These are my people....

Please see footnote at end of post for photo details
Most of the work I currently do is related to street-dwelling drug users. As a former street-dwelling drug user (I no longer live on the streets), I have an added empathy for this population. I am aware of this "bias" and I am also aware that my story is not their story. Each person has their own story, and this community is not homogeneous, but there are certainly some generalisations one can make. However, most of the time we have these generalisations wrong. Each time I am fortunate enough to spend some time with street-dwelling drug users, I am reminded of how wrong many of the genrealisations are. This is my final facebook post for 2015, that expresses some of my frustration around this:

It was a fitting end to 2015: Central Cape Town doing needle exchange and chatting to service users - the people I choose to serve and learn from. Please don't ever tell me "these people" are:
1. In denial
2. Are not resourceful
3. Don't care
4. Are powerless
5. Should just stop using drugs (and then everything will be OK)
6. Cannot make a contribution

The truth is:
1. They fully understand the implications of drug use, what drives their use, what would help them use more safely or cut down their use. But they are seldom consulted on it.*(see footnote)

Myths of Addiction

This is a recent talk I presented at the South African College of Applied Psychology Festival of Learning and at the University of Cape Town Department of Psychiatry and Mental Health addictions forum.

In it I dispel the myths that: 
  • Addiction is caused by drugs, 
  • once an addict always an addict, 
  • addiction is progressive 
  • abstinence is required to initiate treatment or for remission.

I feel strongly that if we allow these myths to continue, we will not develop practical and helpful treatment modalities or public policies. At the end of the talk I made some suggestions regarding treatment. Comments and criticisms are welcome!

Injecting Drug Use and Harm Reduction

I was recently quoted, along with a colleague and some of our out-reach workers in an article on increased levels of injecting drug use in the Western Cape.

The message is important, and unless substitution therapies are introduced it is likely that there will be a significant increase in overdose deaths and a spread in HIV and other infectious diseases.

This article was originally published on Ground Up and then on allAfrica. The article is by Ian Broughton, and the photo is by Andrea Schneider.

Healthcare workers worry injecting heroin on increase

Sunday 31 August was International Overdose Awareness Day. Health workers in Cape Town have warned of a possible increase in drug overdoses and the spread of infectious diseases, including HIV, if the use of needles to inject drugs increases.

August 2014 Newsletter

The recent death of Robin Williams is incredibly sad. As always, when a celebrity dies, especially when substance use is somehow involved, there is a lot of talk about the dangers of drug use and how addiction so often leads to death. I have a slightly different take on the issue: life long substance use disorders, where there is a constant battle against relapse - are usually the sign of something severe that underlies the SUD.

In this case, it seems, the monster below the surface was unresolved pathological depression. Of course, that mixed with an alcohol use disorder is a recipe for disaster. But the alcohol is an adjunct - it is both the (temporary) solution, and the (long-term) catalyst. It is not the primary disease.

I often see how by focusing on the SUD the real pathology is missed. Each relapse brings around renewed focus on the SUD rather than sparking the question: "Well, we know that SUDs die a natural death in most cases, unless there is a contributing factor, this person is not getting better, so what is the contributing factor, and how do we resolve that?"

It is sad that complex problems get reduced to the simple statement "Oh, he was an alcoholic".

In this newsletter I bring together some information from different types of addiction and drug use. When put together much of the research seems to be stating the obvious and, in my opinion, addiction looks more like a learning disorder or adaptive process and not a primary disease of the brain. It seems that Maia Szalavitz agrees with me.

We look at Marijuana and brain changes and schizophrenia, methamphetamine and brain changes, porn and brain changes, internet addiction (and brain changes), Tom Hovarth and SMART Recovery, the results of the Global Drug Survey. I hope you enjoy, and please feel free to comment! Please click HERE to find out more about the Cape Town Recovery Film Festival 2014.

March 2014 Newsletter

It has been a while since the last newsletter. What with holidays, the start of the new academic year, a revamp of the program I run and various other commitments time has been short. I will try to produce at least one newsletter per quarter for 2014, but can't guarantee it! Please feel free to forward any articles you feel should be included.

It has been a sad time for us in South Africa with the death of Nelson Mandela. Even though this was some months back his presence is very much evident. It is very difficult to explain to those without an intimate knowledge of our history just how much this man has come to symbolise. He is the figurehead that represents the struggle of many other great men, a nation and the political structures he represented. If it was not for the efforts of Mandela and these individuals, the treatment centre I run would not be legal. This is a thought that is truly bizarre,  and a sad indictment on those that allowed the apartheid system to flourish under the old regime. We miss Tata Madiba.

In the last news letter I spoke about the Mind & Life Conference on craving, desire and addiction. Well, that is now past, and it was indeed extremely interesting. I have summarised all the presentations, and they can be accessed through this post here.

Due to time constraints this is a shortened newsletter, but I'm sure you will find these articles and subjects as interesting as I have. These include: Addiction as Relationship, Stress and Addiction, Gabapentin, Buprenorphine, Rat Park, Mindfulness and addiction, Mike Ashton, Logical Fallacies.

The Relationships of Addiction

I would like to thank the ever gracious Marc Lewis for his input and commentary. Please visit Marc's blog site, Memoirs of an Addicted Brain. Parts of this talk have been taken from my own piece A Christian and an Addict Walk Into a Meeting

Those of you who grew up in the eighties will know that Roxy Music had a song called “Love is the Drug”, and indeed, as we shall see, some research shows that being in love is much the same as being in the throes of active addiction. But tonight I want to look at this from another angle as well – addiction as a relationship. This thought started with my looking at a particular definition of addiction:

Addiction is a pathological relationship with a substance or activity at the expense of more beneficial relationships. 

Now I am very much opposed to the anthropomorphisms that are so common in the addiction field where we often hear about “the disease talking”, but being a child of the 70’s and 80’s I was exposed to Frank Zappa’s rock opera Joe’s Garage where Joe forms an intimate relationship with a household appliance, so maybe my mind has been open to the idea of forming a relationship with inanimate objects – such as drugs, gambling or money!

Mind & Life XXVII - Craving, Desire and Addiction

The Mind & Life Institute is an initiative that aims to alleviate suffering and promote human flourishing. They aim to bring together scientists, contemplatives and scholars to deepen our understanding of the causes of suffering.

Part of their strategy is to hold dialogues with His Holiness the Dalai Lama. This years dialogue focused on craving, desire and addiction. A group of scholars from the fields of neuroscience, Buddhism, Christianity, psychology, psychiatry and the social sciences gathered at Dharamsala to share their ideas and gain a deeper understanding of addiction.

The speakers were: Marc Lewis, Kent Berridge, Thupten Jinpa, Nora Volkow, Vibeke Asmussen Frank, Matthieu Ricard, Wendy Farley and Sarah Bowen. Brief biographies and their topics, as well as the program, can be downloaded here.

I have watched each of the talks and summarised them. None of this is my original work, but rather was done so that I can have a reference for myself, and I have made this available to you simply to help you choose which talks you may wish to watch in full and for academic purposes. All the videos are available in their entirety here. My summaries can be seen by clicking on the days below:

Day One
Marc Lewis - Craving, Dopamine and the Cycle of Addictive Behaviour 

Day Two
Kent Berridge - Brain Generators of Intense Wanting and Liking
Thupten Jinpa - Psychology of Desire: A Buddhist Perspective
Day Three
Nora Volkow -The Role of Dopamine in the Addicted Human Brain  
Vibeke Asmussen Frank - Beyond the Individual: The Role of Society and Culture in Addiction.

Day Four
Matthieu Ricard - From Craving to Freedom and Flourishing: Buddhist Perspectives on Desire 
Wendy Farley  - Contemplative Christianity, Desire and Addiction.  

Day Five
Sarah Bowen - Application of Contemplative Practices in Treatment of Addiction