A glass of liquor and cigars beside it lie on a table.

Addiction

Prominent psychologist Jordan Peterson has undergone recent treatment for a drug habit. He has found it impossible to quit taking clonazepam voluntarily, though he insists that his problem is physical dependence and not addiction.

I hope he will find an effective treatment soon. In the meantime, his dependence raises an interesting question: How should we label drug habits?

The habitual character of drug use does not reveal itself for many drugs and most drug users. Yet in posting a description of mental effort, I mentioned that some kinds of voluntary learning change to automatic behavior, passing from voluntary cortical control to involuntary striatal control. This can occur with drug use, too.

Addiction involves learning. The search for the origin of addiction in each drug user’s brain has lately focused on synaptic plasticity, both LTP and its cousin, long-term depression or LTD.

The idea occurred to brain researchers a while ago. Here’s one review from Kauer and Malenka and an updated view from Lüscher.

Drug experimentation is not uncommon among writers, artists, scientists, and physicians, though few seem to become addicted. Famous exceptions are Sigmund Freud, who never forsook his everpresent cigars  other than briefly during treatment for oral cancer, and Mark Twain, who was moved by cardiac pains rather than cancer to try smoking fewer than 40 per day.

The term “addiction” is still common, but DSM-V abandoned the label in favor of “substance use disorder”. An addict bears a stigma, and even substance abuse has moral overtones.

A packet of pills is shown sticking out of a denim pocket.

BIO: A benzodiazepine habit like Dr. Peterson’s probably results from disinhibition of dopamine-releasing neurons in the midbrain that send their axons into the forebrain.

The director of the National Institute of Drug Abuse, Nora Volkow, presented an excellent summary of such views of addiction in this talk, which only lasts 24 minutes. Hank Green, with superior narrative chops if less institutional cred, has offered a useful accompaniment.

Note that Dr. Volkow acknowledges that addiction is not inevitable, and that biology alone seems not to be able to predict when it will take hold. She brings up environmental influences at about minute 20.

It is helpful to avoid talk about drugs “hijacking the brain”. Here’s addiction. And here’s bootlegging, which begat hijacking, or taking possession of someone else’s truck without the legal niceties. But hijacking the brain is a fallacy.

Addiction is not a thing in the brain that takes control. It’s a construct that applies to several processes within ourselves. And we can’t hijack ourselves any more than we can give ourselves a gift*.

*Wittgenstein, Philosophical Investigations, #268.

PSYCHO: One obstacle in finding an exclusively biological explanation of addiction arises from the fact that addiction is not directly observable. It is a psychological construct and may be culture-bound. That is, it is not a universal behavior pattern of individual people but a cultural pattern, with cultural variations. Furthermore, it is a truly biopsychosocial phenomenon, and appears to lack a single cause or mechanism.

An unfortunate argument has developed between those who hold that addiction is a brain disease, and therefore biological, and others who argue that it is not a brain disease, and that addiction is a social, environmental, or experiential phenomenon.

Part of the controversy revolves around criticisms of the Rat Park experiment, yet convinced some folks that addiction must be exclusively an outcome of experience and not a neuropharmacological event. The argument is still going back and forth: addiction is a brain disease; no, it’s not. But it is. Is not.

To me, much of this suggests confusion about necessary and sufficient conditions in the logic of neuroscience. While it is true that experience registers in the brain and that organized behavior will not occur without the nervous system, we would have a troublesome time identifying addicted neurons or specifying neural causes for most of our complex behavior. The neural explanations of behavioral addiction are still rudimentary, and there is still not a measure of brain activity that will predict addiction upon first drug use or the freedom from it that may emerge from aging. Talk of risk factors comes as a relief.

SOCIAL: Our bloodstreams and our sewers are full of drugs that vary in their threat. When addiction involves prescription painkillers–opioids or synthetic opiates–we see an epidemic that is hard to describe–except to acknowledge that the mid-Atlantic region has an abysmal record.  It’s an epidemic in Iowa and next door in West Virginia, too. The national media point to the use of food stamps for buying soft drinks as an obesity threat, and one magazine has described a black-market soda economy that supports the opioid epidemic. Another has dubbed Appalachian towns  the new inner city.

Like most stigmatizing conditions, the concept of addiction is heavily influenced by social attitudes. In this respect it resembles race, and it is sometimes applied to drugs based on social acceptability rather than biological criteria. Nearly everyone has abandoned the preachy doctrine that addicts are bad people. The medicalization of addiction turned them into sick people. But there are voices—conservative, liberal, unspecified—imploring us to consider social viewpoints.

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