This handout is a quick way to start the conversation in groups. I have folks circle the 10 traits that they (think/feel) have. Than I ask them to put them in a numbered order (1 to 10), best to worst. One day someone suggested that they had way more negative traits so…. I started asking folks (after they shared the positive traits) to write their negative traits on the back and share.
Most of the people that I worked with for the last 10 years were men between 20 and 35. Most had started using intoxicants as teens with cannabis and moved onto oxie and later stronger opioids and/or fentanyl. Most had felony possession charges and/or were on probation.
I kept a lose record of what people chose as their top 3 positive traits: 1. Hardworking, 2. Reliable, 3. Strong. One last thing, I usually asked folks at the end of group would their loved ones and/or family (however they chose to define that) agree with their list of positive traits. Most said (hell) no.
Substance addiction is a perplexing phenomenon for those who fortunately do not suffer from it. Although it is incredible to believe that people would willfully engage in behaviors that create problems with their lives on so many levels, substance addiction is a reality for millions of people. According to data published by NIDA (National Institutes of Drug Abuse) nearly 20 million Americans have undergone opioid de-addiction therapy in 2010. What makes some people so susceptible to substance abuse while others are able to protect themselves? A study of brain images of heroin addicts, conducted by Gold, Liu and colleagues, shows significant differences in brain activity even in resting state, without heroin use. Functional MRI (fMRI) images from opioid addicted patients were compared with similar images from health people.
Resting state fMRI images of men undergoing opioid substitution therapy showed that areas of the brain engaged in reward perception, motivation, memory and self-control show significantly different activity than comparable regions in healthy individuals. Areas like the orbitofrontal cortex, cingulate gyrus and hippocampus show consistently different resting state activities in heroin-dependent and healthy subjects. The prefrontal cortex of dependent patients was less active than that of healthy patients in the resting state, during de-addiction therapy. However, this area which controls motivation as well as degree of inhibition, was observed to be highly active during periods of opioid use. Other areas of the brain like the hippocampus which regulates memory, also showed activity patterns that were different from those in healthy subjects, in the resting state in addicted individuals. These images shed light on the mechanism of addiction in people and the areas of the brain that are engaged, perhaps constitutively, in sustaining addiction.
Given that study participants were enrolled from de-addiction clinics, episodes of heroin abuse had already taken place in their life. It is unclear whether the same areas of the brain would show similar activity in naive individuals. If this possibility is validated by comparative studies, these fMRI imaging techniques may have tremendous diagnostic potential in identifying people who are at high risk for addiction. One drawback of this investigation is that only male patients were included in this study. Therefore, we do not know whether there are gender-based differences in the resting state brain activity of female opioid addicts.
The study does throw up interesting possibilities. It is possible to enroll naive subjects, possibly teenagers or pre-teens, and obtain baseline brain images before these people have tried out any addictive substance like tobacco, heroin or alcohol. Follow-up studies with the same people can indicate whether experience of addictive substances can change the baseline pattern of activity. This kind of long-term and long-range study may help to identify brain markers for specific addiction disorders. The study also indicates why counseling fails to have an impact on some patients. It is likely that profound changes in resting state brain activity resulting from addiction may override the effects of received and processed advice.
Zhang Y, Tian J, Yuan K, Liu P, Zhuo L, Qin W, Zhao L, Liu J, von Deneen KM, Klahr NJ, Gold MS, & Liu Y (2011). Distinct resting-state brain activities in heroin-dependent individuals. Brain research, 1402, 46-53 PMID: 21669407
Recent research from Brown University could pave the way for new methods of treatment for those recovering from addiction. Researchers identified an exact brain region in rats where the neural steps leading to drug relapse take place, allowing them to block a crucial step in the process that leads to stress-induced relapse.
Prior research has established that acute stress can lead to drug abuse in vulnerable individuals and increase the risk of relapse in recovering addicts. But the exact way that stress triggers the neural processes leading to relapse is still not clearly understood. The Brown study provides new insights on how stress triggers drug abuse and could lead to more effective treatments for addiction.
According to the study, stress has significant effects on plasticity of the synapses on dopamine neurons in the ventral tegmental area (VTA), the brain region where the neural activities leading to a stress-induced drug relapse take place.
Stress activates kappa opioid receptors (KORs) in the VTA, and the researchers found that by blocking the KORs, they could prevent the rats from relapsing to cocaine use while under stress.
Published in the journal Neuron, the study shows blocking these receptors may be a critical step in preventing stress-related drug relapses in humans, as well. The chemical used to block the receptor, “nor-BMI,” may eventually be tested on humans, according to the study’s authors.
“If we understand how kappa opioid receptor antagonists are interfering with the reinstatement of drug seeking, we can target that process,” senior study author Julie Kauer said in a statement. “We’re at the point of coming to understand the processes and possible therapeutic targets. Remarkably, this has worked.”
Kauer noted that the study builds upon over a decade of research on how changes in brain synapses relate to behaviors like addiction. The advance is significant and could accelerate progress towards a medication for those struggling to recover from addiction.
“If we can figure out how not only stress, but the whole system works, then we’ll potentially have a way to tune it down in a person who needs that,” Kauer said.
Whether consciously acknowledged or not, we live in an almost constant state of anxiety. We are concerned with what we may lose, or what we may not gain. We also live in grief and regret over what we have left behind or at least feel we may have indeed lost. We thus attach ourselves to the very things that we cannot, ultimately, control, the past and the future. In truth, there is only today, this moment, and this breath with which we are, and can be, connected. The past is gone, and the future has not yet happened. We are here, now.
From a Buddhist perspective, addiction might be considered the archetype of attachment. Addiction is, in fact, a collection of attachments. It is attachment to fear, attachment to loss, and attachment to longing, emptiness, and a lack of a sense of purpose. Whether we choose alcohol, drugs, sex, food, pornography, exercise or even shopping, we are simply employing the means serving the compulsion to fill a space and dampen our pain. The means does not matter; that is simply a gesture. The compulsion is the crux of it, and that compulsion is not so much to drink, or do drugs, or to spend; that compulsion, ultimately, is to fill that space.
And just what is that space? We might look upon it as the “God-shaped hole.” The wisdom teachings suggest that in identifying with a self, a “me”, we divorce ourselves from the true nature of our existence. From a psychological perspective, this division presents itself as inauthenticity, and the internal conflict that condition engenders promotes internal strife. In our attempt to reconcile this sense of inauthenticity, we cling even more desperately to establishing a sense of “me-ness” and can, in some cases, become morbidly self-destructive in our attempts to soothe the pain of failure in that reconciliation.
Addiction generally begins as an interest. As soon as we express an interest in something, we are expressing a preference. In expressing a preference, we are dividing our attention and creating an attachment to something in the world around us. As that interest turns into a fascination, our attachment deepens. Our attention becomes more and more exclusive, and we become increasingly imbalanced; emotionally, intellectually, and spiritually.
Fascination may then flower into obsession, and we become a slave to our attachment. We are no longer ourselves, and rather than ‘losing our mind’, which would be the skillful means by which to escape our attachment, we are trapped inside the mind.
With obsession, our attachment becomes even more intensified, and our exclusion even more narrow. As we become slaves to our attachment, our mind, and our behavior, we lose the ability to exercise free will and, in that light, move from obsession to compulsion; from place of being driven, to a place of need.
At this point we fail the First Noble Truth; our attachment has become so involved that we have invited suffering. We are no longer willful, but, rather, subject to and at the sufferance of the will of our attachments. When we find ourselves in a place that we cannot live without exercising this attachment, whatever it may be, we have fallen into a state of addiction.
Within the context of addiction, people often feel that they do not have a choice. Nothing could be further from the truth. We always have a choice. When confronting someone who themselves is confronting an addiction, saying to them, “Stopping your behavior is your choice.” is, however, often met with profound resistance for their failure to see that choice.
The key to getting a grasp on this is recognizing that choice is a constant state; it is not a single moment in time. If the choice not to be addicted were a single choice point, then all we would ultimately do is move our attachment from something socially defined as negative (say, drinking or being promiscuous) to something that is socially defined as positive (not drinking or being chaste). In fact, we would become addicted, or at the very least attached, to not being addicted.
Buddha spoke of the Middle Way. Within the context of choice that suggests that if we are present in the moment, our choices are constant. We do not, then, go right or left, say yes or no, think good or bad, or see black or white; rather, we are aware that both opportunities are presenting themselves, we recognize this and acknowledge it, then choose neither.
When we lose the Middle Way and fall off our balancing point, we create our pain. We create our sense of emptiness, and our anxiety around loss. We deceive ourselves into believing that we are less than whom and what we are by virtue of attaching ourselves to things, objects, situations, emotions, and anxieties that take us away from ourselves. This is the engine of addiction.
Coming back to the present moment brings us back to our constancy of choice. We find ourselves in the Middle Way, on the balancing point and we are able to see both choices. Seeing both sides in balance and in perspective then gives us the opportunity to exercise compassion. Most importantly, it gives us the opportunity to exercise compassion toward ourselves. We are able to see the left and the right, and we are also able to see the left in the right and the right in the left.
Our frustration with the world and sense of victimhood thus becomes transformed into the recognition that we must set an intention in our lives. Our depression finds an antidote for itself in the gratitude that we can express simply for being alive. We begin to see outside ourselves with a clear vision and recognize that the things outside ourselves are, in fact, quite outside ourselves. In letting go of our attachments we also let go of the things that influence us and draw us into a state of mind where we feel less than we are, where we feel that something is missing, where we need to fill the space, or dampen the pain, or simply make it go away.
Coming back to the breath as a marker for the present moment and exercising the constancy of choice in that moment and every moment also gives us an opportunity to break free of the bonds of this supreme state of attachment and begin to climb out of the pit of suffering into which we have gotten ourselves.