From Abuse to Recovery: Understanding Addiction

From Abuse to Recovery: Understanding Addiction

by Scientific American Editors

From Abuse to Recovery: Understanding Addiction by the Editors of Scientific American

Addiction is costly on many levels to the individuals affected, their families and society as a whole, but science may soon be able to offer treatment options to make the road to recovery a little smoother. In this eBook, From Abuse to Recovery: Understanding Addiction, we


From Abuse to Recovery: Understanding Addiction by the Editors of Scientific American

Addiction is costly on many levels to the individuals affected, their families and society as a whole, but science may soon be able to offer treatment options to make the road to recovery a little smoother. In this eBook, From Abuse to Recovery: Understanding Addiction, we tackle the many facets of this complex issue. First, we investigate why and how people succumb to a veritable prison of the mind as Sections 1 and 2 delve respectively into the psychology and the neurochemistry behind addiction. In "Time-Warping Temptations," David Freedman posits how "temporal discounting" can lead us to give into immediate impulse gratification rather than consider the long-term consequences. Later, two articles by Eric Nestler, "The Addicted Brain" and "Hidden Switches in the Mind," break down how both reward and pleasure circuits become overactive and sensitized to our drug of choice. Subsequent sections break out addictive substances individually: recreational drugs, prescription drugs, alcohol and nicotine. In "Bad Combo," Melinda Wenner Moyer looks at the death of Whitney Houston, who overdosed in February 2010 on a deadly mixture of alcohol and prescription drugs. "Alcoholism and Our Genes" by John Nurnberger, Jr. and Laura Jean Beirut is a lengthy story exploring genetic association studies. Since smoking is one of the hardest habits to break, another article, "Hooked from the First Cigarette," by Joseph DiFranza discusses exactly why this is the case. Finally, Section 7 examines new avenues for overcoming addiction. Michelle Solis's piece, "A Lifeline for Addicts" describes addiction as an impairment in reversal learning and a consequence of rigid synapses – an impairment that studies show could potentially be treated, thus making the recovery process easier. While rehab centers, counseling and 12-step programs are effective for many substance abusers, they're also ingrained as the only way to overcome addiction. New research such as this advances our knowledge of the physical component, knowledge that could lead to a more complete protocol that treats both the psychological and physiological aspects of addiction.

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From Abuse to Recovery

Understanding Addiction

By Scientific American

Scientific American Inc.

Copyright © 2013 Scientific American, a division of Nature America, Inc.
All rights reserved.
ISBN: 978-1-4668-4255-7



The Psychology Behind Addiction

Boredom Leads to Higher Risk-Taking Behavior

by Anna Gosline

For most people, boredom is a passing, nearly trivial feeling that lifts as soon as your number is called, a task is completed or a lecture ends. But boredom has a darker side: Easily bored people are at higher risk for depression, anxiety, drug addiction, alcoholism, compulsive gambling, eating disorders, hostility, anger, poor social skills, bad grades and low work performance.

Despite boredom's ubiquity and pathological associations, psychologists have yet to pin down what, exactly, it is. Several different scales all claim to measure boredom — the most widely used is the Boredom Proneness Scale — but a recent analysis suggests that they are measuring slightly different phenomena. Explanations for ennui are even more plentiful, ranging from Freud's theories of repressed emotions to individual differences in personality traits, the need for excitement, and attention skills.

Part of the boredom puzzle may be individual differences in how much excitement and novelty we require. Men, for example, are generally more bored than women. They also exhibit more risk-taking behaviors, report enjoying more dangerous entertainment and are more likely to say that their environments are dull. "People who are more likely to become bored do not see their environments as very rich or lively," says Stephen Vodanovich at the University of West Florida in Pensacola, who has been working on boredom for about 20 years.

Clues to the underlying causes of boredom have come from patients who suffer traumatic brain injuries (TBI). According to James Danckert, a neuroscientist at the University of Waterloo in Ontario, people with TBI often begin to indulge in riskier activities after their accidents. These activities might include taking drugs or jumping out of planes-pursuits they pick up in an attempt to deal with their new and chronic boredom.

Danckert theorizes that the massive flux of endorphins or pain medication necessary for recovery from a brain injury may have literally raised these patients' threshold for psychological pleasure and reward. "Now instead of a coffee doing it for you, you need a triple espresso," Danckert explains. "Anything that used to give you pleasure now has to be ramped up in order to succeed." Like chronically bored but healthy people, they need far bigger hits to find fun.

Highly bored individuals also tend to lack the ability to entertain themselves. As a result, they may turn to activities like doing drugs, says McWelling Todman at the New School for Social Research in New York City. "Drug use takes place during downtime when the person would have otherwise been entertaining themselves." This may be especially true during adolescence, a time "when they are putting together the skills needed to deal with boredom in adulthood." Boredom therefore becomes a lifelong cue for sensation-seeking behavior. If drug addicts can learn to deal with their doldrums, however, they may be less likely to relapse. In one study of 156 addicts ranging in age from 24 to 68 at a methadone clinic, the subjects' reported levels of boredom were the only reliable factor that predicted whether they would stay on course, Todman notes.

Our culture's obsession with external sources of entertainment — TV, movies, the Internet, video games — may also play a role in increasing boredom. "I think there is something about our modern experience of sensory overload where there is not the chance and ability to figure out what your interests, what your passions are," says John Eastwood, a clinical psychologist at York University in Toronto.

It is possible that the roots of boredom lie in a fundamental breakdown in our understanding of what it is we want to do. Bored people tend to score low on measures of self-awareness. They find it difficult to accurately monitor their own moods and feelings and hence understand what they truly want. These findings fit into the psychodynamic model of boredom, whereby people repress their true wants and desires and therefore cannot locate satisfying activity. The repression part is still debatable, but Eastwood has found that students who scored high on scales of alexithymia — difficulty in describing or identifying feelings, distinguishing between bodily sensations and feelings, and an inhibited inner emotional and fantasy life — also tended to be bored.

At a more functional level, the ability to focus or engage also plays a significant role in boredom. People with attention deficit hyperactive disorder (ADHD) are more likely to be bored, as are those who score low on measures of sustained attention. So, too, are individuals who have brain injuries or are prone to flips of attention (such as driving on autopilot or putting the milk in the cupboard). In fact, direct manipulation of attention can lead to boredom. In a classic experiment from 1989, James Laird at Clark University in Worcester, Mass., found that low-level distraction — by way of a quiet television in the next room — caused participants to find a reading task "boring."

These results support the idea that we label tasks as boring when they require a great deal of focused effort to hold our attention. In the 1970s, psychologist Mihaly Csikszentmihalyi, who is now at the Claremont Graduate University in Claremont, Calif., coined the term "flow psychology" — the idea that great absorption, focus and enjoyment of work results from a balance between our skills and the challenge of the tasks we face.

Both tasks that are too dull, such as factory work, or too complicated, such as doing taxes, feel tedious. Of course we all differ in our ability to focus, see the beauty and complexity of our surroundings, or ascribe meaning to our actions. We also differ in our interest or knowledge of an area. "You might love something that I would consider incredibly mundane," Vodanovich says. "I have some good friends who love classical music and I cannot stand it."

Boredom, like so many quirks of the brain, remains a mystery. One step toward unraveling it would be to develop better tools to measure boredom. There might even be different types, ranging from the existential, always present ennui to the transient, toe-tapping kind. As a result, different explanations may apply to different situations. "It is about bringing together all these different areas and trying to make some kind of synthesis," Danckert says. "Is it an emotion that we can't understand? I think we can understand it much better than we currently do. But like all things in the brain — there will be some parts of it that continue to elude us."

--Originally published: Scientific American online, February 26, 2007.

Why We Return to Bad Habits

by David DiSalvo

If you have ever lost weight on a diet only to gain it all back, you were probably as perplexed as you were disappointed. You felt certain that you had conquered bad eating habits — so what caused the backslide? Research suggests that you may have succumbed to a cognitive distortion called restraint bias. Bolstered by an inflated sense of impulse control, we overexpose ourselves to temptation and fall prey to impulsiveness.

Northwestern University psychologists first asked a group of smokers to take a self-control test. Unknown to the participants, the test was a pretense to randomly label half the group as having high self-control and half as having low self-control. After hearing their supposed result, participants played a game that involved watching the 2003 movie Coffee and Cigarettes while challenging themselves with one of four levels of temptation, each with its own cash reward. They could keep a cigarette unlit in their mouths (for the most money), unlit in their hand, on a nearby desk or (for the lowest reward) in another room. Participants earned a prize only if they avoided smoking for the entire 95-minute film.

Smokers told that they had high self-control exposed themselves to significantly more temptation than their counterparts — opting on average to watch the movie while holding a cigarette — and they failed to resist lighting up three times as often as those told they had low self-control.

"Restraint bias offers insight into how our erroneous beliefs about self-restraint promote impulsive behavior," says lead author Loran F. Nordgren of Northwestern's Kellogg School of Management. "It helps us to understand puzzles in addiction research such as why recovered addicts often relapse after they have broken free of withdrawal symptoms." The lesson? When you've made progress avoiding your indulgences and that little voice in your head tells you it's okay to start exposing yourself to temptation again — ignore it.

--Originally published: Scientific American Mind 21(1), 13. (March/April 2010)

There a Link Between Creativity and Addiction?

by David Biello

A drink of alcohol, any kind; "rails" of white powder; a pill prescribed by a pediatrician to assist with attention deficit disorder. Whatever the poison, addiction can take a powerful toll. Nor is it limited to drugs — food, sex and even death-defying stunts can exert the same pull.

But it seems to be a particular breed of person who succumbs to addiction, most recently exemplified by the late singer Amy Winehouse. She joins the "27 Club" of rock stars who died, via addictive behavior, too young — Kurt Cobain, Jimi Hendrix, Janis Joplin and Jim Morrison. Nor is it limited to the rock-and-roll lifestyle — Thomas de Quincey invented the modern addiction memoir with his Confessions of an English Opium-Eater in 1821. In fact, the list of addicts often overlaps with the giants of culture.

So is there a link between creativity and addiction? To find out, Scientific American spoke with neuroscientist David Linden of Johns Hopkins University School of Medicine and author of The Compass of Pleasure: How Our Brains Make Fatty Foods, Orgasm, Exercise, Marijuana, Generosity, Vodka, Learning and Gambling Feel So Good.

[An edited transcript of the interview follows.]

Is there a link between creativity and addiction?

No. I think the link is not between creativity and addiction per se. There is a link between addiction and things which are a prerequisite for creativity. ... We know that 40 percent of a predisposition to addiction is genetically determined, via studies on heritability in families and twins. There's no single addiction gene. We don't even know all the genes involved in conferring addiction risk. But the ones we do know have to do with the signaling of the neurotransmitter dopamine for pleasure and reward.

You don't become addicted because you feel pleasure strongly. On the contrary, addicts seem to want it more but like it less. They feel pleasures more weakly and are more likely to try more to achieve more. This blunted dopamine hypothesis is supported by brainimaging studies and biochemistry tests in rats and monkeys. It also holds for addictions to food, sex and gambling.

Genetic variants make for a low-functioning dopamine system, specifically D2 receptors. If you carry those variants, you are more likely to be more risk-taking, novelty-seeking and compulsive. None of which are explicitly creative, but they are things that get to creativity. So novelty-seeking might be a spur to creativity. Risk-taking might lead you to go more out on a limb. If you're compulsive, you might be more motivated to get your art, science idea or novel out into the world. These traits that come from having low dopamine function have an upside. These traits can contribute to people having great success in the world, like business leaders.

Genetics is 40 percent, it's not 100 percent — it's not the whole show. It's possible to carry the variants and not be an addict, and it's possible to not carry the variants and still be an addict.

Is there a link between addiction and other human attributes we might value?

There have been some studies in Scandinavia associating personality traits with the genetics of D2 receptors. If you carry these variants that turn down dopamine, you become more socially desirable. There is something charismatic about risk-takers.

Does curing the addiction eliminate the creativity?

Usually not. When you cure the addiction, you're not changing your genes. People are in recovery for life. ... There is always a tremendous risk of relapse. Successful recovering addicts adopt behavioral strategies that allow you to resist or reduce cravings.

If you develop a full-blown addiction to a drug, the indications in rats are that it changes the brain forever. You can get it back a little but never entirely.

Is there a specific time that is more vulnerable?

There is nothing magic about that age [27]. Brain maturation ends at about age 20. In the early 20s, you have your adult brain. In the late 20s, it's the same.

Generally speaking, 27 is an age where you can have achieved a lot and be at a place that is very enabling. The one thing that we really know about relapse and addiction is that it is stress-triggered. Anyone dealing with an addict knows that relapse doesn't happen when things are going great.

Stress is a biological phenomenon. We know the intermediate steps. You argue or you're fighting off an infection and your body releases stress hormones, which bind to receptors in the brain pleasure circuitry that ultimately result in cravings. We know how stress causes craving. ... The two biggest factors are genetics and stress.

--Originally published: Scientific American online, February 7, 2008.

Time-Warping Temptations

by David H. Freedman

Walk into any fast-food restaurant, and you can watch a small crowd of ordinary people doing something that is utterly irrational: eating junky, excessweight- inviting food likely to leave them feeling bad about their bodies and open to a host of serious ills. We literally line up to trade our health and selfimage for a few minutes of pleasant mouth feel and belly comfort — because the latter is right here, right now, whereas the former is months, years and decades away.

This foolish exchange refiects a glitch in our brains that may wreak more havoc in our lives and in society than any other. Known as temporal discounting, it is our tendency to view small rewards available now as more desirable than even much bigger payoffs down the road. Scientists think this trait may have been programmed into us by evolution at a time when the environment, with its many threats to our survival, favored those who grabbed whatever they could whenever they could get it.

Today this tendency plays out in overeating, overspending, abusing drugs, and more. "Because the rewards for our good behavior are off in the future where they seem less important, we are almost guaranteed to often act against our own interests," says Laurette Dubé, a psychology and marketing researcher at McGill University.

The drive to instant gratification appears to be hardwired in humans. But that fact does not mean we are destined to grab immediate rewards we will later regret. "It was long thought that impulsiveness was fixed," says psychologist Samuel M. McClure of Stanford University. "Now there's a lot of evidence it can be moved."

New insights into the psychological subtleties of temporal discounting have suggested ways to counteract the distorted thinking behind the phenomenon and change shortsighted behavior. If these strategies work, we will be more likely to eat more healthfully, exercise, stay out of debt, and even avoid drug and alcohol addiction.

A Matter of Time

Temporal discounting has long been seen as the triumph of feelings or impulses over reason. To go beyond that imprecise insight, several groups of neuroscientists, including teams led by Paul Glimcher of New York University and B. J. Casey of Weill Cornell Medical College, have scanned people's brains using functional MRI while they were tempted to grab immediate rewards. They found that this urge seems to originate in the brain's limbic system, a set of cerebral regions charged with emotion, along with the ventral striatum, a hub for reward, among other areas associated with feelings and impulsivity.


Excerpted from From Abuse to Recovery by Scientific American. Copyright © 2013 Scientific American, a division of Nature America, Inc.. Excerpted by permission of Scientific American Inc..
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