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 

Day 5 - Mind and Life XXVII - Craving, Desire and Addiction

You can view the videos here.

The point of this summary is not to replace the complete video and nor is it fully comprehensive, but rather the intention is to give a brief overview of proceedings so as to assist the reader in determining which sessions they would like to watch in full. 

Day Five of Mind and Life XXVII - Sarah Bowen discusses the Application of Contemplative Practices in Treatment of Addiction

Day 4 - Mind and Life XXVII - Craving, Desire and Addiction

Dr Matthieu Ricard

Dr Wendy Farley

You can view the videos here.

The point of this summary is not to replace the complete video and nor is it fully comprehensive, but rather the intention is to give a brief overview of proceedings so as to assist the reader in determining which sessions they would like to watch in full. 

Day Four of Mind and Life XXVII - Matthieu Ricard discusses From Craving to Freedom and Flourishing: Buddhist Perspectives on Desire and Dr Wendy Farley talks about Contemplative Christianity, Desire and Addiction.

Day 3 - Mind and Life XXVII - Craving, Desire and Addiction

Dr Nora Volkow

Dr Vibeke Amussen Frank

You can view the videos here.

The point of this summary is not to replace the complete video and nor is it fully comprehensive, but rather the intention is to give a brief overview of proceedings so as to assist the reader in determining which sessions they would like to watch in full. 

The third day of Mind & Life XXVII - Dr Laura Volkow talks about The Role of Dopamine in the Addicted Human Brain and Dr Vibeke Amussen Frank follows with Beyond the Individual: The Role of Society and Culture in Addiction.

Day 2 - Mind and Life XXVII - Craving, Desire and Addiction

Dr Kent Berridge

Dr Thupten Jinpa

You can view the videos here.

The point of this summary is not to replace the complete video and nor is it fully comprehensive, but rather the intention is to give a brief overview of proceedings so as to assist the reader in determining which sessions they would like to watch in full.

The second  day of Mind & Life XXVII - Kent Berridge talks about Brain Generators of Intense Wanting and Liking followed by Thupten Jinpa presenting Psychology of Desire: A Buddhist Perspective.

The day got off to a light-hearted start with Dr Richard Davidson putting single marshmallows in front of the delegates, offering them two if they could resist. This was in response to the discussions about delay discounting and restraint on day one. His Holiness (HH) wanted to know if he could get three if he waited 15 minutes!

Day 1 - Mind & Life XXVII - Craving, Desire and Addiction

Dr Marc Lewis

Dr Richard Davidson

You can view the videos on HERE.

The point of this summary is not to replace the complete video and nor is it fully comprehensive, but rather the intention is to give a brief overview of proceedings so as to assist the reader in determining which sessions they would like to watch in full.

I would also strongly recommend visiting Marc's blog where he will be offering his first-hand insights into the experience.

The first day of the XXVII Mind & Life gathering includes an introduction and establishment of context by Arthur Zajonic, Diana Chapman Walsh and Richard Davidson. In the afternoon session Dr Marc Lewis, author of Memoirs of an Addicted Brain, spoke about Craving, Dopamine and the Cycle of Addictive behaviour.

October 2013 Newsletter

It's almost the end of the year. In our setting, because we are moving into summer and festivities, this usually sees a drop in those seeking help for their substance use issues, but often their is a brief spike shortly after new year as resolutions are made and the after-effects of the partying are felt! I recently attended the Dan Siegel Interpersonal Neurobiology workshop that was held in Cape Town, hence the photo. In this month's edition of Addiction Information we hope to spark some thought around some controversial topics, but one topic that should become less controversial is that of opioid substitution therapy, for which their seems to be mounting evidence as a stand-alone treatment modality.

We look at: An opioid addiction switch, Behavioural Interventions and Buprenorphine Maintenance, Chronic Care, Remission Rates, Choice and Will Power, Dr Dan Siegel and the Mind & Life Conference.

August 2013 Newsletter

This newsletter was delayed, but I have a reasonably good excuse. I had a heart attack. Not to be put down by something minor, I used the opportunity to find out how much emergency room personnel know about addiction. Not very much it appears! I wrote about it in this piece: Substance Use Knowledge Amongst Emergency Room and General Medical Personnel. I am back at the office and its business as usual, which in the addiction field is anything but usual. Hope you enjoy this months newsletter, because it very nearly didn't happen!

This time we talk about: The Reward Pathway of Opioid Addiction, Does Maintenance Therapy Need Counselling?, The Scottish Review of Methadone Treatment, Is One Too many?, The Multistep Theory of Transition to Addiction, Internet Addiction, Scott Kellogg.

Famous for Being Homeless

I went viral. I wrote a seemingly innocuous anonymous letter to the press about being homeless and it received over 60 000 views and 700 shares from one facebook page alone. It was suggested that I did not exist and that the journalist who read out my letter on air had made me up, so I decided to "out" myself. Since then I have been sought for interviews in the press and on radio. I am not necessarily comfortable with all this media exposure, but if it can help give the marginalised a voice, I will use it. Hopefully this will help me bring the issues that are on my heart regarding addictive disorders and mental health into the public consciousness and promote debate. Here is the story:

A Christian and an addict walk into a meeting...

Recently Richard Wilmot(PhD), author of “American Euphoria: Saying 'Know' to Drugs”, posted this provocative statement on a LinkedIn discussion group:

“Today one of the main criteria for a diagnosis of drug addiction/alcoholism is: continuing to consume alcohol or another drug “despite unpleasant or adverse consequences” (DSM). For the Christian martyrs the same criteria would apply. People of that time and place—Rome, 2nd century A.D.—could also say that this new Christianity was like a drug that endangered lives and that being a Christian had all the adverse financial, social, psychological and physical consequences that we now see in the lives of drug addicts and alcoholics. And yet Christians, of all ages, in spite of the consequences, continued to profess their faith… and continued to be eaten by lions.

Obviously there was something to Christianity that prevented the Christian from being abstinent from Christianity. It was something internal… an internal euphoria. It was something that could not be seen but nevertheless was something that was felt… and felt as something awesomely significant. It was something that made all the pain and suffering worthwhile: it was a religious experience.

Substance Use Knowledge Amongst Emergency Room and General Medical Personnel

Recently I had the misfortune of having to receive emergency treatment for a heart attack. I used this opportunity to do some investigation into how much emergency and other medical personnel know about substance use, and how much training they have been given.

Before I go any further, I would like to state that all the staff that I interacted with were excellent, and I believe I received a high standard of care, so I am not looking to criticise them or their abilities, but rather spot gaps in their training, pertaining specifically to substance use.

June 2013 Newsletter

After a busy two months I have finally managed to produce a newsletter. I recently gave a talk on the emerging divide between those who believe that opioid substitution is a treatment in itself, and those who believe that it is not really recovery. My talk, Opioid Substitution Therapy: Treatment vs. Recovery can be found here. This was prior to me being aware of the DSM qualification of "on maintenance therapy" for those in remission from Substance Use Disorders. I think we will see this argument developing in the States, and opinions will remain polarised. Hopefully we will see a more balanced approach in the South African setting. Comments are most welcome.

In this month's newsletter we talk about: Agonist Therapy for Stimulant Addiction, Is addiction a Disease?, The Anti-Reward System, Stimulant Addiction and Gray Matter, The Most Important Treatment Studies Matrix, Chris Arnade, Mindfulness and Improved RCTs in addiction.

Opioid Substitution Therapy: Treatment vs. Recovery

Introduction

Opioid Substitution Therapy has been a controversial topic. Somehow it is easier for the addiction recovery industry to accept medications such as Disulfiram with its aversive effect or acamprosate which does not carry the risk of approximating the state of alcohol intoxication and because studies have suggested that it is only effective in conjunction with psycho-social interventions. OST, on the other hand, uses opioid agonists or partial agonists that act in similar ways to the drugs of dependence, albeit without the same quality of high, and this, some have suggested, shifts the addiction from opioid dependence to another dependence and may be of more harm than good to the addict.

Addiction Information March 2013 Newsletter

This month we celebrated Human Rights Day in South Africa. I was given the opportunity to share my opinion on why those suffering from addiction are seldom afforded the same rights as others. A copy of my speech can be found here: Human Rights Day: Addicts are also Human. This month saw the first International Conference on Behavioral Addictions taking place in Budapest and so it is fitting to talk a bit about gambling addiction. Also in this issue: 

The DeltaFOSB Feedforward Loop, Drug Court, The Portuguese Drug Policy, Russel Brand on Addiction, Discontinuation of Sublingual Buprenorphine and Possible Approval for Buprenorphine Implants

Human Rights Day Speech

Addicts Are Also Human

By Shaun Shelly
This is a speech I delivered at a public function held to celebrate Human Rights Day in South Africa. Addicts are one of the most marginalised groups in society, not even enjoying the right to freedom or medical care:

The Bill of Rights is a cornerstone of democracy in South Africa. It enshrines the rights of all people in our country and affirms the democratic values of human dignity, equality and freedom.  It places a responsibility on the state to respect, protect, promote and fulfill the rights in the Bill of Rights.

Addiction Information February 2013 Newsletter

This is Newsletter Number 2, which is a little late due to a crashed hard-drive. The only two documents I had not backed up were the talk I was due to present "Sex, Drugs and No Control", and this newsletter, so it was back to the keypad! But we've made it, although in a slightly shorter version. I hope you find this summary of addiction news from around the world useful. Your suggestions are again most welcome, and articles for the website or that you would like to have linked to this newsletter can be directly submitted to me by e-mailing shaun.shelly@yahoo.com.

Please like us on facebook.

In this issue: 
Inside Rehab, Celebrity Rehab, Recovery or Treatment?, Dr Mark Willenbring, OST, Naloxone, NMDA  Modulators, Epigenetics, Frankenstien Drugs, Local Research, Ibudilast for Meth addiction?, Policy in NZ, Columbia and Africa, Banker or Dealer?

Sex, Drugs, and No Control

Sex as Addiction and the Treatment Thereof

There is much controversy around the use of the term "sex addiction." This article gives a brief overview of the arguments against this term, and then shows some of the aspects as to why sex may indeed be an addiction and how it may be treated. There is certainly a need for further research in this area before anything definitive can be proclaimed, but perhaps the study of behaviours that present as addiction can give us further insight and understanding of exogenous addictions.

PDF Version (Printable)

According to the DSM-V Sex Addiction is not a diagnosable condition. Sexual addiction was mentioned in the DSM-III-R, but disappeared in the DSM-IV, threatened a come-back in the DSM-V but has now been discarded. Sex, however, has long been described as addictive. In the late 1800s Freud described masturbation as the “original addiction.” Rado in the 20’s described addiction as “compulsive” and made the reward/pleasure/sex link. We saw words such as nymphomania (Ellis) and the clumsy “Don Juanism”(Stoller). In the 70’s Mac Dougall spoke of “addictive sexuality”. It was originally proposed that sex be included under the heading of addiction in the DSM-5, and then that was discarded and the idea of hyper-sexuality was introduced as a possibility. Eventually none of these proposals was accepted, and so sexual addiction has ceased to exist, according to the DSM, that is.

Addiction Information January Newsletter

Introduction

Welcome to the first Addiction Information Newsletter. The object of this newsletter is to give you a monthly overview of what is happening in the world of addiction across a number of fields. You can subscribe to this newsletter and receive an e-mail version by joining our mailing list. Your suggestions are most welcome, and articles for the website or that you would like to have linked to this newsletter can be directly submitted to me by e-mailing shaun.shelly@yahoo.com.

In this issue:

The Motivated Addict, Dual-process models, CBT Ineffective?, Drug Policy, Brain Structure, Meth Psychosis, Transcriptional Mechanisms, Nepicastat & 18-MC Trials, Neuroscientist Marc Lewis, Dr Frankenstein's Cure and "beating addiction"

CBT Doesn't Work for Heroin Addiction?

Study Suggests Buprenorphine is enough. I Disagree.

In the January 2013 edition of The American Journal of Medicine there is a clinical research study conducted by members of the Yale University of the School of Medicine entitled: A Randomized Trial of Cognitive Behaviour Therapy in Primary Care-based Buprenorphine. (Fiellin, et al., 2013). In the abstract for the study, the stated objective was “To determine the impact of cognitive behavioral therapy on outcomes in primary care, office-based buprenorphine/naloxone treatment of opioid dependence.” The abstract concludes: “Among patients receiving buprenorphine/naloxone in primary care for opioid dependence, the effectiveness of physician management did not differ significantly from that of physician management plus cognitive behavioural therapy.”

In the Press.....

   

PRISON NO CURE FOR ADDICTION: EXPERT
By simone.williams
2013-01-15 09:00   
HARSH penalties for drug-related crimes do more harm than good.

This is according to Shaun Shelly, Addictions Programme Manager of Hope House Counselling Centre in Military Road, Retreat. In his opinion, the Drug Watch campaign by LeadSA, and editorial comments and letters in the local press seem to all be praising criminal sanctions for drug addicts encouraging harsher penalties. He complains his letters to the press have been ignored by editors.

Medication in Recovery

IMPORTANT: This article deals with treating post-detoxification addicts who have been weaned from their drug of choice under medical supervision and those who don’t have a co-morbidity that presents an immediate danger to themselves or others. I am also not talking about those who are on a supervised substitution or aversion program. We must also accept that there is a minority amongst us for whom a life free of medication is an unrealistic goal. We should recognise this and not exclude these people from the recovery process.

PDF Version
Many have come to accept addiction as a disease, and one of the down-sides of this belief is that addiction can be easily treated via pharmacological interventions. Accordingly, many recovering addicts are dealing with their symptoms via medical intervention. I think this is a mistake. Here’s why:

The neurobiological underpinnings of addiction.

A brief overview of our current understanding of the neurobiological processes that underlie addiction.

PDF Version Plus Figures 
It is only recently that the idea that addiction is a brain disease has begun to be accepted by the general population. The disease model was at the centre of the AA/NA message long before it became accepted by even the medical field. As we make advances in neuroscience we are finding that many of the conclusions drawn from anecdotal evidence have, in fact, a sound neurobiological basis. There is indeed a strong neurological underpinning for addiction, and in this essay I will summarise the current understanding of this.

The Common Reward Pathway

The common reward pathway for substances of abuse, specifically relating to neuroanatomy and neurophysiology.

PDF Version
Although substances of abuse have varied and diverse primary targets and acute effects neurochemically, research has shown that almost all substances of abuse lead to an increase in dopamine in the mesocorticolimbic dopaminergic system. The understanding of this common reward pathway is important as it could (i) lead to the development of a single medication that works for various classes of substances of abuse in addiction treatment; and (ii) give a better understanding as to why all those suffering from addiction experience similar psycho-social devastation in spite of the variety of drugs of choice.

Treatment not Time:

Addiction is health issue, not a criminal one.

The recent Drug Watch campaign, editorial comments and letters in the local press seem to all be prescribing harsher criminal sanctions for drug addicts. Even the recent special remissions of sentences, granted by the State President, have excluded those convicted of drug related crimes. Even so, I would like to suggest that this approach is both ill-informed and not helpful if we are to make in-roads in dealing with the drug problem that undoubtedly affects our community. We need to base our approach on sound research and not on popular sentiment.

An Overview of Bipolar Disorders

A brief overview of bipolar disorders for addictions counsellors
PDF Version

“Compared to bipolar's magic, reality seems a raw deal. It's not just the boredom that makes recovery so difficult, it's the slow dawning pain that comes with sanity - the realization of illnesss, the humiliating scenes, the blown money and friendships and confidence. Depression seems almost inevitable. The pendulum swings back from transcendence in shards, a bloody, dangerous mess. Crazy high is better than crazy low. So we gamble, dump the pills, and stick it to the control freaks and doctors. They don't understand, we say. They just don't get it. They'll never be artists.”

-David Lovelace, Scattershot: My Bipolar Family

Obsessive Compulsive Disorder

A brief overview of Obsessive Compulsive Disorder for addictions counsellors

PDF Version
When you attempt to eliminate risk from your life, you eliminate along with it, your ability to function.

- Fred Penzel

I once watched a man attempt to cross Belgravia Road. He approached the traffic light, turned away. He approached it again, and again he turned away. He repeated this process at least six times. Eventually he reached out to touch the button that would activate the pedestrian crossing light. Then he withdrew his hand, wiped it vigorously on his shirt and attempted to do it again. Again he withdrew. The next time he covered his figure with his shirt, but still he could not touch the button. The car behind me hooted, and I was forced to pull off. I was not convinced that this man would ever make it across the road. Such is the nature of OCD – obsessive, compulsive and utterly debilitating.