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Addiction and the brain
Brigid
Veteran
Here's an article from the New York Times yesterday that has me very excited and grateful to be living in this day and age:
The New York Times
Scientists Tie Part of Brain to Urge to Smoke
By BENEDICT CAREY
Published: January 25, 2007
Scientists studying stroke patients are reporting that an injury to a specific part of the brain, near the ear, can instantly and permanently break a smoking habit, effectively erasing the most stubborn of addictions. People with the injury who stopped smoking found that their bodies, as one man put it, “forgot the urge to smoke.”
The new finding, which is to appear in the journal Science on Friday, is likely to alter the course of addiction research, pointing researchers toward new ideas for treatment, experts say. While no one is suggesting brain injury as a solution for addiction, the findings suggest that therapies might focus on the insula, a prune-sized region under the frontal lobes that is thought to register gut feelings and is apparently a critical part of the network that sustains addictive behavior.
Previous research on addicts focused on regions of the cortex involved in thinking and decision-making. But while those regions are involved in maintaining habits, the new study suggests that they are not as central.
The study did not examine dependence on alcohol, cocaine or other substances. Yet smoking is as at least as hard to quit as any habit, and it probably involves the same brain circuits, experts said. Most smokers who manage to quit do so only after repeated attempts, and the craving for cigarettes usually lasts for years, if not a lifetime.
“This is the first time we’ve shown anything like this, that damage to a specific brain area could remove the problem of addiction entirely,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which financed the study, along with the National Institute of Neurological Disorders and Stroke. “It’s absolutely mind-boggling.”
Others cautioned that the study was small, and that scientists still knew little about the widely distributed neural networks involved in sustaining habits.
“One has to be careful not to extrapolate too much based on brain injuries to what’s going on in all addictive behavior, in healthy brains,” said Dr. Martin Paulus, a psychiatric researcher at the University of California in San Diego, and the San Diego VA Medical Center. Still, he added, the study “opens up a whole new way to think about addiction.”
The researchers, from the University of Iowa and the University of Southern California, examined 32 former smokers, all of whom had suffered a brain injury. The men and women were lucid enough to answer a battery of questions about their habits, and to rate how hard it was to quit and the strength of their subsequent urges to smoke. They all had smoked at least five cigarettes a day for two years or more, and 16 of them said they quit with ease, losing their cravings entirely.
The researchers performed M.R.I. scans on all of the patients’ brains to specify the location and extent of each injury. They found that these 16 were far more likely to have an injury to their insula than to any other area. The researchers found no association between a diminished urge to smoke and injuries to other regions of the brain, including tissue surrounding the insula.
“There’s a whole neural circuit critical to maintaining addiction, but if you knock out this one area, it appears to wipe out the behavior,” said Dr. Antoine Bechara, a senior author of the new paper, who is a neuroscientist at U.S.C.’s Brain and Creativity Institute. His co-authors were Dr. Hanna Damasio, also of U.S.C., and Nasir Naqvi and David Rudrauf of the University of Iowa.
The patients’ desire to eat, by contrast, was intact. This suggests, the authors wrote, that the insula is critical for behaviors whose bodily effects become pleasurable because they are learned, like cigarette smoking.
The insula, for years a wallflower of brain anatomy, has emerged as region of interest based in part on recent work by Dr. Antonio Damasio, a neurologist and director of the Brain and Creativity Institute. The insula has widely distributed connections, both in the thinking cortex above, and down below in subcortical areas, like the brain stem, that maintain heart rate, blood pressure and body temperature, the body’s primal survival systems.
Based on his studies and others’, Dr. Damasio argues that the insula, in effect, maps these signals from the body’s physical plant, and integrates them so the conscious brain can interpret them as a coherent emotion.
The system works from the bottom up. First, the body senses cues in the outside world and responds. The heart rate might elevate at the sight of a stranger’s angry face, for example; other muscles might relax in response to a pleasant whiff of smoke.
All of this happens instantaneously and unconsciously, Dr. Damasio said — until the insula integrates the information and makes it readable to the conscious regions of the brain.
“In a sense it’s not surprising that the insula is an important part of this circuit maintaining addiction because we realized some years ago that it was going to be a critical platform for emotions,” Dr. Damasio said in a telephone interview. “It is on this platform that we first anticipate pain and pleasure, not just smoking but eating chocolate, drinking a glass of wine, all of it.”
This explains why cravings are so physical and so hard to shake, he said: they have taken hold in the visceral reaches of the body well before they are even conscious.
And at least one previous study suggests that people can reduce the sensation of pain by learning to modulate the activity in an area of their brain linked to pain — suggesting another possible therapy.
“The question is, Can you learn to deactivate the insula?” said Dr. Volkow said. “Now, everybody’s going to be looking at the insula.”
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Comments
My doctor and I talk a lot about my attempts to quit smoking and he once said something that stuck in my head. He said "Brigid, it's not you that's smoking. It's your brain."
I consider myself (or my brain, I should say) to be a heavily addicted smoker and I have beaten myself up about it ever since my teens. I've always considered it my greatest regret, weakness and failure and have extremely deep shame about it. I always support and applaud efforts by governments around the world to help stop the spread of the habit by enacting anti-smoking legislation because of how much shame and guilt I feel about it and because anything that makes it easier to protect workers and harder for people to start the habit is a good thing in my book. (Not at the expense of civil rights though, obviously.)
My mother smoked heavily when she was pregnant with me and from the day I was born until I smoked my first cigarette at the age of 12 I was always in the presence of cigarette smoke except when I was in school or at a friends house. Everyone in my family smoked. My mother and my four older siblings all smoked cigarettes and my father smoked a pipe and cigars. Even in the car when I was a baby. I was born and raised in the late 1960s and early 1970s in a fairly constant cloud of cigarette smoke. So the chances are very good that I was already addicted to nicotine before I ever smoked my first cigarette.
I tell you this for two reasons: It helps to assuage my guilt and shame by shifting the blame from myself, and also because it's true. I know, addicts always want to blame someone or something else for their addiction. We're always making lame excuses, lying to ourselves and to others. But I'm struggling to find the middle ground in all of this. I need to get rid of some of the horrible guilt and shame I feel because it's not helpful in the least. In fact, it does more harm than good. But I still need to retain some regret and responsibility for my smoking in order to remain in reality, which is the only place I'm going to be able to quit once and for all.
I've tried SO hard to quit and you wouldn't believe the abuse I've heaped upon myself for my failure to do so, which makes it all the worse. So if science can teach me that I'm not some kind of pathetic, weak willed, pleasure and comfort seeking person, that there are other reasons why I may find it so hard to quit smoking, I may actually succeed after all. In fact, if the brain sciences continue to advance at this amazing rate someday, maybe soon, there will be more understanding, empathy and compassion for those of us who are addicts as more proof surfaces that we are not as in control of our addictions as some might think. Which is, of course, a double edged sword. But if this new information brings about new ways to treat addiction we could be on the verge of something very good and hopeful. Taking the hard road with some addicts may work. Tough love and so on. But I think a scientific understanding of the nature of addiction will help more.
I read this article this morning. Very interesting to say the least. And like you said, for us smokers that have been trying to quit for what seems like aeons, there may finally be some hope to being able to quit. I have tried the patch, the pill, the gum, cold turkey, weening myself off of them, etc... There were a couple month spurts here and there when I quit but the urge was so strong I always went back to it. Maybe some day...
Does that mean I have to have compassion even for Rush Limbaugh, addicted as he was to the pain medicine OxyContin? Gee, you'd think that would really be a diificult "comfort" to shed. (I mean the drug, not the compassion.)
I don't think that he's evil.
But the worst that you can say
about him is that basically
he's an underachiever.
—Woody Allen
Yes... twice - and both of these instances lasted for years.
I even remember when I started up again. I thought I was in control. Hell!, I had quit before.
I liked smoking. Still do. I love a good mild cigar. But, I know I can't do that.
I know all the struggles you've gone through. I know how you've beaten yourself up. I know how you wish you could quit and can't. I know how you think, "What am I going to do when I quit? What will I enjoy? What will I do? What DID I do with my time before I smoked? I don't want to quit! I like smoking! I like relaxing with a smoke! Get off my BACK!"
But, eventually, both of you will have to make the decision. You'll either make it on your own - or possibly at the end of a breather. Or when you have emphisema(I'm too lazy to check the spelling of that word), when you your life is cut short and you don't get to see your children or grandchildren get any older. Or maybe when you're stuck in the hospital watching your life and lungs rot away - coughing up shit all the time - never able to catch your breath - just sitting across the room from Death - waiting for your gab to gasp it's last breath... Then the time for a decision will come - whether YOU are actually making the decision (or your doctor is) or not. You won't be smoking in a hospital on an oxygen tank - and then you might even wonder if those little fuckers were worth all the pain, loss and suffering you'll be experiencing in that moment.
You have to really want to. Not just "wish" that you didn't. I wished for years and years. Honestly! I hated it - but I liked it. I liked doing it - I hated the smell and the mess - but I sure did enjoy a smoke.
Wishing won't do you jack shit. Failing? So you decide to quit and have to have one. Big deal! Your goal should still be to quit. It took you a long time to incorporate it into your system and psyche - it's going to take a long time to get rid of it. Both times I quit, I never said I was quitting. I just wasn't having a cigarette or a cigar. If I wanted to, I could with no sense of failing - but I just kept choosing NOT to at that moment. It was hard sometime. Actually, maybe what you should do is quit for two weeks - and the tell yourself you're going to smoke like 10 in a row and evaluate the situation. Then after you go through the sweats, nausea, illness - maybe you'll think, "Boy!, do I want to do THAT again!?!?!"
I've heard many times that the physical addiction is gone in about a week. It's the oral fixation and the mental addiction that is so hard to get rid of.
I wish I could have a stogey... right now, in fact. But... I'm glad that I don't smoke anymore. I wish you two the best with this. You will be in my thoughts.
-bf
As I said, the tough love approach like the one in your post may work for smokers who are in deep denial about their addiction but empathy and understanding through scientific knowledge will work better. Neither I nor LFA are in denial so your post is neither warranted nor helpful. It's just harsh. And you seem to have missed my point entirely which was that addicts deserve the same amount of compassion, empathy and understanding as anyone else who is battling a disease over which they have little control. Your post was unkind, unhelpful and unnecessary and illustrates the type of thinking that I hope this and future scientific discoveries will eventually dispel.
-bf
You know, when I was writing that post... I wasn't assuming that I knew what you were thinking of or dealing with. It was mostly all the kinds of things that ran through my head as I tried to prepare myself for quitting.
Did I want to end up on a respirator? Would it cause me to die early? Miss my son? Miss my grandchildren? What did my lungs look like? All the toxins I was sucking into my body.
Those are things I thought of. They may never cross your mind.
It wasn't really tough love as much as it was my experience. I mean, you really will have to make a decision someday - but that's totally up to you. I really wish you the best with your experience, Brigid. You know that.
-bf
Me and the boy are going boarding right now.
Have a good day!
-bf
I love to smoke........I know it is bad for me.......But my favorite time of day is in the morning when I sit down with a hot cup of tea and my smokes........I know ........it's terrible. But it is the truth.................
Boo, Don't be to hard on BF............A smokers most harsh critic is an X-smoker. They have gone thro it and did it.........So it is harder for them to understand why others can't.
I quit several times. Fun to quit and not too difficult. Hardest part is STAYING QUIT. That takes a lot of self-directed anti-smoke propaganda. (Have some compassion on your lungs! IT STINKS!! &C)
I have had two or three smokes in the last nine years. Made me nauseous. I must be lucky, though, 'cuz I was really always allergic or something to the derned cigarettes. For years before I finally quit for the last time, when I didn't have to rush to get about the day's duties, I'd have my first cigarette kinda reluctantly, thinking, "well, eventually, I'm gonna need one." But in the background, I always realized that they made me feel so darned rotten and that if I really was sick, the tobacco usage would probably cover that fact up...
Well, I think was Brigid has brought up here is a very important subject, and that WHATEVER anyone has to say, whether flippant, a bit ugly, constructive, or whatever; all can be appropriated towards some solution for somebody. I'm not sure I was ever so addicted, as I have had a brain injury, perhaps to that part of the brain.
I was merely relaying some of the thoughts I used to have when battling that monkey.
I also have a hard time with "addiction is a disease". I think addiction is a choice. You're addicted because you made a choice to be addicted. I never said, "Becoming unaddicted is a cakewalk." Otherwise, what would be the big deal about an addiction?
I can have compassion for people with addictions. Look at people in rehabs where they are physically kept from supporting their addiction. Some of them look incredibly sick and crazed. Who wouldn't feel compassion for the suffering of someone else.
But, it's not like a person with Parkinsons can just go to a center where they lock you in a room and feed you really well for a month and then your disease is gone!
I didn't mean to sound as if I didn't have any compassion for people that struggle with smoking or any other thing that brings us suffering.
Truly.
-bf
-BF
-bf
But I'm not going to debate with you whether addiction is a choice or not. The point I'm trying to make is that being judgmental about those who have addictions, casting blame, fault, shame, fear or any number of other negative things upon them is detrimental to their ability to get out from under their addiction.
By the way, this was harsh:
I don't find this particularly compassionate. You think I don't torture myself with these thoughts already? I told you how much I agonize over this addiction. Didn't you believe me? I don't need this kind of shock therapy, BF. It doesn't help. It sets me back. I'm already sick with fear and adding to it makes it worse. Whether you believe that addiction is a choice or not is irrelevant. What I'm telling you is that making me more afraid, being harsh, being hard assed about it disempowers me and pushes me further away from being able to deal with this addiction. And I don't think I'm the only addicted person in the world who feels this way.
Perhaps you're addiction to cigarettes was a choice, BF, and you were able to quit by using sheer willpower alone. Everyone else is not like you and many, many people can't do it with sheer willpower alone. To say that all addictions can be conquered this way is nonsense and the scientific and medical communities have known this for years.
The reason I posted this article in the first place is because it gives many people hope that there may be new ways in the future to deal with addiction more effectively now that there is proof of the brain's involvement and more understanding about how addiction works. It was not to debate an outmoded and unhelpful attitude towards addiction.
I do not know anything about the science behind addictions or their effects on the brain, but I do know something about addictions themselves. I have been mentally and physically addicted to many things in my short life. I am intimately aware of what it is like to have something that was once done for the simple pleasure of doing it become an all-consuming habit that eats away at one’s physical and mental health; and that even if one were able to stop such a destructive habit, how the craving and desire to indulge in those old comforts are always present in the background. I think that while the superficial aspects and objects of each individual's addictions are as different and complex as the stars in the sky, the mechanisms underlying those addictions are basically the same.
The body is nothing but a lifeless shell without the mind, and even though addictions can be physical in the sense that the body can become trained to need certain substances present in its system in order for it to function as it did before we became addicted, the mind is where all of our choices and decisions are made. When seen in this way, it is easy to see that the mind plays an important role no matter what the addiction. For someone to physically pick up an alcoholic beverage and drink it, the mind must have already had the intention to do so. For one to physically light up a cigarette and smoke it, the mind must have already had the intention to do so. For someone to physically do almost anything, the mind must have already had the intention to do so. With my own addictions, whether or not my body was dependent upon the object of my addiction, there still was a choice in my mind to give in to those cravings and desires.
For the most part, addictions are really nothing more than a means for the temporary relief of our daily suffering, pain, and unhappiness in that they either ease the mental and/or physical symptoms of our suffering, or they serve to take our attention away from those symptoms. Addictions can also become near and dear to us when they induce pleasant mental states and bodily sensations, or act as a security blanket for our fears and social anxieties. Addictions can do all these things and much, much more; nevertheless, the only thing that they cannot do is actually remove the causes for our suffering. All too often, we do not see that the short term suffering of denying our unskillful cravings their objects of desire is preferable to the long term suffering of being a willing slave to those unskillful cravings. The difficult part is that even if we know that this is indeed the case, we are still unable to deny those unskillful cravings for very long.
The Buddha often talked about clinging, but the word for clinging is sometimes translated as addiction—what we cling to, what our mind takes as its sustenance, is also seen as what we are addicted to. The four types of clinging that the Buddha mentioned were clinging to sensual passion for sights, sounds, smells, tastes, and tactile sensations, to views about the world and the narratives of our lives, to precepts and practices, and to doctrines of the self. What this means is that suffering comes down to the feeding habits of the mind. One reason that we are unable to simply let go of these addictions when we realize that they are bad for us is that the mind is not strong enough to stop feeding on them, and even if we manage to pry it from one source of nourishment, it just keeps finding new (and usually unskillful) ways to feed and cling—in other words we relentlessly feed our addictions, or we substitute one unskillful addiction for another.
In my experience, the answer to freeing ourselves from our unskillful addictions lies in replacing them with more and more skillful addictions and training the mind. When we become addicted to more skillful things such as being generous, practicing mindfulness, et cetera, we slowly change the types of food that our minds feed upon. We rewire ourselves to find pleasure and happiness in more and more skillful ways, which will eventually help us to abandon all forms of addiction once and for all. When we train our minds, when we develop their powers of mindfulness and cultivate more and more refined states of concentration, we help to make them strong enough to overcome our addictions. A strong mind can ignore the voices of craving, and eventually silence those voices forever.
Sincerely,
Jason
It was harsh.
I don't know what you torture yourself with.
I really hope that the medical community comes up with a pill, program or procedure for the brain that allows people to remove addictions from their lives.
-bf
I think I just heard a choir of angels rejoice over this last post. But it could be the Beethoven. I'm kinda addicted. The Piano Sonatas, Missa Solemnis, his one opera, Fidelio...
Jason,
Once again you're wisdom and ability to clarify the issue just astounds me. Amazing post and I particularly loved this last paragraph above.
With the advent of new brain scanning technologies and advances in the brain sciences we're learning more and more about how our brains actually work and this I feel is very important because I am convinced beyond any doubt, and through personal experience, that when we understand our brain functions we're able to literally change the way they work through more skillful means. Just as you are saying, Jason. And as the Buddha taught, of course.
The example from my own experience is my panic attacks. After years of bewilderment and confusion about how to deal with this disorder I finally did some hard research into how fear is processed in the brain and how this process can become...corrupted, for lack of a better term, by environmental, genetic and other factors. When the fear center of the brain, the Amygdala, is activated our brain automatically releases a host of chemicals (like adrenaline, for example) in order to prepare us for whatever danger we are about to face. However when this process is not working correctly the Amygdala can be activated when there is no actual clear and present danger. It can become hypersensitive and become activated by frightening thoughts alone.
To make a long story short I learned that the problem with the panic disorder was that my frightening thoughts were bypassing the reasoning part of my brain and going straight to the Amygdala, causing panic with all its mental and physical symptoms. (Panic attacks can become so severe that the person suffering one can be going through the same mental and physiological terror as someone who is trapped in a burning building when there is actually no danger to them at all.) So the key is to either strengthen or create neural pathways from the frightening thought to the reasoning part of the brain and then, if necessary, to the Amygdala. And this can be done with practice. So when a frightening thought occurs we can literally force that thought to go to the reasoning part of the brain instead of directly to the Amygdala and that thought can be analyzed critically and calmly and understood for what it is; just a thought, not a real danger. The more we do this the stronger the neural pathways in the brain become and eventually the brain will do it automatically on its own. It's basically a rewiring of the brain.
That's a very simplified explanation but I think you get my gist. So when I hear about advancements in the brain sciences I can't help but think to myself that science is catching up to what the Buddha taught in the first place. And if we learn more about addiction and the brain it gives me hope that we may learn how to more effectively and more skillfully deal with addiction. I will always rely on the Buddha's teachings about clinging, as Jason beautifully described them, but it's nice to have the science behind it to make it more visual for me until I get more advanced in my Buddhist practice.
Anyway, on the choice v. disease debate I can see both sides. Treating addiction as a disease seems to take away the power of one's own choice in affecting change. Considering that any addiction is simply a habitual series of similar choices, which are dependent on various conditions, I don't have a problem viewing addiction as a choice. However, pidgeon-holing (sp?) addiction to a simple matter of choice seems to sort of disregard the conditions that leads one to such choices.
With smoking, for example, there are physical side effects which can disable one's ability to quit the habit. Also, regarding addiction as a simple matter of choice tends to imply the weakness, stupidity and/or insanity of the individual who is addicted. Even if those qualities can be established in the individual, making such implications often does not help the individual. In many cases, the individual already feels this way about themselves. So, such statements actually induce a state of mind which is a trigger for the addiction.
Anyway, I really don't see anything wrong with what Buddhafoot said, as he was just relaying his own personal experience & approach to this very difficult matter. Perhaps he has found that giving himself any sympathy towards the 'addict' aspect of his personality would enable the addictive behavior. Not sure. But perhaps we should not take statements personally that were not intended as such.
metta
_/\_
I (IMHO) believe that I made a choice in everything/addiction that Ive had-I have NO EXCUSE. This may or may not be the same for the rest of you.
cheers!
Thats all Im going to say about this matter.
respect to you all
Xray.
-bf
Absolutely, BF: having experienced withdrawal from beta-blockers, I can assure youy that it is not only "bad" drugs that have these effects.
It is interesting to note that morphine derivatives do not lead to dependency when used to control extreme pain.
You are a very special and unique individual who, no matter what you do, is essential to the universe. I really believe that. I have always enjoyed the posts that you have made and I sincerely hope that you will be able to look at yourself more positively and realize your value and significance (as, I think, everyone here does) and realize that people care about you and love you the way you are.