News flash: NA groups provide opioids for members!

You probably didn’t think it was possible. How could this be? It’s scandalous! Providing opioids for the very people who are trying so desperately to get off them. But since this is Week 2 of our be-nice-to-12-step extravaganza, let me tell you the story.

In the comments following my last post, Elizabeth told us of a study (Coan and colleagues, 2006) showing that hand-holding can diminish people’s response to threat. Unfortunately the link only takes you to a brief summary of the study. I went back and read the full version, and this is what happened.

Fifteen women who reported high quality marriages were put into an fMRI scanner, with their husbands and the experimenter remaining outside in the room. The women were shown cues on a screen several seconds before an electric shock was possibly administered to their ankle by an electrode. These electrical zaps are generally only slightly painful (in psychological experiments). But the cue on the screen, coming a few seconds earlier, is bound to make one anxious. Especially because it announces that a shock may come, but it may not. In other words, the subject is in a state of uncertainty and anxiety, waiting to see if the shock will come or not.

This experimentally-induced state of threat or anxiety is, of course, meant to simulate real-life stress. And I think that’s fair enough. Let’s get specific about opiate addicts. Will I be okay? Will I be able to restrain myself today? Or will things get so shitty that I’ll fall off the wagon — again? And if I do, there will be hell to pay when I get home…etc, etc, etc. We all know the drill. Being an opiate addict in recovery is being in a state of anxiety or stress — for much of the time — and the only relief may be…a shot of heroin (or pills, or whatever) OR a visit to your local NA group. That makes you feel better too. That’s why you go.

Little did we know that the group makes you feel better for the same reason (at the cellular level) as a shot of heroin.

Some very prominent emotion scientists have theorized that opioids (made inside our brains) are at the root of human attachment. Mother’s milk is rich with opioid molecules. In other words, nature found a surefire way to soothe the baby with its mother’s milk, using the same chemical formula that’s responsible for the soothing feeling of heroin. Jaak Panksepp theorizes that all social attachment is based on the release of opioids within the brain. Here’s a quote from him, referring to his early attempts to publish this work, cited in a very nice review for the non-scientist:

“When we first tried to publish our paper on the role of opioids in social attachment in three species, we submitted it to Science,” he said. When he asked the editor [why the paper was rejected, he was told], “‘We decided it was too hot to handle. If love and attachment ride on the same system as narcotic addiction, that’s too scary…’ ”

The review goes on to show how parents also get opioids from their kids. They feel great gobs of love and mush because their own brains produce a glut of opiods just at the sight of those sweet little faces. But let’s get back to Coan and colleagues’ experiment.

When the woman in the scanner was holding her husband’s hand, through a little hole in the side of the machine, many brain regions involved in stress or negative emotion showed reduced activation. On some trials, the hand she held was not her husband’s but that of the experimenter, a friendly male stranger. Even on those trials, many of the same brain regions showed reduced activation. Now here’s the kicker: The brain regions that got calmed down by hand-holding (including regions of the ventral ACC, ventral prefrontal cortex, striatum, and insula) are the same brain regions that have a high density of opioid receptors! The authors speculate (and I think it’s very likely) that opioid release is what causes the deactivation of these emotional hot spots. The subjects also reported less unpleasantness when they were holding hands while anticipating the shock. And, get this, the reduction in unpleasantness was correlated with the reduction in brain activity in these hot spots.

Thanks for the opioids, dear.

Elizabeth said in her comment that she heard a lecture by the same researcher, reporting that some of the same neural calming effect was found when the person’s partner was just in the same room with them, never mind hand-holding. So you don’t need to hold someone’s hand to get opioid soothing. You just need someone who cares for you to be in the same room.

In a recent debate on this blog, I argued that a supportive group like NA makes sense as a primary treatment for addiction–not a secondary one. Certainly members of NA or AA see their group experience — with or without hand-holding — to be the most powerful antidote to their feelings of anxiety, stress, loneliness, and all the other negative variants that can lead to relapse. Now we can point to a very concrete, biological mechanism responsible for the soothing function of the group: when you are in close contact with people who care about you (even a little), your own brain releases opioids. And, in a sense, those opioids replace the opioids you’d otherwise be buying on the street.

A final word: this is not some cheap trick the brain is playing on you. Internal opioids are not like methadone maintenance. Opioids have been nature’s way of soothing our pain and our stress, for tens of millions of years of evolution! That’s why we need them. That’s why we like them. NA, and other forms of intimate group experience, help us to get them from our connections to other humans (something we’ve perhaps forgotten how to do) rather than the guy on the street corner.

That’s what nature intended.

54 thoughts on “News flash: NA groups provide opioids for members!

  1. fredt October 18, 2012 at 6:38 pm #

    The other thing the groups do are provide a social contact form of like minded people. A new safe social setting is often needed for recovery, as our old social group remain using, and are unsafe to hang with. Do not underestimate the social need, or the power of the group dynamic.

    • William Abbott October 20, 2012 at 11:32 am #

      Why are we being ni e to 12 step. Thereis some evidence it is helpful and some that it is harmful and lots that it is not effective. In my opionion it helps thosewho it helps and that isthat

      Broup support is helpful to those who dont seem to be able to do it on theri own . Choice of which of several options available is best with the individual as it itself is a motivator and sign of commitment to change and ownership of the problem .

    • Marc October 23, 2012 at 8:11 am #

      The feeling of “safety” is exactly what opioids provide, Fred. It’s ironic, isn’t it, that addicts are seeking safety both when they’re using and when they’re trying their best not to.

      William, it is be-nice-to-12-step week simply because we’re heard a lot of criticism in the past. So this is an effort to balance the books. Your comment also points to pro’s and cons. Except for that thorny issue of “effectiveness”– which seems much more complicated than I first imagined.

      • fredt October 23, 2012 at 1:46 pm #

        I mean safe as not among a bunch of users and pushers. We need to get accustomed to the low level of endorphins that we produce to feel ok again.
        And to Mr. Abbott, 12 step those who want to be helped. Few of those who walk through the doors the first time want to be helped. Many are court, employer, wife mandated. Until they honestly want to be helped and become willing to clean up their lives, the program is just a place to get their ticket punched.
        The program is useful for recognizing that we have a problem, and understanding that there is a solution. Many of the young members have psychological and philosophical issues that need to be addressed. The programs can be a wonderful resource once the newcomer loses the belligerent attitude so many come in with, and become teachable. Until then, the old members will not waste there time on explaining much to overcharged egos, so you have not entered the program. What is the failure rate of those who have truly entered the program? Many know they have one more relapse in them, but we are not sure that we have one more recovery.
        The program was there for me when there was nothing else, and we are there for those who want the program. Those that do not want it are just noise, wind in the trees.

        • Marc October 24, 2012 at 4:06 am #

          That all makes sense. And it’s very informative: I didn’t think much about the proportion of attendees who are mandated to be there. You are really saying that the program defines the “market” more than the market defines the program. In other words, nobody really knows whether they fit until they start coming back with more serious intent. And the group doesn’t know either, who will benefit–until each person starts getting serious.

          That’s a neat little formula, and it helps bring some order to the chaos that we often hear in the debate about 12 steps. Sort of like a first marriage (in this era of the 50% divorce rate). And with addicts it’s a fundamental fact that you can’t predict who will recover and when…until it happens.

        • Persephone October 30, 2012 at 12:29 pm #

          I can speak perhaps best from my own experience, fredt, on this one. My personal success rate while IN the program was 0%. Utter failure. With all due respect, I am not mere noise, nor are the others who want to fix their lives (or wanted to and did fix their lives!) without a 12 step program, and an unwillingness on the part of adherents to 12 step programs to even acknowledge the rest of us (or dismiss us with disparaging language) shows a remarkable lack of compassion to fellow sufferers.

          Apologies for seeming belligerent myself here, but this is a serious subject to me.

          **Not sure if this is an edit function or not, I just wanted to stress that I was not trying to elicit an argument with this comment, just to stress the trials and tribulations that go with taking a different route. This is one of the few addiction sites that has not degenerated into a “slug-fest”, as Marc called it earlier, and I don’t want to contribute to turning it into one.

          • Marc October 31, 2012 at 11:50 am #

            I won’t say much, since this dialogue is officially terminated (for now), but your words are compelling and your perspective is critically important. Thank you.

  2. Christina October 19, 2012 at 4:54 am #

    Dear Marc, I had written in the previous 12 Step blog that even though I found the ‘program’ dogma ultimately not for me – but I had stated that I would still send someone who wanted help to a 12 Step meeting/group…. Mainly for that ‘primary treatment’ you mention above. Many people can not go to a dual diagnosis 30-day program like Sierra Tucson, so a 12 Step program offers an immediate and convenient option that can have lasting results.
    I have a background in analytical, neuro/attachment research – Dr. Daniel Seigel, Dr. Bessel VanDer Kolk (I have an MA in Clinical Psychology and was working on a PhD in Clinical Psychology). My brain looks at the addiction as complex versus simple. The simple is ‘One Day at a Time’, ‘Sit Down and Shut Up’ – the complex was the need to understand my behavior and responses to what was had happened when I was a child, and was currently happening in my adult life.
    I needed to understand and try to ‘process’ my life experiences as an integral driving force.
    I can honestly say that I am envious of 12 Step followers that got everything they needed – Plus ‘The Miracles’!!!
    Christina

    • Marc October 23, 2012 at 8:30 am #

      Hi Christina. Yes, you did say you’d send anyone who was desperate straight to a 12-step group. And clearly this is a “simple” approach compared to the “complex” pathways provided by insight therapy. I like your idea of working at both levels, or of being able to go back and forth between them.

      It seems to me there is a commonly practiced sequence: you start with simple, until your life goes from intolerable to tolerable, and then you have the capacity to do some exploring of the complex stuff. But I’ve heard others say, in contrast, that they didn’t get anywhere with recovery until they got a good glimpse of underlying causes.

      Yet “sit down and shut up” doesn’t sound the same as “one step at a time”. If there is, as you say, a great variety of styles in AA/NA, then I would sure prefer the latter.

  3. Carolyn Kay October 19, 2012 at 6:04 am #

    I thought oxytocin (http://bit.ly/T4Bfjb) was the relationship hormone. Does it have some relation to natural opioid production in the brain?

    • Marc October 23, 2012 at 7:23 am #

      Good point, Carolyn, and good reply, Elizabeth. What Elizabeth says makes sense. Opioids go straight from the hypothalamus to receptors in multiple brain regions. So the time course may be much faster.

      The authors of the study speculate that oxytocin release is the primary cause, and that opioid release is triggered by oxytocin. I’m no expert on this, but my understanding of the “opioid attachment” hypothesis is that it doesn’t need any help from oxytocin or anything else. It’s primary. Opioids simply soothe stress–they don’t necessarily get you to feel special feelings for whomever is present. Stress reduction would then be a primary reinforcer, and thus something we seek out time and time again.

      Opioid-based attachment strikes me as simplistic, even dumb, compared to the effects of oxytocin, which is a much more complex chemical. But then again, the simplest mechanisms are often those selected by nature, simply because they’re more foolproof.

  4. Elizabeth October 19, 2012 at 8:54 am #

    Wonderful post! I like how you made this study approachable and relatable. It’s interesting to think of recovery from addiction as a transition from modulating your neurotransmitters in a very extreme way via drugs and compulsive drug use to finding a new way of self-medicating: finding those natural reinforcers that occur in everyday life and, slowly, learning to use those (e.g., social interaction, exercise, learning a new skill, etc…) as a replacement. It is what our brain is geared to deal with, not the extreme highs and, as a result of opponent-process mechanisms, compensatory lows. It just takes our brain some time to re-calibrate and become sensitive, again, to natural forms of reinforcement.

    P.S. Carolyn, I’m not an expert in this field, but you are correct. Oxytocin is also important for social bonding. The way I see it is that oxytocin is a hormone that must be released from the pituitary gland to your bloodstream and circulate to have its effects. Thus, oxytocin is likely slower acting than centrally-active opiates. It may be better at producing more long-term states of bonding, whereas opiates may be more time sensitive, if that makes sense.

    • Marc October 23, 2012 at 7:29 am #

      I totally agree, Elizabeth. See my comment above.

      The sad thing, as you say, is that we become insensitive to normal levels of opioid release. So we don’t get much satisfaction from the minimal soothing we get from other people. Clearly it’s a vicious circle. The more we use drugs, the more we isolate ourselves socially as well as chemically, so the less attractive are natural reinforcers that come from other people. So we use drugs more and more.

  5. JLK October 19, 2012 at 12:12 pm #

    Hi Marc et al

    I guess as the most experienced blogger in the group I should step in.with an opinion (Donnie response or no).

    Yes the group DOES provide mutual support from people who have been thru similar or same addictive experiences. But it is much more than what you mention.

    It IS kinda cool (for me) to find out how the brain chemicals react in this setting. But most of the guys don’t care. That is why I am here. I like knowing what is behind it all and these discussions really help. A lecture on brain reaction actually sent me to AA.But I am one in a hundred..

    Also the 12 Steps were only the beginning. What I found to be important is the fact (I believe) that once an addict always an addict “it always gets worse, never better”. So thing AA or NA can be used to get you thru the rough spots of the first 2-3 years then you can leave, to me is false hope.

    I did the Steps in early days then I focused on two things: compartmentalizing or eliminating resentments (THE killer emotion for an addiction psychology) the second is getting to my meetings early enough so I can get my usual seat on one of the couches (chesterfields to you Canucks) so I can stare at one of the pieces of calligraphy that an old (late) friend did with various Big Book pieces. This one is called the “Promises” and I use it for my benchmark to progress in my personality development, I pretty much ignore the 12 steps these days but AA offers a lot of different ways to get there. “There” as I have said before means a lifetime of sobriety and, to most a lifetime commitment to AA and its principles.

    I went in as a cynic and have come to be a cheerleader and a “true believer” I guess, in the AA route to lifetime success. I don’t proselytize BUT I am there for people that ask for help..

    And I still believe that people that use the “God Thing” as an excuse to stay away are rationalizing. IT is NOT about God. It is about a HIGHER POWER of “Your Understanding” whatever that may be. Marc’s blog has amply demonstrated that the Group itself is the REAL higher power.

    Sorry about that last…obviously I get frustrated about what I consider an “excuse” but it does segue’ with Marc’s blog perfectly.
    JLK

    • Victoria Hunt October 19, 2012 at 7:53 pm #

      Jlk-
      When you say some use the excuse of “God thing” maybe they just don’t want to join AA/NA. It’s not rationalizing, their saying “it ain’t my thang” and anyway why do 12 steppers get so defensive when the big book says all you can do is introduce them to the program, if they want to come back, they will. If not, it’s not your business. No biggie. Ones recovery is individual to them, however they define it and how they choose live it.

      PS-I have met a couple of atheists who are decade clean members of AA and their “higher power” is gravity. Also they attend one mtg a week because the program works for them and they have a active social life that is no longer consumed with constant talk of recovery, what’s sad is seeing people who have 4-5 yrs clean still hanging on by their fingernails and still attending 4 or 5 meetings a week. I say that’s a program not working. Just my 2 cents.

      • JLK October 19, 2012 at 9:28 pm #

        Hi Victoria

        You have misunderstood me. That is one of the main bitches I have against E Mail conversations. I am only referring to people that use the “God Thing” as an excuse not to try mainly because it is sheer bullshit and therefore an excuse We are used to, as I have said repeatedly, to an 80% failure rate for whatever reason. BUT the sheer size of the program means a huge amount of success. As you said Atheists (whom I consider as nutty as “Holy Roller” types) use gravity???? as their higher power. I use Rationality of the universe and the group.

        I have also said over and over “to each his own”. I can only speak to my experience and the experience of the hundreds/thousands of stories I have heard in meetings.

        I also attend just one “maintenance” meeting where I take a 95 year old retired physician who LOVES meetings on Sundays as he lost his license to drive.

        I also have never heard of a program that is more successful although they may exist. I do know a lot of “fluff and buff” programs that are invariable long term failures.

        The alternatives mentioned here are things that may “work” for a few people but not the millions (current est 2 mil) that are members of AA.
        JLK

        • Marc October 24, 2012 at 4:26 am #

          But John, how do you know that the “god thing” is pure bullshit. I’ve heard it said enough times to believe it’s not. It may be the case that in your group and many others, the “higher power” is truly left to each person to identify. But it seems that many groups DO gravitate toward a more Puritan/Christian ideal. Check out the famous Orange Papers site, if you doubt it. You and others have convinced me that there are great differences from one group to the next. So?

          Also, some of you guys (like you) continue to beat their chests about the success rates. It all boils down to statistics, and as explained by fredt, above, it simply is not the right thing for many people. The SMART recovery movement also boasts excellent success rates, sometimes far better than those of 12 step. However, like the presidential debates, these claims are just total rhetoric without clearly presented statistics to back them up.

      • Marc October 24, 2012 at 4:09 am #

        Very interesting points, Victoria. Especially about the different kinds of roles the program can play following recovery. Thank you.

    • Donnie Mac October 22, 2012 at 12:40 am #

      “I pretty much ignore the 12 steps these days ” said JKL

      That’s painfully obvious to everyone , you don’t even “pretend” to practice what you preach . Please stop this silly passive aggressive pot shot at me , it’s childish . If you have something to say to me “Feel Free” , I’m a big boy .
      Donnie Mac

      • Marc October 23, 2012 at 7:37 am #

        I don’t detect any viciousness in JLK’s comments. The one comment that mentions your name is fairly light-hearted.

        However, your words, above, are intended to hurt and humiliate. That’s enough of that. Please.

        • Chris October 23, 2012 at 2:24 pm #

          Perhaps I should stay out of this, but in the interest of civil discourse, I’ll chime in anyway.

          From my point of view, Marc, your decision to take a side in the disagreement between John and Donnie is unfair. It is, of course, your blog to moderate as you see fit, but …. if you’re going to ask Donnie not to react to John’s parenthetical snipes, in all fairness, John should, at the same time, be asked knock off the the snarky asides directed at Donnie. John’s parenthetical ‘Donnie comments’ contribute absolutely nothing to the discussion, but do serve to fuel the conflict by keeping it front and center rather than allowing it to fade away. After all they were BOTH asked to stop. I had the hope Donnie would be the adult and elect to ignore John. Parallel to it was my hope that if Donnie didn’t react, John would stop lobbing little balloons of gasoline at the fire you’ve been trying to put out for quite a while now. Both hopes may yet be fulfilled.

          One of the basic ideas of 12-Step philosophy, as someone with John’s years of experience in the program is no doubt aware, is this: In all interpersonal interactions, an alcoholic in recovery strives to keep her/his side of the street clean. Period. The goal is to avoid reaction, even if provoked, rather to continue to act in a principled manner. Sweeping dirt into the other person’s path is not part of keeping one’s own side of the street clean. This is an aspect of the Tradition of placing principles before personalities.

          • Marc October 23, 2012 at 3:55 pm #

            Chris, I appreciate your comment, and for sure I could use some guidance on this. But John’s last comment, “(Donnie response or no)” seems pretty mild compared to “you don’t even “pretend” to practice what you preach . Please stop this silly passive aggressive pot shot at me , it’s childish…” which was Donnie’s last response. I’m really trying not to take sides, and I don’t want to muzzle anyone. But… seems like one of them isn’t even making the attempt.

            I asked both parties to stick to issues and move away from interpersonal diatribes…consistent with your interpretation of the 12-step philosophy. I’d like to think that both are at least trying to do so.

            The danger, for me, is that I don’t want my reactions or anyone else’s to conflate feelings about AA with judgements about blogging styles.

      • Marc October 24, 2012 at 7:52 am #

        PS to Donnie. I recently gave JLK shit too (see last week’s post). I didn’t see his most recent pot-shot until just today. I am REALLY not taking sides. I’m asking you both to cease and desist.

        But don’t desist from commenting on this blog 🙂 I think you are both interesting and fun, and I would hate to lose either of you.

    • Marc October 24, 2012 at 4:17 am #

      I like the thought of you claiming your favourite seat, John. And you bring a humanizing flavour of the 12-step approach to the blog. I can imagine something of how it feels, now having been to a meeting, and I can see the attraction. Your comments jibe with those of fredt above.

      Also, glad you appreciate the neuroscience. What goes on in mind and brain are not exactly synonymous, but each is dependent entirely on the other. So, whether people are interested or not, it matters.

  6. Richard Henry October 19, 2012 at 6:11 pm #

    A feeling is forever from a moment in time, my inner afflictions and unresolved issues, my emotional conflicts have affected my outer actions.

    My choice in pursuit of peace and comfort have fallen short in addictions I was driven to avoid sadness and seek out rewards of happiness in all the wrong places, when all along it was right in front of me, my family.

    This post Is confirmation for me that in fact the love of those around you can satisfied the need to escape using other outside influences, like drugs and alcohol.

    To my family and friends:

    Thanks for helping me reclaim my “life for love and love for life”… for ever and ever amen

    • Marc October 24, 2012 at 4:33 am #

      Beautifully said. While I can talk about the neurochemical events the underlie feelings of closeness and safety, I realize that this is a “second language”. And all of us actually function, think and feel, in the world of human experience, not brain events. What is most fascinating to me is that evolution has provided us with the fleshy tools (a brain, its connections and its chemicals) to realize feelings like love, commitment, and attachment.

  7. Victoria October 20, 2012 at 8:58 am #

    Jlk-

    You are correct, I misunderstood. I have been in the midst of an AA convention and no one can dispute the power felt in that hall of many thousands like minds. And yes there are many ways to “recovery” and the “HOW” of it.
    And it’s definition is different for each of us.

    I am now interested in the “WHY” of addiction. The all awesome mind boggling brain. This is why I enjoy Marc’s work, as well as, others exploring the science of the addicted brain. There are as many “how to” blogs as there are _A meetings. This blog (for me) is refreshing and dares to ask us to think deeper.
    The brain is a terrible thing to waste.

    • Marc October 24, 2012 at 4:37 am #

      Yes, and a terrible thing to ignore. Our poor little brains do all this work, yet they sit alone in our craniums, packed in bone, with so little attention. I’m glad you like talking brain talk. But see my response above to Richard Henry.

      Also please see my reply above (Oct 24) to JLK…I don’t think you were entirely mistaken in your interpretation.

  8. Victoria October 20, 2012 at 9:17 am #

    Jlk

    Oh man.. I have to apologize for my short term memory deficit. I just re-read this blog entry and your comment. I see you are interested in the science too and well…Marc did say this was week 2 of “b nice to 12 step….”

  9. AnonymousRon October 20, 2012 at 10:43 pm #

    I have attended 12 step meetings for some time and have seen numerous people recover there. I have also seen people die that did not “get” the program.
    Most recently I have been drawn to research other non-anonymous programs. The group dynamic seems to be the consistent theme in all of these addiction recovery.

    From the original Native American
    circles, through the Washingtonians of the 1840s, the fraternal orders
    of the late 19th century, the Keeley Leagues of the early 20th, Alcoholics
    Anonymous in the mid-20th century, and many others, underneath
    all kinds of different paintwork and ornamentation, the core
    concept is the same: bring people together. Samson Occom (the Mohegan
    abstinence leader), John Hawkins and John Gough
    (Washingtonian orators), Nathaniel Curtis (Sons of Temperance),
    Leslie Keeley (Keeley Leagues), Bill W. and Dr. Bob (Alcoholics
    Anonymous), Jean Kirkpatrick (Women for Sobriety), Charles Dederich
    (Synanon), and many others – no matter their culture, creed,
    or treatment technology, they were all convenors. (White 1998)

    They all brought people together with a common purpose- to support one another.

    I believe that there are many roads on the path to recovery. The sooner we can agree not to disagree, but to practice unconditional acceptance; that we are not all the same. The more efficient we will be at matching people with the appropriate treatment.

    Keep it up Team Addicted Brain! Spirited discussion is a great tool to help us look for better answers.

    • Marc October 24, 2012 at 6:59 am #

      Hey, I wish I could frame this. I’m used to thinking of the togetherness aspect as an extension of the “therapeutic alliance” idea in psychotherapy. Apparently there is no brand of therapy that’s consistently found more helpful than the others. Whether it’s psychoanalytic, CBT based, Gestalt, humanistic, emotion-based, behavioural, or whatever, the greatest predictor of treatment success is the quality of the therapeutic alliance — which just means the quality of the mutual trust and connection between therapist and client.

      Your comment makes me think of another, related, idea. The group as something that is more powerful than an individual alliance, or which at least has a different kind of power. I think of the American Native sweat lodge, gospel-based churches with their amazing choirs, Iron John’s groups of “liberated” men howling at the moon, and of so many other group-based practices, some which go way back in time. I wonder if the group helps redefine the world, not just the individual. You can be a new kind of individual in a world that works, and feels, like this.

      • AnonymousRon October 25, 2012 at 1:13 am #

        In the street vernacular, “get in where you fit in.” Whatever group that fills the sense of belonging to something or someone will do just fine.

        Lets take a little liberty with your choir example. We do our individual ‘practice’ (with the therapist or ‘tuning’ ourselves). We come together with the rest of the ‘choir’ and as a group we perform in ways we couldn’t on our own. Our efforts, actions and attitudes carry forth in waves to the rest of the world. Yes, we are redefined in a world that makes sense and the world is affected by our actions towards and connections with the world.

        The old saying, “There’s power in numbers.”

        I believe evolutionary psychology can tie together our need for groups from an original survival and safety function to our present day need for emotional security and self actualization. This instinctual need creates a dichotomy in Western society. We are told to be self sufficient, but at the same time our brains have a need to embrace our interdepence.

        Plenty of beautiful choirs are waiting to sing!

  10. Gray Lindsay October 21, 2012 at 5:44 am #

    Thank you all, for your comments. My favourite blog site.

    • Marc October 23, 2012 at 4:00 pm #

      Great to hear!

  11. Roger G. Albert October 21, 2012 at 6:43 pm #

    Fascinating, Marc. This adds a neuro-biological dimension (I always knew it was there) to our understanding of the human propensity to sociality. We need other people, literally for our survival. Norbert Elias argues that contrary to our perceptions and everything our societies tell us, self-directed, self-generated (sui generis) individuals we are not! We are societies in and of ourselves, incapable of existence outside of the group, interwoven and interdependent generationally, politically, and whichever other way we can think of. Churches must be just as good at generating opioids in us as AA or NA meetings. The ‘collective effervescence’ (Emile Durkheim’s term) experienced in church services must be enormous. Of course, the same can be said for attendance at football, hockey and baseball games, at the gambling tables and at the race track. Oh, we are little opioid sponges, that’s for certain…and we get them where we can.

    • Donnie Mac October 22, 2012 at 12:23 am #

      Churches have sobered up more people than all the 12 step organizations could ever dream of .
      Great Post !

      • Marc October 24, 2012 at 7:05 am #

        Hi Donnie. Still friends? I wonder if churches and 12 step groups work on very similar principles. At least there is a common feeling of “belonging” that brings people together and allows them to trust each other. See AnonymousRon’s comment above and my response. But I guess there’s a big difference: churches follow the principles of a leader who subscribes to a particular dogma, AA groups follow a dogma, but there is no identified leader. Still, I guess either can help a lot of people…and turn off plenty of others. So you end up with those you attract, and the rest don’t matter.

    • Marc October 24, 2012 at 7:18 am #

      Hi Roger, I just pasted your correction into your original comment and deleted the post-script. Just a hint of my ENORMOUS POWER.

      Yes, most of those groups would generate the endogenous opioids. Also see Anonymous Ron’s historical summary, above. Some of the groups you mention are also riding on waves of norepinephrine (a chemical closely related to adrenalin, but for brain cells only). And gambling only gives you your opioids AFTER you win. Before that, you are a hapless victim of too much dopamine. Which means you are so goal-directed that you can’t think of anything BUT your goal.

      Different types of social groups, much like different types of drugs, can each deliver up a specialized cocktail of neurohormones (viz neurotransmitters, neuromodulators). That is the only way our brains can realize the FEELING of value, connectedness, belonging, and achievement.

      I also think of the debate about where the mind is located. I agree with you and Elias that the mind does not reside IN the brain, it resides in our social relationships.

  12. Donnie Mac October 22, 2012 at 1:25 am #

    AAakkkkk I can’t take it anymore ! I’m just plain old to lippy ! This may also explain why women go to the bathroom together as well . As you know I am not a Doctor (nor do I play one on T.V)
    and with a rudimentary ( very rudimentary ) understanding of brain chemistry I have come to understand that opioids are also released by “Smashing your head against a wall ” . I was wondering if anyone has correlated how many times I must “Smash my head ” to equal the amount of Opioids produced in a “Meeting ” because that’s what I’m willing to do at this point .
    Thanks
    Donnie Mac

    • Marc October 24, 2012 at 7:25 am #

      Excellent point. Why is it that opioids are delivered both by pleasure and by pain? It sounds so contradictory. Yet the answer is simple. Opioids probably evolved to help animals keep from dissolving in the face of pain, stress, or fear. So its main function was to deliver relief. When you think about it, how different is relief from pleasure? Hard to say. Food tastes a lot better when you’re hungry, and togetherness feels a lot better when you’ve felt isolated. I think the brain “retrained” itself to use opioids for a function that was broader than its original function — for a general feeling of satisfaction and comfort and, yes, pleasure. Evolution is highly economical that way.

      Still, smashing your head agains the wall has some unfavourable side effects, which might be why you still go to meetings?

  13. Jordan O. October 23, 2012 at 4:01 pm #

    Marc, I have found your recent exploration of the 12-step environment to be heartening and uplifting. I have worked in adolescent addiction rehab programs (outpatient and inpatient) for the past 6 years. When I began participating in group outings to the NA nooners, I arrived with my skeptic’s hat firmly in place – I had heard tales of the turbulence and God-invocation common in the meetings. The line “we had sought help through psychiatry etc. and found that none of these were sufficient” always struck me as being somehow defiant or antagonistic, expressing a bias against medical or evidence-based treatment approaches.

    Since these early experiences in the rooms, I have felt my mind open up (always a pleasant sensation). I see no value in us-versus-them, for/against type mentalities when it comes to NA, AA and the like. I see NA’s potential as both a primary route to healing (for some if not all), and as an extremely useful adjunct to other forms of treatment. I personally prefer an eclectic approach that incorporates each individual’s unique character. The overwhelming aspect of NA, in my view, is their willigness to accept anybody, in any condition, providing they have a desire to heal. I am always struck by the warm welcomes and nonjudgmental stances of the committed individuals who greet our young people, many of whom are experiencing these meetings (and feelings of acceptance?) for the very first time. I fully agree that the sense of empathy and community is palpable.

    Hey Donnie and John – your exchanges are amusing and pretty typical of the more heated conversations that occur in meetings, but I think you’re stressing Marc out. 😉 I love reading this blog but the personal stuff is a little smelly, how about we keep it constructive?

    • Marc October 24, 2012 at 7:38 am #

      Yes, those guys stress me out a bit, and I have no recourse to opioids these days, except of the home-made variety. Thanks for that remark!

      The “mind opening up” experience you describe is very similar to how I felt when driving away from the NA group in Peter’s car, through the misty lands somewhere between Manchester and Liverpool. I had resisted group-based treatment when I was in the throes of narcotic addiction, for the reasons you and others have mentioned, and I still felt skeptical and dubious. Now, that whole slate of premises was dissolving around my ears. So I got a meta-dose of acceptance. The acceptance of the group, now clear to me, and my acceptance of that process as quite wonderful.

      We are left with the strange dichotomy between the non-judgemental stance that’s at the heart of many 12-step groups, and of the program in general, versus people’s continued sightings of judgment, exclusion, and isolation by the group, especially when you fail to remain clean or sober, or else when you show a little “attitude”. Not to mention the recent slug-fest on this blog.

      I guess the simple answer is that people aren’t perfect, and being non-judgemental is an ideal that is just so hard to achieve when the stakes are high and the emotions run rampant. So we try for it, and sometimes we get it and sometimes we don’t.

  14. JLK October 25, 2012 at 12:13 pm #

    HI Marc

    I know the “God Thing” as you frame it is NOT “pure bullshit” mainly by experience. I have been to more and more varied meetings than all of you put together…I can tell by the answers. One meeting does not tell you much but it’s a start.

    As I said there ARE meetings where the “Puritan” (Puritan? isn’t that a little old fashioned like 400 years?) gravity pull as you put it does happen but those are ONLY for people with that kind of bent anyway and are very much (at least in Portland) in the minority. We have 450 meetings of various kinds to choose from. Some I like some I don’t.

    My fellow members in 95% of meetings I attend are not that way and even guys with 25 years or more are not that way. Some mention God in their lives but VERY briefly and it is very inoffensive to the rest of us who are not believers.

    Speaking for myself I will ALWAYS have a problem with the Divinity of Christ even after 10 years 20 years whatever..

    And BTW what is with this big deal about the God Thing anyway. I have never understood people who are so closed minded/ideological whatever to be oh so sensitive about anyone mentioning “God”. I have no personal problem with organized religion (even Mormonism) as it has helped many people in their lives. Faith is not a crime or a moral failing. As long as they don’t proselytize I have no problem.

    My shrink (he also believes AA is the only way as do all the area treatment centers less one) showed me one of these “alternative programs”. It was hilarious…it was called “Progression Malibu or some such and showed pictures on their site of expensive boats, houses, ocean views etc. They also claim to NEVER mention the “God Thing”. I will bet dollars to donuts 30 days there of “fluff and buff” cost at least 50 grand.

    JLK

    • Chris October 26, 2012 at 10:15 am #

      John – I can’t speak for anyone else, but I can say for myself that I have no problem with anyone whose recovery includes the requirement they rely on their ‘higher power’ for it. More power to them. Whatever it takes for people who are constitutionally unable to recover under their own steam is okay with me.

      What I do find offensive is the arrogant assumption that anyone who uses other support systems is somehow in greater danger of relapse or wasn’t really addicted to their substance of choice in the first place. Jim Christopher, the founder of SOS, has been sober since the early 80’s. Marty Nicholas, a former member of SOS and one of the founders of LifeRing Secular Sobriety, just celebrated 20 years of sobriety. SMART Recovery® has hundreds of meetings all over the United States and in other countries and has been a recovery resource since it split off from Rational Recovery® in the early 90’s. The number of people in recovery outside the rooms of AA has been growing steadily for several decades. Meanwhile AA membership has been essentially stagnant since the turn of the millenium. I see a trend; you do not. Time will tell.

      Every person escaping addiction faces a huge challenge. It requires major changes in lifestyle, thinking patterns, and emotional responses. The 12 Steps are one valid way a portion of addicts facilitate those changes. There are many other ways equally as valid.

      Peace out, brother. Congratulations on your recovery. It really is something quite special. May it continue for the remainder of your life.

      • Marc October 26, 2012 at 11:01 am #

        Amen!!! (no Higher Power intended).

        Someone had to say that in no uncertain terms, and you just did.

        Let me add that “fluff and buff” is a ridiculously over-inclusive label as you, John, use it. Sure, some recovery programs are bunk, and expensive. But you can’t believe that all alternatives to AA are “fluff and buff.” I think that is not only inaccurate but also insulting to many hard-working, dedicated, and effective treatment providers as well as the people they help.

  15. Chris October 26, 2012 at 9:37 am #

    What timing! The lead article in The Fix this morning is titled “Do the 12 Steps Belong in Addiction Treatment?” (http://www.thefix.com/content/do-12-steps-spirituality-effective-addiction-treatment8221) The author’s (Maia Szalavitz) premise: “… opposition to the inclusion of 12-step work in rehab …” and ” … insistence that medical experts—not people in recovery—be in charge of addiction care that gets insurance or government reimbursement.”

    She does a better job articulating her case than I would, so I’ll let those interested read the article rather than mangle the subject. While acknowledging the value of ‘spiritual exploration and growth’ in the recoveries of *some* addicts, she lays out the reasons why going to meetings and praying should not be medically reimbursable expenses.

    One last quote: “Nor do I think discussions of spirituality have any more place in professional addiction treatment than they do in psychological counseling for depression or other disorders. If someone wants to explore their relationship with a higher power, there are plenty of places outside the medical system that can help with that … As in cancer care or in hospices, pastoral care should be an adjunct to treatment for those who want it, not a substitute or requirement.”

    • Marc October 29, 2012 at 8:39 am #

      Thanks, Chris. I finally got a chance to read the article in The Fix. It certainly does fit the present debate.

      For one thing, the author is pretty clear that the “god thing” is not some occasional mutation that only a small number of 12-step groups are infected by. It is central to the 12-step philosophy. Fair enough.

      But I have a real problem with her assumption that addiction treatment must EITHER be based in medicine or in religion. She says, treatment should be in the hands of doctors, paid by insurers (for those fortunate enough to have insurance in that backward country)….RATHER than in the hands of Christians. I don’t see that it should be in the hands of either.

      Only if you buy the disease metaphor heart and soul does this argument even begin to sound rational. And there’s enough evidence now to show that addiction may be LIKE a disease but it isn’t really a (medical) disease in the normal sense. There is no necessary change to any organ, except the brain, which happens to be designed to change in structure. Only when medical detox is necessary should doctors be in control, in my view.

      The author does see the value of “social” elements in the treatment process. I should hope so. We have heard a lot, both from inside and outside the 12-step community, about the value of the group, especially fellow recoverers. That’s more than just “social” as an adjunct to real medical treatment. It may well be the centerpiece of any successful treatment.

    • nik October 30, 2012 at 5:19 pm #

      Chris, thanks for the link Maia S wrote a good article, to which I’d respond as follows

      ===

      Maia seems quite good on a number of points: She gives persuasive arguments on three questions: 1) Should medical insurance pay for interventions with a strong ‘spirituality’ (e.g. prayer) component? 2) Should any professional treatment *force* spirituality–some spiritual or religious practice– on the subjects. 3) Is addiction, uniquely, or specially related to ‘spiritual’ problems’. Her answer to all three, is ‘no.’

      That said, she seems most unclear about some basic issues. Is addiction a mainly medical issue? Should medical persons be the main ones in charge? Generally, which problems are, according to her, ‘medical’ or a mixture of medical and spiritual?

      MS //Nor do I think discussions of spirituality have any more place in professional addiction treatment than they do in psychological counseling for depression or other disorders. If someone wants to explore their relationship with a higher power, there are plenty of places outside the medical system that can help with that,[…]

      Of course, with data increasingly showing that meditation and exercise can be effective in dealing with multiple psychological problems, I see nothing wrong with programs that incorporate these powerful tools into treatment: indeed, I think they should be encouraged.//
      ——

      Well, taking the case of depression, aside from the more extreme cases, is it a medical condition requiring medical treatment? Is it, to use the well known analogy, like having diabetes? She herself alludes to evidence that depression may be helped (cured?) with meditation (though
      of course she wants meditation to be an adjunct). She does not mention, on the other side, that treatment of mild to moderate depression with SSRI’s (a main weapon in the medical armament) is often no better than placebo (Fournier, 2010)

      http://jama.jamanetwork.com/article.aspx?articleid=185157

      What would it say about diabetes as a ‘real disease’ if the doctor-recommended insulin therapy generally did NOT work better than placebo, yet meditation sometimes remedied it?

      In a word, problems of living, which Maia mentions several times (despair, meaning of life, ‘bad habits’) may well best be conceived in a social framework, and dealt with as such. She mentions this, but as an added dimension (to a medical condition). But in fact it may be the major
      and essential dimension, as a number of researchers have suggested, for example, Lawrence Stevens. http://www.antipsychiatry.org/abolish.htm

      (One makes exceptions for extreme cases, where there is demonstrable neurological disease, e.g. Alzheimers.) I agree, then with Maia that there is no reason to single out addiction as especially linked with spiritual (basic life problems) matters; it’s in the same boat as depression or alleged ‘personality disorders’ (e.g., ‘dependent personality’).

      Psychologist James Hillman has written extensively on the misuse of a ‘therapy’ approach to life problems, modeled on medical diagnosis and intervention. http://www.scottlondon.com/interviews/hillman.html

  16. nik October 26, 2012 at 11:46 am #

    Hi Marc,

    I read your latest blog entry and liked it. One question that occurs
    to me, in connection with the catchy title. How does the level of opiates (in the neurons or their links) in hand holding compare to that from a medium sized ‘hit’ of H? Is it a factor of 100? 1000? 1,000,000?

    By the way, in connection with ‘be kind to 12-step groups– the
    friendship and support is certainly there in lots of cases, so say
    lots of people. Yes, let’s be kind. They are a way, for many.

    The downside, however, includes stuff like, 1) being cut off when the
    recovery falters, and in particular 2) some having the sense of failure
    when perfect ‘sobriety’ is violated, leading in some rare cases (I have this, second hand) to suicide. That’s the downside, for some, of the Higher Power as they conceive ‘him’– ‘He’ may be mightily peeved at fallings short (cashing out as, “I’m going straight to hell”).

    3)gaining a substitute compulsion in place of the old addictive one.
    For food, for example, going to meetings once or twice a day, calling a sponsor when tempted, daily check-in, etc. I pick food, rather than,
    say, cocaine, because maybe for some drugs, it’s clearly preferable to
    be going to lots of meetings ‘compulsively’, as opposed to being dead.

    4)failing, in some cases, to address underlying problems, where there are some. The 12 steps seemingly address moral failings (e.g. lying) and surpassing them with ‘Higher Power’s’ help. Issues such as childhood sexual abuse may not be addressed. While there is no ban on outside therapy, there is also no requirement of it. So a person may complete an AA program, stop drinking, but remain depressed and, for example, sexually disordered (either reclusive or acting out) because an underlying problem was not addressed in AA. The person must find another 12-step meeting: So to say, one for each symptom.

    This last blog thread was extremely successful, in my opinion.
    Congratulations. It’s good too that John is floating a 20% recovery figure, though it clearly applies to those who can make (and do make) considerable investment, e.g. coming for a year.

    One thing I’m becoming informed, indirectly, a bit about one Canadian (Toronto) organization, Bellwood Health Services, a commercial quasi medical enterprise, (15K for 3 week live-in treatment) I’m sure you’ve heard of. They claim success rates of about 70% or better for both substance and other (“S,” eating, gambling) addictions; again, for those admitted to, and having completed some of their programs.

    http://www.bellwood.ca/why-success_rates.php

    These are, apparently ’12-step’ in essence, based on their suggested readings. I have no reason to doubt that many people are happy to have succeeded in their programs (stories posted on their website).

    I believe, also, there is a demand, in their “S” programs [and others?] for ‘total abstinence’ (analogous to AA, in other words). For sex addiction, this would mean, at least on a temporary basis, i.e., 3-5 months, no sex of any sort, including masturbation or intercourse with one’s spouse. I’m not sure if there is any published evidence supporting this particular feature, though of course, the overall success, as in their report, suggests that at least some ingredients are ‘working.’

    • Marc October 27, 2012 at 4:32 am #

      Thank you for a very informative comment, nik. Your inventory of the potential pitfalls of 12-step programs seems comprehensive and fair. You also give them credit where credit is due, and this kind of balanced viewpoint is commendable.

      As for your question — trying to compare the opioid levels provided by interpersonal touch, e.g., hand-holding, with those provided by a hit of heroin — I have no idea. I can’t even imagine how you’d measure such a thing, since there are opioid receptors all over the nervous system, from the spinal cord up to the prefrontal cortex, and the stomach as well. So opioid metabolism will depend not only on how much but also on which receptors are activated. But ok, a rough guess based simply on my personal subjective experience: about 1 to 1,000. Clearly we don’t need the 1,000 to feel ok.

      These days I notice a “rush” that I’m sure includes opioids when my 6-year old sons hug me. One of them leaps on me and buries his head in my chest, every morning before school, hanging on tightly and making sweet sounds. That really feels fine.

  17. JLK October 27, 2012 at 10:07 pm #

    Hi Marc

    Good answer. As I was talking to the guys at a meeting today about our ultra long and ultimately useless arguments (in other words talking past each other) they told me it was useless anyway.

    Everyone has their own beliefs and as the 11th of the 12 Traditions tells you don’t proselityze but allow people to discover us as the “last house on the block”. When you hear hundreds of the kinds of stories I have heard from the “low bottom” people you wonder how else you can do it. It is hard to believe, but I could be wrong.

    The last comments I will say about it are two things:
    1) the “God Thing is an excuse because it is NOT about the “God Thing”
    2) Even if the numbers are stagnant we still have as many meetings per week in Portland alone than the alternate program you mention have in the WHOLE COUNTRY. Wherever you go…even Asia… you can go to a meeting. Just check the Headquarters website and you will find it. I know…I have been to them myself.

    Good luck to you all in your “alternatives”… AA works for me and I will hope that some will “Investigate prior to rejection”.
    With that I am done

    JLK

    • nik October 28, 2012 at 12:09 pm #

      Hi JLK,

      You said, “Good luck to you [ML] all in your “alternatives”… AA works for me and I will hope that some will “Investigate prior to rejection”

      Let’s be quite clear, here, who is rejecting or calling into question, prior to investigation, collecting of evidence, weighing it, and so on. Based on your postings, it’s you.

      Your position is like that of a Cardinal in the catholic church who says, “If you want to know about the Catholic church, talk to me. And no, I don’t know of
      any systemic problem related to the all-male, celibate priesthood.”

      As far as I can tell, your sample is longterm attenders and some of those who’ve dropped out, of whom rumors have come to you, of failure,
      destruction, and death. To look at the issue of alcoholism recovery you would have to look into the following categories of heavy “addicted” users defined objectively (amount of intake, effects on own life, attempts to quit). In other words, one can’t just look at those among the extreme cases who declare their lives to be ‘unmanageable’ AND who start attending AA meetings regularly.

      Successes and failures among….

      1) Persons who are never come to AA, but seek alternate treatments.

      2) Person who never receive treatments and just stop or ‘age out’.

      3) Persons who attend a few AA meetings and ‘disappear’.

      4) Persons who, having attended regularly and entering ‘recovery’, continue to attend infrequently yet maintain recovery. (i.e. NOT as recommended and said to be necessary to maintain recovery).

      Looking at all such persons is required to judge ANY approach (CA, NA, OA, etc.), to any population, including other ‘addicts’ of all kinds and varieties.

      =====

      I don’t fault you in particular, since those who state the virtues and successes of various treatments (patients at clinic X, or the directors of that clinic) typically have failed to collect and produce good data.

      **Hence the many unknowns in addiction treatment.**

      It does seem a priori unlikely that all problems in addiction treatment were solved by 1939, with practices described in the first Big Book.

      Again, on the issue of evidence, the number of AA meetings in Portland or worldwide is not really proof as to effectiveness. There are a number of worldwide organizations, such as Oxfam, Berlitz schools, McDonalds, the Church of Scientology, the Catholic Church, and the Baptist denominiation. Some of these popular services and products may be good or benign, others, of no particular benefit (compared to alternatives), and some, malign in influence. And this is not something that could be determined by focusing on satisfied insider persons and ‘happy users’ of the product or service.

  18. JLK October 28, 2012 at 12:29 pm #

    Jesus Christ I can’t even mea culpa to you people (especially nit-picking Nik or JLK -hating Donnie) without a snide answer!. Haende Hoch! Ich habe kein waffen!!! Gimme a break. (Now I suppose someone will take exception to my German grammar)

    Just quit telling me how oh so well informed you are and oh so stupid, (or whatever it is you are trying to get across) I am. I am sick of it. To me it’s not worth reading as it is the same thing over and over and over. I apologize. I am sorry…. I am prostrating before your superiority on the subject. Is that enough?
    JLK

    • Marc October 29, 2012 at 8:14 am #

      Yes, that’s enough!!! Time to move on.

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