Category: Connect

I have to figure out this blogging thing. About 2 weeks ago I was invited to host a blog on the Psychology Today website. So I set up a sort of parallel blog there, with most of the same posts. I’ve been making them a bit shorter and punchier for PT, and I’ve been providing more detail, including neuro detail, for my home blog (this one).

But I’m slightly mixed up on where to go from here. Should I retain two blogs? My PT blog gets up to 500 visits per day. It’s PT, after all. This one gets anywhere from 10 to 50 most days. And why bother with two, after all? Especially if they cover more or less the same content? But I like having my OWN blog/site, and all those flashing ads on the PT site annoy me. I have old-fashioned eyeballs.

Maybe the thing to do is to get more flowy — more personal, more newsy — and move away from essay-like postings. So says Isabel, my wife, who did a very successful blog during our last couple of years in Toronto. I like blog writing. It’s great to knock off a piece of…something…in an hour or so, rather than spend six months on a scientific paper that very few people will ever read. But the flow of my life is pretty calm at the moment, and I’m not going to try to interest people in what I’m having for lunch or my thoughts while stuck in traffic.

People who read this blog are, I think, I hope, either those with present addictions, past addictions, or people interested in the science and/or treatment of addiction. So what’s to flow about…that might be of interest to you? My addiction is mostly past, not present, though I have struggled with it in recent times. A “memoir” article in Toronto Life (November 2011  issue) recounts my difficulty getting off oxycodone last spring, after a stint of severe sciatica and recovery from spinal surgery. And I sometimes drink more than I should. So, yeah, I’m not completely in the clear. As far as I know, no addict ever is. But I’m in good shape these days.

I recently found a blog by someone who is currently — like this month! — getting off alcohol. She’s on week 2 or 3 of recovery by now, and I really admire her blow-by-blow description of what it’s like to quit: how it feels, the voices in her head, the spikes of craving, and the relief at moving on. That’s one kind of flow that can be of real interest to people in the addiction world. But my struggles just aren’t that dramatic these days.

And then there’s all this late-breaking news on the science, psychology, and politics of addiction. A special issue of Nature Reviews Neuroscience was recently dedicated to addiction. And the Addiction Newsfeed from Science Daily pulls all kinds of interesting stuff from just about everywhere — Click on Home and scroll down to see it. I can be more current and more, I guess, opinionated if I follow this stuff more closely. Maybe I’ll try that for a while.

I’m just thinking out loud at the moment. But I’d love to hear your thoughts as well.

Steven Pinker (the evolutionary biologist) recently released ANOTHER book, entitled “The Better Angels of Our Nature.” In it he shows how violence has declined over the last 30,000 years of human affairs. And he says that’s due to the rise of competing characteristics, like cooperation, self-control, and empathy. According to Pinker and others, human characteristics like these arose from brain evolution. For example, our urge to cooperate evolved over time, because the laws of natural selection favoured a brain with plenty of social circuitry. (A lot of this circuitry is thought to be in the medial prefrontal cortex, just in front of the ACC.) When a tendency or a characteristic improves your ability to function and survive, and especially your ability to produce and raise children, then you’re more likely to have more kids (who also have more kids, who also have more kids) than your neighbours. I mean, wouldn’t you pick a cooperative, empathic, self-possessed partner over a raging savage to have your babies with? So then the biological quirk that gave you that quality — in this case a more humane brain  — becomes a part of human nature. It beats out the competition.

What about addiction? We know that the tendency to pursue specific rewards (drugs, booze, porno, food, internet gambling, feet if you’re a foot fetishist, etc.) grows easily into addiction. That’s why so many of us are addicted to something. And we know that certain brain processes, like the rise in dopamine whenever you’re reminded of the thing you want, are what make addiction happen. In fact, much of the prefrontal cortex seems prewired for addiction. Increased dopamine flow cultivates more and more synapses in the orbitofrontal (lower/prefrontal) cortex, and in the nearby ventral striatum. These synaptic networks come to represent the details, angles, images, and the beatific value of the thing you crave. Which dredges up more dopamine from the brain stem, so you wire up more synapses in the addictive network, and on and on it cycles. No wonder we’re easily addicted. Our brains seem perfectly designed for it.

Addiction as a byproduct of brain evolution

Yet, brains did not evolve to make us better addicts! That wouldn’t make sense. Addicts are not very functional (except when it comes to meeting certain needs), they often don’t survive as well as most, and they make relatively lousy mates and parents. The brain processes that underlie addiction should have been weeded out, not strengthened, by natural selection.

Except that natural selection (evolution) doesn’t explain everything about being human. (As argued most forcefully by Stephen Jay Gould, one of Pinker’s detractors.) A lot of human characteristics are byproducts, accidents, that arise from structures designed for different purposes. For example, half the people I know over the age of 35 have back problems. Did back problems evolve because they’re adaptive? Of course not. Back problems are a result of walking around with an upright spine, something our ape ancestors didn’t have to worry about. Having an upright spine is good for a lot of things. Like having your hands free to do stuff while your feet take care of locomotion. In the same way, I think that addiction is a byproduct (a nasty one, quite often) of having a brain designed to maximize goal-pursuit in an uncertain world.

A circuit evolved for goal-pursuit

The circuitry connecting the orbitofrontal cortex and ventral striatum is a beautifully crafted machine for learning what you like and pursuing it with single-minded purpose. Its fuel is dopamine, sucked up from the midbrain (upper brain stem). And this machine sends messages directly to the premotor and motor cortex, which trigger behaviour, action, in pursuit of the good things in life. This machine evolved so nicely because it’s really really important to pursue valuable goals. Immediate goals. And not all those goals can be prewired from birth. You need to learn them as you go along. So the goal-pursuit circuit is flexible. It learns. It’s always open to try new rewards, and then to pursue them if they’re as good as they look (or taste, or smell). That’s why we pursue goals ranging from fruit, to fries, to Ferraris. We go after money — a relatively recent invention — because it’s really nice to have. It makes life better. We go after romantic partners deemed to be attractive by movie and magazine images. We can learn to go after anything, full bore, if it attracts us. And that’s how we get ahead in life.

But it’s also how we get addicted. The goal-pursuit circuit is a bit too flexible. Cocaine high. Oh yeah. That feels good. Want more. Got to get it. That drink at the end of the day. Feels good. Want it. Stop at the liquor store on the way home. These tendencies eventually cause us a lot of suffering, but they are simply byproducts of a brain that evolved to seek rewards, based on their attractiveness, and to pursue them with almost relentless energy.

When your back-ache gets bad enough, you start doing physio or yoga, so that you can use your upright spine to its best advantage. When your addiction gets bad enough, you’d best figure out how to use the goal-pursuit circuit for what it’s designed for: to be successful and happy, to avoid suffering, and — of course — to feed the little ones back at the cave.

This post also appears, with a bit less detail, on my “other” blog on the Psychology Today website. I know, I have to consolidate…

Reader responses (here and on my new blog on the Psychology Today website) highlight both sides of the self as experienced with dissociative drugs (DXM and ketamine). There is a sense of being centred, perhaps while in free fall and watching the world go by, and there is a sense of freedom from constraints. You no longer care about the rules and regulations of that other world, the one you left behind, now that you are so very present in this one. On the other hand, you can’t seem to take this experience back home with you. So can it be of any real value? Without being moralistic about the fact that you got there with drugs, there’s also a real loss, a real sadness, about having to say goodbye to that magical place.

My own days of dissociating.

So what do I say to Charles? I used to drink bottles of DXM in my twenties (they hadn’t invented ketamine yet). I would sometimes drink a 250 ml bottle and then go to see a movie. Sitting there, melting in that cushy seat, I would feel that the movie had a special significance — that the people on the screen were really there for me, and I was a part of them. The people in the theater, breathing and whispering all around me, felt like an intimate tribe. (Then I’d try to leave the theater after everyone else, because I couldn’t walk without stumbling.) Or I’d sit on the Toronto subway brimming with exaltation. Every stop seemed a fantastic production, a special performance just for me. All that screeching of the brakes, the careening people, and finally….that glorious moment of stillness, punctuated by the dramatic whoosh of the opening doors — all at the same time! My emotions, my sense of astonishment, and the freedom of the moment were real. But it was a temporary reality. One that only crazy people can hold onto for good. In fact, ketamine is the drug that has been used most often to study the experience and the neurochemistry of schizophrenia. Hmmm….that doesn’t sound good.

A true self?

My diversions with dissociatives seem pretty juvenile compared to Charles’ existential struggles. Blockade your NMDA receptors for a few hours and you really will experience the world in a new way, you really will drop a lot of baggage, that baggage being all the rules, judgments, and mental habits you’ve been acquiring since infancy. Is there a true self left over when comprehension begins to disintegrate? For Charles it seems that way. He feels like he’s returned to his soul, or some reincarnated entity that came before birth or before the long road of knowledge acquisition, cognitive development, and increasing socialization that he’s followed ever since. But is this his true self?

Or is the true self rather the sum total of all that knowledge and comprehension, the tinker-toy configuration of familiarity that we build up over the years, as well as the peaceful, self-forgiving messages that blow through that complicated structure on good days? It seems to me that the true self actually includes the self-imposed constraints, rules of conduct, and uncomfortable habits that we’ve worked on for all these years. But also the energy and insight capable of changing them. If that’s so, then the true self might be something one wants to learn to accept, just as it is, with all its confusing habits. Rather than something one wants to relocate in a purified wonderland. Charles thinks he can find his soul by taking dissociatives. But I suspect that what he finds is a state of cognitive relaxation that can be very pleasant and that seems incredibly meaningful because it allows him to imagine himself at the centre of the universe.

Or maybe there’s a third answer. Maybe there is value in watching your values disintegrate, watching the rules melt away, just so you can finally get a glimpse of how those habits dominate you from day to day. If that’s the case, then Charles might be advised to see what’s left the next day: just loss, a headache, and some nausea….or is there some wisdom he can take with him?

In response to a recent post about Charles’ dilemma, readers brought up several issues that I’d like to address…before getting to Part 2. The issue of good vs. bad came up. Charles’ quest for his “true self” seemed to be based on an experience of goodness that could not be replicated without drugs (in his case, dissociatives like DXM and ketamine). But then he worried that what he was doing was not good…it wasn’t right or proper somehow. Readers also suggested that finding the “true self” is an achievement: it takes place over development — i.e, over time — and it requires hard work. Putting these ideas together, we’re stuck with a definitional matter that needs to be resolved before we can provide some advice for Charles.

Here goes:

Definition #1: the moral good.

Good means right, means socially acceptable, or valid, or productive, vs. bad, the opposite of those things. And this polarity further breaks down into detailed comparisons and ratings, like harm vs. help: if I’m not helping myself or others, then whatever I’m doing is not GOOD. Similarly, if I’m harming myself or others, that’s BAD. This already gets tricky: is harming the self necessarily morally bad? What about suicide in the case of terminal illness? What about slapping the side of your head to coach yourself against acting like an idiot? If you follow it to its logical conclusions, this kind of definition gets clunky and/or arbitrary and sometimes irrelevant; because it’s really just based on a simple formula: normativity. Following norms (either past or present, idealized or actual) gets to be the only reliable yardstick for being good. Sounds a bit boring. And perhaps irrelevant to things like…well, like taking drugs, which might harm the self a little, or a lot, in the short run, or the long run. But may also help, by opening doors that were previously closed. Yeah, boring but complicated (at least for a non-philosopher like me).

Definition #2: feeling good.

The other definition is that good = feeling good. Nothing moral or normative about it. Feeling good is easy to determine. It’s the most basic perception one can possibly have. Ask any two-year old. Without the complexity of “norms” to follow or defy, two-year olds just go with the straightforward definition: Good = happy. Bad = unhappy. And that perception of the world comes straight from their orbitofrontal cortex (OFC). This relatively primitive part of the prefrontal cortex is called “paralimbic” for good reason. It’s intimately connected to limbic structures like the amygdala and striatum. But it also serves as a sort of limbic structure itself. Cells in the OFC fire more rapidly when you eat something sweet. That’s a natural reinforcer (reward), built into our biology. But other cells in the OFC respond to “secondary reinforcers” like a sexy smile from someone you find attractive, or the steam rising from your foil-wrapped burger, or a green light. You can’t argue with your OFC’s perception of good. The OFC has been around for at least 100 million years, and it knows its job.

The developmental angle.

Little kids perceive good via definition #2. They just feel it. And besides, norm-following, i.e., the capacity for moral behaviour, does not come on line until about the age of 3 1/2 to 4 years, when children acquire what’s known as Theory of Mind, an important watershed in cognitive and social development. Before the onset of Theory of Mind, you can’t imagine what others might be thinking or feeling. You just think that everyone sees things the way you do. So kids younger than 3 1/2 can’t possibly be good in a moral way that requires seeing the impact of their actions on others. All they can do is follow rules to avoid punishment.

What’s so bad about feeling good?

Charles says he feels good according to definition #2. But that’s a child’s definition. Isn’t it distasteful because it’s indulgent and immature? Or is it spontaneous, and thus precious? Charles tells me that the “goodness” of getting high on dissociatives (e.g., ketamine and DXM) involves feeling wholeness, excitement, and spontaneity. Good on the inside. Plus — and here’s the special bonus, available now for the next 8 hours, so hurry before the offer expires! — pot and/or DXM and/or ketamine allow you to disengage from definition #1, to shuck off those normative demands. Because the obligation to follow, or at least to be concerned with, social norms breaks down when you’re on these drugs. And that’s because norms and standards make up a large part of the sense that’s held together by networks of cortical neurons, communicating through NMDA receptors. Recall that dissociatives are NMDA antagonists, which break up the orderliness of the cortex. So they break up your model of what’s moral. Pot can do the same through a different mechanism. Now put together that fundamental child’s feeling of goodness, e.g., via wholeness and spontaneity, with freedom from norms and societal constraints, and Charles gets to his “true self” — at least that’s how he sees it.

I think definition #2 is crucial for thinking about GOOD vs. BAD when it comes to drug/alcohol use. Yet we (most of us, including, no especially, ex-addicts) tend to slip into definition #1 instead. We get moral, and we tend to dismiss the very plain fact that drugs, booze, and other things to which we get addicted, feel good. At least for a while. Intrinsically good. Or else we wouldn’t keep going back to them again and again.

Feeling good is the guiding force behind children’s spontaneous behaviour, including their love, their eagerness, and their creativity (all mediated by the OFC, which develops a few years ahead of the dorsal prefrontal circuits — e.g, the dACC — which support norm-following). Feeling good is our principal, fundamental aim in approaching and understanding the world, before we learn morality. It’s bodily good, sensory good. It’s the good that comes from activating orbitofrontal circuits that evolved to keep us tuned into what’s valuable in life. Rather than take the high road of morality, I write quite a bit about the “goodness” of drugs in my book — even as I emphasize their dark side.

So, back to Charles’ dilemma: if you can knock out the blind pursuit of being good (morally, slavishly, obsessively) for those few hours, at the same time as just feeling good…well, that sounds pretty damn attractive.

Please add your own thoughts and impressions, and stay tuned for Part 2.

I’ve been talking to a young man about his drug issues, and he feels he’s got a serious dilemma to unravel. Lately he’s been taking dissociatives — dextromethorphan (DXM) and ketamine — and they take him somewhere he can’t seem to get without them.

Charles (I’ll call him) is in his early twenties, bright, energetic, and a bit lost. He’s tried a number of jobs and hobbies, a little time at university, and lately quite a few drugs. He seems to have a healthy fear concerning really nasty drugs like meth, crack, and heroin. But dissociatives are freely available among his friends and at the local drugstore, they don’t come with a heavy price tag, either in terms of money or raised eyebrows, and they don’t seem very dangerous to him. In fact I’m not aware that there is a toxic dose for these drugs, though you can sure make yourself sick. And brain damage does not seem likely, but it wouldn’t be that hard to kill yourself if you stumbled around in traffic or fell down the stairs.

What dissociatives do to your mind and brain.

Dissociatives do exactly what their name suggests. They break down associations between current experience and all the reference points, memories, and meanings that normally make experience make sense. Experience that pulls away from sense is a liquid sea of emotions, impressions, and shifting boundaries between the real and the imagined. Take enough and those boundaries disappear for hours at a time. Take more and you can’t walk or talk very well, if at all. Dissociatives work by blockading NMDA receptors all over the cortex. These are principal channels (entry ports into neurons) for communication among cortical regions. But NMDA channels have a special function: they receive information that allows cortical activation to cohere rapidly and sensibly. In other words, they might not be much good for interpreting abstract art, but they tell you what you’re doing, where you’re doing it, when you started doing it, and why it makes sense to be doing just that. This is all pretty important for day-to-day living. But it gets seriously messed up with DXM or ketamine (or PCP or angel dust). Now you can experience things the way they seem to be or the way you want them to be. With your cortex in disarray, meaning might get formed by more primitive (e.g., limbic) parts of your brain, without the usual “reality testing” that goes on every moment. Sounds interesting.

Charles was not surprised when I shared this information with him. But his dilemma remains. There are times when he’s on these drugs that he feels completely free of the constraints, values, and habits he’s been enslaved by (so it seems to him) for most of his life. The rules by which he conducts himself, his constant efforts at impression management, and his sometimes suffocating need to be “good” dissolve into a mist of spontaneity and adventure. He can let himself be himself, his real self — the true self that, as he puts it, has been out of reach for his whole life. So his question is this: I know I get there through drugs, I know it’s a short-cut, and I know it won’t last, but isn’t there something productive, even wonderful, at finding my true self, even for a few hours?

I’d like to know your thoughts about this. I’ll tell you what I think in Part 2, coming in a couple of days.