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A New Definition of Addiction Makes Rehab and Recovery More Effective
We have typically defined addiction as needing a substance to function normally, but this ignores crucial psychological qualities of addiction. A new and better definition has arrived, says Maia Szalavitz.
Maia Szalavitz is widely viewed as one of the premier American journalists covering addiction and drugs. A neuroscience writer for TIME.com and a former cocaine and heroin addict, she understands the science and its personal dimensions in a way that few others can. is the first book-length exposé of the "tough love" business that dominates addiction treatment. Her newest book is Unbroken Brain: A Revolutionary New Way of Understanding Addiction.
Maia Szalavitz: Addiction is compulsive behavior despite negative consequences. And it's really important to start by defining addiction because for a long time we really defined it very poorly. We used to think that addiction was needing a substance to function. And what that resulted in was that cocaine was not addictive because cocaine does not produce physical withdraw that is noticeable. You may be cranky and irritable and crave cocaine, but you won't be puking and shaking and have the classic symptoms that you would see with alcohol or heroin withdrawal. So cocaine wasn't addictive. Then crack came and we realized that defining addiction in that way not only harms people by telling them that cocaine is not addictive, it also harmed pain patients because people who take opioids daily for pain will develop physical dependence but they are not addicted unless they have compulsive behavior despite negative consequences. I see addiction as a learning disorder and the reason that I see it that way is because the biology of addiction unfolds in a developmental context over time and that means that a huge amount of variables come into it, not only genes and early environment, but also culture, your family, the way you interpret your own experience. So it becomes very complicated pretty quickly.
Addiction is a learning disorder because it can't occur without learning. You have to learn to associate the drug with some kind of relief or pleasure. And you need to do that repeatedly over time before you can become addicted. This is why a baby can't be addicted because a baby who is born with physical dependence on something like heroine doesn't know whether it needs a diaper change or just wants mommy or wants heroin. And it certainly can't you go out and score despite negative consequences. So that's another reason what that it's really important to distinguish between physical dependence and addiction. So the learning is involved where you learn that this works to fix a problem and you basically then fall in love with the substance.
And once you've fallen in love with somebody or something you will persist despite negative consequences in order to sustain that relationship because the biology is going to tell you that your life depends on this. It basically acts in the brain region that is involved in survival and reproduction and those are the two fundamental purposes of biology. So that creates really, really strong cravings and it changes your priorities tremendously. And we don't really think about that when somebody falls in love and gets married and has a kid, we think that's very normal. And it is very normal. But if you notice how people behave around love affairs, where licit or illicit, they will tend to put that first and they will do things that they might not otherwise do in pursuit of that. And you can certainly see that when people have affairs where they will lie, et cetera.
It's both. In order to overcome addiction you need to figure out what purpose the addiction was serving. In my case I had a lot of depression and I had a lot of difficulties connecting with people. I was also sort of overwhelmed by my senses and emotions a lot of the time and opioids turned that down very nicely. So I needed to sort of figure out what was up and deal with those issues in order to be healthy and comfortable in recovery. And that's going to be different for different people because they are going to have different issues that they are medicating with the drugs.
I think psychedelics may be very useful in the treatment of addiction, but they are certainly not a cure. I think it's very important to keep in mind that insight alone does not change behavior. And with the drugs like ibogaine, which seems to help relieve opioid withdrawal, it's all well and good if you have a trip and then you are no longer physically dependent on the drug. But if you then go back to the same environment and you haven't made changes that are going to allow you to cope in a different way you will probably relapse and end up back in the same situation. So while it could be very useful to gain insight on what's going on with you via psychedelics, this idea that there will be a sort of one shot cure for addiction has been a tremendous problem in the field for a really long time and I think it's really important for the people who are promoting the use of psychedelics in addiction treatment not to over promise.
Addiction is a very human problem and this is often why people propose and some people benefit from a spiritual solution to it. That's not to say we should treat medicine and medical conditions as spirituality, but the reality is that addiction and depression and a lot of other mental illnesses do often involve struggling with that potential question. And so it is not going to be the case that you can just put a brain implant in and addiction it will go away without a big chunk of yourself going away. So the Chinese are horribly experimenting with this horrific brain surgery where they ablate, i.e. burn out the nucleus accumbens, which is basically the brain region that provides pleasure and motivation and they think that this is actually going to cure addiction. Of course, what happens is you get to people who are just anhedonic who relapsed because now they have even less.
So this idea that like we could use a drug that would block the effects of the drug of choice is generally misguided because the problem isn't the drug of choice, the problem is why you need that drug and why those drugs appeal to you and why you are trying to get out why you are trying to escape and what you need in your life in order to feel comfortable and safe and productive. So I don't think that there will be future weird cures like that. But what I do think is interesting about the future of drugs is that we can make better drugs. Part of the reason that prohibition is collapsing at the moment is because of what are called new psychoactive substances or legal highs. And basically you can make a new recreational drug by sort of tweaking molecules of the other ones and it will be technically legal because it hasn't been made illegal.
And what this reveals is that our system for making drugs illegal is completely irrational and based on 19th century prejudices. It has nothing to do with science. And if we apply science to this problem and look at well people are always going to want to alter their consciousness in some ways, how do we reduce the harm associated with this? How do we create drugs or medications that will allow people to feel safe and comfortable in the world but not be so distracting or it's problematic that they will not be able to connect with other people, they won't be so out of it. So I think the future of drugs is better drugs. I don't think the future of drugs will be, or virtual reality these kinds of things could all be very interesting. But I think that so long as people ask the question why am I here and so long as people need each other to love and connect we are going to have people who want to find ways to make that work better.
The biological definition of addiction that has informed lawmakers and the general public about drug use — defined as the necessity of a substance to function normally — is vastly inadequate to diagnose and treat drug addiction. Journalist and drug addiction researcher Maia Szalavitz proposes a new definition of addiction which gets to the core psychological causes: addiction is compulsive behavior despite negative consequences.
One practical problem with the biological definition of addiction is that it does not cover cocaine addiction. Unlike when someone abuses alcohol or opioids, the body does not go through violent withdraws when a heavy cocaine user suddenly abstains. But of course cocaine an be an addictive substance and abusers are likely to ignore the negative effects the drug produces in their lives.
Szalavitz's newest book is Unbroken Brain: A Revolutionary Way of Understanding Addiction.
Moreover, the biological definition of addiction fails to address the psychological dependency that drug addiction creates. The negative consequences of drug addiction are very real, so why do users persist at their own peril? As Szalavitz explains, the reason is quite simple: drug abuse is not an indelible stain on a person's moral character, but a signal that the user has learned to associate positive emotions like love, connection, and security with the high of drug use.
For this reason, Szalavitz describes drug abuse primarily as a learning disorder. As such, there is no cure-all for drug addiction, though certain treatments like spiritual direction and targeted use of psychedelic substances may calm cravings. What is needed is a systematic reevaluation of treatment based on a new definition of addiction, a definition that understands the psychological causes of drug abuse.
Join Pulitzer Prize-winning reporter and best-selling author Charles Duhigg as he interviews Victoria Montgomery Brown, co-founder and CEO of Big Think, live at 1pm EDT tomorrow.
A study looks at the performance benefits delivered by asthma drugs when they're taken by athletes who don't have asthma.
- One on hand, the most common health condition among Olympic athletes is asthma. On the other, asthmatic athletes regularly outperform their non-asthmatic counterparts.
- A new study assesses the performance-enhancement effects of asthma medication for non-asthmatics.
- The analysis looks at the effects of both allowed and banned asthma medications.
WADA uncertainty<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzUzNzU0OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMDc4NjUwN30.fFTvRR0yJDLtFhaYiixh5Fa7NK1t1T4CzUM0Yh6KYiA/img.jpg?width=980" id="01b1b" class="rm-shortcode" data-rm-shortcode-id="2fd91a47d91e4d5083449b258a2fd63f" data-rm-shortcode-name="rebelmouse-image" alt="urine sample for drug test" />
Image source: joel bubble ben/Shutterstock<p>When inhaled β-agonists first came out just before the 1972 Olympics, they were immediately banned altogether by the WADA as possible doping substances. Over the years, the WADA has reexamined their use and refined the organization's stance, evidence of the thorniness of finding an equitable position regarding their use. As of January 2020, only three β-agonists are allowed — salbutamol, formoterol, and salmeterol —and only in inhaled form. Oral consumption appears to have a greater effect on performance.</p>
The study<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzUzNzU0Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1MTIzMDQyMX0.Gk4v-7PCA7NohvJjw12L15p7SumPCY0tLdsSlMrLlGs/img.jpg?width=980" id="d3141" class="rm-shortcode" data-rm-shortcode-id="ebe7b30a315aeffcb4fe739095cf0767" data-rm-shortcode-name="rebelmouse-image" alt="runner at starting position on track" />
Image source: MinDof/Shutterstock<p>Of primary interest to the authors of the study is confirming and measuring the performance improvement to be gained from β-agonists when they're ingested by athletes who don't have asthma.</p><p>The researchers performed a meta-analysis of 34 existing studies documenting 44 randomized trials reporting on 472 participants. The pool of individuals included was broad, encompassing both untrained and elite athletes. In addition, lab tests, as opposed to actual competitions, tracked performance. The authors of the study therefore recommend taking its conclusions with just a grain of salt.</p><p>The effects of both WADA-banned and approved β-agonists were assessed.</p>
Approved β-agonists and non-asthmatic athletes<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzUzNzU1MC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMzkxODk0M30.3RssFwk_tWkHRkEl_tIee02rdq2tLuAePifnngqcIr8/img.jpg?width=980" id="39a99" class="rm-shortcode" data-rm-shortcode-id="b1fe4a580c6d4f8a0fd021d7d6570e2a" data-rm-shortcode-name="rebelmouse-image" alt="vaulter clearing pole" />
Image source: Andrey Yurlov/Shutterstock<p>What the meta-analysis showed is that the currently approved β-agonists didn't significantly improve athletic performance among those without asthma — what very slight benefit they <em>may</em> produce is just enough to prompt the study's authors to write that "it is still uncertain whether approved doses improve anaerobic performance." They note that the tiny effect did increase slightly over multiple weeks of β-agonist intake.</p>
Banned β-agonist and non-asthmatic athletes<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzUzNzU1Mi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzNjI3ODU5Mn0.vyoxSE5EYjPGc2ZEbBN8d5F79nSEIiC6TUzTt0ycVqc/img.jpg?width=980" id="de095" class="rm-shortcode" data-rm-shortcode-id="02fdd42dfda8e3665a7b547bb88007ef" data-rm-shortcode-name="rebelmouse-image" alt="swimmer mid stroke" />
Image source: Nejron Photo/Shutterstock<p>The study found that for athletes without asthma, however, the use of currently banned β-agonists did indeed result in enhanced performance. The authors write, "Our meta-analysis shows that β2-agonists improve anaerobic performance by 5%, an improvement that would change the outcome of most athletic competitions."</p><p>That 5 percent is an average: 70-meter sprint performance was improved by 3 percent, while strength performance, MVC (maximal voluntary contraction), was improved by 6 percent.</p><p>The analysis also revealed that different results were produced by different methods of ingestion. The percentages cited above were seen when a β-agonist was ingested orally. The effect was less pronounced when the banned substances were inhaled.</p><p>Given the difference between the results for allowed and banned β-agonists, the study's conclusions suggest that the WADA has it about right, at least in terms of selection of allowable β-agonists, as well as the allowable dosage method.</p>
Takeaway<p>The study, say its authors, "should be of interest to WADA and anyone who is interested in equal opportunities in competitive sports." Its results clearly support vigilance, with the report concluding: "The use of β2-agonists in athletes should be regulated and limited to those with an asthma diagnosis documented with objective tests."</p>
Certain water beetles can escape from frogs after being consumed.
- A Japanese scientist shows that some beetles can wiggle out of frog's butts after being eaten whole.
- The research suggests the beetle can get out in as little as 7 minutes.
- Most of the beetles swallowed in the experiment survived with no complications after being excreted.
Richard Feynman once asked a silly question. Two MIT students just answered it.
Here's a fun experiment to try. Go to your pantry and see if you have a box of spaghetti. If you do, take out a noodle. Grab both ends of it and bend it until it breaks in half. How many pieces did it break into? If you got two large pieces and at least one small piece you're not alone.
But science loves a good challenge<p>The mystery remained unsolved until 2005, when French scientists <a href="http://www.lmm.jussieu.fr/~audoly/" target="_blank">Basile Audoly</a> and <a href="http://www.lmm.jussieu.fr/~neukirch/" target="_blank">Sebastien Neukirch </a>won an <a href="https://www.improbable.com/ig/" target="_blank">Ig Nobel Prize</a>, an award given to scientists for real work which is of a less serious nature than the discoveries that win Nobel prizes, for finally determining why this happens. <a href="http://www.lmm.jussieu.fr/spaghetti/audoly_neukirch_fragmentation.pdf" target="_blank">Their paper describing the effect is wonderfully funny to read</a>, as it takes such a banal issue so seriously. </p><p>They demonstrated that when a rod is bent past a certain point, such as when spaghetti is snapped in half by bending it at the ends, a "snapback effect" is created. This causes energy to reverberate from the initial break to other parts of the rod, often leading to a second break elsewhere.</p><p>While this settled the issue of <em>why </em>spaghetti noodles break into three or more pieces, it didn't establish if they always had to break this way. The question of if the snapback could be regulated remained unsettled.</p>
Physicists, being themselves, immediately wanted to try and break pasta into two pieces using this info<p><a href="https://roheiss.wordpress.com/fun/" target="_blank">Ronald Heisser</a> and <a href="https://math.mit.edu/directory/profile.php?pid=1787" target="_blank">Vishal Patil</a>, two graduate students currently at Cornell and MIT respectively, read about Feynman's night of noodle snapping in class and were inspired to try and find what could be done to make sure the pasta always broke in two.</p><p><a href="http://news.mit.edu/2018/mit-mathematicians-solve-age-old-spaghetti-mystery-0813" target="_blank">By placing the noodles in a special machine</a> built for the task and recording the bending with a high-powered camera, the young scientists were able to observe in extreme detail exactly what each change in their snapping method did to the pasta. After breaking more than 500 noodles, they found the solution.</p>
The apparatus the MIT researchers built specifically for the task of snapping hundreds of spaghetti sticks.
(Courtesy of the researchers)
What possible application could this have?<p>The snapback effect is not limited to uncooked pasta noodles and can be applied to rods of all sorts. The discovery of how to cleanly break them in two could be applied to future engineering projects.</p><p>Likewise, knowing how things fragment and fail is always handy to know when you're trying to build things. Carbon Nanotubes, <a href="https://bigthink.com/ideafeed/carbon-nanotube-space-elevator" target="_self">super strong cylinders often hailed as the building material of the future</a>, are also rods which can be better understood thanks to this odd experiment.</p><p>Sometimes big discoveries can be inspired by silly questions. If it hadn't been for Richard Feynman bending noodles seventy years ago, we wouldn't know what we know now about how energy is dispersed through rods and how to control their fracturing. While not all silly questions will lead to such a significant discovery, they can all help us learn.</p>
Several experts have weighed in on our sometimes morbid curiosity and fascination with true crime.
- True crime podcasts can get as many as 500,000 downloads per month. In the Top 100 Podcasts of 2020 list for Apple, several true crime podcasts ranked within the Top 20.
- Our fascination with true crime isn't just limited to podcasts, with Netflix documentaries like "Confessions of a Killer: The Ted Bundy Tapes" scoring high popularity with viewers.
- Several experts weigh in on our fascination with these stories with theories including fear-based adrenaline rushes and the inherent need to understand the human mind.
Why are we fascinated with true crime stories?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzUzODA1MC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1MzkwOTAzOX0.7WqeWaf-odtEJV5XB2jdEG1uPU5d6Uaujw6iy6MKMbw/img.jpg?width=1245&coordinates=0%2C0%2C0%2C0&height=700" id="d99fc" class="rm-shortcode" data-rm-shortcode-id="e14d547e4d386925bad470882a823333" data-rm-shortcode-name="rebelmouse-image" alt="woman standing in front of crime scene notes" />
Several experts and psychologists weigh in on why we could be so fascinated by violence, destruction and true crime stories...
Photo by Motortion Films on Shutterstock<p>Several experts have weighed in on this topic over the years, as the spike in popularity of true crime media has continued at an astonishing rate.</p><p><strong>Psychopaths are charismatic.</strong> </p><p>One of the <a href="https://www.scienceofpeople.com/psychopath/#:~:text=Psychopathy%20researchers%20found%20that%20psychopaths,defer%20gratification%20and%20control%20behavior" target="_blank">defining qualities of a psychopath</a> is that they have "superficial charm and glibness", which could explain part of our fascination with podcasts, TV shows, and movies that cover the lives of famous serial killers like Ted Bundy.</p><p><strong>Our psychology demands we pay attention to things that could harm us.</strong></p><p>Psychology can play a large role in why we like what we like, and our fascination with true crime stories is no exception. When it comes to potential threats or things that could be threatening to humanity, perhaps we've been conditioned to pay those things extra attention. </p><p>According to Dr. John Mayer, a clinical psychologist at <a href="http://www.doctorondemand.com/" target="_blank">Doctor on Demand</a> who spoke about the process <a href="https://www.nbcnews.com/better/health/science-behind-why-we-can-t-look-away-disasters-ncna804966" target="_blank">in an interview with NBC News</a>, seeing destruction, disaster, or tragedy actually triggers survival instincts in us. </p><p>"A disaster enters into our awareness - this can be from a live source such as driving by a traffic accident or from watching a news report about a hurricane, a plane crash or any disaster," Mayer said. "This data from our perceptual system then stimulates the amygdala (the part of the brain responsible for emotions, survival tactics and memory). The amygdala then sends signals to the regions of the frontal cortex that are involved in analyzing and interpreting data. Next, the brain evaluates whether this data (awareness of the disaster) is a threat to you, thus judgment gets involved. As a result, the 'fight or flight' response is evoked." </p><p><strong>Could it just be morbid curiosity? </strong></p><p>Dr. Katherine Ramsland, Ph.D., a professor at De Sales University, explained <a href="https://www.bustle.com/p/why-are-people-so-obsessed-with-true-crime-experts-reveal-the-evolutionary-reasons-why-18138062" target="_blank">in an interview with Bustle</a>:</p><p>"Part of our love of true crime is based on something very natural: curiosity. People reading or watching a true crime story are engaged on several levels. They are curious about who would do this, they want to know the psychology of the bad guy, girl, or team. They want to know something about the abhorrent mind. They also love the puzzle - figuring out how it was done." </p><p><strong>Perhaps it's a way of facing our fears and planning our own reactions without risking immediate harm. </strong></p><p>In an interview with NBC News, psychiatrist Dr. David Henderson suggested that we may be fascinated with violence, destruction, or crime as a way of assessing how we would handle ourselves if put into that situation:</p><p style="margin-left: 20px;"><em>"Witnessing violence and destruction, whether it is in a novel, a movie, on TV or a real life scene playing out in front of us in real time, gives us the opportunity to confront our fears of death, pain, despair, degradation and annihilation while still feeling some level of safety. This sensation is sometimes experienced when we stand at the edge of the Grand Canyon or look through the glass at a ferocious lion at the zoo. We watch because we are allowed to ask ourselves ultimate questions with an intensity of emotion that is uncoupled from the true reality of the disaster: 'If I was in that situation, what would I do? How would I respond? Would I be the hero or the villain? Could I endure the pain? Would I have the strength to recover?' We play out the different scenarios in our head because it helps us to reconcile that which is uncontrollable with our need to remain in control."</em></p><p><strong>Psychologically, negative events activate our brains more than positive events. </strong></p><p><a href="http://psycnet.apa.org/doiLanding?doi=10.1037%2F0033-2909.134.3.383" target="_blank">A 2008 study</a> published by the American Psychological Association found that humans react to and learn more from negative experiences than we do positive ones. The term "negative bias" is the tendency to automatically give more attention (and meaning) to negative events and information more than positive events or information. </p><p><strong>A forced perspective may trigger empathy and act as a coping mechanism. </strong></p><p>Viewing destruction (or listening to/watching true crime stories) could be beneficial. According to Dr. Mayer, "the healthy mechanism of watching disasters is that it is a coping mechanism. We can become incubated emotionally by watching disasters and this helps us cope with hardships in our lives…" <a href="https://www.nbcnews.com/better/health/science-behind-why-we-can-t-look-away-disasters-ncna804966" target="_blank">Dr. Stephen Rosenburg points out</a>, however, that this empathetic response can also have a negative impact. "Being human and having empathy can make us feel worried or depressed."</p><p>Dr. Rosenberg goes on to explain that this can also impact the negativity bias. "We tend to think negatively to protect ourselves from the reality. If it turns out better, we're relieved. If it turns out worse, we're prepared." </p><p><strong>Perhaps the adrenaline of fear that comes from listening to or watching true crime can become addicting. </strong></p><p>Similarly to how people get a "runners high" from exercise or feel depressed when they have missed a scheduled run, the adrenaline that pumps during our consumption of true crime stories <a href="https://www.psychologytoday.com/us/blog/science-choice/201508/can-you-be-addicted-adrenaline" target="_blank">can become addictive</a>. According to sociology and criminology professor Scott Bonn, <a href="https://www.psychologytoday.com/us/blog/wicked-deeds/201605/the-delightful-guilty-pleasure-watching-true-crime-tv" target="_blank">in an interview with Psychology Today</a>: "The public is drawn to these stories because they trigger the most basic and powerful emotion in us all: fear."</p>