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 

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.

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.