Sunday 2020-05-24

In the Realm of Hungry Ghosts by Gabor Mate.

Can addiction be harnessed to a greater good? What exactly is the difference between a habit and an addiction?

Human beings have an ingrained opposition to any sense of being forced, an automatic resistance to coercion that my friend Dr. Gordon Neufeld has called counterwill. It is triggered whenever a person feels controlled or pressured to do someone else’s bidding — and we can generate counterwill even against pressure that we put on ourselves.

This book covers some of the horrific neurochemistry, while spending most of its time on depictions of people self-medicating to cope with prior brain damage. Although William Halsted is mentioned in passing, it is not a book for people wondering about any possible benefits.

Unlike Prozac, cocaine is not selective: it also inhibits the reuptake of other messenger molecules, including serotonin. By contrast, nicotine directly triggers dopamine release from cells into the synaptic space. Crystal meth both releases dopamine, like nicotine, and blocks its reuptake, like cocaine. The power of crystal meth to rapidly multiply dopamine levels is responsible for its intense euphoric appeal. These stimulants directly increase dopamine levels, but the action of some chemicals on dopamine is indirect. Alcohol, for example, reduces the inhibition of dopamine-releasing cells. Narcotics like morphine act on natural opiate receptors on cell surfaces to trigger dopamine discharge.9 Activities such as eating or sexual contact also promote the presence of dopamine in the synaptic space. Dr. Richard Rawson, Associate Director of UCLA’s Integrated Substance Abuse Program, reports that food seeking can increase brain dopamine levels in some key brain centres by 50 per cent. Sexual arousal will do so by a factor of 100 per cent, as will nicotine and alcohol. But none of these can compete with cocaine, which more than triples dopamine levels. Yet cocaine is a miser compared with crystal meth, or “speed,” whose dopamine-enhancing effect is an astounding 1200 per cent.
Environmental cues associated with drug use—paraphernalia, people, places and situations—are all powerful triggers for repeated use and for relapse, because they themselves trigger dopamine release.
It’s a simplification, but an accurate one, to say that the frontal cortex—and particularly its prefrontal portions—acts as the chief executive officer of the brain. It is here that alternatives are weighed and choices considered. It is also here that emotionally driven impulses to act are evaluated and either given permission to go ahead or—if necessary—inhibited. One of the most important duties of the cortex is “to inhibit inappropriate response rather than to produce the appropriate one,”
Ultimately, Awareness of an addiction can lead you to the way out.
Step 1: Re-label
Label the addictive thought or urge exactly for what it is, not mistaking it for reality.

Step 2: Re-attribute
Learn to place the blame squarely on your brain. This is my brain sending me a false message.”

Step 3: Re-focus
Buy yourself just fifteen minutes.

Step 4: Re-value
Drive into your own thick skull just what has been the real impact of the addictive urge in your life: disaster.

Step 5: Re-create
Life, until now, has created you. You’ve been acting according to ingrained mechanisms wired into your brain before you had a choice in the matter. It is time to re-create: to choose a different life.

Anticipate and Accept.
To anticipate is to know that the compulsive drive to engage in addictive behaviour will return. There is no final victory — every moment the urge is turned away is a triumph.