Director of the prestigious Center for Studies in Addiction at the University of Pennsylvania, Charles O’Brien MD PhD, was recently featured in an NPR piece on addiction. When asked to explain what addiction is – he responded by calling it a reflex:
Addiction is a memory. It’s a reflex. It’s training your brain in something which is harmful to yourself. And we can see these changes in the way they react in brain imaging situations. So, we know, for example, if we have a former smoker or a former cocaine addict, if they’ve just been off of that drug for 30 days or so, the acute effects are gone. And then we show them pictures or odors or people that anything that’s linked to their addiction, the brain automatically lights up. It’s a reflex. They don’t have to think about it. [1]
He’s either being very sloppy with his choice of words, or he’s just very sloppy in his thinking. I think it’s probably the latter.
The original question (according to the transcript) was: “So, what exactly is addiction?” And in response, he calls it a reflex, and he describes what I think we’re supposed to believe is the neural activity involved in the reflex. But he never quite describes how that translates into the actual behavior that’s usually described as addiction – nor does he assert, in his response, that it even does translate into the action of substance use. Instead, he offers a sort of half-answer, that encourages the listener to fill in the gaps, and become smokescreened into believing that substance use, for addicts, is an involuntary behavior akin to a sneeze or blink. What else could his use of the term “reflex” imply?
Scientists have been abusing the concept of reflex for over a century now, as Neurologist Robert Efron explained in 1966. It’s important to be clear about the terms we use, and Efron did a great job of clearing up the meaning of “reflex”:
The definition of “reflex” found in Webster’s Third New International Dictionary is a precise formulation of the concept of the reflex as it developed historically: “An act (as a movement) performed automatically and without conscious volition in consequence of a nervous impulse transmitted inward by afferent fibers from a receptor to a nerve center and commonly through adjuster neurons outward by efferent fibers to an effector (as a muscle or gland).”
To analyze this definition: The genus of “reflex” is an action performed by a living entity. The differentiae are (a) the action is automatic, that is, performed without conscious volition, and (b) it is a consequence of a stimulus to a sensory receptor that initiates a nervous impulse which is transmitted along a specific neuroanatomical pathway to an effector organ (“reflex arc”)….
The definition of “reflex” action contains… by implication, reference to a class or classes of action which are non-reflexive. This is necessarily so, since the purpose of a definition is to isolate the essential attributes which differentiate one phenomenon from another.
Behavior which is automatic, innate, involuntary, and independent of consciousness needs to be isolated conceptually, only because other behavior exists which is voluntary, learned, and dependent on conscious activity. [2]
Doesn’t that describe what you generally think of when you hear the word “reflex” – it’s an automatic, simple behavior – like a blink, or a sneeze, or a muscle contraction after the doctor taps your knee with a mallet. You know it’s out of your control. You don’t think about it, and even if you did, you probably couldn’t stop it. It just happens. This is all as opposed to more complex actions that involve conscious evaluations of a particular course of action, and the choice to pursue it for the results it will bring. Yet O’Brien expects us to equate simple unconscious reflex behaviors with the extremely complex behaviors of seeking, acquiring, and using drugs and/or alcohol. (and it’s not just him – Volkow and all the other diseasers communicate the same idea – O’Brien just happens to be uncommonly explicit about it)
After discussing the brain activity, O’Brien claims “It’s a reflex. They don’t have to think about it.” What exactly is it that “they don’t have to think about”? Substance use – or making their brains “light up”?
If it’s the act of making your brain light up that you don’t have to think about, then who cares? Is anyone trying to make their brains light up in response to drug cues? And more importantly, is this “lighting up” even consequential – that is, does the fact that your brain lights up in response to drug cues have anything to do with subsequent drug use? It would seem that it has little to do with it (or at least, it doesn’t necessitate it). After all, he’s speaking of test subjects who’ve been abstinent for 30 days. Did they start smoking crack right there in the lab after they saw the drug cues and their brains lit up? Did they go running out of the lab in a fit of addicted mania searching for a high as soon as they were shown drug cues?
Probably not (I hope he’d report such a result though!). Such brain activity has been commonly found in both active substance users, and those who have been abstinent for substantial periods of time. It has also been shown that much of the altered brain activity decreases over time. However, it has not been shown that such brain responses go away first, and then the choice to abstain follows. It’s the other way around. The very research he’s citing attests to the fact that people abstain, even while their brain is known to “light up” in response to drug cues.
Addiction – repeated substance use in the face of high negative consequences – is not a reflex. It’s a complex behavior – or as As Herbert Fingarette, Ph.D. called it, “conduct”:
A pattern of conduct must be distinguished from a mere sequence of reflex-like reactions. A reflex knee jerk is not conduct. If we regard something as a pattern of conduct . . . we assume that it is mediated by the mind, that it reflects consideration of reasons and preferences, the election of a preferred means to the end, and the election of the end itself from among alternatives. The complex, purposeful, and often ingenious projects with which many an addict may be occupied in his daily hustlings to maintain his drug supply are examples of conduct, not automatic reflex reactions to a singly biological cause. [3]
Harvard’s Gene Heyman PhD also noticed that it was important, when discussing addiction, to distinguish between reflexes and voluntary behavior. He used a reflex as an example of an “involuntary behavior”:
Blinks are involuntary and winks are voluntary. To see why this is so, consider the following similarities and differences. Both have biologies, both are mediated by the brain, both involve facial muscles, and they certainly look similar. Nevertheless, they occur under very different conditions. Winks vary as a function of their consequences, particularly socially mediated ones, whereas blinks are elicited by stimuli and are relatively if not totally immune to their consequences. [4]
It’s not enough to show that some brain activity exists in response to a visual stimulus, and declare the behavior of addiction to be a “reflex.” Remember that in his answer, O’Brien stated that addiction is a reflex, and then presented some information about brain activities that exist when “addicts” are abstinent – and then he restated that addiction is a reflex that you “don’t have to think about.” He offered nothing to sufficiently prove or explain his assertion that the act of substance use is a reflex.
[1] With Addiction, Breaking A Habit Means Resisting A Reflex. (n.d.). NPR.org. Retrieved October 25, 2013, from http://www.npr.org/2013/10/20/238297311/with-addiction-breaking-a-habit-means-resisting-a-reflex
[2] Efron, R. (1977). Biology Without Consciousness- and its consequences. In R. G. Colodny (Ed.), Logic, Laws, and Life Some Philosophical Complications. Pittsburgh; Chicago: University of Pittsburgh Press Chicago Distribution Center [Distributor]. Retrieved from http://digital.library.pitt.edu/cgi-bin/t/text/text-idx?idno=31735057893590;view=toc;c=pittpress LINK
[3] Fingarette, H. 1975. Addiction and Criminal Responsibility. Yale Law Journal, 84, 413—444. (quoted in: Schaler, J. A. (2011). Addiction Is a Choice (1st ed.). Open Court.)
[4] Heyman, G. M. (2009). Addiction: A Disorder of Choice (1st ed.). Harvard University Press.
Since there’s no wrong way, IMO to clean up and un-screw a life, I hate this crap. A Dr. could convince me in my face that I’m choosing. Well congratulations. That fact is of no meaningful positive consequence, so bite off! Congratulations on being right. I’m just trying to get a life any way I can.
Is anyone with me? There seems to be a situation, maybe related to reductionist stuff, that the truth doesn’t nesessarily set a person free. Forget Miranda Rights. Science is not an altar of mine. I think about it as a color blindness… if I can’t see red, you can’t teach me to. You could be right as rain, and I won’t get it. Thankfully, that doesn’t mean there’s no way out of my little storm, involving decades of neglect.
If getting wine isn’t a reflex, why does it sometimes feel like it is? You know how your road home is consistent?…. you might have an alternate if traffic sucks today… but reflex means something else then. Today, I had an impulse=reflex to take another route because traffic was heavy. If I want wine now, things change. Is it faster to sit in traffic to Walgreens or go straight home and walk over? I get lost in talk about what I’m voluntarily doing; it seems that everything I do is voluntary. But from the outside looking in, I’d coach myself out of it. I’d say: go home, dufus, and do your laundry. I’m sitting in a place where I’m like, what’s a workable model? I don’t have a chance with the AA ponzi scheme. Grr. For that to work, you have to offer a solution, have recovered, really tell a success story…and I’m still trying to find my own way. Lost!