Addiction Trajectories: Book Review

Striving for that elusive middle ground.

For a journalist who covers neuroscience, the political and psychoanalytic focus of anthropology sometimes feels like a baffling trip to a foreign land. References to Foucault and Derrida abound, and Freud hovers in the middle distance. The investigative landscape is comprised of socially constructed experiences and environmental processes. Trained to seek out cultural and economic experiences as first causes, many cultural anthropologists have been fighting a rear-guard action against the advances of neuroscience for years now. Which is a shame, because anthropology, importantly, can serve to remind medical scientists of the multi-dimensional nature of addiction. “For psychoactive substances to transform themselves into catalysts for and objects of pleasure and desire,” writes anthropologist Anne M. Lovell, “they must circulate not only through blood, brain, and other body sites but also through social settings.”

It is anthropologists, for example, who have documented that “three-fourths of all state-licensed drug treatment programs in Puerto Rico were faith-based.” This study of faith-based healing in the addiction recovery community forms one chapter of a new volume, Addiction Trajectories, edited by Eugene Raikhel of the University of Chicago and William Garriott of James Madison University.

What anthropologists can do for addiction science is document these sociocultural attributes of addiction. In a chapter on buprenorphine and methadone users in New York City and the five boroughs, Helena Hansen, assistant professor of anthropology and psychiatry at New York University, finds that buprenorphine users live in predominantly white, high-income neighborhoods, tended to have college educations, and get their bupe from a private doctor. However, “others are directed to methadone maintenance programs with requirements for daily attendance, urine drug screens, surveillance, and control,” and there is little overlap between the two recovering populations.

There is a chapter devoted to a punitive form of addiction treatment known in Russia as “narcology,” and another that dwells on the semiotics of meth addiction. There are chapters taking drug counselors to task for their inadequate training and lack of nuanced background. And there is a chapter that views the advent of buprenorphine for heroin addiction as a step backwards, or, at best, a typical step sideways—addictive drugs for addiction, just like the old days when heroin addicts were offered alcohol as a cure.

A chapter by E. Summerson Carr is devoted to the treatment known as motivational interviewing, a technique with which she claims “drug users can talk themselves into sobriety regardless of whether or not they originally believe what they say to be true.” Irrespective of your view on M.I., Carr makes a useful point when she notes that sometimes a client’s refusal to admit drug use, even after a positive drug test, is not because of denial, but because of a logical understanding that their status as credible plaintiffs in legal proceedings could be on the line.

And there is simply no arguing Carr’s central point—while addiction science has been increasingly incorporated within the broad outlines of neuroscientific models, “the project of using talk to treat denial and demonstrate insight remains remarkably consistent” in the treatment practices used by the more than 13,000 outpatient addiction treatment programs across the U.S.

What else can anthropologists bring to the table? An understanding of “the loaded institutional and cultural conditions of clinical assessments, which inevitably and profoundly shape what drug users do and do not say.” Chief among these, Carr writes, is “the distinctly clinical terms of addicted denial, the chief organizing heuristic of mainstream American addiction treatment.”

The gap remains wide between addiction viewed as the neuroscientist’s disease entity, and addiction viewed as the anthropologist’s contingent outcome emerging from specific social settings. It’s easy to see why the attempt at an alliance between anthropologists and neurobiologists is an uphill struggle. Reading Addiction Trajectories, it becomes apparent how frequently the two disciplines are talking past one another. But I like to think there are enough bright and motivated anthropologists and neuroscientists around to forge some manner of middle ground; the elusive third way of viewing addiction, holistically, as a living blend of genetic and environmental influences, sensitive to both, and registering that dual sensitivity in the form of compulsive drug taking. (See, for example, anthropologist Daniel Lende’s recent post.)

The more invigorating contributions in this volume help us to zero in on “the popular representation of drugs as inherently criminogenic,” writes William Garriott, as well as the concomitant “lack of faith in the ability of the criminal justice system—and the state more generally—to address drug problems through the punitive management of the addicted offender population.” It is anthropologists, not neuroscientists, who dwell on the ramifications of this paradox: “The majority of Americans appear committed to fighting a war they feel cannot be won, using a strategy in which they no longer believe.”

The present volume is sometimes inclined to view biology with suspicion, and many of its contributors are quick to point out the hazards of attempting to meld social science and neuroscience. A similar but somewhat less skeptical collection—one that seeks to connect the socioenvironmental influences helping to shape how the biological disorder known as addiction will play out in the real world—was published last year by co-editors Daniel H. Lende and Greg Downey. In The Encultured Brain, Lende and Downey look ahead to a time when field-ready equipment will measure nutritional intake, cortisol levels, prenatal conditions, and brain development in the field. Predicting the future is a fool’s game, but it seems clear that the field of anthropology is aware of, and awake to, the controversial research avenues opened up by advances in contemporary neuroscience.

Graphics credit: http://www.culturalneuroscience.org/

Science On the Web and In the Flesh

Thoughts on the ScienceOnline2013 conference.

As a blogger, I write about the science-based investigation of drugs and addiction—but I am not a scientist. Far from it. My educational background is in the Liberal Arts and the Humanities, with a degree in journalism and mass communications. I cover science, and I talk to scientists, but I don’t DO science. And in fact, there is often an adversarial relationship between a journalist and the people a journalist writes about.

A remarkable conference held annually in the Raleigh-Durham Research Triangle, hosted by North Carolina State, attempts to do something about this divide by throwing together 450 bloggers, journalists, editors, scientists, science teachers, public information officers, and science artists—plus a smattering of entrepreneurs, web developers, government workers, librarians, literary agents, and all-around gadflies. A few years ago, a troika of innovative thinkers in the Raleigh area—Boris Zivkovic, Anton Zuiker, and Karyn Traphagen—put together what became the annual ScienceOnline conference. They realized that science writers and scientists were on the same team, and that their mutual business was the effective communication of scientific and evidence-based knowledge. It may sound obvious, but in actual practice, it isn’t.

However, the rise of online science communication means that everybody is talking to everybody else all the time, and that the divide separating the writer from the scientist is permeable under the right conditions. The “Unconference,” as ScienceOnline quickly became known, features a collaborative style of creating and moderating panel sessions—sessions in which, wonder of wonders, the audience is expected to participate as much as the panel moderators. Some panels become more like casual group bullshit sessions than formal laser-pointer presentations by a moderator doing a monologue. (Not that some moderators don’t lapse into monologues, but usually those offenders are professors, so we must forgive them.)

I hate conferences, and generally avoid them. But ScienceOnline caught my interest due to the way it invokes a variety of subtle structures and cues to bring a relaxed, improvisatory, conversational tone to the 4-day event. To begin with, attendance is held to 450 people, who apply on a first-come, first-served basis. Despite pressure to expand as the popularity of the conference has grown, the organizers have chosen instead to encourage Watch Parties in cities around the world. In addition, a constant stream of conference information courses through online social media for months before and after the actual event. Rather than leading to a feeling of exclusivity, this approach puts everyone on an equal footing, scrambling like rock fans trying to score a ticket to a good show before they sell out.

Upon arrival, you find that your standard conference badge has your name on it—but no job title, institutional affiliation, or any other outright clue to whatever the hell it is that you do for a living. In place of that is your Twitter handle, since this conference pulls heavily from a group that is already well entrenched online. Some people know each other; some people are there for the first time, like any conference. Without the obvious indications of rank and hierarchy of employment, people will be much more willing to approach people they don’t know for conversation, is the idea. It is one of the ways that the producers of the conference attempt to move the emphasis from speakers on the stage to conversations between people in the conference café, the lobby, the lounge, the bars... Like atoms banging against each other as the heat rises, attendees trade thoughts, hatch projects, land freelance assignments, and hear from other people about the one thing everyone has in common: the business of communicating the work of science to the world at large—a task that can only become more crucial with time.

The same ethos applies to the sundry sessions and panels that make up the conference. Moderators, who have cooked up the topics and ideas for the panels in group wiki sessions during the previous year, are expected to make some prefatory remarks and then starting fielding questions in order to get a sense of where the audience wants to take the subject. Of particular interest to me this year were sessions about how to be appropriately skeptical when covering scientific and medical studies, how to blog for the long haul, how to navigate the perils and pleasures of explanatory journalism, and how to use history to relate current events in science.

In the end, the conference does what it is intended to do: Provide a comfortable, optimistic environment in which a pack of nerd scientists, rogue journalists, extreme introverts, and knowledge-hungry students can shoot the shit with each other without the distractions of poster sessions and prepared presentations. That may sound like it’s a lot easier to do than it really is. Such conferences are rare indeed, and ScienceOnline2013 is a rare example of the successful blending of conference, convention, and think tank retreat. Plus it’s the only conference I’ve ever gone to where the free goodies turn out to be books. A literal stack of them. Like cocaine to a herd of hyper-literate scientists and professional writers. The registrations costs are absurdly low, the shuttle buses incredibly efficient, the wifi access unbeatable. Early figures indicate a level of coffee consumption somewhere in the neighborhood of 15 gallons per hour. And did I mention the food?

For more on the conference, go to ScienceOnline Information Central HERE.

NIH Director Calls Off NIDA-NIAAA Merger

Nation’s addiction research institutes to remain separate but unequal.

Two years ago, the National Institutes of Health’s Scientific Management Review Board (SMRB) issued a report recommending that NIH move to establish a new institute focused on substance use, abuse, and addiction-related research to optimize NIH research in these areas. The idea was to combine the two existing addiction research agencies: the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Skeptics like myself wondered if it would ever happen.And now we have our answer—no, it’s not going to happen. (NIH'S Collins)-->

Score one for the alcohol researchers, who mostly opposed the merger from the start, viewing it as more of a hostile takeover. NIAAA has always been the weaker sister in the addiction research family. With only half of NIDA’s billion-dollar budget, NIAAA deals strictly with alcohol research, even if the NIAAA has at times seemed unsure of what constitutes its main area of study—alcohol the addictive drug, or alcohol the healthy beverage. The merger would have represented a recognition that alcohol is just another drug, albeit a legal one.

It was an obvious thing to do. Former NIH director Harold Varmus had complained that the sprawl was hobbling NIH’s ability to “respond to new science.”

However, in a Science (sub req) interview that year,  Francis Collins, the current director of the NIH, said: “I guess most people would have said, ‘Well yeah, of course.’ But when you look at the details…. and you consider that alcohol is after all a legal substance and 90% of us at some point in our lives are comfortable with taking it in while the drug abuse institute is largely focused on drugs that are not legal. So there's a personality of the institute issue here that people thought might be important to preserve, others thought would be good not to preserve.”

It did not take long for the fraternity of alcohol researchers to view the potential move with alarm. Acting NIAAA director Dr. Kenneth Warren offered up what has come to be seen as the basic counter-argument: “The best way forward is a structure that increases collaboration all across NIH… nothing is gained by structural merger.” Warren said he favored “a separate, but equal” pair of agencies. “Alcoholism is a much broader issue than simply addiction.” 

Here is where it starts to get tricky. The assertion that alcoholism is not simply an addiction distills the disagreement down to its essence, which can be found not so much within the arena of science as within the arenas of morality, ethics, and the law.

On Friday, the traditional time for troubling news announcements in the media world, the NIH released its statement  from Director Collins: “After rigorous review and extensive consultation with stakeholders, I have concluded that it is more appropriate for NIH to pursue functional integration, rather than major structural reorganization, to advance substance use, abuse, and addiction-related research.”

Collins added: “The time, energy, and resources required for a major structural reorganization are not warranted, especially given that functional integration promises to achieve equivalent scientific and public health objectives.”

 But the smooth and cost-effective advance of addiction science may have met a stumbling block in the director’s refusal to do the obvious, and streamline the crucial research on drugs and addiction performed by the nation’s premier medical research agency, the NIH. As one observer commented,  there are rumors that “the alcohol beverage industry is lobbying Kentucky politicians, including U.S. Rep. Hal Rogers, chairman of the House Appropriations Committee, to keep the institutes separate because it doesn’t want alcohol to be associated with cocaine.”

The Encultured Brain: A Book Review

How biology and culture jointly define us.

Anyone who follows academia knows that the broad category of courses known as the Liberal Arts has been going through major changes for some time now. In a sort of collegiate scrum to prove relevance and fund-worthiness, disciplines like sociology, anthropology, human ecology, cultural psychology, and even English, have been subjected to a winnowing process. The clear winner seems to anthropology, which has expanded its own field by connecting with modern findings in neuroscience while simultaneously swallowing up what was left of sociology.

It makes sense. Take addiction for an example. Anthropology is a natural and accessible discipline within which to connect the two often-conflicting facets of addiction—its fundamental neuroarchitecture, and the socioenvironmental influences that shape this basic biological endowment. In The Encultured Brain, published this year by MIT Press, co-editors Daniel H. Lende and Greg Downey call for a merger of anthropology and brain science, offering ten case histories of how that might be accomplished. The case histories are lively, ranging from the somatics of Taijutsu martial arts in Japan, to the presence of humor among breast cancer survivors. These attempts to combine laboratory research with anthropological fieldwork are important early efforts at a new combinatory science—one of the hot new “neuros” that just might make it.

I have corresponded with Daniel Lende, one of the book’s co-editors, and I am happy to disclose a mention in the book’s acknowledgements as one of the many people who formed a “rolling cloud of online discussion” with respect to neuroscience and the new anthropology. I am pleased to see that the thoughts of Lende and Downey and others on the emerging science of neuroanthropology are now available as a textbook.

The term “neuroanthropology” was evidently coined by Stephen Jay Gould. A number of prominent thinkers have dipped into this arena over the years: Melvin Konner, Sarah Hrdy, Norman Cousins, Robert Sapolsky, and Antonio Damasio, to name a random few, but the term didn’t seem to get a foothold of note until Lende and Downey began their Neuroanthropology blog, now at PLOS blogs.

The term has the advantage of meaning exactly what it says: an engagement between social science and neuroscience. Lende and Downey look ahead to a time when field-ready equipment will measure nutritional intake, cortisol levels, prenatal conditions, and brain development in the field. As such, neuroanthropology fits somewhere in the vicinity of evolutionary biology and cultural psychology. As a potential new synthesis, it is brilliant and challenging, representing an integrative approach to that ancient problem—how our genetic endowment is influenced by our cultural endowment, or vice versa, if you prefer.

 Lende is no functionalist when it comes to the neuroscience he wants to see incorporated in anthropology. His approach calls for applying a critical eye to any and all strictly brain-based explanations that ignore both environmental influence and biochemical individuality. The possibility that anthropologists may be incorporating neuroimaging technology into their working tool kit is a heady notion indeed. Anthropology may be a “soft” science, but it has always been about the study of “brains in the wild.”

Here, from the introductory chapter, is the short definition of neuroanthropology by Lende and Downey: “Forms of enculturation, social norms, training regimens, ritual, language, and patterns of experience shape how our brains work and are structured…. Without material change in the brain, learning, memory, maturation, and even trauma could not happen…. Through systematic change in the nervous system, the human body learns to orchestrate itself. Cultural concepts and meanings become neurological anatomy.” From the point of view of actual study, there is no choice but to join these two when possible—a task make more difficult by the rampant “biophilia” found among anthropologists and sociologists, as well as the countering notion among biologists that anthropology does not make the cut as a “real” science.

We have come a long way from the simplified view of the brain as some sort of solid-state computer, or, alternatively, a lump of custard waiting to be endowed with functionality by selective pressures from “outside.” We know by now that neural resources are frequently reallocated; that “physiological processes from scaling to connectivity shape what brains can do and why.”  We need to stop viewing culture as “merely information that is transmitted over evolutionary time and recognize that enculturation is, equally, the ways that our interaction with each other shapes our biological endowment, and has been doing so for a very long time,” Lende writes.

At bottom, says Lende, it is a simple notion: “Biology and culture jointly define us.” For example, Lende points to the way tool use affects cortical organization. Monkeys trained to use rakes to fetch food “evidence increasing cortex dedicated to visual-tactile neurons.” Lende wants us to incorporate neuroscience into the broader study of man. He writes that “the activation of neural reward centers, such as the mesolimbic dopaminergic system, is inherently bound up in sociocultural contexts, social interactions, and personal meaning-making.”

As an example, Lende contributes a chapter on “Addiction and Neuroanthropology,” in which he describes research he conducted on drug abuse among young people during a decade he spent in Colombia. Lende found that the addictive spiral “was not merely a neurological transformation, but a shift in habits, clothing, friends, hangouts, and other external factors that re-cued drug seeking behavior, drove addicts to take drugs, even when the young people sought to stay clean. Addiction is not simply in the brain, but in the way that the addict’s brain and world support each other.” And now, he writes, “This combination of neuroscience and ethnography revealed that addiction is a problem of involvement, not just of pleasure or of self. That decade showed me that addiction is profoundly neuroanthropological.”

In other words, tolerance and withdrawal aren’t enough. It is fiendishly complex: “The parts of the brain where addiction happens are not single, isolated circuits—rather, these areas handle emotion, memory, and choice, and are complexly interwoven to manage the inherent difficulty of being a social self in a dynamic world.”

Trying to pick apart the relative influences of nature and nurture comes to look, ultimately, like a fool’s game, “because changes in behavior exposed users to situations in which specific neurophysiological effects were cued with greater frequency; both environment and biology were moving together into a cycle of addiction.”

In a chapter titled “Collective Excitement and Lapse in Agency: Fostering an Appetite for Cigarettes," Peter G. Stromberg of the University of Tulsa argues that the dissociative environment in which college students often try cigarettes for the first time can lead to the loss of “the sense of agency,” meaning that people sometimes carry out activities without taking full responsibility for the decision to do so. As Stromberg writes, “Early smoking experiences typically occur in effervescent social gatherings marked by a high level of excitement and highly rhythmic activities, such as conversation and dancing." Cigarettes acquire a “symbolic valence” in such settings, and the ability to handle a cigarette adroitly confers what Stromberg terms “erotic prestige.” Furthermore, “As anyone who has ever been in a conga line can attest, we humans can be strongly motivated to entrain with rhythmic activities, even if those activities might be judged as unappealing in other contexts.”

If young people smoke at parties for many of the same reasons that they dance at parties—a “desire to increase status” and enter into “joint rhythmic play”—then potential nicotine addicts will be gently nudged into a position of associating party feelings with cigarette feelings, regardless of the actual physiology of nicotine. And, by fostering a dissociative mode of consciousness, college parties help foster the conviction that the use of cigarettes is not completely under one’s volitional control (“I was going to leave, but we danced all night.” Or, “the next thing I knew, the pack was empty”). The smoker may falsely attribute these feelings to the direct effect of the drug, rather than the set and setting.

This is only one example of the many ways in which a combination of neurobiology and anthropology can lead to new questions and fresh approaches. Where might all this be heading? “As research continues,” write Lende and Downey, “greater recognition of neural diversity as a fundamental part of human variation will surely become an even more substantive part of the neuroanthropological approach.”

The Empty Seat at the Holiday Table

Mothers and the War on Drugs.

Guest post by Gretchen Burns Bergman

Gretchen Burns Bergman is Co-Founder and Executive Director of A New PATH (Parents for Addiction Treatment and Healing) and lead organizer of Moms United to End the War on Drugs.

The Holiday season is upon us. At this time, when the weather turns chilly and we move indoors to enjoy the warmth and safety of our homes and the closeness of family and friends, I am acutely aware of those not so fortunate: people who are out in the elements, either because of dire financial situations or mental and addictive illness.

The Holidays are particularly difficult for those who must navigate the mighty and destructive waves of addiction. It is a painful time for families who are separated because of a loved one’s incarceration, whose young person is lost on the streets due to drug problems, whose children are in danger because of the violence of the drug cartels, or those who have lost a loved one to overdose. Often a family member is missing from the festivities because of stigma and shame.

I don’t remember when I started dreading Thanksgiving. It wasn’t after my father or my nephew died, because they were remembered and celebrated at the table, or even after the breakup of my first marriage. It was all of the times that my older son was absent because he was locked behind bars in that cold, concrete jungle, and I couldn’t figure out where I belonged – with him to somehow nurture and sustain him, or in the bosom of the rest of my family. It is the memories of holidays when one of my sons wasn’t included because he was lost in the maze of his addiction, and his name wasn’t even mentioned because of pain, discomfort, and even judgment. Those omissions widened the hole in my heart.

I weep for the countless families who have been torn apart by discriminatory and destructive drug policies that lock up fathers and remove children from their mothers in the name of the war on drugs, which is really a war waged against families and communities.

This season, mothers are banding together and speaking out with human stories of injustice and devastation, to encourage other mothers to join our voices for change. Moms United to End the War on Drugs is a national movement to end the violence, mass incarceration and accidental overdose deaths that are result of these blundering punitive policies. At a time when 2.3 million people are incarcerated in the United States and overdose is a leading cause of accidental death, mothers must lead the way in demanding harm reduction strategies, health-oriented solutions, and restorative justice.

The following are stories written by mothers who have experienced the ravages of the war on drugs, and who honor that empty seat at the holiday table:

The missing seat at the prison visiting table.

It was Thanksgiving and my family and I drove 4 hrs to visit my young son in his California prison for the holiday. He was serving time for drug possession, celled with a murderer, in one of the state’s highest security prisons, so “processing time” including prison official dysfunction, near total disrobing, endless questioning, metal detectors, sally-ports, and guard escorts, took about 4 hours to complete before we got to the highly secure visiting room. Because of this time consuming process, there was only 45 minutes left to visit. On the other side, my inmate son was being strip searched and waiting in a line moving at glacial speed to enter the visiting area. I cried to the guard that, as time ticked by, I was being left with five minutes to see my son for Thanksgiving…but I wanted those five minutes. He waited in his sally-port on the other side, while we all waited at our assigned table for that precious few minutes with my son. That seat remained empty. Alerts sounded that visiting was over.

--Julia Negron, A New PATH Los Angeles, California

Until this war ends, an extra place at my table.

During the holidays, we reflect as we prepare meals, set our tables, and decorate our homes. As I begin planning, with my daughter and husband’s help, I think back to the time when I was addicted to heroin, and missing from my family’s holiday table. Though it was more than 20 years ago, my family experienced extreme grief over my addiction. My father tells me that he is so grateful that I am alive. He didn’t know, in the midst of my homelessness, whether I’d ever be able to attend, let alone host, a Thanksgiving with my own family. I think how lucky I am, because I had the opportunity to get treatment that worked for me. I know someone waited and despaired over me. Now, I wait for those with substance use disorders to be served by our health care system rather than languishing in prison. Until that wait is over, there will always be an extra place setting at my holiday table for those who are locked up, thrown away or left out. The person in prison for a drug crime might not be able to eat with me this year, but perhaps next year, they will.

--Kathie Kane-Willis, Illinois Consortium on Drug Policy, Roosevelt University

Emptiness is everywhere.

Since our son was born, we always picked out the Christmas tree together. It became a tradition and one of the fun parts of the holiday rush. Dad would put the lights on the tree and make clam chowder, while Jeff and I did the ornaments. As years passed, it was sometimes difficult for us all to be together for this tradition, but we were. Our son had addictive illness, and through the many rehabs, the short county incarcerations, the times where he’d isolate because he was using, we somehow were able to keep that tradition. Christmas Eve was spent with our entire family either in our home or my sister’s. The first year without Jeff – just 3 months after he died of an accidental overdose and 2 days after release from 4 months in county jail, was unreal. Jeff had been so much a part of Christmas, sharing Santa duties and passing out gifts to the little ones with the biggest smile on his face. The emptiness was EVERYWHERE. He should have been there. We haven’t had a Christmas tree or decorations in our home since 2007. I don’t think we ever will again. The Holidays bring nothing but pain.

--Denise Cullen, Broken No More, Orange County, California

Photo Credit: http://sisterjohnpaul.blogspot.com/

What Do We Mean When We Talk About Craving?

An essay on drug addiction and need.

For years, craving was represented by the tortured tremors and sweaty nightmares of extreme heroin and alcohol withdrawal. Significantly, however, the one symptom common to all forms of withdrawal and craving is anxiety. This prominent manifestation of craving plays out along a common set of axes: depression/dysphoria, anger/irritability, and anxiety/panic. These biochemical states are the result of the “spiraling distress” (George Koob’s term) and “incomprehensible demoralization” (AA’s term) produced by the addictive cycle. The mechanism driving this distress and demoralization is the progressive dysregulation of brain reward systems, leading to biologically based craving. The chemistry of excess drives the engine of addiction, which in turn drives the body and the brain to seek more of the drug.

Whatever the neuroscientists wanted to call it, addicts know it as “jonesing,” from the verb “to jones,” meaning to go without, to crave, to suffer the rigors of withdrawal. Spiraling distress, to say the least—a spiraling rollercoaster to hell, sometimes. Most doctors don’t get it, and neither do a lot of the therapists, and least of all the public policy makers. Drug craving is ineffable to the outsider.

As most people know, behavior can be conditioned. From maze-running rats to the “brain-washed” prisoners of the Korean War, from hypnotism to trance states and beyond, psychologists have produced a large body of evidence about behavior change—how it is accomplished, how it can be reinforced, and how it is linked to the matter of reward.

It is pointless to maintain that drug craving is “all in the mind,” as if it were some novel form of hypochondria. Hard-core addicts display all the earmarks of the classical behavioral conditioning first highlighted almost a century ago by Ivan Pavlov, the Russian physiologist. Pavlov demonstrated that animals respond in measurable and repeatable ways to the anticipation of stimuli, once they have been conditioned by the stimuli. In his famous experiment, Pavlov rang a bell before feeding a group of dogs. After sufficient conditioning, the dogs would salivate in anticipation of the food whenever Pavlov rang the bell. This conditioned response extended to drugs, as Pavlov showed. When Pavlov sounded a tone before injecting the dogs with morphine, for example, the animals began to exhibit strong physiological signs associated with morphine use at the sound of the tone alone. Over time, if the bell continued to sound, but no food was presented, or no drugs were injected, the conditioned response gradually lost its force. This process is called extinction.

Physical cravings are easy to demonstrate. Abstinent heroin addicts, exposed to pictures of syringes, needles, or spoons, sometimes exhibit withdrawal symptoms such as runny noses, tears, and body aches. Cravings can suddenly assail a person months—or even years—after discontinuing abusive drug use. Drug-seeking behavior is a sobering lesson in the degree to which the human mind can be manipulated by itself. The remarkable tenacity of behavioral conditioning has been demonstrated in recent animal studies as well. When monkeys are injected with morphine while recorded music is played, the music alone will bring on withdrawal symptoms months after the discontinuation of the injections.  When alcoholics get the shakes, when benzodiazepine addicts go into convulsions, when heroin addicts start to sweat and twitch, the body is craving the drug, and there is not much doubt about it. But that is not the end of the matter.

“Craving is a very misunderstood word,” said Dr. Ed Sellers, now with the Centre for Addiction and Mental Health in Toronto. “It’s a shorthand for describing a behavior, but the behavior is more complicated and interesting than that. It’s thought to be some intrinsic property of the individual that drives them in an almost compulsive, mad way. But in fact when you try to pin it down—when you ask people in a general context when they’re exposed to drugs about their desire to use drugs, they generally give rather low assessments of how important it really is.”

While cravings can sometimes drive addicts in an almost autonomic way, drug-seeking urges are often closely related to context, setting, and the expectancy effect. It has become commonplace to hear recovering addicts report that they were sailing through abstinence without major problems, until one day, confronted with a beer commercial on television, or a photograph of a crack pipe, or a pack of rolling papers—or, in one memorable case of cocaine addiction, a small mound of baking powder left on a shelf—they were suddenly overpowered by an onrush of cravings which they could not successfully combat. “If you put them in a setting where the drug is not available, but the cues are,” said Sellers, “it will evoke a conditioned response, and you can show that the desire to use goes up.” Most people have experienced a mild approximation of this phenomenon with regard to appetite. When people are hungry, a picture of a cherry pie, or even the internal picture of food in the mind’s eye, is enough to cause salivation and stomach rumblings. Given the chemical grip which addiction can exert, imagine the inner turmoil that the sight of a beer commercial on television can sometimes elicit in a newly abstinent alcoholic.

When addicts start to use drugs again after a period of going without, they are able to regain their former level of abuse within a matter of days, or even hours. Some sort of metabolic template in the body, once activated, seems to remain dormant during abstinence, and springs back to life during relapse, allowing addicts to escalate to their former levels of abuse with astonishing speed. This fact, and no other, is behind the 12-Step notion of referring to oneself as a “recovering,” rather than recovered, addict—a semantic twist that infuriates some people, since it seems to imply that an addict is never well, never cured, for a lifetime.

Relapse sometimes seems to happen even before addicts have had a chance to consciously consider the ramifications of what they are about to do. In A.A., this is often referred to as forgetting why you can’t drink. It sounds absurd, but it is a relatively accurate way of viewing relapse. Addiction, as one addict explained, “is the only disease that tells you you ain’t got it.”

Graphics Credit: http://www.aapsj.org/

sciseekclaimtoken-4e72318e6c06c

Drug Links, Various

It’s summer vacation. Did I turn off the stove?


Some recent posts I wrote before ending my run as editor of TheFix.com News Blog:

Drugging the Elderly
Why seniors take too many of the wrong medications at the wrong dose.

Never Heard of Kratom? You Will.
A plant from Thailand with opiate-like properties is the latest "designer drug" speeding its way through America.

How Binge Drinking Causes Fetal Damage
Studies in mice show that alcohol is toxic to DNA in the absence of two specialized enzymes.

Senators Blast Feds for Border Scandal
Botched gun-smuggling scheme put weapons in the hands of Mexican drug thugs, endangered informants, and may have gotten agents killed.

Testimonials to Betty Ford
In the wake of Mrs. Ford’s death, celebrities and politicians tell their personal stories about her work in raising awareness of addiction and recovery.

New Synthetic Marijuana Arrives to Replace Spice, K2
Designers are already busy with the second generation of cannabis-like drugs.

Crack and Coke Will Finally Receive the Same Legal Penalties
Civil rights leaders charged that the legal system's intense obsession with crack amped up minority arrests, but had no scientific basis. Turns out they were right.

Miracle-Gro Goes After the Medical Marijuana Market
It’s just quasi-legal cooperative organic gardening, right? All $1.7 billion of it.

(R.I.P. Amy Winehouse)