Next step: The subtle but essential psychology of addiction

Hi all. I’ve taken a little break from blogging. The final send-off of my book manuscript gave me a chance to catch up with email, reading, and some other writing projects. I even sneaked in a novel. It’s called The Humans, by Matt Haig. I picked it up at an airport bookstore on my way to Budapest, where I gave a talk at the International Conference on Behavioral Addictions. Beautiful city, great conference, and a really engaging novel: it’s about an alien who comes to earth on a mission to kill a math professor whose discovery threatens the entire universe. Humans might now acquire the technological capabilities to wreak havoc on a cosmic scale. But against his better judgement, he actually learns to like us, and before long he wants to be one of us. Sweet, funny, and often wise.

Anyway, I’ve thought about where I want to go next in blogging. I want to move on. Through this blog and my writing, I’ve arrived at a place in my own understanding of addiction which I think covers the basics, so to speak: the neural, psychological, and experiential elements that converge in addiction. I’ve shared all this with you: the neuropsychological basis of craving, the cycle of seeking and losing that accelerates learning, the narrowing window of desire and attention and its biological foundation in the dopamine system, the critical importance of self-narrative, of connecting desire with a self-defined future rather than remaining stuck in the present. And all the rest of it.

This leaves me with the sense of having built a good solid foundation for a model that makes addiction comprehensible without shovelling it into a pat category — like disease, or choice for that matter — and filing it away for the experts to dissect.

But there’s a lot farther to go. I want to build more floors onto this model. I want to make it as big, comprehensive, articulate, balanced, and realistic as possible, using the tools I know: psychology, neuroscience, others’ experience, and my own self-honesty.

headmessfreudI think the next level has to do with the way we talk to ourselves — the running dialogue or monologue through which we organize our thoughts and orchestrate our feelings. The hells and heavens we create for ourselves in imagination and reality. We all know that drugs and other addictive substances and acts can have tremendous appeal, or they can feel like relentless attackers. We sometimes pursue them even while we revile them, and sometimes we shun them even when they call to us in their sweetest voices. Our ruminations, our internal rebellions against real and imagined authorities, our construction of plans, limits, goals, and rules all have a great deal to do with whether, when, and how we pursue these angel-demon entities. Whether we remain addicted or break free.

on the couchI think these psychological processes are critically important for understanding addiction in a more detailed, more intimate, and more realistic way. And I think we can access them, bring them into the daylight of examination, and work with them — in ourselves, our loved ones, or our clients — in order to gain mastery over addiction.

So that’s where I want to go and I want to bring you with me. We learn a lot from each other. We’ve graduated from Kindergarten; now let’s move on.

41 thoughts on “Next step: The subtle but essential psychology of addiction

  1. Jacquelynn Hanke March 30, 2015 at 9:07 am #

    I just want to thank you. My name is Jackie, I’m from Texas. I’ve been a nurse going on 16 years and for the last 6 I’ve been addicted to opiates. Its caused me to loose my marriage, I have a criminal record now, and almost lost my daughter. Since May of 2014 I’ve been completely clean, but wow the changes our bodies and mind go through. I read your book Addicted Brain and it hit home for me. I’ve been educating myself with as much information as possible to understand what and why I feel the way I do, what to expect next in this journey.

    Waking up after a long time of being in a haze is a high all in itself and I’m obsessed with learning more. The US views addiction in a totally different way that I cant wrap my head around their tough love policies. I’ve been to 2 different rehabs (one was Scientology,a horrible place) that I feel my parents completely wasted their money on.
    I wish I would of heard about you a lot earlier.

    Mostly I want to tell you thank you and that I appreciate you sharing your experiences and knowledge. Any material or tools you feel may be helpful in this “recovery process” would be greatly appreciated. I can’t wait for your new book to come out and thank you for all your wisdom.

    • Marc March 30, 2015 at 9:44 am #

      Thanks so much, Jacquelynn. I get a serious rush from the feeling of helping. A lot of us do, which is why a lot of former addicts end up helping other addicts become former addicts. I’m a member of that club, and it sounds like you are too.

      So let’s proceed and see what we can discover…about how we can so easily choose that oblivion that obscures so much beauty and value.

  2. Gary Goodwin March 30, 2015 at 9:15 am #

    Hi Marc…

    Just wanted to say congrat’s on the completion of your book and I hope you enjoy more time with your family after your hard work, dedication and sacrafice.

    Being compassionate is a driving factor as well as having support from those close to you.

    I’ve sincerely enjoyed the blog and as reflective mirrors the bloggers have helped me to see myself a bit diffrent than I could have otherwise which is enlightening.

    The demensions of a blog are much different than a book and isn’t defined from cover to cover but tends to be more of a living entity in its shape, form and direction.

    Once you discover that you are your own authority change really is an inside job!~

    • Marc March 30, 2015 at 9:49 am #

      Hi Gary. Well spoken! Yes, a blog is a completely different entity — a brand new phenomenon in our rapidly evolving culture. I love that fluid, dynamically self-defining feature you mention. It’s sort of like diary writing — I just picked up a book full of diary snippets from the last few centuries — but instead of just writing to yourself you are sharing your thoughts with many others, and they with you. Yet it flows and mutates in a similar way, and it continues to be coherent only be virtue of being true to itself. It pulls for honesty, like a diary does. Except that blogs also pull for intimacy and even consensus among people who have never met. It’s an amazing thing.

  3. Richard March 30, 2015 at 9:28 am #

    Thanks Marc for sharing with us all your posts.

    I have learned a lot, and along with all my other readings from professionals on addiction and substance abuse, I have come to a better understanding of the bigger picture.
    From self trust, to envisioning my future self, a place I catch up to all the time.
    It’s always a better place then where I have came from.
    If I have learned anything it’s that I still have a lot to learn, everytime I get one of those aha moments, I get so excited and just want to share it with everyone.
    Thanks for giving me those moments.
    I just finished a online Smart recovery course and am look forward to facilitating a meeting here in the Ottawa area.
    Respect Richard Henry

    • Marc March 30, 2015 at 9:52 am #

      Hi Richard. That’s very good to hear. You are an amazing fellow. I’m glad you got into SMART and are helping to bring it to our part of the world (yes, I still see myself as home-grown Ontario). And those “aha” moments — we are basking in them as they come flying in from all the contributors here. What a cool thing that is.

  4. Denise March 30, 2015 at 9:32 am #

    Hi Marc, It’s good to hear from you again… 🙂 Reading now that you want to focus on the psychological piece, the inner dialogue/monologue, etc. makes me feel like we’ve graduated from college (or post-grad) and are going back to kindergarten. I say this because coming from the psychological perspective myself, I’ve learned so much from you about the neuro-psychological piece, and my hope has been to somehow move on from there. Maybe what this means, and what you’re saying, is that the next step is somehow combining the two perspectives. Or it means answering this: if I understand that my craving comes at least in part from my brain chemistry, then no matter how well I may understand my inner dialogue I still can’t not be addicted, what hope is there? I’m at a point where I understand a lot but remain confused. I look toward folks like you to straighten things out for me (no pun intended). Thanks. Denise

    • Marc March 30, 2015 at 9:39 am #

      Hi Denise. We are definitely NOT going backward. Just because we focus on psychological issues doesn’t mean we forget about the brain. Don’t forget, every time you have a thought, a wince of discomfort, a flash of insight, or a moment of raw despair there is an avalanche of neural activities at the same time. And vice versa: there is no biological event (at least in the limbic system and above) that doesn’t have a psychological correlate — at the same moment! — if we’re tuned in enough to notice it (and hopefully not be overwhelmed by it).

      I know what you’re saying, but to paraphrase a frequent critique of brain-based approaches: biology does not equal destiny.

      • Suzy March 30, 2015 at 12:59 pm #

        In terms of our inner dialogue, there is some research being done on self-narrative as it relates to addiction. I haven’t looked into it much, a local psychologist mentioned this to me. I think the term used here is “narrative” which could inform part of your study if it hasn’t already. I am sure it varies though as terms do in emerging science. When we argue between biology and conscious (or subconscious) control we may forget that one affects the other. Our thoughts affect our biology. It can be hard to remain calm and consider all of the data when we are so passionate about this!

        • Marc March 30, 2015 at 2:08 pm #

          Hi Suzy. Narrative is hugely important. Self-narrative takes up a large part of the last chapter of my book. The trouble is that brain science isn’t nearly advanced enough to capture the subtleties of thoughts, intentions, and associations as they appear on the screen of our minds. So we might have to leave the brain behind, at least for now, in order to catch up with the subtleties — or not so subtleties — of our experience.

  5. William Abbott March 30, 2015 at 10:03 am #

    Welcome back Marc– I for one have missed this

    YOu have struck a chord with me in my intention to understand and promote understanding of this globally horrendous problem

    The word is CONVERGENCE. The convergence of factors including biologic( neuroscience) and the psychology of mind function, and environmental – maladaptive interactions of self with surrounding circumstances .

    The message here is the danger of getting lost in the massive impetus in the US at least towards Nora Volkows narrow claims of disease of the brain

    • Marc April 6, 2015 at 5:57 pm #

      Hi Bill. Convergence is certainly the name of the game. Sally Satel, Carl Hart, Gabor Mate, and recently Johann Hari are all moving in the same direction. We can’t forget about the biology just because we want to catch up with the psychology, sociology, and even the politics of addiction. But we don’t have to remain stuck in the biology either. And yes, I agree, the US in general, and Dr. V. in particular, sometimes get hung up on normative thinking — good vs. bad, disease vs. cure — at the level of cells and nerve pathways, where it often doesn’t work.

  6. Beth@WeightMaven March 30, 2015 at 11:35 am #

    How timely … I came across Milton’s quote “The mind is its own place, and in itself can make a heaven of hell, a hell of heaven.” this past weekend and was struck by how it resonated wrt addiction. Looking forward to your book (not soon enough!) and your new thoughts here.

    • Marc March 30, 2015 at 2:09 pm #

      Lovely. Exactly so.

  7. Jeff Skinner March 30, 2015 at 11:36 am #

    Congratulations on your graduation from The Lewis School of Addiction Studies with a shiny new PhD in Cross Discipline Synesthesia.

    Your diploma is in the mail.

    • Marc March 30, 2015 at 2:10 pm #

      I try to keep an open mind.

    • Matt March 30, 2015 at 6:24 pm #

      Is that where I can get into that Johns Hopkins study where they feed psilocybin to experienced meditators….??

      • Jeff Skinner March 30, 2015 at 6:53 pm #

        Yessir. Shrooms with a view.

        • Marc April 6, 2015 at 6:00 pm #

          Shrooms with a view. Love it.

  8. Doug anderson March 30, 2015 at 11:50 am #

    An interdisciplinary approach is the hardest to do, but ultimately is the only way to shed light on a complex issue like addiction. We can refine the definition of disease to match the current definition of addiction using taxonomic parameters or use a multidisciplinary approach to nail down what addiction is and how to effectively treat it. Currently, some people never respond well to any treatment and others respond to simple snake oil like treatment. One can only conclude that we haveno idea what we are doing, and that won’t change untill we fully understand the pathopsycobiophysiology and uncover something that is pathopnumonic.

    • Marc April 6, 2015 at 6:05 pm #

      You lost me in the last sentence. But I’m with you till there. Through hundreds of millions of dollars of painstaking research we’ve found the placebo treatments work as well as the most sophisticated antidepressants for many subcategories of depression. Snake oil works wonders when it’s delivered with care.

  9. Valeria March 30, 2015 at 1:18 pm #

    Hi Marc,
    welcome back!!!
    Any news about addiction at the International Conference?

    • Marc April 6, 2015 at 6:07 pm #

      Hi Valeria. Lots. I haven’t even re-read my notes. But the most interesting thing for me was having Kenneth Blum (the guy who invented reward deficiency syndrome) tell me exactly what was wrong with my talk. A few others just turned a bit pink and walked out early.

    • Marc April 6, 2015 at 6:12 pm #

      Sorry, here’s the link, with a downloadable file of all abstracts: http://icba.mat.org.hu/

  10. Kevin Cody March 30, 2015 at 2:18 pm #

    Hey Marc, thanks for coming back.

    Off topic, you were right about Habilitate-Too extreme I spend 34 days there and it was about 30 too many. However, it did help me get what I needed and for that I am grateful. If you ever get in the neighborhood of Oahu you should really talk with Jeff Nash there and get a tour maybe give a talk. It is a very interesting treatment alternative-tongue in cheek.

    Over the past couple of years since reading your first book and talking with you as well as reading your blogs, I finally achieved the sobriety I have wanted, in part. Your life and subsequent writing surely has been a big part of me no longer even wanting to ingest any mind altering substance. At some point in my self-incarceration at Habilitat I fell it all, almost physically, slip away. And there was a point which I wanted to hold on to it. At that point I knew it was a choice and something else…I am still not sure what that something else(s) might be.

    I just wanted to say thank you publicly – properly.

    It is good to see such a wide range of people here and elsewhere getting together to tackle not just substance use/abuse but the addictive cycles of thinking and self-talk which creates such massive problems for our species – greed and ignorance.

    Thanks again Marc, and community – I am so grateful to have found people (virtual) who found that it was no moral failing or intentional illegal activities which required immediate and swift punishment. I could not fin and still do not find such people in my day to day life and that too must change for the benefit of others. It is funny how easy it is to change the addictive cycle of drug addiction for me now. Why could it not happen before maybe be the question I will never know the answer to?

    • Marc April 6, 2015 at 6:22 pm #

      Hi Kevin. Good to hear from you, and really good to hear you sounding so peaceful and easy about not wanting to go back there. And I’m honored that the book, the blog, and our conversations played some part in your transition. That’s really something.

      I think a lot about why it’s often so hard to stop. What you say about wanting to “hold onto it” is key. Sometimes it just seems like a long dysfunctional love affair that’s too hard to walk away from because you can’t imagine filling that space. But other times I think it’s because a strong part of us feels we don’t deserve to be free. The unspeakable unthinkable conviction that I deserve to suffer….and this is one way I can keep on suffering within safe limits…that may be the lock that evades all our attempts to understand. It shouldn’t be so hard to want to be happy and just reach for it.

      I want to keep thinking about this with you and the others here. It may not be as unfathomable as we believe.

      • Kevin Cody April 6, 2015 at 10:36 pm #

        Deal, let’s continue to think about this together.

        I am still trying to find some help with recovery. Mostly to be on the safe side. But it is a 100% all or nothing – either submit to the diseased model or go away. And the ego of some when it comes to helping people who are not completely desperate…it is almost like there is some level of enjoyment. I equate that attitude to the part of me wanting the choice not to allow he addiction to slip away.

        For instance, I recently lost monetary benefits for “not complying” to rehab standards-I have been seeing a psych but did not get the compliance letter.So I got kicked out of my China Town boarding room.

        (no big deal I hardly ever sleep or do anything which requires a home right now)

        But, I went to the Salvation Army Drug treatment place where they do residential and was hoping they’d at least give me a clue where I could get a clean shelter for a week or so maybe a month.

        He gave me the same tired/over-burdened social satety net places which have ten year waiting lists…and did it almost with a smile…he acted like I was ego driven and was going to come back all beat down and seemed to be okay with that?

        We owe it to ourselves, Marc and community, to continue this discussion dn sharing our thoughts so our posterity doesn’t have the pathetic modalities of treatment we are faced with today. Its heartbreaking seeing all this real mental illness. Its heartbreaking to see how ineffective modern treatment is. It should be criminal – at least more criminal than treating people with abuse/misuse disorders as they are the criminals.

        Best regards,
        KC

  11. Nicolas Ruf March 30, 2015 at 5:07 pm #

    Psychology is a dead end. Perhaps some mindfulness meditation. Check out the recent stuff on the ACC and insula and beware the autobiographical snares.
    I just have to go back to kindergarten (having pissed off Stanton Peele) for two final points re the disease not disease. If my kidneys are malfunctioning I have kidney disease, right? How about my liver? But if my brain is malfunctioning and dysfunctional it’s not a brain disease? And so if the problem is overlearning, are the folk we see who have addiction problems students or pupils? None of this makes me no sense.

    • Donnie Mac March 31, 2015 at 8:47 pm #

      Mr Ruf :
      “When AA co-founder Bill Wilson was asked in 1960 about AA’s position on
      the disease con
      cept, he offered the following response:”We have never
      called alcoholism a disease because, technically speaking, it is not a
      disease entity. For example, there is no such thing as heart disease.
      Instead, there are many separate heart ailments, or combinations of
      them. It is something like that with alcoholism. Therefore, we did not
      wish to get in wrong with the medical profession by pronouncing
      alcoholism a disease entity. Therefore, we always called it an illness,
      or a malady – a far safer term for us to use”

      • Marc April 6, 2015 at 6:34 pm #

        Interesting historical footnote, Donnie. I know that AA took on the disease idea decades after it Bill W veered away from it, and this happened by a kind of osmotic or even parasitic relationship that evolved between AA and institutional treatment initiatives like Hazelden and such. Medicine kind of latched onto AA through the treatment world: hey this is really a disease, right? Well, isn’t it?

    • Marc April 6, 2015 at 6:29 pm #

      You do keep going back there, Nick. So then why not move on? After our talks and reading and talking with Stanton and all the rest of it, I never thought I’d here myself say: I don’t care what you call it. Matter of definition. It does get old, and that’s why we need to move on.

      I don’t like the disease model, as you know, but the only thing I really hate about it is that it leads many of us in the diametrically opposite direction to where we need to go.

  12. Guy Lamunyon March 30, 2015 at 10:00 pm #

    Marc,

    Good luck with creating (yet another) addiction model (Field Unifying Theory?).In our age of evidence based practice, your model will require the scrutiny of field/outcome testing! Here is some background information:

    http://www.behaviortherapy.com/ResearchDiv/whatworks.aspx

    • Matt April 3, 2015 at 4:50 am #

      Hi Guy

      This ref is cool. Thanks for this. The other interesting thing about this volume is that in the discussion they argue for an “informed eclecticism”, whatever works depending on the situation and individual circumstances…

      • Matt April 3, 2015 at 5:28 am #

        …someone’t “inner narrative” could be integral in determining what approach/es might work best…

    • Marc April 6, 2015 at 6:46 pm #

      What an interesting list, Guy. I’ll have to look at the source, but this seems a useful tool. Look, I’m not imagining I can create THE grand unified theory of addiction. Not even close. But I can keep going in my own direction and improve the quality of whatever bit I have to offer.

      And you know as well as I do that “evidence based” is a buzz phrase that hides all kinds of shady stuff. Small-n trials can show successes that never see the light of day in real-world treatment settings.

      • Guy Lamunyon April 6, 2015 at 9:51 pm #

        What, no Field Unifying Theory? I am disappointed.

        “There are three kinds of lies: lies, damned lies and statistics.”
        – Mark Twain’s Own Autobiography: The Chapters from the North American Review

  13. Shaun Shelly March 31, 2015 at 12:57 pm #

    Hey Marc,

    Looking forward to the next part of the journey.

  14. Cheryl April 1, 2015 at 1:29 pm #

    Hi Marc! I have enjoyed your research into this subject am happy to hear it will continue. I think the narrative piece is huge and most helpful. Looking forward to the new book!

  15. Matt April 2, 2015 at 4:26 pm #

    It all starts with a narrative— addiction and recovery— so what better place to start looking for some regularity in the experience and behavior?

    I’ve been talking with a lot of people in different programs and seeing a shift in perspective on “addiction”. There is a growing demand for a more open source, “whatever works” approach, depending on means, opportunity, availability, etc.. I feel like it’s a reaction to the dissension between programs and approaches that has so slowed progress in the treatment arena.

    It’s puzzling that many people insist on a single prescriptive approach, even if in reality the approach itself they are insisting on is a hodge-podge of many things that have proven effective in the past. I think part of it has to do with three features of being human. (1) We desperately resist change, even though we realize it’s an undeniable inevitability of existence. (2) We don’t like difference; we like to be around the same people, feel the same, maintain habits, use familiar approaches to problem solving, etc. And (3) we definitely don’t like to be wrong. So when it comes to some primal behavioral phenomenon with dire consequences–like addiction–people understandably have some very strong opinions.

    The symptoms of these three “human features” are multiple. We get bogged down in terminology and people’s personal definitions of things like powerlessness and disease, choice and self-medicating, and so on. We neglect to see the historical context out of which they’ve sprung. We get proprietary, dogmatic, and rigid regardless of what camp we claim allegiance to.

    The problem is that all this focus on “our position” or “our program” begins to pull us away from everyone’s common overarching purpose: to get people sober.

    This is being realized slowly but surely by new programs springing up that embrace an all-encompassing, more inclusive approach. Meetings, medication, meditation, diet, therapy, exercise, spirituality. Then the true task of treatment becomes helping people figure out what is going to work for them as individuals. This is key. When we get distracted by religiosity, or disease models, or lack of moral development or some other contention, we can miss the forest for the trees.

    We don’t have to have dogmatic and circumscribed views about what works and can bring about some relief. Absolutist and fixed views are what got us into addiction in the first place. “This is the only thing that helps me. I have to have this. Nothing else matters.” The dogma heuristic. Is it helpful to use these views, this heuristic to argue about what works— SMART, AA , organized religion? People have to find new habits and ways of thinking that work for them in recovery, not be told.

    I feel like I’m cured of my addiction to substances now. But only because I try to remain open to possibility, both positive and negative. What might be helpful to me, and what will take me down the wrong road. I think closing ourselves off to the opportunities the world affords us and tempts us with is the nature of addiction. That funnel-like tunnel vision that narrows the focus of our lives to a single point. Our perspective becomes narrower and narrower, not more expansive and inclusive.

    And when I say I’m cured, that doesn’t mean I think I can use in safety. It means I learned the same lesson that I learned the first time I touched a hot stove when I was little. At first it’s warm, then it burns, and if you hold your hand there long enough it will cause severe injury. I don’t need to burn myself anymore to learn the lesson.

    I was talking to a woman in a detox the other day. A very kind, wise, yet very agitated woman. She came in late to my meeting and was sorry she missed the meditation exercise. She had come to sobriety through 12 Step programs, and it had worked for her, until her father died suddenly. She was a veteran nurse, and had a very no-nonsense practical approach to helping and healthcare issues.

    This woman could see the potential benefit of a cognitive/behavioral problem solving approach, but didn’t understand why it was necessary. “Why do we need it? My sobriety was fine, and I got all the same things you are talking about out of AA/NA, through the fellowship and my meetings. You can look past the God stuff, or reframe it. It’s about people helping each other. “

    We sat and talked a little while and realized we agreed on all the important points about addiction and recovery. I had the same experience talking with a couple of colleagues from AA/NA the same day. We are all trying to do the same thing, but we have to be open, listen to ourselves, and listen to each other—everyone who’s working toward the same solution. Otherwise, this shoveling against the tide is never gonna end…

  16. not moses August 24, 2016 at 12:50 am #

    Khantzian, E. J.: The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence, in American Journal of Psychiatry, Vol. 142, 1985.

    Khantzian, E.J.: The self medication hypothesis of substance use disorders: a reconsideration and recent applications, in Harvard Review of Psychiatry, Vol. 4, No. 5, Jan-Feb 1997.

    Shaffer, H.; LaPlante, D., La Brie, R.; et al: Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology; in Harvard Review of Psychiatry, Vol. 12, 2004.

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