Addiction: It’s Not About the Brain, by Bruce Wilson (Science and Medical Writer)

Art and I were expressing our exasperation about two items that crossed our attention this week, both of them related to addiction.

The first was a WSJ article about a study looking at the adolescent brain: “Are Some Teenagers Wired for Addiction?” Using fMRI, the researchers identified a particular pattern of neural activity in teens who had a tendency to become addicted to drugs or alcohol. Specifically, these teens had lower activity in the orbitofrontal cortex (OFC), a region that mediates impulse control. The implication is that faulty brain activity causes poor impulse control which in turn causes kids to become easily addicted. A different pattern of faulty networks was found in kids with ADHD, also related to impulse control. In other words, the brain is the problem.

The second item was a segment on CBS’s 60 Minutes about the work of addiction researcher, Nora Volkow. In addition to being the director of the US National Institute on Drug Abuse, Volkow has the dubious distinction of being Leon Trotsky’s great granddaughter and actually grew up in the house where he was murdered. She describes addiction as a physical disease: “we know that drug addiction is a chronic disease; the drugs physically change the brain…those changes are very long lasting and persist for a long period of time after the person stops taking the drug.” The culprit? Dopamine! In Volkow’s view, addicts are conditioned by triggers that cause a dopamine rush, making them feel, “I want that!” And because of drug tolerance, “I want that!” becomes “I want more and more!” Hardened addicts are merely conditioned, like Pavlov’s dog, perhaps by a genetic disposition, the theory goes. But instead of salivating; they crave. Show them a photo of someone hitting up their favourite substance of abuse and the dopamine surges through their midbrain, reinforcing more brain dysfunction. Once again, the brain is the problem.

The problem with both of these reports is that the brain is not the problem; it’s what’s deep within the brain that’s the problem – the pain of unmet need. But why don’t these researchers see this?

The answer is that you have to feel it to see it, and they don’t feel it.

Over my twenty-year history working in the medical community, I’ve met precious few scientists who are able to see the full implications of what they are studying. Medical scientists are trained to analyze and to seek explanations for living processes in terms of the bits and pieces of life: molecules, biochemistry, pathways, and genes. This works well for genetic diseases such as cystic fibrosis or Huntington disease, but is utterly inadequate for mental conditions such as depression, schizophrenia, and…addiction.

As Iain McGilchrist points out in his brilliant work, The Master and His Emissary, analysis is a function of the left hemisphere whereas synthesis and intuition are functions of the right hemisphere. Whereas the left sees only the bits and pieces, the right sees the “big picture.” The best scientists use both processes when trying to explain phenomena but modern behavioral scientists seem to have forgotten that. The very term, “behavioral science” implies that people are stimulus-response units—turn on the stimulus switch and the response follows as behavior. The left brain scientist tries to explain that behavior in terms of brain mechanisms. As one cognitive scientist put it, the brain is nothing more than a “computer made of meat.”

Apparently, Volkow gets $1 billion a year to study the biological mechanisms of addiction, delving ever deeper into the neurons, synapses, receptors and cellular biochemisty, searching for the cure for this “brain disease.” The same is true at addiction research centres everywhere.

Meanwhile, the real cause of addiction is ignored, except for those who can see it because they feel it. Art Janov was writing about the primal causes of addiction as early as The Primal Scream. Gabor Maté, no stranger to addiction himself, works with hopelessly addicted patients in Vancouver’s Downtown Eastside, which he tells in his heart-wrenching book, In the Realm of Hungry Ghosts. Every one of Maté’s patients suffers from the pain of terrible childhood abuse, which is clearly the cause of their addictions. Neuroscientist, Jaak Panksepp, who has spent his  career studying the neurology of animal feelings, sees addiction as an attempt to resolve the pain of unresolved separation distress, or in primal terms, a futile effort to get the love one didn’t get as a child. Addictive substances not only stimulate brain dopamine, they stimulate endogenous opioids as well – the body’s own pain killers.

No doubt, brain function is deeply altered by addiction; levels of neurotransmitters are altered; receptors are changed. But to conclude that these aberrations constitute a disease process that appears out of nowhere or is influenced by brain biology or genes is scientific reductionism at its worst. What about the personal history? The family history? What about the social determinants of addiction? What about poverty, stress, and the hopelessness of your life situation?

None of this counts in mainstream addiction research – the biological cause must be identified and a chemical cure must be found! So an army of left brain analytical scientists continues to spend more effort and more money to find what will never be found, the medical “cure” for addiction. Volkow—who goes for a seven-mile run each morning to get her own addictive hit of dopamine—envisions a vaccine that will banish addiction once and for all, as though it were a virus. But the real virus seems to be the one preventing scientists from recognizing addiction’s true cause and we already have a treatment for that – feeling.