Tuesday, December 16, 2008

Strung Out



Heroin be the death of me
Heroin, it's my wife and it's my life
Because a mainer to my vein
Leads to a center in my head
And then I'm better off than dead

The Velvet Underground


"An orgasm is nature's pale imitation of heroin."

Unattributed (if anyone knows source let me know)



Psychology Today blogger Stanton Peele, Ph.D. has a post proposing, according to him, the seven most addictive "substances," from cocaine (least) to, believe it or not, love (most). I won't quibble with his ranking per se, but since many people ask whether one can be addicted to such things as shopping, food, the Internet, and sex, it brought to mind how we go about defining addictions.

The problem is that the very concept of addiction is controversial and philosophically problematic, touching on great questions of free will, emotion, and even spirituality. Most of this is beyond the scope of this post (and, it must be said, beyond the scope of this amateur philosopher), but it seems safe to say that addictions are never entirely chosen nor entirely determined. They always hover somewhere in between, and it's hard to get one's mind around that (sort of like the uncertainty principle of quantum mechanics on a psychological level, perhaps). It is simple-minded to claim that willpower is absolute, but with addictions there is always room for choice ("Do I stop by the liquor store on the way home? Just two won't hurt.").

When we say that someone has a "conventional" addiction to something like nicotine or alcohol, we mean that the direct neurobiological effects of the substance are, if not removing, at least significantly impairing a person's capacity to avoid the substance. If a person stopped smoking three days ago and , feeling intense craving, gives in and takes a smoke, do we say that he was absolutely compelled (against his will) to do this? Well, no, but we think he has diminished volition--because of biological withdrawal effects--as compared to someone, say, who takes a smoke after being abstinent for a year.

We have a great deal of evidence now, from neuroimaging and other sources, that substances of abuse powerfully affect brain pathways. The conundrum is: how do we get form there to inferences about free will? After all, it is pretty likely that, say, flying into a rage is accompanied by certain neurobiological changes as well. If someone looks at me the wrong way and I take him down (I have not, generally, been known to do this), what keeps me from saying that "my brain made me do it?"

There would seem to be two answers to this, one biological and one sociological. Biologically, the question is how specific and how intense the neurochemical changes are as compared to what one might think of as a "normal" pleasurable experience (such as a walk on the beach, an enjoyable concert, or even sex). The more specific and prominent these changes are, the greater reduction in free will we might expect.

The sociological answer would seem to be that society, over time, develops, one hopes, a more refined consensus about what can reasonably be expected from individual behavior. It is reasonable to expect people not to fly into a murderous rage; it is not reasonable to expect all people at all times to be able to stop smoking at will without biological and other cessation strategies that may reduce hindrances to their free will.

Which brings us to the questionable "addictions" to sex, the Internet, and even food. The problem is that these activities just may not override the brain's volitional system in the same way that nicotine, etc. do. After all, just as a thought experiment, suppose that I enjoy reading books; I may even read them, at times, to cope with life's slings and arrows. In fact, I enjoy reading books so much that if I were prevented from reading them for a day or two, I could deal with it, but if it went on for much longer I would start to miss them, would become mentally restless, and would overall feel less happy. Would I be in "withdrawal" from a book "addiction?"

Similarly, if a materialistic person suffers a major financial hit, is he in withdrawal from a money "addiction," or if a "workaholic" is obliged to reduce his hours, does he suffer from "work withdrawal?" We may jokingly say yes, but we shouldn't really mean it.

To return to my example, what if I felt compelled to read so much that I neglected family and work responsibilities? (Note to wife if reading this post: please do not comment here). And after all, inasmuch as reading is pleasurable for me, it is probably associated with release of endorphins and other neurobiological changes at some level. The problem is that these changes are not above and beyond the evolutionary normal pathways that dictate our values and how we choose to attend to them. I would be overindulging in reading not because of an addiction, but because I was repeatedly choosing to do so (as emotional distraction or whatever).

There may be interesting gray areas. One might think sex would be one--after all, sex is arguably, in a purely biological sense if nothing else, one of the most focused, intense, and "rewarding" experiences we are naturally equipped to have. But the operative word here is "naturally," as nothing is evolutionarily normal if not sex. For eons societies have expected individuals to govern their sexual impulses without appeal to anything like a sex addiction clinic.

A true gray area could conceivably be video games and other virtual experiences. As these grow in intensity and engagement, perhaps they could stimulate the brain's reward systems in a way that may be beyond the evolutionary pale, such that cyberdetox would be necessary. Ars Psychiatrica does make for compelling reading, I know, but generally speaking the Internet doesn't appear yet to have reached that point.

None of this is to say that overindulgences in food, sex, or the Internet aren't problems; they certainly can be. But the issue, which may well be amenable to psychotherapy or other means of amelioration, is the individual's basic system of emotional self-regulation, not an "addiction."

13 comments:

Gerard said...

("Do I stop by the liquor store on the way home? Just two won't hurt.").

Two what? Two bottles? Two cases? Two kegs?

I'd answer but, well,

"I guess that I just don't know.
Yes, I guess that I just don't know."

You have, of course, seen the video of kids playing video games at

http://www.youtube.com/watch?v=3gu0iu0xwls

Novalis said...

Just two sips. I promise.

Pam M.S. MD said...

I know I forgot to put the empty vodka bottle in the recycling, I admit, hence Novalis compelled to ramble on addiction in the wee morning hours. If Novalis was no longer able to blog (and drink wine), things might get ugly. By the way, I give up on cleaning the house. Playing on the computer on one's day off is much more fun (as is vodka). Please don't put me in rehab...I will be good next time...
hey, I wonder what YOUR brain scan would look like...

Novalis said...

THANKS FOR THAT. It reminds me that I was going to add that another way of looking at injudicious adventures in love, sex, shopping, Internet, etc. would be as impulse control disorders, that is, as perversions of healthy inclinations rather than, as with the true addictions, a chemical more or less hijacking the brain's pleasure pathways.

Or maybe hitchhiking is a better metaphor; that's where the choice comes in, not picking up the hitchhiker (or not too many).

Gerard said...

Hitchhiker?

Nope. Think Sinbad's Old Man of the Sea:

"Accordingly I advanced to him, and took him upon my shoulders, and conveyed him to the place that he had indicated to me; when I said to him, Descend at thine ease. But he descended not from my shoulders. He had twisted his legs round my neck, and I looked at them, and I saw that they were like the hide of the buffalo in blackness and roughness. So I was frightened at him, and desired to throw him down from my shoulders; but he pressed upon my neck with his feet, and squeezed my throat, so that the world became black before my face, and I was unconscious of my existence, falling upon the ground in a fit, like one dead. He then raised his legs, and beat me upon my back and my shoulders; and I suffered violent pain; wherefore I rose with him. He still kept his seat upon my shoulders, and I had become fatigued with bearing him; and he made a sign to me that I should go in among the trees, to the best of the fruits. When I disobeyed him, he inflicted upon me, with his feet, blows more violent than those of whips; and he ceased not to direct me with his hand to every place to which he desired to go, and to that place I went with him. If I loitered, or went leisurely, he beat me; and I was as a captive to him. "

http://www.bartleby.com/16/606.html

Novalis said...

Good lord, it's enough to drive a person to, well, you know.

Okay, hitchhiker-turned-hijacker; I suppose there isn't really a word for that is there?

Gerard said...

Hitchjacker

Novalis said...

Great--something else for me to worry about on the drive home.

Anonymous said...

Life is like being on death row.

Addiction is the executioner who asks of its victim whether they would prefer anaesthesia before the paralytic, and eventual toxic injection that will stop their heart, or not. Either way, they're going to die; the only difference being pain.

Some noble souls will endure the experience of life with a steadfast will and the power of faith in the idea that 'it's all for the best' and 'what doesn't kill me (yet) will only make me stronger' (ironically, it's usually the religiously devoted that favour this perception).

The addict just doesn't see the point. THe addict is an optimist who makes the best of an impossible situation. The noble soul is in denial of the now --his/her hope lies in what may be (if indeed it be).

Most addicts have a warped neurobiological system which makes them susceptible to any addiction, not just their chosen poison.

So, rotating their addictive substances/habits might give them the fix while still enabling them to be functional on many other levels. Thus, addiction is no longer a problem, but a useful cowardly/smart device. The trick is to identify that tenuous critical point between controlled maintenance and entropy.

You know how the first sip, bite etc. is always the best? You can have that all the time if you broaden your mind a little.

And then you can be happy too!

Time to change...

Novalis said...

I see what you mean, but reread your Nietzsche: it's ART we have so as not to die of the truth, not dope. Try it--it's legal and won't harm your liver.

Anonymous said...

There's only one reference to Nietzche; the rest of what I said is purely speculative based on my observation and interepretation of the addict's psyche and motivations.

Art and dope are: interchangeable; synergystic; masking/unmasking devices; mutually destructive etc. etc. Both are lies we tell ourselves to make life bearable. Both reveal truth through the veneer of fiction.

Just for the record, I've only HAD one genuine addiction, and I presently have been able to channel my demons more creatively -- yes, art is one! (and my liver is superb, thanks for asking).

I don't advocate addiction. But, for some it's the only option, so -- rather than self-implode -- they should mitigate the evilness inherent in this necessary evil. The wisdom of playing with fire without getting burnt.

Gerard said...

Well there's always that vastly under diagnosed illness of our moment:

Intellectual Insanity

River Cocytus said...

Where does obsession fit into this? Obsession is like the addiction you manufacture by your own will - creating positive feedback, withdrawal, etc. Things like drugs probably include both an obsessive element and an addictive element, maybe, like psychedelics and stuff which both fascinate you and compel you chemically by messing with your brain.

But with sex, is there not a difference between the conditions under which it is had, and what those do to the experience? I.e. imagine what the Romans were engaging in near the end of the pagan period compared to what is necessary to reproduce the species. It's bizarre because it is so complex, that I don't think you can call most or all of it 'normal' or even 'evolutionarily normal'.

What do you think about obsessions, i.e. self-created, mental/emotional 'addictions'?

From my faith, we call it the 'habitual sin'. That term refers both to addictions of the physical sort - drink, smoke, drugs - things inbetween - sex, rock and roll, greed - and things obviously in the head - obsessions, vanity, obsessive compulsiveness, etc.

The idea being that they are the same thing in essence, though how one treats them would be based on their individual properties...