Addiction Explained

I want to bring awareness to addiction but explain it in words that we use every day.  I will use words like desire, willpower, and intention.  In the scientific community, this is known as folk psychology, but there is nothing wrong with this.  Although “desire” is a dopaminergic signal found within the mesolimbic system, we want to understand the experience of addiction and not the neuron.

After understanding addiction, it should become clear that compassion and accountability are more appropriate responses to dealing with alcoholics and addicts than demonization and punishment.  Furthermore, addiction meets all of the definitional requirements of being a disease—that is, a part of their addiction is out of their control—which makes punitive measures ineffective in the long run.

The Survival Center

Put simply, drugs and alcohol are compelling because they hijack the precise mechanisms that evolved for sex. [5]

Those that come from alcoholics anonymous get lost in their literature and believe that they must follow the twelve steps word-for-word as if life depended upon it.  In fact, the original steps were written in six steps.  The point is that the overarching mechanism that keeps them clean is probably the group consciousness that makes them adopt new norms that using is not acceptable.

In the process of working the steps, the parts of the mind that have an obsession with the substance become dormant like a muscle that atrophies when not used.  When these parts don’t get used, then the desire to use and the cues associated with using become weakened.  They don’t, however, completely go away which is why, arguably, once an addict, then always an addict (i).

The reason addicts develop strong desires to use in the first place is that they are hijacking their survival center.  This pleasure center (ii) has a dense source of dopamine receptors within the nucleus accumbens and dorsal striatum, and it makes us want and desire things such as caloric-rich foods, sex, and material items.  Drugs and alcohol, unfortunately, target the same part of the brain.

Normal Temptation

Judgment becomes nothing more than the projection of the strongest desire. [1]

In short, we have intentions, desires, and beliefs that interact with one another to create a behavior or action.  This system is controlled by our willpower.  Think of willpower as a skill or a muscle that becomes easier to use when used often and well-rested.  When we resist temptation, it is not because we use good judgment but rather we use willpower in order to stick with our intentions.

The problem with addicts is not their willpower but that the desire to use is stronger than what we would experience in normal temptation.  Not only is their desire stronger but the desire is decoupled from reasoning, which means that reasoning is near impotent (iii).  This does not mean that addicts don’t reason, but when they reason and make choices it will always be biased.

In normal temptation, a person may desire chocolate and indulge by giving in to the urge.  In order to do this, they perform a judgment shift.  A judgment shift is when we place a higher value on what we would gain if we gave in to temptation and a lower value if we were not to give in.  We do this by finding reasons to give in to temptation which reduces our cognitive dissonance.

As an interesting aside, if our intention was to not give in to temptation, then our desire was victorious but we couldn’t say that we went against our better judgment.  We could even say that our decision was rational since when making the choice to indulge or not, we gave ourselves reasons why to indulge.  This although is reason-based rationality and not the rationality that we are familiar with.

Addicts’ Temptation

Desire works by capturing the user’s attention, focusing on what is desired, and narrowing horizons. [1]

When the addict, on the other hand, makes a judgment on whether or not to use, there is such a disparity between the two that not using won’t be tempting.  It is not as if the addict doesn’t realize that the choice to use has consequences but rather the desire to use is much more tempting than to not use.  In fact, the desire is so overwhelming that the consequences feel like a walk in a park.

The only hope for an addict is that their willpower to resist is strong and the desire to use isn’t strong, which occurs with abstinence.  If they try to engage in reasoning, it will be a rationalization or judgment shift in favor of the more desirable (iii).  The use of the word choice just doesn’t make sense for an addict because the feeling to use is heavily anchored, which will bias the decision or choice.

In normal circumstances when our desires aren’t overwhelming, I suppose we can call it a choice when we stick with our intentions in the face of a contrary desire.  That is, we chose to not give in to temptation and instead chose the right path.  But I don’t think that is what is going on here.  Because the one that chose correctly may have just had a weak desire, a strong will, and intentions not to.

Hate But Still Want

There must be an almost complete disconnection between judging an outcome good and wanting it, or, conversely, between judging it bad and not wanting it. [1] 

The addict after time will start to hate the substance yet still want it.  Not surprisingly experiments show that liking (hating) and wanting (not wanting) are distinct phenomena but work under the same motivational system.  For an addict, these two feelings become decoupled as one doesn’t affect the other.  So no matter how much they hate it or think it is “bad” they will still want it.

All of the above discussion assumes a degree of severity in the addict’s addiction which depends on how often they have used, how long, what the substance is, and their own genetics.  Depending upon the stages and severity of the addiction, the disparity between the value assigned to using and not using will diminish and start looking more like a choice as the more they chose not to use.

The interesting thing is why would an addict or alcoholic choose to use years after sobriety.  That is to say what if their intentions change and they decide to use despite having the belief that using will result in consequences.  After all, our intentions, wherever they come from, motivate us directly and don’t require us to have a desire.  This is where the complexity lies, see addendum.

Addiction Is Immoral

If we think of people in categorical ways, then we can label an obese person and an addict as lazy and weak.  After all, it’s their biology and choices that got them there.  But if we allow science to illuminate the details of human behavior, we won’t resort to a black-and-white reading—instead, we will understand addiction as a mechanism and not a moral failing that deserves contempt.

I am not suggesting that we give up labels because they describe what we observe.  Addicts and alcoholics are downright weak when they succumb to substances in order to cope with the pains that life serves them.  They destroy the lives of family members and become a burden to society.  If morality is about the wellbeing of others, then they certainly qualify as being immoral beings.

This viewpoint, however, serves our interests and not the addict or alcoholics.  To help, we must remove morality from the equation.  If we label them as immoral and punish them, then they will only hide their addiction better.  Our penal institutions are a sham for the addict and our attitudes are misguided.  It is time we let science speak and give them a fighting chance to become moral beings.

Notes

i) This means that addicts and alcoholics will often “pick up where they left off” if they start using again.  But this isn’t destiny since the wanting of the substance becomes lessened while they learn how to not act on that want.

ii) This is somewhat a misnomer because dopamine is about “wanting”, and it’s the opioid receptors that give “pleasure”.

iii) This is when an addict is in the active stages of addiction.

Addendum

  • intention – enables us to resolve deliberative uncertainty in order to facilitate action
  • judgments – evaluation or appraisal of what is best
  • desire – a state that preoccupies an agent’s attention with an urge to perform an action
  • willpower or self-control – when one sticks with their intentions in the face of contrary desires
  • weak-willed – when one revises their intentions too readily and can be due to either having one’s willpower depleted or other factors
  • choice – when the situation arises of what to do

References

[1] Richard Holton. “Willing, Wanting, Waiting.”

[2] McGonigal Ph.D., Kelly. “The Willpower Instinct.”

[3] Miller, Shannon. “The ASAM Principles of Addiction Medicine.”

[4] Morgan, Oliver J. “Addiction, Attachment, Trauma and Recovery.”

[5] Wilson, Gary. “Your Brain on Porn.”

The AA Delusion

As fascinated as I am over the founders of Alcoholics Anonymous—a physician and stockbroker who created a mass movement because they couldn’t stop drinking—I would not be much of a freethinker if I didn’t offer a more candid analysis.  The Big Book, despite containing some obvious truths, is a muddled piece of work that seems to only intrigue its members but not the experts.

Although it contains many pithy statements to give it its appeal, the book is far away from a scientific understanding of alcoholism and substance abuse.  Even though it is wrong in its details, the approach works for many (iii) by creating a group consciousness that their pseudo-selfish (i) behavior is destructive to them and to others.  The group acts to reinforce the new social norms created.

Too Smart For Own Good

Now we come to another problem, the intellectually self-sufficient man or woman… far too smart for own good… blow ourselves into prideful balloons… [2]

The theme throughout the book is that the ego, self-will, or willpower is something to be smashed and looked down upon.  The ego is the part of us that we feel when we self-indulge—I want, and I need—and helps us to differentiate ourselves—I am better than he, she, or they—as well as engages in self-appraisals—I did this and everyone needs to know.  The ego is the ugly part in all of us.

But the ego is also the part of us that helps us to advance in life since it drives us to compete with others.  The problem with the Big Book is that it generalizes the ego and equates it to sin.  This isn’t surprising given the Protestant background of the founders, and the same fear tactics are used from religion concerning over-indulgence.  But a big ego in itself doesn’t cause addiction (ii).

The book contradicts itself often and one noteworthy paradox is that the same will and self that is condemned is the same will and self that helps the member to learn new habits and stay clean and sober.  Maybe the founders anticipated members to be critical—”far too smart for own good”—of the newly learned beliefs and hence they decided to denigrate the concept of the ego altogether.

The Self-Centered Man (iv)

Selfishness, self-centeredness! That, we think, is the root of our troubles. Driven by a hundred forms of fear, self-delusion, self-seeking, and self-pity, we step on the toes of our fellows and they retaliate. [3]

Selfishness can’t be the cause of addiction.  We usually stand to benefit when we are being selfish and alcoholics and addicts are beyond the stage of pleasure.  They are driven by an obsession to use the substance and can act compulsively on that impulse.  Selfishness is just not an accurate description especially since their willpower has been hijacked by a very strong desire to use.

Even in the beginning stages of addiction, a member that drinks occasionally would be no more selfish (ii) than someone that indulges in chocolate.  From an outsider, it looks like a selfish act since the attention is on them, but in the long run, there is no net benefit for them, and they end up harming themselves.  At best, we have to settle for a label of quasi or pseudo selfish [1].

The Big Book of course gets it right when it says that arrogance and over-indulgence usually backfire on us, but that does not mean that these qualities cause addiction.  Furthermore, there is no shortage of grandiose personalities who are not addicts or alcoholics, and there has to be the right situational and genetic factors that lend hand to creating what we would call an alcoholic or addict.

A Harmless Delusion

We will suddenly realize that God is doing for us what we could not do for ourselves. [3]

During the course of the day, many of us will think and feel that we are better than average in capabilities, appearance, and intelligence.  This can’t be true if these traits have a bell-shaped curve.  But we operate best when we delude ourselves into thinking that we are slightly better than others.  So is there anything wrong with members believing that God is helping them stay sober?

We should be careful to not dismiss members out of hand because there are well-understood benefits to surrendering ourselves to something greater than ourselves.  This concept is endorsed by Western psychology and even evolutionary psychology as a way to deescalate the defense system (involuntary defeat system) which is what is activated in periods of failure, rejection, and stressors.

The founders wanted members to be demoralized, hence the humiliation of “My name is __, and I am an alcoholic”, so that they realized the severity of their problem.  Members often are in denial to protect their egos, so perhaps this method works in combination with surrendering their willpower to something greater than them so that they open up and address the problem.

But if we want an analysis of what is really going on, then members need to realize that believing in something that feels good doesn’t mean it’s grounded in reality.  A belief in God is optional but is probably harmless.

Notes

i) The best analysis that I have seen on AA was brought to my attention by Dr. David Allen.  Please see the references section [1].

ii) Two personality traits that are related to what we would think of as egotistical would be narcissistic and self-centeredness.  Addiction is correlated with these two traits but that does not mean that they cause addiction.

iii) An analysis of over 27 randomized controlled studies concludes that 42% of 10,565 participants of a 12-step approach will remain abstinent for a period of 1-year or more whereas only 35% would remain abstinent through other approaches.

iv) When I use the word man, I am implying the pronouns he, she, or they.

v) The group’s “serenity prayer”—”. …accept the things we can’t change, the courage to change what we can, and the wisdom to know the difference.”— is powerful and although we may not know it in words, we intuitively do it all the time by letting go of concerns that are out of our control.

References

[1] Allen, Dr. David. “The 12 Steps of AA: A Translation.”  Psychology Today

[2] 12 Steps and 12 Traditions.  Alcoholics Anonymous World Services Inc.

[3] The Big Book.  Alcoholics Anonymous World Services Inc.