Addiction resulting from “choice”

Notice, first, that I say “resulting from” choice. Nobody choses to be addicted. But as people become increasingly hooked, they may increasingly choose to take the pill or the drink, or to gamble or purge, and that’s the thing we need to examine. What is the role of choice in the onset of an addiction? What is its role in recovery?

The voices that oppose the “choice” model often argue that addictive behaviour is nothing like free choice. It is like a compulsion. There is a feeling of need and desire, and perhaps not just a feeling but an actual need, that compels them to choose to use, each and every time. From the “disease” camp, this argument is further bolstered by our understanding (as described last post) that addiction really does change the functioning of the dopamine system. Since our organ of goal-pursuit (the NAC, or ventral striatum) is thus compromised, how could we possibly make free choices. Finally, opponents of the “choice” model argue that framing addiction as choice just invites the humiliations and accusations, both from within ourselves and from others, that become so unbearable. “If it’s a choice, then you damn well need to choose differently, and that’s your responsibility!” That usually makes things worse, not better.

The problem, I think, comes with the phrase “free choice”. Who said choice is free? I’ve covered this topic in two previous posts. In the first of these, I argued that choice comes from the brain – obviously – and it specifically springs from a contest between the striatum’s goal seeking and the role of the anterior cingulate cortex (ACC) in monitoring probable outcomes. In the second, I described how neuroscientific data places the moment of choice in a stream of brain activity, occurring seconds before we’re even aware of making a choice. But I also claimed that we can insert “reflection” into that stream and nudge it one way or the other.

With addiction, the ACC is increasingly weakened by ego fatigue, and the v. striatum responds ever more strongly to gouts of dopamine triggered by addictive cues (including thoughts and memories). So choice becomes increasingly irrational, increasingly spontaneous, and increasingly uncontrollable. Then should we still call it “choice” at all?

One of the most persuasive advocates of the choice model is Gene Heyman. For Heyman, addiction is a result of choosing what is most rewarding in the moment at the expense of long-term gains: choosing ‘‘locally’’ rather than ‘‘globally.’’ He cites studies of delay discounting that investigate these effects. Remember the marshmallow test? Same idea. Rewarding events are much more attractive if they are expected “now” rather than “later”. But this poses a problem: repeatedly choosing the immediate reward makes both immediate and long-term rewards less desirable. In terms of the immediate benefits, heroin becomes expensive, boring, and smeared with self-rebuke. It’s never as good as it was at the beginning. But the value of long-term rewards goes down as well. Once your marriage is shot, you’ve lost your job, and/or you’re deeply in debt, the future doesn’t hold much attraction at all. It becomes less and less rewarding, in fact it becomes painful to contemplate. So the immediate reward, a shot of heroin, remains the best option.

On any single occasion, says Heyman, the local choice continues to be valued above the global choice. In other words, an immediate reward—‘‘one more time,’’ as addicts often tell themselves—is always more attractive than waiting for the long-term picture to get brighter. In this way, addictive choices are like normal choices. You choose what you want based on its expected value. But, unfortunately, the expected value of things gets shifted by the self-perpetuating nature of addictive behaviour.

What’s wrong with the “choice” model? It sounds pretty rational. Just a problem of behavioural economics, as they call it. We keep choosing what feels best. And that also means that we can choose differently, providing a gateway to recovery. Once the future backs right up to the present moment, then the immediate choice, the addictive choice, loses its attraction, and we can choose to stop.

What’s wrong is that the “choice” model ignores the brain. Big mistake! The brain that houses the famous dopamine pump, and its eagerly awaiting customer, the v. striatum, is the same brain as the one we use for making choices. From a brain’s-eye view, the reason people choose the immediate reward is that dopamine highlights immediate possibilities. That’s its function, and has been throughout evolutionary time. Research shows that dopamine rises proportionally as the goal gets closer and closer at hand, driving motivation with it. Now, if that’s the case for marshmallows and other normal rewards, imagine how powerful the dopamine surge is in response to addictive substances or acts! (See recent posts and comments.) That swelling wave of dopamine, announcing the availability of a supremely attractive reward, recasts the balance between present and future appeal — more quickly and more thoroughly than anything else could. To choose future gain, over immediate reward or relief, becomes incredibly difficult when every synapse in the striatum and frontal cortex is resonating to the “neural now”. Especially once ego fatigue sets in.

So, yes, the addictive act is a choice. Each and every time. That means that there is always the possibility of saying No. Yet, saying No is incredibly difficult, and that’s a problem the “choice” camp can’t solve…

…without the help of neuroscience.

34 thoughts on “Addiction resulting from “choice”

  1. Carolyn Kay June 30, 2012 at 6:39 am #

    Even though some self control may be built in (http://bit.ly/QFQr3L), we can also learn to control our impulses (http://bit.ly/QFRDEd). But like the light bulb, we have to WANT to change and be patient and persistent.

    Unfortunately, the process of improving self control involves fighting a tsunami of advertising that encourages us to do the easy thing, the thing that brings pleasure RIGHT NOW. Our whole society has bought into immediate gratification–it’s manifest in the way large businesses are run and our politics, as well as our individual personal lives.

    Carolyn Kay
    http://www.ManyYearsYoung.com

    • Marc July 6, 2012 at 9:34 am #

      Interesting! I hadn’t thought of that. So it isn’t drugs that “hijack” the brain (a favourite quote of the “disease” camp), it’s advertising. Instant gratification was not invented by these forces — it has always been the preference of every animal on the planet. Which is why human evolution had to build inhibitory control into several systems, as a counterforce. But indeed advertising and other cultural entities teach us that “it’s okay, do it!” so it gets overlaid on the ancient machinery for gratification.

      • Jaliya July 6, 2012 at 12:12 pm #

        Does that propensity of a brain for instant gratification relate to the intrinsic vulnerability to addiction that you’ve written of, Marc? … makes me think that there’s not necessarily a ‘deficiency’ which can lead one to become addicted. Perhaps it’s a vital mechanism gone haywire in concert with the ‘perfect storms’ that can occur in a life.

        • Marc July 9, 2012 at 7:59 am #

          That’s exactly what I think. A vital mechanism gone haywire, often because it becomes linked with a cycle of suffering-relief-suffering-relief — a cycle that can often start with traumatic events. I’ll write more about this in my next post.

  2. Julia June 30, 2012 at 2:16 pm #

    I am focusing on one of your statements: “… a contest between the striatum’s goal seeking and the role of the anterior cingulate cortex (ACC) in monitoring probable outcomes.” My question is where do we get any idea of what the “probable outcomes” might be? What past experience can someone who has been a long term addict use as a probable outcome?

    It seems to me that there is no contest in the “choice” between the familiar relief, boost, escape, etc., whatever one gets from one’s preferred addiction, and some vague, abstract ‘possibility’ of having some experience in the future that is different than one has ever had before.

    If one had already had an experience of living life without the addiction and having it be a positive experience, then it might be more of a real ‘choice.’ But usually, that’s a big part of the problem, that one has never known any other way of living so there’s really nothing to refer to as an alternative ‘probable outcome.’

    I think that’s why so many begin their recovery when they ‘hit bottom.’ At that point the very tangible experience of continuing the addiction becomes so painful or frightening that the unknown of life without it looks better. Often it’s not a choice between the addiction and something better. It’s a choice between the addiction having turned sour and just no longer having that option.

    Then, once one has lived without the addiction for some period of time, other experiences just naturally start to accumulate and life without the addiction can eventually become an actual goal to pursue. I’ll probably have more to say after I’ve read the whole post 🙂 Julia

    • Marc July 1, 2012 at 2:23 am #

      Hi Julia. I don’t mean choice between one plus and another plus. It could just as easily be a choice between two minuses. Which one will be worse?

      In fact, the ACC doesn’t work with “vague, abstract possibilities.” It works with memories. Memories are put together in the upper and lateral parts of the prefrontal cortex, with direct access to the hippocampus. Those memories form into expectable scenarios, and they get tested by the ACC on-line. The ACC says, hmm…I could do this, and then this would occur…as it always has in the past, or I could do that, and then that would happen. Something like that. All this happens in less than a second…but of course one could ruminate for hours.

      I agree that the choice between a sure-fire relief and a hollow unknown is a no-brainer (hee hee). But there are lots of specifics on both sides of the line… All one really has to think about is tomorrow morning to get two very concrete images of what to aim for.

      Yet, I agree, that a period of time without use changes the options dramatically. Thank goodness!

  3. Joanne June 30, 2012 at 4:48 pm #

    Re: Julia… Absolutely true. It took a long time for this to be true for me ( many years) but the “choice” for me is no longer the immediate gratification of a drug. It is now not using, because of repeated experiences since getting clean, of living life and being capable of dealing with ( and getting through) all the issues life presents drug free. It took many years of blind faith in other recovering/recovered addicts accounts of such experiences and along the way my own experiences built up.
    Great blog.
    Thanks.

    • Marc July 1, 2012 at 2:28 am #

      Thank YOU. Blind faith, hmmm. It’s hard to find a neural correlate for that, though there must be one somewhere. I’m so glad that worked for you.

  4. Julia July 1, 2012 at 9:24 am #

    Hi Marc, I totally agree with your clarification. Less worse is another kind of ‘better.’
    At the moment the choice is being made, the immediate relief, high, etc. can seem worth the projected price of the ‘morning after.’ Or the addiction hasn’t hasn’t gotten to the point where the consequences have gotten all that bad.

    We do use memories of past experiences to choose an imagined future but obviously there are other factors. Otherwise, how would one ever move into new and unknown territory? Whether it’s going to college or traveling the world, there is some ability or ‘appetite’ humans have to imagine and move towards new experiences.

    That goes back to the decreasing reward of the addiction in relation to an increasingly bad morning after. I’m sure that varies with the substance/behavior. Where one is choosing between a tolerance level just to function as opposed to experiencing withdrawal, the choice is more about which is worse. And that can, and does shift over time.

    In my lay person’s understanding of the various functions of the brain, the advantage humans have with our bigger cortex is that ability to project into the future, to be able to consider possible outcomes and not just react to stimuli or impulses. So, as you say, the battle is really between the cortex which knows better and other parts of the brain operating beyond the reach of the cortex. Maybe the addictive experience has to accumulate to the point where it can be included in the cortical choice-making function?

    There’s also the social part. Besides having the big cortex, humans’ uniqueness has to do with the complexity and power of social bonding. I think much of the choice-making we do is based on how it’s going to affect our relationships, with whatever small group we’re a part of, family, community, religion, etc. as well as the larger society. Changing one’s behavior is also very much about changing those relationships, shifting alliances, shame and self esteem. Even our inner sense of what’s right and good is grounded how we imagine others are judging us.

    That gets into a whole other area in which I think Gazzaniga makes such important contributions. His notion of free will has to do with the fact that the value placed on what one is choosing between (such as in criminal behavior) are largely defined by the culture around us. Choice is always a social construct and individual human behavior can never be disconnected from its social context. Julia

    • Marc July 9, 2012 at 9:08 am #

      Hi Julia. These are excellent points. Yes, we do have the capacity to imagine events and states we have never experienced. But we still build these views on past experience. We extrapolate or vary or otherwise manipulate the “known” into the “unknown”. That’s why your original comment, about how hard it is to imagine a drug-free existence if you have never experienced that (at least after childhood) was so compelling.

      But there’s more to it, and you also get to that here. Something has to get to the cortex, and especially the ACC, so that it can be “chosen”….and yes, it is about weighing the value of the high vs. the negative value of the after-effect. This is partly what I meant about the future backing up to the present. The computation of all the suffering yet to come somehow backs up to the next moment: and then the choice is laid bare in front of you. That is the solution to “delay discounting” — there is no longer a delay, decreasing the impact of the future. The future becomes “present”, so you are choosing between two immediate options, so it seems.

      Really, limbic structures, like the amygdala and insula (which is sort of at the border between limbic and cortical) have to get more and more alarmed and overwhelmed with negative imagery. Or, more precisely, the responses of these organs must become increasingly intense when we anticipate the “morning after” (and after that and after that)…intensely negative, that is. These limbic structures have a direct line to “the immediate” — they get the rest of the brain to get ready to react to something nasty. Only then, I think, does the cortex come on board, as if to say: wait a minute, I didn’t really see the problem before…now I do. It’s right here in front of me. Something has to be done!

      And I agree about the extensive interpenetration of the personal and the social . Someone recently reminded me that someone said, “mind” is not a place in your head — it’s something outside your head, in the community around you.

  5. nik July 1, 2012 at 10:05 am #

    Marc, you raise provocative points, as usual.

    If the brain is a deterministic system, as the brain biochemists say, then the
    brain events corresponding to choices–or, as you say, those a few moments before conscious choice–are determined. And thus also the person’s behaviors.

    When you (ML) say, // But I like to think that choices are moments in a river of brain activity that can be altered by reflection and foresight. // Fair enough, but as
    you suggest elsewhere, whether you can or do reflect or look ahead is a biochemical
    process:

    //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 behavior accordingly (dorsal and lateral regions of the prefrontal cortex). //

    Thus the process (“exchange”) has determinants, and ergo is not free if that means free of determination (impossible to predict).

    The only way out seems to be to say that the brain is not a deterministic
    system, nor the human being as a whole. Predictions, at least sometimes, are
    not possible *in principle*; but that goes against both science and (apparently) common sense.

    Rather that go the route of trying to escape determinism–as you appear to be, above– to have freedom, I suggest that a better alternative is to say, “It’s a free choice if it’s consistent with what I truly am and want to be.” After I have been acting compulsively, perhaps in some ‘trance’ state, I ‘come to’. I say, “That’s not me to self stimulate with coke or sex for hours, while the baby needs tending.” If recovery is as M says, re-learning, then its essence is that one is re-learning to be oneself, to do as one really wants. To be able to say, at the end of the day, “I did what I wanted, and it was me doing so.” Choice then is taking authentic, self-originated, self-developing action.

    • Marc July 9, 2012 at 9:28 am #

      Fascinating stuff, Nik. As you seem to know very well, the issue of free choice is a serious problem for philosophers, and there are really no good solutions. Your solution is to choose according to the momentum of your own self, goals, wishes, history, identity — if I get you right. So the choice is not free of determinism, but it is at least free of compulsive, irrational, or intrusive concerns that fall outside your core self. I like this answer very much.

      But I still wonder if we can have our cake and eat it too. So, let’s go back to determinism. Each moment of choice is determined by what came just before. Frijda says, in that paper I cited, that of course choice is based on the past — what else could it be based on? And yet Julia, above, reminds us that we can choose directions that really are novel, composed, imagined. Which might mean free of determinism after all.

      I’m no philosopher. But if I were, I would look at moments where several paths are all possible and equally probable (which gets into a statistical universe, which I think is the conclusion of quantum theory). At those moments, a tiny nudge would be all that’s needed to choose one path vs. another. You might reply, but that nudge also has a history — it’s not free either. And then I might say: let’s think seriously about quantum physics, and the recent theories of the universe that REALLY DO propose multiple, coexisting realities, or paths….such that the one we “live” is a matter of interpretation, or perspective, or maybe even choice. How mysterious is that?!

      But all this gives me a headache, which is one reason I’d make a crummy philosopher. Thanks for your input.

  6. Michele Patterson July 2, 2012 at 12:54 pm #

    Great post.

    I think the choice model (not the ‘resulting from choice’ model) is largely the default one for describing addiction by the non-addicted. Also, its the one that is used in AA etc; as getting people (sponsors) to help you make better choices in that short term crisis stage is a big part of the remedy.

    However, it makes me wonder if you should be proposing this one as yet another model and calling it something else; since the word choice (as lay people understand it) is being changed to ‘resulting from choice’ which the non-addicted world will see as something different, and perhaps a subset of the disease model.

    And I continue to see that for those of us who have some dependence issues, whichever of the rationales (even Marc’s excellent new one – accelerated learning); the remedies all still seem to revolve around making different choices. There is a clear path…even if it is not an easy one.

    This is such an excellent learning community you have started Marc….very helpful to me in my own journey.

    • Marc July 9, 2012 at 9:36 am #

      It is an excellent learning community! I continue to be amazed by people’s thoughtfulness, creativity, intelligence, and originality. And so good to hear that it is helpful to you in your own struggles, Michele.

      I see what you’re saying. The idea that addiction is not a choice but a result of bad choices could indeed be absorbed by the disease model. A “diseased” brain cannot make healthy choices, and therefore it continues to succumb to addiction, which is the main source of its disease to begin with.

      What I don’t see is how AA can have it both ways. If they are really saying, you have a choice, and you must choose the hard path if you want to recover…if they’re really saying that, then how can they also see addiction as a chronic disease? My understanding is that AA continues to move toward a disease model — perhaps following the footsteps of NA — and I just don’t see how that’s compatible with the idea that we are free to choose and responsible for our choices.

      If you have any insight into that, please share it!

      • Michele Patterson July 17, 2012 at 12:31 pm #

        Well, actually, I have always thought of AA more as a religion based option than anything else.

        Also, with AA – however, its the catch-all as it is not so interested in the reason for addition (which is why the stories and people are so varied but all can relate to eachother) but how to overcome it….much as I have noted a few times with your great research – the solutions still come down to the same ones.

        However, that makes me think too that there is yet another ‘model’ besides choice/disease etc….the morality based model. Its mostly gone out of fashion now but addiction used to be considered immoral and or a religious/spiritual failure. I think this is still out there to some extent with some ideas such as, for example, one is an incomplete person, one is not a whole person, etc.

  7. Jaliya July 2, 2012 at 7:07 pm #

    I’ve been agonizing over this piece since it was posted … Someone I love is presently ‘that far’ from losing everything (again) — including existence — due to alcohol addiction. This person lost a parent about five weeks ago, and has been drunk since the funeral; now s/he is very ill with a lung infection … and I am the only person both geographically and willingly close enough to respond. Do I turn away this time? For once and for all? Can I do this? *Must* I do this, in order to save my own life?

    The question of choice can become an agony and a harrowing ethical dilemma for the sober ones.

    Choice in addiction itself … I wonder if a person loses the *capacity to choose* after a certain point — if the damage done to the brain (thus, volition) is as disastrous as it can be to the liver, kidneys, lungs, etc. I wonder if this is the case for my loved one, who still can be lucid enough to say ‘No’ to all options for wellbeing … if s/he is not too drunk.

    It must be agony, too, for the person addicted … A return to full presence includes receiving the wrath of those who have been injured by the addict’s actions. I imagine that making a choice to become sober is agonizing in part because of what awaits the already wrecked capacities to be in relation and to feel anything other than poisonous (despair, shame, rage, etc.)

    Choice: it’s a hell of a question for all of us, isn’t it …

    • Marc July 9, 2012 at 9:51 am #

      Hi Jaliya. We talked about this recently, one to one. I suggested to you that you DON’T need to choose to turn your back on this person. To make good choices, the first criterion is clear thinking. If you think clearly about where this person is at, and what are his/her capabilities at this point in time, then you may conclude that the degree to which you can help is limited. It’s there, but it’s limited. So I recommended that you think about a “harm reduction” approach — not even trying to reach for recovery at this stage, just helping to soften the shame and isolation, by not expecting too much, just a little, and by opening your door to this person, but not every day and not as widely as you might want to.

      From the perspective of your own life, you can only make choices for you, not for someone else. But you can choose to offer comfort and even love, which might help the other person to make better choices.

      I wonder what others think of your dilemma…

  8. Kathleen July 3, 2012 at 8:39 am #

    I believe that, once in recovery, with some clean time under my belt, I do have a choice.
    When in active active addiction, not so much. I remember driving to get my pills, knowing that it was dinner time and rather then have eat with my husband and children, I was going to get high instead. It was like I was on autopilot, like I couldn’t have turned around if I wanted.
    I get that vicious circle thing too. The addict just keeps using so she doesn’t have to feel the shame and “the wrath” of those she has ripped off, lied to, ignored,taken for granted and neglected in order to use.

    • Marc July 9, 2012 at 9:57 am #

      Yes! That’s what’s so creepy about it. It is the epitome of self-perpetuating. You continue to build up shame which you can only relieve in one way, but the relief creates even more shame to be surmounted tomorrow. I’ll talk about this more in my next post.

      I know what you mean about the “autopilot” mode. In fact I think it’s terribly familiar to many of us. For me, that was a raw determination not to let myself be dissuaded from my goal. I forced myself to keep going toward the drugs when I felt better judgement, or just plain fear, tugging me the opposite way. Why? Because I didn’t want to face the rest of the night unstoned, alone, empty, and bereft. Then that blind determination would settle into a sort of hypnotic state….of following a path without looking up. Just follow…don’t think about it…That’s what I’d tell myself.

      In other words, maybe I was choosing not to have a choice. Because the choice was too threatening: I might choose not to obtain the one thing I felt I really needed.

      Is that anything like it was for you?

  9. John Becker July 8, 2012 at 9:12 am #

    I’ve been thinking again about addictions as a disorder of choice, after something happened yesterday in Group Therapy. One of my cohorts has had a slip and he’s very down on himself. He’s a young father and he said that he just wishes he could tell his wife and son that he will never use again. This set off murmurs of recognition, among all of us, hard-bitten addicts with broken-family-hearts.
    “You just can’t” said a women; five years clean. “I can’t tell my daughters I’m never going to go out. I might go out today.”
    “Yeah.”
    Well, our very experienced therapist, Miguel, he has a response:
    “Do you drive?” he asks the young father. “Do you have a car?”
    “Yes, I do.”
    “Can you promise you will never have an accident?”
    “No, but…”
    “But you drive defensively, paying attention. Not too tight; not too loose. You’re not so afraid of having an accident that you’re all frozen up–”
    “That’s my mother; white-knuckling the wheel–”
    “Not so tight you can’t take in the wider picture, but not careless either, you keep your eyes on the road. You’re not alone in the car; responsible for your family, you want to be skillful.”
    Miguel’s analogy made a lot of sense to everybody, as useful advice for coming back from a relapse or for just staying on the path, day to day. As the discussion went on, I was thinking: are car accidents a disorder of choice? I mean, cars don’t decide to crash into each other, not any more than cocaine chased after me. It’s the people driving the cars who cause the accidents. Typically because we put our attention elsewhere. And sometimes the consequences are disastrous — millions of victims, billions of dollars in damages — and all this disorder because drivers occasionally choose to think about something other than driving. I never intended to get addicted to cocaine either, I was just heading down the road towards more intense sex… and I had an accident.
    We’d know a lot more about addictions and recovery if we understood the mystery of how humans make choices. And it is a mystery; so complex and unknown that we can’t yet even call it a problem. Addictions are a disorder of choice but describing them as such is not the end of the story, it’s just a beginning. Studying addictions and practicing recovery opens a portal to this mysterious component of our nature.
    By the way: is the automobile addictive? I don’t know, but I used to love driving. I live in the heart of the city and I don’t own a car, but I remember the thrill of a fast convertible on a rural Ontario road, smoking pot with my girlfriend, on hot summer night like this one. My world has changed and anyway, this summer is unnaturally hot. An awful lot of gas is still being burned. I imagine that a recovering addict might be a good person to ask why it is that so much of our North American oil got under the Arabian sand.

    • Jaliya July 8, 2012 at 5:15 pm #

      John, funny that you should mention cars … I was just wondering (as I was driving along today) if Henry Ford had any idea of what he was unleashing into the world with his invention of the automobile. All the ripple effects that have come in less than a century …

      Another thought about choice: I notice that the language we use to describe a relapse is often passive, i.e., ‘I had a slip’ or ‘I fell off the wagon.’ — Might our choice of language be part of the problem? — that we tend to assign all power and agency to outside forces? ‘I had a slip’ makes me think of the proverbial banana peel on the street … and possibly another way for us to negate our own responsibility for what we do …

    • Marc July 18, 2012 at 3:23 am #

      Hi guys. I’m glad that you extended John’s discussion of choice, Jaliya. I think it’s crucial. John, you took the words right out of my mouth (another passive metaphor!)… To call addiction a problem of choice is indeed the beginning of the road. We don’t have a clue as to how we make choices. It’s immensely complex, layered, and hidden, but addiction requires us to focus on it anyway and do our best to understand it.

      Actually, I’m so inspired by this issue (and it fits my sleep-deprived state so well) that I’m going to make the rest of my reply into another post. See the latest…

    • Kelly July 24, 2012 at 4:34 pm #

      Addiction resides not in our intelligence, ability, power, health but in that inner world of dreams, hopes, beliefs, desire, passion, love, adventure, thrills, habit, memories. It requires that we BELIEVE it is okay to go there!

      How can you study desire, passion, love, lust, and my beliefs? How can the brain measure WHY one person choose to engage in behavior which has negative consequences, yet the other person won’t do it again? Yes, the brain is the object in which it all happens, but it is not the only piece of the story.

      I would love to read Dreikurs or Adler’s take on addiction. And, your reply to my post.

      • John Becker July 26, 2012 at 3:44 pm #

        I am very pleased to be invited to say more about this. Thank-you, Kelly, and especially for how you mentioned me in the same breath as saying you would love to read the great, late, psychologists Dreikurs and Adler on addictions. I’ve always wished Oliver Sacks would tackle the subject, and I think it’s delightful to speculate on what inspiration the great minds might offer. Who else would we like to hear from?

        And now from me… well, let me invite you to step back a bit from your comment. You say the brain “is the object in which it all happens.” What if, instead of thinking of the brain as an object, we respect its phenomenally complicated nature and imagine it as a process.
        Neuroscience has the misfortune of being a fad right now and so people throw stuff about the brain around like politicians use statistics: more for support than illumination (although as I recall now I think that may have been originally said about drunks and lamp-posts).
        If mind/brain is thought of as processes instead of places/things we can take another look at those two lists in your comment. I reckon that your first group, in which you put “intelligence,” are more objective in quality (but still, I’d say, pertaining to addictions; recall the words of American cowboy-philosopher John Wayne: “Life’s tough… tougher if you’re stupid.” Okay, nevermind). The nature of your second group, in which “BELIEFS” stands out, is more subjective. But, if we are talking about process and energy, do we need to suffer this duality? In the recovering addict’s world there is a great opportunity, because I think understanding addictions and practicing recovery requires us to delve into both categories. And contrary to the impression made in a couple centuries of western science, we can do so; we can be both scientific and subjective, applying theory, experiment and analysis to our subjective experience, productively conducting research into how we make choices, and into how we individually and collectively feel, think and create identities. Contemplative wisdom traditions have been doing it for thousands of years, thanks to which much happiness and well-being has been cultivated. We can apply the same rigorous criteria for truth: the empirical data from personal experiences, the inference of observation and the knowledge of reliable witnesses.
        The field of addictions and recovery can lead the way here, and ultimately, in our self-knowledge and in our practice, we might even be able to illuminate neuroscience.

      • Marc August 13, 2012 at 4:49 am #

        Hi Kelly and John. Please see my most recent post, Kelly, about self-medication vs self-destruction. In it I come to the same conclusion that you do here: addiction requires that we BELIEVE that going there will help us — calm or soothe or animate us, improve us, bring us home….whatever it is. That’s really what the notion of “self-medication” hinges on, although “self-medication” is a much more clinical and boring label than the words you use here.

        As to how that fits with brain science, i very much agree with John’s recent comment, saying that the brain is more process than object. Or perhaps we should say that about “mind” — which then dances between the biology of fleshy creatures and the intensely involving social world with which we continue to resonate all our lives.

        I also agree with you, John, that there is no real contradiction, and that the scientific analysis of the mind/brain interface allows objective study of experience (and that’s important!) while it also permits the infusion of experience into neuroscience, which can bring forth an amazing revolution in the currently nuts-and-bolts scientism of neuroscience.

        One new direction for this kind of study is called “neurophenomenology” — a serious mini-field within cognitive neuroscience that does indeed focus on the contemplative tradition, using authentic, Grade A Buddhist monks and so forth. But more on that later.

  10. Jaliya July 13, 2012 at 3:22 pm #

    More thoughts in re: choice …

    ‘Responsibility’ … at its root, it means ‘the ability to respond’ … It’s that word ‘ability’ that makes me wonder about the passivity that we can experience … More and more I think that addiction and trauma have much in common, including what I call ‘volitional paralysis’ — it seems that something has gone very awry with our ability to act. Traumatized people who survived but were not able to ‘fight or flight’ often experience a horrible sense of frozen ability … an aftereffect of having been brought down and *kept* down.

    The more I read about opioid receptors in the brain, the more I think too that people who have experienced excruciating pain / loss / injury lose something in the ability to *moderate* or mitigate pain … thus the search for whatever might ease it.

    • Marc July 18, 2012 at 8:11 pm #

      So true, Jaliya. The ability to choose gets paralyzed. We literally forget how to move the right muscles. And so we end up going with the flow, wherever that may lead us.

      I think you’re dead on about the role of opiates in soothing the after-effects of trauma. Our internal opioids are helpful for easing pain. That’s their function after all. But sometimes there’s just not enough to go around. The pain is too great, too persistent. Psychological pain is like that, and opioids were introduced into the mammalian nervous system long before “psychological pain” was invented.

      So we go after super-sized showers of opioids — when we can get them. That keeps everything under control. Until it doesn’t.

  11. Elizabeth July 19, 2012 at 8:38 am #

    Hi all!

    This is definitely a late post, inspired by looking over all your comments and insight and mulling over my own recovery from my “addiction”/eating disorder.

    I’m especially fascinated with the way our brains evaluate possible rewards and outcomes. I’ve started to associate my own behaviors with quick, immediate reward, but I also am reminded of the punishment that occurs, albeit delayed, after I get my “reward” following eating disorder engagement. Furthermore, working on a stronger sense of self love and regarding my body as more of a “child I want to nourish and take care of” has helped me override the compulsive behaviors my rapidly firing striatal dopamine neurons are telling me I should engage in. I never had that sort of goal before. I’m wondering how much a sense of love for one’s self and self care engages the prefrontal cortex (PFC) to help us override these behaviors. If the PFC is activated during self-awareness and one of the major goals of engaging in an addictive behavior is to shut off that self-awareness because we don’t like our current state/situation/self, what does that mean for addiction treatments and our ability to make good “choices”? Do we have deficits in the ability to override engaging in our addiction at the early stage because self-awareness is scary? I certainly have felt that way. During the early stages, it seemed easier to just follow a routine that was set out for me. Once I started feeling okay with engaging in self-awareness, my ability to quell my compulsions to binge/restrict became weaker and weaker and are still waning in their strength. I’m wondering if anyone has had similar experiences and if there is any evidence that increased PFC activation in brain regions associated with self-awareness triggers craving at first, and then works to quell cravings later on in the recovery process.

    • Marc July 30, 2012 at 5:13 am #

      Hi Elizabeth. There have been other voices on this blog, including mine, on the value of self-love. You are saying that, without self-love, there is a “rushing ahead” compulsion that allows us to override self-awareness and just do…just do the thing we do…blindly and thoughtlessly. Yes, I agree, that is a big aspect of compulsive behaviour. Compulsions are easy to follow and require no reflection.

      But I was confused by your sentence: “Once I started feeling okay with engaging in self-awareness, my ability to quell my compulsions to binge/restrict became weaker and weaker and are still waning in their strength.” I though you were arguing the opposite. Please explain.

      Also the “whereabouts” of self-love is extremely tricky. But one thing we can be pretty sure of is that the anxiety we feel when we DON’T take care of/love ourselves is concrete and potent, and it would manifest in increased amygdala activity at the very least. Plenty of studies on anxiety focus on an overactive, oversensitive amygdala, and close attachments (including with ourselves!) will calm that anxiety and reduce amygdala activity.

      • Elizabeth July 30, 2012 at 8:44 am #

        You are absolutely right, I was arguing for the opposite in the early stages of recovery. Hopefully this will clarify:

        Before a sense of self-worth is cultivated, the act of increasing awareness may have the effect of making salient a negative self-image, thus increasing desires to remove ourselves from our awareness and making the urge to engage in addictive behaviors stronger. After deciding to love one’s self, increasing self awareness has the opposite effect: to decide NOT to engage in addictive behaviors in order to care for and nourish the body.

        Does that make sense? I don’t really have any evidence for it, it is just based on personal experience.

        I also totally love the evidence that attachment can reduce amygdala activity. I had to practice holding myself like a baby the other day and was absolutely shocked by the immediate calming effect!

  12. Arthur Rosen MD July 30, 2012 at 4:08 am #

    Everyone who stops using what they’ve been addicted to will eventually need it in the future.

    • Marc July 30, 2012 at 5:00 am #

      What on earth do you mean by that? Care to elaborate?

  13. Steve August 4, 2012 at 10:14 am #

    As the famous saying goes, Sow an act and reap a habit..  Sow a habit and reap a character.. Sow a character and reap a destiny.
    Once an addict has sowed the first several acts and reaps a habit he’s well on the path of addiction. Continue this pleasure game and your habit determines your character. By now it’s to hard to change, it’s too much pleasure and pain to want to change and soon you arrive at your destiny. You’re an addict. You wonder how did I get here? How do I stop? How can I change my evil ways? The answer is with persistent and consistent effort. That’s what got you into your addiction in the first place and that’s what will get you out. Learn to face and replace your addiction, journal about your experiences and what sets off the triggers. Every slip up is a learning experience. Practice sitting alone in a room and not doing anything but watching your breath come and go. Notice your thoughts and get to know them. Return back to the breath and continue for 30 minutes this way. If your mind wonders off 1000 times, then bring the mind back to your breath 1000 times. Sounds easy but it’s hard. Why do it? Because it trains your mind to be mindful of your thoughts. It trains you to control your thoughts and impulses. It’s not the magic cure but a powerful tool.

    http://youtu.be/qvXFxi2ZXT0

    It’s choice not chance that determines our destiny.

  14. Steve August 4, 2012 at 10:36 am #

    Buddhists believe that all human sufferings and dissatisfactions stem from desire or “thirst” for possessions , sensual pleasures, power, even for wisdom and knowledge, which warps our minds and distorts our understanding. The Buddha compared a life governed by the delusions of thirst to a river in flood, sweeping us away to a life of constant discontentment. Learning how to control our cravings is the raft that can carry us over the flood to the opposite shore of insight and peace of mind. (Also known as the safe island of mindfulness.)

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