I love finding scientific studies showing “new” information that people with addiction have long known. A very good example of this, and a very good study, came out earlier this year. Here it is:
Childress, AR et. al. Prelude to Passion: Limbic Activation by “Unseen” Drug and Sexual Cues. PLoS ONE (www.plosone.org) Jan 2008 (1): e1506.
The authors used fast functional MRI to measure brain activation to visual stimuli of a rewarding, averse, or neutral nature. The bottom line is that the reward center of the brain responded to rewarding visual stimuli even when the stimuli was presented so quickly as to bypass conscious awareness. So, “triggered” craving can appear to come out of the blue with no trigger at all. I want to quote from page 4 of the article:
“The brain can strike up a prelude to passion in an instant, outside awareness, and without heavy policing from frontal regulatory regions. By the time the motivational state is experienced and labeled as conscious desire, the ancient limbic reward circuitry already has a running start. This dilemma may be reflected not only in our daily human struggle to manage the pull of natural rewards such as food and sex, but also in the chronic treatment resistant disorders for which poorly controlled desire is a cardinal feature (e.g., the addictions).”
Of course, society has just wanted people with addictions to realize the anti-social nature of their urges and stop before they act. People with addiction have long maintained that craving can come out of nowhere and be strong beyond reason before the person knows what’s happening. Examples of this were quite well known by people with addiction long ago. Even in AA’s Big Book:
“Where had been my high minded resolve? I simply didn’t know. It hadn’t even come to mind. Someone had pushed a drink my way, and I had taken it. Was I crazy? I began to wonder, for such an appalling lack of perspective seemed near being just that.”
Science and society would like there to be a way to make the “frontal regulatory regions” to be stronger in people with addiction so that they can fight the urges to use. The reality is that the trigger to crave and use can be so fast as to bypass that region entirely no matter how powerful it is. Power isn’t useful if it can’t be brought to bear. So rather than running the show, our frontal cortex is actually chasing behind the reward center making up reasons for what’s happening.
Relatedly, almost in a footnote of the study, the authors note that there was no significant group effect for “unseen” aversive stimuli vs neutral stimuli, but that the response of a part of the brain, the insula, predicted the emotional response to the stimuli when it was “seen.” What’s interesting to me here is that the insula is related to managing the recognition of stressful and aversive conditions. You may remember that it was in the news a few years ago that people with a damaged insula after stroke stopped smoking. It was hypothesized that in some way there was another addiction/reward pathway not involving the midbrain. Again addicts have long known that there are those who use to repair something missing in their ability to feel rewarded by life and those who use to avoid feeling bad. It seems that the stress relief function of addiction can be triggered without being noticed as well.
In another example of something addicts have suspected all along, someone sent me an article today about a study (Dan T.A. Eisenberg, Benjamin Campbell, Peter B. Gray and Michael D. Sorenson. Dopamine receptor genetic polymorphisms and body composition in undernourished pastoralists: An exploration of nutrition indices among nomadic and recently settled Ariaal men of northern Kenya. BMC Evolutionary Biology, (in press)) that showed that a mutation in a dopamine receptor which is associated with ADD and addiction has been shown to actually improve the survival chances of the individuals who carry it in a nomadic population. This is equally important for society’s understanding of addiction.
Once people I explain it to get past that addiction isn’t a choice, I’m usually hit with something like, “Well if we do genetic testing then don’t let them have kids we’ll be rid of addiction in one generation.” It’s as if there is something morally wrong with the condition. What society needs to understand is that our entire population is quite varied and that that variety is what got us to survive to this point. Some of us have genetics that work in a hunter gatherer society and some have genetics that work best in a corporation cubicle. It’s not that there is something superior about either lifestyle or either biology; it’s just a matter of fit.
Does that mean that all the addicts should move to the forests and start hunting for berries? No, but it does mean that addicts could understand that they aren’t the way they are because they’ve done something wrong or that they are the way they are because they are less than others. There is a difference, yes. But that difference has a great value to society. It’s the variety that keeps our species alive. We can’t always count on our environment staying the same (though it is a pretty fantasy). We should all remember the Irish Elk, a species that lived during the ice ages. It had a 12 foot spread of antlers which worked great on the tundra. Then the weather changed and trees grew and the big antlers became a death trap. Every member of the species had antlers that were too big to survive and in a short time, they were all dead.
Is the problem that there is a genetic difference or that in denying the difference people find other ways to solve the challenge that lead to behaviors that the rest of society doesn’t like?
I’m not saying that addicts are the future of our species, but what I am saying is that we need to value the diversity. Having addiction biology is a challenge in this society and this culture. I’m not asking the culture or society to change, but wouldn’t it be great if kids born with this biology could be told that they have a way of being that is very valuable in certain circumstances and difficult to manage in others. Wouldn’t it be great if we taught them how to manage it rather than pretending it doesn’t exist and letting them find drugs so they can feel better? It would be a lot better than what we’re doing now.
© Howard C Wetsman MD FASAM