Category: Connect

Tomorrow, for my last publicity event in Toronto, I’m giving a talk at a Harm Reduction group. I don’t know that much about harm reduction as a philosophy or practice. I do know that I like the idea that there are many and varied paths to recovery, or maintenance, or whatever you want to call a relatively harm-free solution to addiction. I also recently found out that the Harm Reduction folks don’t even like the word addict. I think I get their point. The tension here seems to resolve to the ongoing debate, both in science and in clinical practice, about whether addiction is a disease or a choice. Here’s what I think.

It’s a false dichotomy. Addiction is not a disease like cancer or diabetes. No way. It’s hard to get rid of, which makes it like a disease, but that’s really just an analogy. The resemblance stops there.You can’t catch it. It’s not communicable. And you can’t cure it according to some specific formula. This idea is very much at odds with the pronouncements of the American Society of Addiction Medicine, the high church of addiction, as it were.  So is addiction a choice, is it just bad behaviour, is it the result of a genetic predisposition to self-indulgence or a low tolerance to psychological pain? All of these other definitions fall short as well. Addiction has an incredibly powerful, self-propelling momentum that takes it beyond the realm of “normal” choice or “normal” bad behaviour. If addiction is neither a choice nor a disease, then the choice vs. disease dichotomy is useless. It creates havoc and argument, it’s confusing, and it takes our minds off the more important issue. Such as: What is addiction really?

The disease camp assumes that the brain is important for understanding addiction. Addiction, they claim, is a brain disease. But the choice people paint themselves into the opposite corner. They claim that the brain is not important for understanding addiction. Rather we need to understand how difficult circumstances — trauma, rejection, economic hardship, and so on — affect substance-taking behaviour. What’s that got to do with the brain?

It’s got everything to do with it! Choices are not some magical puff of our spirit selves. Choices come from the brain. And the choice to take drugs, or booze, or cigarettes, again and again, comes from a brain that has been altered by a series of similar choices in the past. It just takes a moment of reflection to realize that choices are rarely “free”. And while philosophers debate the very existence of free will, we can be much more practical about it. Choices involve an exchange between the part of your brain that wants something (the ventral striatum and related areas) and the part of your brain that thinks about consequences and directs behaviour accordingly (dorsal and lateral regions of the prefrontal cortex). That exchange takes place in the synapses (connections) that join these regions. And those connections are altered by so many aspects of experience: hardship, success, self-image, trauma, and very clearly by the spiralling of wanting and relief that results from substance-taking itself. No two people have the same brain to work with, but there are features of addicts’ brains that neuroscientists can describe in detail: high levels of dopamine continue to strengthen the feelings of craving that spring from the striatum, while the satisfaction of those pernicious goals continue to reinforce the circuits that give substances their meaning and value. And the regions responsible for self-control are themselves weakened by excessive demands for impulse control. So their connections to the regions of craving shrivel because they’ve lost their potency.

Understanding the brain is essential for making sense of the kinds of choices that addicts repeatedly make. But that doesn’t make addiction a brain disease. It makes it an aspect of the biology of being a sensitive human being in an often difficult world.

People have asked me how I feel about the Insite issue. Insite is a clinic in downtown Vancouver that provides a safe environment for junkies to shoot (their own) dope. The Supreme Court of Canada just overruled Harper’s attempt to shut it down. Did they do the right thing? Should we make it easier or harder for junkies to shoot up safely?

Easier is right. When opportunities are present, addicts will take them. And Vancouver is full of heroin. The brains of hungry animals can guide our thinking here. When a starving animal holds any hope of finding food, its brain shifts from a balanced stew of neuromodulators to a dopamine-spiked frenzy. Chemicals like acetylcholine, which usually plays a big part in alertness and action, are shut off at the tap when dopamine takes over. Gouts of dopamine spurt into the ventral striatum, so that all of the animal’s goal-seeking behaviour is directed at one goal only: and that’s food. It’s the same for junkies. When they are in need, there is only one goal anywhere of any value worth pursuing. Need more. Get some. Want it now.

So whether you get a clean needle or a used one just doesn’t occupy much space. Sure, it’s better to be safe, to take no chances, but you’ve taken so many chances in your life, and you’re still here, you’re still in one piece. So one more chance is no big deal. And really, for those minutes and hours between now and the next hit, its importance pales beside the real goal.

I know. I’ve been there. I once found myself in a room with four or five  junkies in downtown Oakland. I was scared. This was the ghetto. I wasn’t even physically addicted at that time. I didn’t know if they were going to include me or knife me, so when one guy offered me the cotton (the leftover heroin at the bottom of the spoon), I said I’d take it.  And I could see that the guy’s eyes were yellow–a common symptom of hepatitis. That’s what kills me when I look back on it. Yet I did it anyway. I was young and stupid. I’d like to think that, a year or two later, I wouldn’t have taken such a chance. But that would depend on how badly I wanted it.

If you can make it so that no heroin is available in Vancouver or its surrounds, then do it Mr. Harper. Otherwise, the Supreme Court did the right thing.

I’m nervous. I’m leaving for Toronto tomorrow for a publicity tour. The book is getting a lot of press, including a full-page article by Ian Brown in yesterday’s Globe. People seem to be grabbed by it. Some admire it. Some are shocked, even horrified, that this professor guy could ever have done such awful things. Some might feel both admiration and disdain. I don’t know for sure, but I’m about to find out. My publicist at Random House has set up a dozen radio interviews and three or four TV spots, including Canada AM and The Hour with George Strombo (gulp). And that’s great for the book… but I’m not sure I want to be there.

The book became more honest the longer I worked on it. I was going to reveal some of the past. Yeah, talk about the acid trips, the bust, well okay the busts, plural, then first experiences with heroin, maybe leave out the OD thing, get into the opium dens in Calcutta—that seemed suitably exotic. But those years of breaking into places, to get drugs, the intense compulsions, the suicidal risks, the lying and cheating and stealing and more stealing…I wasn’t planning to tell it all. But it just kept pouring out.

And then suddenly the book was finished. It was in the hands of the publisher, and I couldn’t have censored it or recanted it if I tried. Okay, I quit thirty years ago. And I’ve redeemed myself, haven’t I? Got back into grad school, worked really hard, got hired as a professor. I’m a neuroscientist now: all brain, no body, no pustules, no scars. Hah! You don’t live through a decade of addiction without a lot of scars, or without some crazy compensations to keep the wounds from opening up again.

So what I’m nervous about is that my squeaky-clean persona is going to be in front of that camera or that microphone and it’s going to turn transparent, so that everyone—relatives, colleagues, friends, ex-wives, children, ex-children—everyone can see the dirt below the surface. What am I going to talk about? How bad it was? How sick it was? How much fun it was? That crazy roller-coaster ride? Not knowing how to get off? And how my brain made me do it… How’s that going to go over?

Wish me luck, because it’s all going to happen in a few days. Feels like another roller-coaster ride, this one legal and acceptable, but with some of the same icicles dripping down the back of my throat.

In less than a week my book will be released. It’s called Memoirs of an Addicted Brain, and it recounts the story of my years of almost continuous drug taking and periods of intense addiction—interspersed with neuroscience, to help explain what was happening to me, why it was happening, and how it is that addictions are, in part, products of our biology. The book says a lot of what I have to say. It’s written from the perspective of a neuroscientist and a recovered addict. So it speaks to both the raw, often horrendous experience of drug use and addiction and to the science of how brains operate, when they’re under the influence…or desperately wishing they were.

So, if the book says it all, why a blog?

This blog can be a meeting ground for people with starkly different backgrounds and life experiences—people who have one thing in common: their lives have been deeply affected by addiction. These include present and former addicts, whether to drugs, alcohol, food, gambling, or other obsessions. They include people whose family members or loved ones have been beaten down by addiction. They include people who just love drugs, or are fascinated by them, who may remain free of addiction for now or forever. And they include scientists, clinicians, mental health professionals, and others who’ve devoted their minds and their careers to trying to understand addiction or help alleviate it. Scientists, clinicians, addicts, nonaddicted druggies…all of us have a lot to say to each other, and a lot to learn from each other. Our lives, one way or another, have been caught in the magnetic field of substances or activities that hijack the nervous system, because…well let’s face it, because they are tremendously attractive.

I know you’re out there: fellow travelers looking at addiction from the inside, because that’s you, or from the outside, because that’s what you’ve devoted your life to studying. I know you’ve got a lot to share. I hope this site will provide space for conversation, confession, soul-searching, questions nobody can answer and questions that we might be able to answer for each other. And I know that scientists, clinicians, and addicts have to talk to each other.

Now I want to hear from you. Tell me how this blog can work for you. What do you want to get out of it? What do you want to tell us and what do you want to learn? How can I help by sharing my own struggles, my own knowledge, and by guiding the conversation to the benefit of all?