Hi all. A number of you have asked if I could post that talk I gave at CAMH (“the scene of the crime”) on the evening of March 27th. Here’s my talk, converted into a PDF file and annotated for “easy reading”. Still X-rated of course. Enjoy…
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
This is a good presentation! That last paragraph that you quote from your book is a really good awakening to thoughts of human nature. This is a big lesson! The process of resisting is a physically exhaustive one, and the dACC’s fatigue leads to the first symptoms of defiance. The tipping point.
I think that this lesson is among the biggest of the book. The fact that we are all vulnerable to mental exhaustion and the consequences it tends towards. Of course, for addicts, this tendency takes on the form of giving in.
Surely some day we will know more about our ability to increase this functioning, but for now the final points you made; changing our environment, nipping the bud on the first thoughts, will have to suffice as our age’s primitive treatment.
Thanks, Marc. The presentation was clear–and dramatic as well. The general point about integrating subjective experience into cognitive and neuro-science is certainly a vital one. There are formidable difficulties in principle and in practice.
The points about the dACC essentially running out of gas are fascinating. A problem–in line with my first point– is that you experience _letting go_ controls, ‘giving in’; these subjective events fit well enough with the depletion you say is happening. What’s tricky is that, in the period a bit before, you might want to say that you’re choosing and self directing; you want to give some causal role to these subjective events. Yet one might simply say, the dACC has NOT run out of gas; your neurotransmitters are in normal order and supply. Isn’t one therefore tempted to say, The feeling of ‘choice’ is thus simply an accompaniment to one’s behavior, in this situation; the foam on the ocean waves, to use an old analogy.
In short the neural and biochemical focus seems to lead towards a kind of spectator model and account, and it’s far trickier to say how an account involving choices is going to be floated–be elegant and tenable. Put a little differently, does the neuroscientist, in his or her account of behavior ever NEED to say, “Here, a choice occurred, and it led to XXX behavior.”?
Just reflections. Congratulations on carrying off a fine presentation, and especially on putting out some ideas in a challenging environment. I suspect that many of your audience were NOT inclined toward your type of model, and indeed some, e.g., the orthodox psychiatrists, may have been rather unsympathetic to it.
Hi Daniel. I wanted to leave the audience with that lesson. I’m sure to get a chuckle when I show Sarah Palin shifting from a frustrated state of self-restraint to that evil and defiant little smirk that follows. But the consequences for addicts are much more dire. I also wanted to highlight the helplessness that mushrooms just before the tipping point. And then that sort of vertigo that opens up in your stomach as you realize you’re falling. Was it you who referred to that as “free fall” several posts ago? Anyway, glad you liked it.
Hi Doc:
You are the Boss.
For me, stay with the Science and please do not get dragged under by the “talking shop people” . The actual performance of the traditional therapists and counselors is absolutely atrocious. Most are utter failures and even the best MD in straight forward medical practice RARELY hits a correct diagnosis 60% of the time and that in in the best facilities. The average county hospital hacker would be lucky to hold a .200 average.
All that they bank is status within closed communities of practitioners.
Identify the major non deniable hard points.
#1: The human brain is a very poor hodgepodge evolved over 100s millions of years and is a complete open source system. Industrial Society can provide nearly limitless amounts of concentrates that will completely disrupt the functioning of your brain as effectively as putting your head through a car windshield at 60 mph.
#2: As such you must NEVER take any psychotropic, ever, no booze, no dope except in a medical emergency. Your only goal as a junkie is to STOP injecting, smoking, whatever you are addicted to. What you “think” now is no good because you are doped.
Okay, from my experience there are 2 😉
Why not talk “shop” with practitioners, Mike? This is more and more of what I do, and I enjoy it. This audience was much more appreciative than a typical scientific audience, because the approach was novel, they like hearing about “real life adventures”, and they found the science to be relevant. Practitioners seem generally open to new ideas, despite the poor success rates you imply, or maybe because of them. They know their trade isn’t perfect, and they seem very willing to listen and think about things.
Two quick requests 🙂
1. I wish you would talk about GHB and some of the latest evidence on the drug as well as who you would see being attracted to it as a drug of choice. Its rare, but it happens.
2. It would be nice if you had a twitter account. You’d be a great person to follow.
Thanks for the suggestions. But I don’t know a thing about GHB…I should look into it….and twitter scares me a bit. I think it means I have to “do” something several times a day. Which probably means I’d have to be organized and up-to-date, things I’m not very good at.
Anyway, thanks for the suggestions. I’ll look into GHB at least.
A sudden thought: If each brain (based on a person’s singular experiences) is so unique in how it functions — even as each human brain is structurally similar … I wonder if the only ‘treatment’ that could work to any degree is meticulously catered to that one individual. Example: Someone I love is addicted to alchol. This person also loves photography, dogs, writing children’s stories, cooking, movies, comedy, and friendship.
Potentially ideal restsoration could include immersion in each of those loves (to a degree that the person is able and willing), alongside whatever best practices could be used in re: the restoration/calming of the brain and body (more universal approaches).
Something else; another universal facet: that ‘sense of belonging’ that you write of in your book, Marc. I’ve come to believe that loving, bonded human relation is our best medicine and first defense against addiction. It’s a biological *need* (remember Harry Harlow’s baby monkeys?). We can and do die from its lack (‘failure to thrive’ can happen at any age).
Safe, loving, and bonded relation with at least *one* other human being is the one form of ‘existential containment’ from which we can, I believe, restore our capacity for presence and engagement … Sigmund Freud was definitely onto something when he suggested that we all want to ‘return to the womb’ … 😉
Hi Jaliya, What you say about the individuality of each brain, overlaid on the commonality of fundamental brain structure, is really a neuroscience analogy of real life. Funny, it’s usually the opposite, whereby we use folk psychology to approximate knowledge of the actual nuts and bolts. But neuroscience just isn’t there yet, in fact far from it. So for this we need to use our street-level intuitions. And they certainly do tell us (as have so many contributions to this blog) that the paths to recovery are incredibly individual, DESPITE the commonality in our brain structure.
I completely agree that safe, loving relationships are the first defense against addiction. When I was helplessly hopelessly addicted, I did not/could not trust others in the way I can now. So it was very hard to find the controlled warmth I found in opiates except in opiates. If I’d been able to, I wouldn’t have needed the drugs.
I still don’t feel completely safe in being loved, but I do feel loved, and I just have to reconcile myself to the fact that nothing — nothing! — is completely safe, and you take a few chances in living life day to day.
Hi Marc,
Wish I’d known about your talk – would certainly have come along to listen. My son is struggling with marijauna use (personally I think he’s completely addicted) as well as mental health issues ….. teen depression, anxiety/mood disorder and has had a psychotic episode about 12 months ago. Anti-depressant I don’t think is the right one for him ….. it’s not a good situation because he doesn’t believe that his marijauna use is causing any problems – typical denial.
Long story short ….. I decided to look you up after seeing your name (and Isabel’s) on the Pine River Institute website. We are currently completing an application for my son because nothing else seems to be helping and I’m very afraid that he is going to end up on the streets or worse.
Your book looks like an extremely good read – I’ll drop you a line via email.
Kind Regards
Gail (Rooster quilt maker)
Hi Gail. Omigod, it’s you! The person who made our fabulous quilt…which we cherish very much.
I’m very sorry to hear about your son, and Pine River may be the best thing for him. For other readers: Pine River is a residential treatment centre near Toronto, specifically for teens with drug problems. It is the only one of its kind in Ontario, as far as I know. My cousin, Karen Minden, was the founder and director until just recently, I’m very proud of her. She got an Order of Canada for her work: providing a service that’s desperately needed and which fell completely through a hole in the Ontario healthcare network.
Addiction issues with teens combine the worst of many worlds. Teens are highly vulnerable just by virtue of being teens. Their brains are changing faster than at any other time of the lifespan, with the exception of infancy. They don’t know who they are or who they’re supposed to be. So they rely heavily on peer associations and values. If these include a lot of drug taking, watch out! And the rapid formation of new synaptic pathways in the adolescent brain make us concerned that excessive drug use in these years can have an excessive impact for years to come.
Given the power of the peer group, Pine River takes the teen far away from the home environment and aims for a fairly radical makeover of values, goals, strengths and skills. I wish you and your kid luck, Gail. Let me know if I can be of any help.
Best,
Marc
Just finished watching your lecture in Toronto on TVO, absolutely brilliant. As a person who is addicted to pain killers for back pain, I realized a lot about myself well watching this lecture and I wanted to thank you for sharing your story with the world I can’t wait to read the book. I have some things to work on.