Is Addiction Really a “Disease”?

1. Is Addiction Really a “Disease”?

2. Free Will exists Responsibility Can stop Punishment and Coercion DO work BEHAVIORS No Free Will No Responsibility Can’t stop Punishment and Coercion DON’T work SYMPTOMS “Choice” vs.“Disease”

3. Very Good Questions Raised by the “Choice Argument” … • Why do most people with drug and alcohol problems stop spontaneously and with no treatment? • Why do addicts “love” drugs? • Where does spirituality fit in with all this brain science? • What’s to keep the addict from using “I have a disease?” as an excuse? • Does punishment/coercion work?

5. The Disease Model(a CAUSAL model)

7. If ever we could fit addiction into this model, then it would win admission into ”The Disease Club”. . .

8. And now, we finally can …

9. Addiction is a BRAIN disease • The brain’s a HARD organ • No good tests for brain diseases • People with brain diseases start out at a disadvantage

10. The Frontal Cortex • Confers semantic content onto objects in the world • Emotional meaning • Seat of the Self and Personality • Love, Morality, Decency, Responsibility, Spirituality • Conscious

11. The Frontal Cortex: Defective in addiction? • Where drugs work? • Addict personality? • Sociopathy? • Self-centeredness? • Character defects? • Immorality? • Weak will? • Poor socialization? • Bad parenting?

12. But drugs don’t work in theFrontal Cortex . . . • Drugs work in the Midbrain

13. The midbrain is a scary, spooky, fascinating place . . . What does it handle? - Love? - Morality? - Decency? - Responsibility? - Spirituality? - Free Will? - Conscious Thought? NO . . . the midbrain is a way-station for incoming sensory information on the way to the cortex . . .

14. The Midbrain is the SURVIVAL brain • Not conscious • What handles the next thirty seconds • A life-or-death processing station for arriving sensory information

15. The Midbrain is your SURVIVAL brainIt handles: • EAT! • KILL! (defend) • F _ _ _ !

16. Frontal “Cortism” • Human prejudice in favor of the cortex • Belief that the cortex is ALWAYS stronger than the midbrain • Illusion that we are fully conscious of all our brain’s activities • Neurologic evidence tells us otherwise (ex. “blindsight”)

17. Drugs work in the Midbrain • NOT in the Cortex (and don’t take my word for it . . .)

18. Olds experiments: Where do drugs work? Old Mouse experiment

19. Mice preferentially self-administer cocaine ONLY to the Reward Centers of the Midbrain • To the exclusion of all other survival behaviors • To the point of death

20. Mice get addicted to drugs, but … • Mice don’t weigh moral consequences • Mice don’t consult their “Mouse God” • Mice aren’t sociopaths • Mice don’t have bad parents “Mummy didn’t love me….”

21. Mice studies separatecorrelation from causationAddiction can exist where “behavioral” variables do not applyMoral, personality, and social learning variables can sometimes go along with addictionBut they cannot cause addictionNor can addiction cause them

22. The Drug becomes Survival at the level of the unconscious . . .

23. NON-ADDICT---------| (non-user) | (experimenter) | (user) | (abuser) | DRUG = DRUG | ---->ADDICT DRUG = SURVIVAL A line is crossed …

24. The addicted brain is quantitatively differentfrom the normal brain (it’s not just a beer/spliff anymore . . . . . . it’s the main way of coping with life)

25. What causes that change?What makes the addicted brain fundamentally different from the normal brain? (You’re not going to like this . . .)

26. STRESS : the causal agent in addiction

27. We all face stress, yes . ..But we don’t all: • Face the same severity of stress • Face the same pattern of stress • Have the functioning coping mechanisms • Come to the table with the same brain

28. EU-STRESS: - good stressors - resolved when the subject successfully acts (exert themselves) on the environment - ex. studying for a test and getting an A, sports victories, art, helping others - can actually protect the subject from addiction DYS-STRESS: - bad stressors - nothing the subject tries to resolve the stressor works (loss of power) - ex. Domestic violence, sudden illness, injury or death, grieving - particularly harmful in the formation of addiction 2 different KINDS of stressors

29. Stress changes the physiology of the midbrain . . .

30. Under chronic, severe and unmanaged stress, two things change in the brain: Novelty seeking genes come on Dopamine neurotransmission changes

31. DOPAMINE mediates the experience of pleasure

32. Stress change the brain’s ability to process Dopamine (pleasure)

33. The Brain has a Hedonic “Set Point”

34. The Dopamine System changes in conditions of severe, chronic stress

35. High stress hormone levels reset the brain’s pleasure “set point”

36. Now that the midbrain has found what secures survival …… how does it motivate the individual to repeat that behavior?

37. Stress = Craving

38. Why the “Choice” argument fails … • It fails to take into accountCRAVING • It measures addiction only by the addict’s external behavior • It ignores the suffering of the patient • You don’t actually have to have drug use for the defective physiology of addiction to be active • The addict cannot choose to not crave

39. It’s not that the addict doesn’t have “values” . . . It’s that in the midst of survival panic the addict cannot draw upon those valuesto guide their behavior . . .The midbrain now reigns . . .And conscious thought becomes constricted.

40. Alcohol & Sedative/Hypnotics Opiates/Opioids Cocaine Amphetamines Entactogens (MDMA) Entheogens/Hallucinogens Cannabinoids Inhalants Nicotine Caffeine Steroids Dopamine-Releasing Chemicals

41. Food (Bulimia & Binge Eating) Sex Relationships Other People (“Codependency,” Control) Gambling Cults Performance (“Work-aholism”) Collection/Accumulation (“Shop-aholism”) Rage/Violence Media/Entertainment Dopamine-Releasing Behaviors

42. Alcohol & Sedative/Hypnotics Opiates/Opioids Cocaine Amphetamines Entactogens (MDMA) Entheogens/Hallucinogens Cannabinoids Inhalants Nicotine Caffeine Steroids Food (Bulimia & Binge Eating) Sex Relationships Other People; (“Codependency,” Control) Gambling Cults Performance; (“Work-aholism”) Collection/Accumulation; (“Shop-aholism”) Rage/Violence Media/Entertainment The Full Spectrum of Addiction

43. Definition of Addiction: Addiction is a dysregulation of the midbrain dopamine (pleasure) system due to unmanaged stress resulting in symptoms of decreased functioning, specifically: 1. Loss of control 2. Craving 3. Persistent drug use despite negative consequences

44. Addiction fits the “Disease Model!”

45. But questions still remain … • Why do most people with drug and alcohol problems quit spontaneously and with no treatment? • Why do addicts “love” drugs? • Where does spirituality fit in with all this brain science? • What’s to keep the addict from using “I have a disease?” as an excuse? • Does punishment/coercion work?

46. Addiction Part Two: • The drug takes on personal meaning • The addict develops an emotional relationship with the drug • The addict derives their sense of self and exerts agency through the drug

47. 1. To give the addict workable, credible tools to proactively manage stress and decrease craving 2. For each individual addict, find the thing which is more emotionally meaningful than the drug - and displace the drug with it The Two Tasks of Addiction Treatment:

48. The trouble we have in calling addiction a “disease” isn’t because addiction doesn’t fit the Disease Model (because it does); the trouble we have in calling addiction a “disease” comes from theproblems inherent in the Disease Model itself!

49. So what’s the causal element that explainsthe Bio-the Psycho-the Socio-and the Spiritualvariables of addiction?

50. Punishment won’t stop drug use because the drug is survival • Nothing’s higher than survival • No threat matches loss of survival • The addict must first secure survival before attending to anything else • And the survival imperative exists at the level of the unconscious