A common theme in the SCHC research about the experience of intoxication is that addicts are absorbed in the moment. They seem to focus on whatever has captured their attention. If they are in a bar, they become absorbed in the noise and energy. If they are locked away in the basement, they may feel isolated and lonely.
There is a growing amount of research that, for example, the real power of alcohol is not in losing one’s inhibitions but, rather, in becoming absorbed in whatever is immediately facing the person. They relax and enjoy the flow of things during intoxication. As Malcolm Gladwell said, the real effect of alcohol intoxication is not “disinhibition. It’s myopia.”
Perhaps this is why addicts routinely say that life is richer when intoxicated. Music seems to be fuller, movies seem more engrossing, and sex seems better. Even the monotony of the daily work grind is more bearable under the influence. Even high school students who have succumbed to addiction tell us that, for example, math class is so boring that if they didn’t smoke a joint beforehand they wouldn’t make it through the period.
When intoxicated, were you absorbed in the moment?
When intoxicated, did music, movies, etc, seem richer and more interesting?
Now that you are in recovery, have you been able to gain this experience without the drug?
Every once in a while, the media get interested in drugs and addiction. This week was one of those times. The Vancouver Sun newspaper carried an article on addiction, entitled “Call to Legalize ‘hard’ drugs meets Opposition.” The article described the reaction of the Prime Minister’s government to a report written by team of academics based at the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University.
The academic report proposed legalizing marijuana and decriminalizing other drugs. The researchers argued that the federal government’s drug strategy had clearly failed. This policy emphasizes the three strategies of enforcement, treatment, and prevention, though most money and effort is in the enforcement strategy. The researchers were following another strategy that the federal government dismissed: harm reduction.
Another media example: This week, a local Vancouver radio station wanted to know about crack cocaine, after Toronto Mayor Rob Ford was accused of using the drug. The radio host wanted to know why people used crack, and what negative effects it had. He even mentioned that he’d heard that if someone “smokes crack once, he can get addicted.” (I suggested that such stories were not true.)
This curious mish-mash of media reports on drugs reflects some of the current popular thinking; there is nothing new here. More than that, though, the views expressed are those of the outsider, peering into addiction and desperately trying to figure out what is going on.
At SCHC, we’re currently conducting a large research project. One of the key features of the research is to listen to how addicts made sense of their addiction and recovery. In other words, we’re interested in the insider’s view (though the research also contains the outsider’s view).
When we listen to the addicts, themselves, we discover many themes not described in the popular media and many themes contradicting popular media. In this blog series, we’ll look at a handful of themes that seem to be common for those suffering from addiction. These research findings are only provisional right now, since we can’t be sure until all the data are analyzed, but they do offer several promising leads.
Week One: What’s an Addictive Personality?
One of the interesting findings so far is that all sorts of people are addicted. This idea of having an “addictive personality” lacks evidence and research support. We noticed four common personalities among individuals in addiction treatment.
Some have stable upbringings, but perhaps they suffered a great loss triggering their addiction. They may have also experienced a dramatic event causing similar outcomes.
Other individuals seem to have certain personality traits. A typical one is an impulsive personality or an impulsive style of engaging the world and making decisions. This group makes decisions on a whim and rarely reflect on their life and the decisions they’ve made.
On the other side of the spectrum, some individuals display traits of an obsessive-compulsive personality. These addicts are characterized by a rigid pattern of thinking, accompanied by intense and purposeful effort. Unlike impulsive individuals, everything they do is extremely deliberate with the utmost concentration. What is particularly noticeable is how pervasive this thinking is in their world.
We also noticed paranoid personalities/traits among clients in treatment. At SCHC, this is often seen in those suffering from PTSD. They, too, have focused attention. Unlike the obsessive-compulsive type, their attention is generally focused on finding some hidden threat behind new information or events. They perform detailled dissections of everything in hopes to find the “big secret”.
As you see, currently our research shows there is no such thing as an “addictive personality.” We’ve talked about this elusive idea before in our online support program and we pointed out that 50 years of scholarly research has yet to find a shred of evidence for this popular idea. That the “addictive personality” keeps popping up is another one of those curious things in the addiction field.
We hope you enjoyed our video. We invite you to take part in our conversation on “What’s an Addictive Personality?” by answering the following questions in the comment section below.
Do you believe in an addictive personality?
Does it surprise you to learn that those with addictions are as various as the wide mix of society?
If you don’t believe in an addictive personality, how do you make sense of addiction?
Teachers that participated in the study were trained to intervene with alcohol-abusing ninth-graders who were then compared with a control group of students who received standard alcohol prevention programming only. Interventions consisted of identifying and intervening upon children considered at-risk for alcohol abuse based on four observed behaviours: anxiousness, feelings of hopelessness, impulsiveness and thrill seeking. Once identified, teachers spoke to struggling students about how they dealt with life through alcohol or other ineffective strategies and also provided basic cognitive-behavioural therapy.
Research Outcomes
The results of the teacher intervention were remarkable. Overall, a 29% reduction in drinking compared with schools that relied on prevention education. Similarly, at-risk teens were 43% less likely to binge-drink.
Teacher-Led Interventions are Feasible
An argument in support of the teacher intervention program is that, since no specialized mental health professional was involved, costs to school boards could be kept to a minimum*. Furthermore, teacher and student alike would experience minimal classroom disruption since only two 90-minute sessions with students is required to achieve the results published in the study.
This approach is in marked contrast to the D.A.R.E. program where children participate in role-playing exercises designed to help kids say no to drugs. As this video reveals, D.A.R.E. does not enlist the participation of educators but, rather, relies upon law enforcement to deliver their message of abstinence:
It’s All About Program Funding
This research is just the latest to point out that D.A.R.E. is a waste of money (see the Jessica Reaves article, Just Say No to D.A.R.E., TIME magazine, February 15, 2001.). The real question, however, is why law enforcement continues to receive funding for D.A.R.E. while schools receive little to no funding for substance abuse therapy or prevention. It would appear that the issue is more than a turf war between teachers and cops. Clearly, as long as drug and alcohol misuse is considered a criminal issue, rather than a mental health one, D.A.R.E. will remain the only resource for schools hoping to reduce the impact of drugs and alcohol in our communities.
(*) Note: the research did not mention what the outcomes could have been if interventions with students were facilitated by trained mental health professionals.
Neuroscientist and Synaptic Pharmacologist Susan Greenfield discusses how damaged prefrontal cortices can influence impaired thinking and cognition. The following is only an excerpt from Susan’s interview with The University of Melbourne’s research talk-show “Up Close”. To hear or read her entire interview, click here.
Shane Huntington: Susan, I recall a case from 1848, Phineas Gage, a railway worker had a one metre iron pole put through his skull. Was his degree of consciousness changed as a result of this sort of accident?
Susan Greenfield: Well first thing, it wasn’t put through as sort of a deliberate intervention. It was because he was pushing down explosive to try and remove debris for laying tracks from the east to the west coast in the States – he was in Vermont. Sadly the explosion went off prematurely and drove the so called tamping iron through an area of the brain called the prefrontal cortex. Now why this is interesting, and I’m pleased you’ve flagged it, is that he earned his place in history because he didn’t die. He wasn’t seemingly mentally impaired, and in fact in those merciless days before Social Security, he actually went back to work. It was only as the days turned to weeks, turned to months, that people noticed a difference. Astonishing it was because he had this great hole through is head. What the difference was that he became more childlike, more irascible, quick to anger, and indeed more reckless.
He was the first case of what was then to be a sadly repeated syndrome seen with shrapnel wounds in the first and second world war, when people had similar damage and this presented with the same so called frontal syndrome. Now what this was, was if you like a return to childhood, if one summarises it crudely. That fits because we know this frontal part of the brain which occupies 33 per cent of the human brain, only 17 per cent in chimps, is very much a sort of Johnny come lately on the evolutionary scene. As always evolution reflects in development and we know that the prefrontal cortex is very important area, is only fully operational in the human brain in late teenage years, early twenties.
Now this raises some interesting questions because I have suggested that an underactive prefrontal cortex is very similar to what I would call a small assembly mode. That is to say a world where you are living in the here and now. You’re not aware of consequences, hence you can be reckless. You’re very much governed from moment to moment. You live in a sensory world more than you would a cognitive world. So I would have said that what had happened to Phineas, and indeed to others perhaps you have malfunction of the prefrontal cortex, is that they are much more in the small assembly mode, much more living the kind of consciousness, having the sort of view of world that a child might have where you’re very impressed and distracted by, and reactive to the outside world as opposed to some inner world that is more specific or idiosyncratic to you.
QUESTION: Is there a potential connection between addiction and damage or injury to the Prefrontal Cortex?
SCHC Clinical Director, Geoff Thompson, discusses whether he believes a connection exists between reduced cognitive thinking and addiction.
“This has been known for a long time. There is also a famous case of a US Supreme Court judge who had cancer in the prefrontal cortex. His IQ remained very high, but he would do things such as stop a lawyer in mid sentence and tell him, ‘You’re a F-in idiot, you know that.’
But massive organic destruction in the prefrontal lobes is different than having the neurotransmissions a bit wonky in addiction. In fact, NIDA’s obsession with this was not very scientific. One of their lead thinkers, Richard A. Rawson, noticed that cocaine addicts had trouble “connecting the dots.” He looked into their brain chemistry to figure out why this was. When NIDA noticed the correlation between dopamine problems in the prefrontal cortex and stimulant addicts, they decided stimulant addicts had impaired thinking. So, what they did was to assume a problem in thinking and then go out and find the reason. Not exactly the most objective way of discovering scientific facts. (Freud abused cocaine. I’m not sure anyone would be willing to say he couldn’t think.)
But I think there is a good chance that problems in the prefrontal cortex are associated with impulsive action. Lack of dopamine in the prefrontal cortex is also associated with ADD (Attention Deficit Disorder). Lack of serotonin is a common problem with juveniles who lash out.
Personally, I think it’s overrated in terms of addiction. We’ve had plenty of stimulant addicts who were quite intelligent. I think that addicts like to be “impulsive” because it’s more exciting. If you deconstruct the addicts’ “impulsiveness,” it turns out that their actions and planning to get drugs are very detailed and goal-oriented. Shapiro argues that what appears to be impulsiveness is really a reflection of the person’s worldview.
I think mainstream treatment’s concern with impulsive behavior says more about their approach to addictions. They wanted an answer to the question: Why would anyone use drugs knowing that they lead to suffering? The impulsiveness argument is a good explanation for them, because it suggests that the thinking person is not in control, which, of course, reinforces the argument that the addict is powerless.”
Helping kids moderate the time they spend in front of screens is a challenge for the modern family. Many parents have turned to psychology for answers and, fortunately, research on screen addiction has been around for a long time thanks to television.
The First Screen Addiction: Television
By the 1960s, television was already a target of critics who saw the negative impact of this powerful new medium. In 1966, a new children’s television show was conceived that would “master the addictive qualities of television and do something good with them.” * That show? Sesame Street. Ironically, in 1979 the show created a new character, Telly the Television Monster, to help kids understand the detrimental effect of excessive television viewing:
Like any addiction, it is important that one identify the negative consequences of excessive television viewing. After all, an important criterion of an addiction is repeated engagement in a substance or activity despite negative consequences. * In an interview ** promoting his 1977 book, Four Arguments for the Elimination of Television, former advertising executive Jerry Mander cautioned that television “affects the psychology of people who watch. It increases the passivity of people who watch. It changes family relationships. It changes understandings of nature. It flattens perception so that information, which you need a fair amount of complexity to understand it as you would get from reading, this information is flattened down to a very reduced form on television. And the medium has inherent qualities which cause it to be that way.”
In their book, Television and the Quality of LIfe: How Viewing Shapes Everyday Experience, researchers Robert Kubey and Mihalyi Csikszentmihalyi described an experiment where survey participants were provided with beepers which would signal them randomly day and night over the course of a week. When prompted by the beeper, participants would write down what they were doing and how they were feeling at that moment. The beepers allowed experimenters to look closely at all daily activities such as working, eating, reading, playing sports, etc. What they found was that heavy television viewers felt significantly more anxious and less happy during unstructured time, particularly when alone.
In a separate study, *** University of Manitoba researcher, Robert D. McIlwraith, found that self-described TV addicts were more easily bored and distracted and had poorer attentional control. These same TV addicts said they used TV as a distraction.
Additional negative consequences of excessive television viewing were uncovered in a sociology study by Tannis MacBeth Williams from the University of British Columbia. In the study, two separate sets of interviews with residents in a remote BC community were conducted. The first interviews occurred just before one of the towns obtained television for the first time. Two years later, in late 1975, follow-up interviews revealed that, town residents scored lower in creativity, perserverence, and were less tolerant of unstructured time. A control group in a nearby, separate community confirmed the results.
(*) Note: for more information on defining addiction see an earlier article, the 3 C’s of Addiction.
(***) Source: Robert D. McIlwraith, “I’m Addicted to Television”: The Personality, Imagination, and TV Watching Patterns of Self-Identified TV Addicts in Journal of Broadcasting and Electronic Media, Vol. 42, No. 3, pages 371-386; Summer 1998.
Understanding the Biological and Psychological Attraction of Screens
In their article, Television Addiction is No Mere Metaphor, Kubey and Csikszentmihalyi found that the average individual in the industrialized world devotes three hours a day to watching television, topped only by work and sleep. Gallup polls in 1992 and 1999 found that “two out of five adults and seven out of ten teens surveyed said they spent too much time watching TV.”
So why don’t people simply cut back? Laboratory experiments involving brain wave monitoring showed, as measured by alpha wave production, that television induces a relaxed state. However, researchers found that once the television is turned off, survey participants would report feeling passive, depleted and less alert. When the television was switched back on, the relaxed state would return. Over time, heavy users learn that it is best to keep watching rather than experience the discomfort of no TV.
A second feature of screens that help explain their attractiveness has to do with our “instinctive reaction” to movement. We have a built-in survival mechanism that detects changes in our environment, like a predator or a falling rock. In response, the brain focuses on the movement, which may explain the hypnotic effect of television.
Conclusion
The negative effects of excessive television viewing have been well documented. As Kubey and Csikszentmihalyi pointed out long before the introduction of smartphones and online gaming, “knowledge of how the medium exerts its pull may help heavy viewers gain better control over their lives.” * This is helpful advice for addicts regardless of their preferred screen type.
It appears that addiction research is finally catching up with what the general public has known for a long time: exercise can help in the treatment of addiction. For as long as we have been open, callers considering our program have always been interested in our recreational amenities and scheduled activities involving fitness. Regardless of the damage done by their drug of choice, many clients can’t wait to get back to the gym and get back in shape.
While Sunshine Coast has invested heavily in our fitness program by adding an indoor pool and having a full-time registered kinesiologist, most residential addiction programs fear that clients will simply switch from drugs or alcohol to an exercise addiction. This is an unfounded belief that needs to change. Staff at Sunshine Coast has found that, while some monitoring of those with eating disorders may be necessary (see “Woman battles exercise addiction for nearly 20 years“) , the vast majority of clients exercise with moderation. Furthermore, as first pointed out by American psychiatrist Dr. William Glasser in his book, Positive Addiction, exercise helps repair both the body and mind of the addict.
EVIDENCE SUPPORTING PHYSICAL FITNESS IN ADDICTION TREATMENT
This past summer, I accompanied my colleague, Dr. Tatiana Tsarouk, to Palm Springs, California for the 2012 National Institute of Drug Abuse (NIDA) International Forum. There were hundreds of addiction researchers that gathered in Palm Springs for this event and, to my surprise, one of the best-attended session was on exercise. It turns out that addiction has been a hot topic in NIDA research for for the past few years as evidenced by the June, 2008 NIDA symposium, Can Physical Activity and Exercise Prevent Drug Abuse?
NIDA has also provided funding to the University of California Los Angeles (UCLA) to conduct research on aerobic exercise to improve outcomes for the treatment of methamphetamine dependence. According to principal investigator of the NIDA grant, Dr. Richard A. Rawson, preliminary results are promising. In a recent article, * Dr. Rawson cites research showing exercise to be an effective treatment for:
1. Medical Conditions – the US Department of Health and Human Services presented its first-ever 2008 Physical Activity Guidelines for Americans which documented ” ‘strong evidence’ for general health benfits of physical activity including lower risk of early death, heart disease, stroke, diabetes, high blood pressure, etc.”
2. Depression and Anxiety – aerobic exercise interventions are useful in the treatment of anxiety and depression, with benefits comparable to medication, individual psychotherapy, group psychotherapy and cognitive-behavioural therapy.
3. Cognitive Impairment – controlled clinical trials support a positive relationship between physical exercise and cognition. Improvements are are most significant when it comes to executive functions (e.g. planning, scheduling, dealing with distraction, multi-tasking, etc.).
4. Substance Abuse – so far, most of the literature on exercise as an adjunct to treatment for substance abuse concerns nicotine addiction. Consistent positive effects on cigarette cravings, withdrawal symptoms, and smoking-related behaviours have been demonstrated.
Dr. Rawson’s current study expands on aerobic exercise to the treatment of methamphetamine dependence.
At Sunshine Coast, we’re excited about this positive, new direction in addiction research. However, we believe that the physical benefits of exercise are just the tip of the iceberg and that exercise also has psychological and social motivators:
1. Competence – as your body repairs itself through exercise you get stronger you learn to control your weight, run further, lift more, etc.
2. Relatedness – as you spend time working out or playing sports you begin to connect with other people in a positive environment. Over time, you develop a sense of community with those who share your interest in fitness and/or sport.
3. Autonomy – when you exercise on a regular basis you feel a sense of independence, that you are in control of your life. When you play team sports you may even find yourself developing leadership skills.
Readers of our blog on agency and community may have noticed the similar notions of autonomy and relatedness.
One area of study that also has yet to be studied is the benefit of team sports. From our own anecdotal evidence, team sports are even better than exercise when it comes to developing social skills and a sense of belonging.
Note: when it comes to team sports, the benefits apply to both kids and adults!
By Geoff Thompson, Ph.D. (cand.), RCC
Program Director
A large number of psychological theories of addiction argue that addiction arises because addicts have learned that using is a form of coping for various problems. For example, a person who is troubled and not able to sleep may use marijuana or alcohol to help them sleep. Others who are shy may use cocaine or alcohol to help them overcome shyness. Others who live a fast-paced life may use cocaine or speed to give them energy to pursue all this effort. In any case, addicts maintain their addiction because they have “maladaptive” learned coping skills.
Treatment based on this idea is usually to replace the unhealthy coping skill with healthy coping skills. This idea is the basis of most relapse prevention treatments. G. Alan Marlatt developed the most famous relapse prevention treatment. Marlatt proposed that relapse was a response to what he called immediate precipitators and covert antecedents. Immediate precipitators included high risk situations, such as going to the bar. It was not the situation itself that was the problem; rather, it was how person’s response to the situation based on their maladaptive learned behavior. Covert antecedents were subtle conditions such as living a stress-filled life or “testing” one’s sobriety. These antecedents had no direct connection with using, but these seemingly irrelevant decisions and conditions combined to make the person vulnerable to relapse.
Marlatt offered several ways for those in recovery to deal with immediate precipitators and covert antecedents, as well as other factors in relapse. In other words, replace unhealthy coping skills with healthy coping skills. In his latest research Marlatt showed that mindfulness meditation could help in “urge surfing,” a technique to help people overcome the impression that they were hopeless victims of drug cravings.
By Geoff Thompson – Ph.D.(cand.), RCC
Program Director
Lots of treatment providers today say that they use an “eclectic” approach to treatment. Basically, this means they mix-and-match therapies. So, they might use motivational therapy when a client arrives, to help support the client’s desire to change. The program might pay attention to the biological component of addiction, encouraging clients to eat healthy, sleep at reasonable hours, and exercise. And keep away from nicotine, caffeine, and sugar.
The treatment program will usually address how a client thinks and acts. Therapists may believe that a client is in “denial” and work to help the client become aware of what addiction has done to them. They might help the client make sense of their lives in a way that reduces stress. For example, the client might think that everyone should like them. The therapy would help the client appreciate that this is irrational thinking.
Many programs use what are called behaviorist therapies. This means they have lots of rules that clients are expected to follow. Staff check up on clients to ensure they are following the rules. Did the client make the bed, do chores, show up to group on time, etc. Clients are “punished” for not following the rules and rewarded for following them. The idea here is that clients develop new healthy habits.
There are literally dozens of different theories of addiction. It should be no surprise that most of these theories have been engineered into practical programs for treating those suffering from substance dependence.
In fact, there are more than 100 treatments that claim a scientific basis in research and theory! Just google “treatment for addiction” and you’ll get millions of hits. Some of the more interesting are “The Russian Cure for Addiction: Spanking” and Dr. Abram Hoffer’s “Alcoholism: The Vitamin Cure.” Yes, these, too, claim scientific research supports their treatment.
But more mainstream treatments tend to follow mainstream theories. The range of treatments is really quite remarkable. In Handbook of Alcoholism Treatment Approaches, for example, Drs. Hester and Miller examined 99 different treatments that had a research basis. Because there are so many treatments that are so different, some psychologists, such as Ballinger, Matano, and Amantea, concluded that “The number and variety of treatments reflects our incomplete understanding of the multiple factors influencing alcoholism.”
Does one type of treatment work better than another? Much of this depends on what you think success means and how you measure it. But experts agree that well-designed programs are very helpful to those seeking to recover.
All this scientific research is good, because in the old days we really had no idea if any treatment worked. Lots of treatment facilities provided programs, but very few bothered to study success rates. Actually, very few paid attention to even defining what an addiction was. Strange, but true. An individual therapist might declare his or her program “worked” but really had no idea if this were, in fact, true.
And all this scientific research offers great hope for the future. As we understand addiction more and as we study treatments, we will gain a better understanding of what does and does not work. (We’re conducting another major study of the Sunshine Coast in the Fall, which will help us refine it.)
In coming articles, we’ll look at four of the most famous scientific treatments for addiction: treatments for disease, unhealthy learned behavior, and motivational problems. The last describes a sort of mix-and-match approach.
By Geoff Thompson, Ph.D.(cand.), RCC
Program Director
Some theories of addiction argue that it is a matter of motivation. The solution to addiction is to help people develop a powerful motivation to be clean and sober. William Miller is generally recognized as the key figure in the development of motivational therapies.
Miller’s research convinced him that motivation was most powerful when it came from within the person. The public tends to think that outside pressure can force the addict to quit using. They might believe that greater legal penalties for using are the answer, or perhaps forcing the price of the drug up will force people away from drugs. Many families believe that if they put enough pressure on their loved one, then he or she will quit using.
There is some truth to the idea that outside pressure can motivate addicts to quit, especially in getting them to enter recovery. But Miller recognized that these external pressures are much less powerful than internal pressure. This more powerful form of motivation to quit using occurs when the addict makes the decision to quit, because they want a better life.
Motivational therapy usually starts with helping the client find some internal motivation to quit. The therapist does not tell the client to quit but, rather, helps clients find their own reasons. Once the client has decided, then treatment can help clients learn what they have to do for recovery and support them on the journey.
Miller also argued that external pressure from others to quit the drug created resistance to recovery.
Sunshine Coast Health Center is a provincially-approved drug and alcohol rehabilitation facility licensed by VCH
Sunshine Coast Health Center is an accredited health care provider with Accreditation Canada