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Fri, Oct. 7th, 2011, 07:30 pm
[psych] Addiction

This is the one most critical thing you need to understand about addiction.

What makes addiction dangerous is that it is, in Anders Sandberg's felicitous turn of phrase, a "motivation hazard".

We have feelings for a reason. We do not work, as organisms, without our feelings. That which we do not do out of unthinking habit, we do, 99.9% exclusively, because of feelings. Feelings are part of the feedback loop of human behavior. That feedback loop works as follows: we encounter stimuli in the world; we have feelings, big and little, in reaction to those stimuli; we pick/emit behaviors in reaction to those feelings.

So it comes down to this. Imagine your left hand on a hot stove. Normally, you'd feel pain, and you'd snatch your hand away. Now, imagine in your right hand, you have a magic box with a button under your thumb. So long as you have that button pressed, not only can't you feel pain in your left hand, you actually feel pleasure. It feels really nice. Now, not only can you not tell that you're doing tremendous damage to your left hand, you have a positive motivation to keep doing it. In fact, if the button was pressed before your hand came to rest on the stove, and you didn't notice where you put your hand, you might never know how much damage you were doing to yourself. Indeed, if that happened, and you momentarily lost a grip on the button, you might find yourself in such pain that your first response would be to -- press the button again.

Our emotional discomfort is what tells us that our environment is in some way harmful[*] to us. If you use a chemical intervention[**] in an otherwise healthy person to disable emotional discomfort, they will stop taking positive actions to get themselves out of environments that bode harm. They will stop taking their hand off the burner.

And when that intervention is delivered in response to discomfort, it is conditioning[***]. The dumb yet amazingly in-charge part of your brain starts associating the feeling of emotional discomfort with the relief provided by the substance. Operant conditioning. Instead of thinking, "I don't like how he talked to me, I should confront him on that", one thinks, "I don't like how he talked to me, I'll have a drink". Instead of thinking, "My apartment sucks, I should move", one thinks, "My apartment sucks, pass the crack."

Substance abuse short-circuits the feedback loop of motivation. This is why substance dependence, untreated, is a progressive fatal illness. I'm not just talking about the direct effects of the substance of abuse, e.g. cirrhosis of the liver in alcoholism. Allowed to progress unfettered, not only will the patient lose motivation for doing things to make their life better, they will lose motivation for doing things to make their life continue. Like eat. "I could spend this $5 I just panhandled on food, or I could spend it on booze...."

So this is what the problem can be. Not how much or when or which substance or even if it is a substance, but rather, instead of what and what's the result.

[* To a first approximation, what we have physical pain for is to report physical damage happening, and what we have emotional pain for is to report the threat or increased likelihood of physical damage happening. Of course, we sometimes malfunction, and the modern world can be confusing to our ancient bodies. Also, sadness/grief may be an exception.]

[** Or, you know, sticking an ice pick into their pre-frontal cortex by way of the orbit of the eye socket. One of the classic negative outcomes of prefrontal lobotomies was pathological apathy. We know much of what we know about the role of emotion in regulating behavior due to the study of people with brain traumas, whether injury or treatment.]

[*** My psychopharm prof was a substance abuse specialist, and he pointed out that the difference between a drug with a high abuse potential and one with out was how long it took to work. An SSRI can take up to seven weeks to actually change your mood: there's no way the dumb part of your brain will figure out that your antidepressant makes you feel better, and so won't be conditioned to associate it with relief. This is why nobody is knocking over pharamcies for Prozac. On the downside, that's why it's so freaking common and easy for people with depression to stop taking their SSRI. Contrast to immediate-acting anxiolytics, e.g. Klonopin, which are massively conditioning, and thus have a vast illegal market. Patients prescribed Klonopin do not forget to take it, and they generally never miss their psychiatrist appointments, without attending which they cannot get the next month's prescription.]

Sat, Oct. 8th, 2011 12:21 am (UTC)
lupagreenwolf

*nods* Non-addicts also don't often realize how often trauma is co-occurring with addiction. So many of my internship clients had a similar storyline--multiple traumas while young, addiction modeled as a coping skill, tried addiction and it numbed things enough that they thought it "worked", which then led to numbing as the automatic response to any distress, and increased vulnerability to further trauma.

Sat, Oct. 8th, 2011 02:55 am (UTC)
siderea

This brings up another interesting wrinkle. There's evidence that for some childhood trauma survivors there is actual developmental damage to the parts of the brain which experience, regulate, and remember trauma, leading to having, among other sx, outsized emotional reactions to stimuli -- literally feeling more extremely than normal, healthy controls. To follow the metaphor, here are people whose neurology tells them they're touching a hot stove when their hand is resting on a counter that's merely warm. In such a case, substance abuse makes a particular kind of sense as a response, as "self-medication".

Sat, Oct. 8th, 2011 01:25 pm (UTC)
metahacker

"leading to having, among other sx"

Is sx an abbreviation for a term I don't know?

Sat, Oct. 8th, 2011 04:09 pm (UTC)
siderea

"symptoms"

Sat, Oct. 8th, 2011 12:26 am (UTC)
indicolite

Thank you very much for this Siderea-essay; that said a lot of things I didn't know (like the fast vs. slow-acting drugs) and phrased things that I actually knew in an accessible fashion. Not in the immediate future, but in the foreseeable one, may I confirm that I may link to this post?

Sat, Oct. 8th, 2011 02:42 am (UTC)
siderea

You're very welcome. Of course, be my guest.

Sat, Oct. 8th, 2011 12:36 am (UTC)
herbivore

This is excellent. Also, your last point is illustrated so clearly not only in the fact that abusable drugs act fast, but in that users find all sorts of ways to make them act even faster (e.g., taking oxycontin via insufflation or injection versus just swallowing the pill).

Sat, Oct. 8th, 2011 02:47 am (UTC)
siderea

I had a roommate who previously had been an undergrad at a certain large university hereabouts. He reported on one occasion a group of students got the brilliant idea of air-sealing a chunk of dorm and then putting vodka in a vaporizer. They were taken out of there on stretchers.

Sat, Oct. 8th, 2011 02:55 am (UTC)
herbivore

That's actually a new one on me.

Sat, Oct. 8th, 2011 03:23 am (UTC)
siderea

Do you know the one about giving blood first, so your bodily blood volume is lower than usual? If you can't afford to raise the numerator of your blood-alcohol concentration percentage, you can just drop the denominator.

Sat, Oct. 8th, 2011 03:54 am (UTC)
herbivore

That one I have seen. As far as alcohol goes, the wildest may have been the grain alcohol enema.

Sat, Oct. 8th, 2011 04:57 am (UTC)
siderea

I'd forgotten about that form of administration, but now you mention it, I recall some safety info I once read! Gosh. The human inventiveness in finding ways to administer drugs is like nothing else.

When we do a SA intake, we have to ask after all classes of drugs, and how they were ingested. This lead recently to the following dialog:

Me: "So, weed. You smoked it?"
Ct: "...as opposed to what?! Oh, you mean eat it, like in brownies?"
Me: "I don't know. People are creative. I assume nothing."

Sat, Oct. 8th, 2011 12:39 am (UTC)
nancylebov

This matches what I've heard about why alcoholism is a risk after weight loss surgery-- a shortened digestive tract means that alcohol hits faster, which makes is a much more interesting drug.

Sat, Oct. 8th, 2011 02:56 am (UTC)
siderea

!!! I didn't know that. Thanks!

Sat, Oct. 8th, 2011 05:43 pm (UTC)
nancylebov

I've heard that 1/3 (!!!) of people with gastric bypasses become alcoholics-- this matches my sample of anecdotes, but I don't have a huge sample.

And I wonder how much is the drug effect, and how much is that alcohol is a compact source of calories.

Sat, Oct. 8th, 2011 03:34 am (UTC)
etherial

Yup. I've gone out to dinner socially with a person with a gastric bypass. They get tipsy on the first drink, shit-faced on the second, and are sober by the time dinner is over.

Sat, Oct. 8th, 2011 01:52 am (UTC)
m_danson

That was enlightening.

Sat, Oct. 8th, 2011 01:22 pm (UTC)
metahacker

Thank for the well-written explanation.

I think this is also why sabbaths and holidays from X work for those who aren't too far addicted--they give you a chance for other things to be pleasurable, to build up a competing conditioning loop, perhaps with something more productive and perhaps slightly more challenging to come by (allowing more time before payoff for things other than the payoff to occur).

(Also, I presume you've read the story of the poor woman given an implant that made her orgasm, who wore her fingers to the bone adjusting the strength dial for maximum effect...your hand-in-the-fire image resonated strongly for me because of this story.)

Another essay for another time: the other half of this story, to wit, the exploitation of the abused; greasing the inclined slope to make a profit. Someone's *selling* that crack or that ad stream.

Sat, Oct. 8th, 2011 05:24 pm (UTC)
siderea

I hadn't run across that story, though there are many others in SF that illustrate the principle at, er, hand.

Re "other half of this story", er... no. I strongly disagree that supply side is the "other half of this story", and actually find the idea somewhat offensive.

ETA: I can't find it in my heart to consider the guy down at the corner packie who sells beer to be morally responsible for alcoholism, any more that I consider the gal managing my local Shaw's who sells glue morally responsible for huffing. I think there's some serious hypocrisy which is probably tied into classism around the whole "other half of this story" narrative.




Edited at 2011-10-08 05:30 pm (UTC)