Category: Connect

There is something terribly interesting about the moment of giving in. That moment when the teeter-totter crosses that invisible threshold, when the momentum shifts, when you know you’re going to do it, despite the hours of telling yourself you won’t. It’s a very distinct feeling, says a recent reader. It’s a lot different from thinking about getting high. It’s not thinking at all, really. It’s not imagining what it will be like. Rather, it’s a feeling of free fall, a release from the incessant gravity of your own rule book. It’s a massive change: from control to freedom, from responsibility to neglect, from wisdom to foolishness, from security to doom — all at the same time.

We’ve just come through the holiday season, most of us intact, I hope. And yet many of us may have slipped in one way or another. If you’re a recovering alcoholic, you may have buckled and started drinking. Maybe for a night, maybe for a week, or maybe you’re still drinking. If you’re a chipper (a sometimes addict), maybe you chipped at something a lot bigger and a lot more dangerous than you thought you would. If you live on the clean side of the line of self-indulgence for most of the days of your life, maybe you crossed the line — for an hour, a night, or a week — with a bottle, with your neighbour’s spouse, with a reckless ride through the dark side of the internet… What I’m interested in is that moment when you actually cross the line. When it’s no longer a choice that you continue to make or that you’re always about to make, but a choice (if you still want to call it that) you’ve already made. That’s when the free-fall starts…that pitch away from your centre of gravity to a new orbit, a new star, much brighter in that moment than the dull planet you’ve been calling home.

Sometimes the moment of giving in is barely conscious, and sometimes it comes long before there’s a full recognition that you’ve already changed orbits, irrevocably, and the crash landing is coming next. Just the other night I read of the “fall” of a reader/fellow blogger whom I respect very much. She’s a recovering alcoholic who gave in to a couple of drinks, and she wrote about it before, during, and after crossing the line. In one post she describes the moment when (I’d say) her intention shifted trajectories, though that moment was still embedded in the chatter of a familiar self-dialogue:

Today I was at the market and managed to talk myself into buying wine — for taking to a friend’s house for dinner tonight, of course, but the truth is  we don’t have to take wine. We’re bringing other things, so wine is probably a bit too much. But I talked myself into buying it anyway, “just in case”. Just in case WHAT, I now ask myself. I tell myself, you know. Who are you trying to kid, you know exactly just in case WHAT. What was I thinking? Ohhhh, I’m so far out on the limb I’m not sure I can get back.

At a certain point she warned herself, “One sip is too many…the dangers are huge…but the desire is chipping away at my resolve.”

Once you’ve said that to yourself, it’s pretty much game over.

In my years of addiction, I told myself many many times that my resolve was weakening. Like that terrible weekend in Thunder Bay when it became inevitable that I would steal more drugs. I had lost the belief that I was capable of self-control. And I was so fed up with the whole process that I took absurd chances that night and managed, finally, to get caught in the act and carted off to jail. To say “my resolve is weakening” is code for “I can’t stop myself anymore.”

But luckily, this blogger — someone I now consider a friend even though we’ve never met — stopped herself, just an hour or two later. Check out her second post. It’s a happy ending. Relapse is part of recovery, so they say.

Where am I going with this? I want to spend the next couple of posts thinking about loss of control – a major theme in the psychology and neuroscience of addiction. Psychologists have been studying a phenomenon known as “ego fatigue” for roughly ten years. That’s when you’ve been trying to suppress or inhibit an impulse continuously, for an hour or more, and the result is a breakdown in the self-regulatory function – which we think is housed in the anterior cingulate cortex (ACC: see my book for details). After excessive use (think of a car that’s been going uphill in first gear for an hour), that part of the brain literally runs out of its fuel supply (glutamate and/or GABA), and like an over-used muscle it just caves in. Recovering addicts have the unfortunate mission of maintaining active, effortful – sometimes tremendously effortful — self-control. Not just for an hour but for a day, several days, a week, maybe a month or more. Our neural machinery wasn’t made to take that kind of strain.

But that first pivotal moment of giving in doesn’t just feel like a branch breaking under too much weight. There is also excitement, tingling anticipation, hope, freedom, relief — and something a lot like pride — for some of us — a sense of triumph, just for that brief window of time. Now you are no longer ensnared in a tug-of-war between two ideal selves. Now you are wholly and completely you. Or so it seems.

In my next post I’ll get into some details, looking at people’s experience of the loss of control and the brain processes behind those experiences. Stay tuned.

Hello readers! Happy New Year and all that. I took a couple of weeks off for the holidays and went to visit family and friends back in Toronto. It was a time of heart-warming reconnection with people I’ve known for much of my life. But it was also a time of emotional pain: loss, disappointment, regret — stuff like that. Hence the topic of this post…

In a very cool blog called Neuroskeptic. I recently found a reference to a paper by Feinstein et al (2010, senior author Tramel), reporting on a man who had lost almost his entire limbic system.

The limbic system is a widely distributed assembly of very different structures, most notably the amygdala (responsible for emotional associations) and the hippocampus (necessary for encoding episodic memory so that events stay in mind for more than a few seconds). Some people include the ventral striatum (the foundation of anticipation and desire) and its source of dopamine, the VTA, all under the rubric of the limbic system. All these structures are “sub-cortical” — they are more primitive than the cortex. They are its underlying machinery, the stuff in the basement (though they are more advanced than other systems — the ancient engines still at work in the subbasement of the brain stem). And then there are higher structures, sometimes called limbic cortex — parts of the cortex bordering the limbic system. These include the orbitofrontal cortex, which appraises the value, likability or aversiveness of incoming stimuli, and the famous ACC (anterior cingulate cortex) which does response-monitoring, selective attention, and effortful engagement. (All these parts and their functions are described in detail in my book.)

Limbic structures are the basis of learning. They grow synapses that connect with all parts of the cortex. That’s how the sophisticated perceptions of the cortex remain anchored to an emotional self — a core self. The cortex houses the most advanced software, but its programs are grounded in meaning through the limbic system.

A man named Roger had just about all of his limbic system destroyed by a very nasty (and rare) herpes infection. Yes, herpes can be a lot worse than you think. To quote from Neuroskeptic: “…his is the worst case of herpes encephalitis damage among patients currently alive.” And he has been alive since the damage occurred 28 years ago. So what was the result? What happens when you lose your limbic system?

Roger lost his capacity to remember things from then on — called anterograde amnesia — but his mood improved! You’d think losing half your brain would make you a tad grumpy. But in the words of Feinstein et al: “He readily displays signs of positive emotion including happiness, amusement, interest, and excitement…”

The limbic system evolved with the advent of mammals. The limbic system allows us to play, to be social, to form attachments, to love, to feel our connection with others and with our own goals. And it allows us to suffer. Thanks to the limbic system, we struggle to be the best we can be so that we can partner with other mammals (mates, children, parents). And we expect the same from others. Unlike frogs, whose goals are hard-wired, mammals must learn to achieve what they want, and avoid what they fear, through emotional striving.

So the lesson I take from Roger is that the psychological qualities of creatures like ourselves come with a huge price tag: emotional pain. Roger lost the neural foundation of meaning — of what it feels like to be a human mammal — but he no longer experienced suffering. He became a happy camper in a shallow world.

To my mind, and to other students of addiction, like Gabor Mate, we drink or take drugs to reduce the fundamental pain of life — the emotional suffering that constitutes the background music of the mammalian nervous system. Like other evolutionary achievements, the limbic brain is a double-edged sword. And we use drugs and alcohol in order to protect ourselves from its savage blade. That’s why addiction is an inevitable byproduct of human evolution.

That’s a quote from a recent reader, and I think it’s a fabulous metaphor. The idea is that brains and the chemicals that run them come from molecules that have been part of the evolutionary marketplace for a very long time. So the “code” that our brains use to operate (and to have fun) is easily mimicked by compounds out there in the world. When we find those compounds and consume them, we hack our own nervous systems.

Indeed, our major neurotransmitters are extremely old. So are the neuropeptides (which include opioids). I read somewhere that male lobsters stand up and rear their claws when they get a spurt of the peptide vasopressin…which comes from their own brainstems. Vasopressin is an important neurochemical for inter-male aggression in humans! A humbling thought. So not only do we share neurochemicals with extremely ancient ancestors and extremely distant cousins, we even share their functions.

Now pre-hominids weren’t much good at extracting stuff from plants. Hands are really useful for that. But hominids have been around for a couple of million years, and even the period of agrarian civilization, about 5-10,000 years old, is plenty of time to experiment with the profusion of plants that make feel-good chemicals. The fact that neurochemicals are cobbled together from existing molecules, as pointed out by the same reader, is hugely important. That’s what improves the odds that our favourite neuromodulators will have cousins in the plant world. All we had to do was find them, refine them, and eat them (or smoke them or snort them or shoot them).

According to Berridge’s theory, dopamine doesn’t make you feel good, but it makes you feel engaged and excited. It’s opioids that make you feel good. The fact that opioids automatically release more dopamine means that liking and wanting are closely bonded. Unfortunately, though opioids increase dopamine flow, the reverse is not the case. Dopamine flow just makes you try harder. Hence, whether you get your dopamine rush from methamphetamine, coke, from planning your next batch of cookies, from anticipating the next rib, or from the vicious cycle of addiction itself, there is no pot of gold waiting at the end of that rainbow. Unless you put it there yourself.

We are indeed a species who hacks our own brains with the stuff we find lying around in nature. And since dopamine and opioids are so crucial to the reward system, it was almost inevitable that we’d find them, use them to hack our brains, use them some more because they work, and then start to work hard to get them. Thus, it’s almost inevitable that we’d evolve into druggies. And, I suppose, just as bad backs are an unfortunate byproduct of upright posture, it’s almost inevitable that many of us would become drug addicts.

Last post, I lamented the fact that I spend most of my lunch looking forward to the next bite (and not tasting the present one). I blamed this habit on the role of dopamine in the ventral striatum: to anticipate rewards, work toward them, and focus attention on what’s next. Here’s a picture (a reconstruction, obviously, as cell phones lacked camera functions in those days) of Homo habilis having lunch. H. habilis lived about 2 million years ago, and is thought to be the first member of the Homo genus. In other words, he’s our direct ancestor, and no doubt our brains resemble his in many ways. Well, we have bigger frontal lobes. But…so what? How often do we use them to advantage while eating lunch? I use my frontal lobes to read the newspaper while having lunch, which is an elaborate way to avoid any contact with the taste of my food.

What does any of this have to do with the psychobiology of addiction? Goal anticipation equals craving when the goal is out of reach. This is a common state for addicts, even for recovering addicts. When the goal (let’s say more ribs) is in reach, then the dopamine surge simply directs you take more. The theory I follow for understanding the addicted brain divides motivated behaviour and pleasure into two distinct functions: wanting and liking. This theory has been proposed and defended by Berridge and his colleagues for over 10 years, and as far as I can see, it beats other theories hands-down. According to Berridge, wanting is subserved by striatal dopamine, and liking is subserved by…you guessed it…opioids. I cover all this in detail in my book, but the thumbnail version is this: When you like something (and get a rush of endogenous opioids), it is adaptively important to get more of it. That requires wanting. Opioids make you feel good, but they also increase dopamine flow to the ventral striatum (from the VTA, ventral tegmental area, in the midbrain). So dopamine takes over from opioids, by which means wanting takes over from liking. Your brain lurches into gear: where will I find more? how will I get it? I can’t wait! The symptoms of craving are obvious.

Our ancestor, whose mesolimbic dopamine system was pretty much exactly the same as ours, looks to me as if he’s saying: “Hmmm, not bad, tastes pretty good. Where can I get more…?” He’s just at the shift point from liking to wanting. Look at the creases in his brow. I’ll bet you he’s already thinking about the next bite.

I want to thank those of you who replied to my query. A lot of your advice converged to a few simple themes:

1. Keep blogging

2. Go with reviews of interesting research, bridges and connections between data and interpretation, opinions about where we are and where we’re going in the science and policy of substance use (and its discontents).

3. The style and form of the blog can be intriguing in themselves. Let the blog wander but keep my own voice.

4. Let it be personal, yes, and detailed, and most important, don’t limit the blog to addiction. There are many other topics, only loosely related to the neuroscience of addiction: the science of behaviour, the neuroscience behind clinical disorders, issues concerning willpower and self-control, and my thoughts while stuck in traffic or eating lunch. I agree: there’s lots to talk about!

Today I won’t share my thoughts while in stuck in traffic, but I will share with you what I had for lunch.

What I had for lunch was dopamine, and plenty of it. Isabel had made these incredible ribs the night before. Thick, dark, juicy sauce stuck intimately to the most tender meat, which pulled easily off the bone in my exultant teeth. (Hope not too many of you are vegans) So you’d think I’d be very aware of the taste — the delicious taste — of these succulent morsels — brought to you by the opioid bath (internal, please!) washing over those orbitofrontal neurons. But I was hardly aware of the taste or texture at all. What I was aware of, during the execution of each bite, was the following bite. Dopamine, which is the chief underpinning of anticipation, drove my attention to the near future — the next bite, getting the right amount of sauce on the next piece to enter my mouth — even as I commenced on the present bite.

How stupid is that?

My kids also gobble down their food without tasting it. I tell them, “Taste every molecule!” But they don’t, and neither do I. During my rib extravaganza, I was somewhat aware of the waste of consciousness, and not pleased about it. I tried to slow down. I reflected on how different the experience of eating is when you’re sitting at a nice restaurant, with candles going, very aware of the moment, I think, but perhaps more aware of the imperative to be in the moment. That’s not quite being in the moment. It’s just another algorithm for focusing on the future.

What I’m railing against is the  power of dopamine to suck you away from the now, into the future. It’s so ubiquitous. For example, my last post was entitled “What’s next…?” That’s where we live: in the future. The purpose of dopamine uptake into the ventral striatum is to define and sharpen the focus of attention — attention to the next goal, or the next step toward the next goal. After all, present pleasures are in the bag. Future…opportunities…are where one’s attentional focus can really make a difference. It is of no adaptive advantage to focus on what’s happening right now. What’s happening right now is just about over.

I guess the upside is that this state of affairs provides steady employment for Buddhists, meditation teachers, contemplatives, and so forth. They’ve got lots of work to do, mainly in helping us resist impulses nested deeply in our brains.

But for now, I’m feasting on dopamine — the exquisite  anticipation of the next bite. And that’s pretty typical of the evolutionary lunch stand where we gobble down what we have and prepare for what’s next. It’s also the common neural pathway of all addictions.