, or the anticipation of the drug/drink. It’s also the blissful shutting off of that nasty voice of self-rebuke.

Think about it this way: When are you more likely to yell at your kid? When she is playing safely in the playground, or when she’s wandering out into the street? When your kid is approaching an oncoming truck, or a cliff edge, is when you lose it and scream: Stop! Go back! I told you NEVER to do that!

So what’s going on in the brain during this state? Picture your ACC, sitting near the top of the brain, trying to keep control, but finding it slipping, slipping. Two floors down there’s the amygdala, the organ of emotional colouring. As your ACC starts losing it, your amygdala begins to panic. Not only because of the longterm suffering you’re about to contract, but also because the internal “parent-like” voice is getting more and more harsh, nasty, and punitive.

With the ACC losing control and the amygdala responding with waves of anxiety, the two voices in your head, the childish self and the scolding parent, become more desperate, and more desperately at odds with each other. There is no consensus on where internal voices are generated in the brain, but we do know that anger is associated with the left prefrontal cortex (PFC) and fear with the right. The left PFC, being involved in planning, logic, and making sense, has also been associated with moral judgment. The right PFC is more “childish” — it develops rapidly in infancy, before the left — and it’s more closely connected with raw emotion. In fact, some neuroscientists claim that an important job of the left PFC is to regulate the right. That often means inhibiting impulses. So now you’re losing control, the amygdala is blaring anxiety, and the “childish” right hemisphere is being suffocated by the moral authority of the left.  This is no picnic. It’s a major family argument in the privacy of your own brain!

And then comes the pivot point. The ACC is finally too “fatigued” to keep controlling impulses. So here’s what I think happens next:

Without the ACC to help keep the ship on course, the left-based punitive “voice” loses its authority. The right PFC is suddenly free to take the emotional path of least resistance. Left-hemisphere reasoning now switches over to become allied with its old friend, the ventral striatum (the engine of goal-pursuit), which has silently toppled the ACC in terms of cortical supremacy. In fact the whole frontal brain becomes unified behind one exalted goal: LET’S GET HIGH. And the left PFC does its part by planning (its specialty) — how to get it, how to pay for it, how to hide it. The amygdala is suddenly passing along waves of excitement rather than anxiety, and you are cruising, rudderless, in a tide of pure intention.

This kind of brain modelling needs to be verified by research, and we’re just starting to acquire the tools to go there. For example, recent research (in a related model) shows that, when the inner voice of restraint is coming from brain regions that represent other people (not oneself), we stop listening, and we stop acting responsibly.

So there it is: a (speculative) brain-based model of the relief that comes from escaping self-restraint. But I’m not recommending it! (Don’t try this at home, kids.) That relief is real, both psychologically and neurologically, but it is a temporary flash of positive emotion at the start of a long dive into negative emotion. This is part of the siren song, the fool’s gold, of substance use. It doesn’t last long, and it leaves you empty and gasping when it’s gone.

I know this post is a little dense. I wanted to get these ideas down before leaving for the US book tour — in less than two days. But please post your comments or questions, I’ll check in while I’m on the road, and I hope to unpack some of these themes in the near future.

 

 

 

 

Why the new book image on the homepage?

My book is going south. It just got published in Australia/New Zealand, and on March 6th it will be released in the US. The cover you see now is the US version. The Australian version, which features my addicted brain as a moth-infested lightbulb, can be seen on the “Buy” page. Who is that fellow, and what’s his problem?!

Interviews and reviews are gearing up again. I’m starting to get calls from reporters, columnists, reviewers, and producers for radio and TV shows, and I’m going on a US book tour in two weeks. All very exciting…and weird. I’ll keep you posted as to the reception.

Meanwhile, if you’ve got anything to say about the book (and it doesn’t have to all be positive), please consider writing a “customer review” for Amazon.com (not Amazon.ca). That will help spread the buzz southward.