Last week, a new study was published in Science which many journalists and commentators seem to think is a smoking gun proving the theory that some physical defect in the brains of addicts is the cause of their behavior (i.e. the brain disease theory of addiction), and thus they’re incapable choosing their own behavior in regard to substance use.
Lead researcher Dr Karen Ersche said: “It has long been known that not everyone who takes drugs becomes addicted.”
She told the BBC: “It shows that drug addiction is not a choice of lifestyle, it is a disorder of the brain and we need to recognise this.”
However, all sensationalism aside, it turns out this study probably isn’t much of a smoking gun. There are some interesting dissenting opinions on the significance of this research from both Stanton Peele Ph.D, and Simon Rippon of Oxford University’s Ethics Blog, which I quite agree with, but I have my own take too.
Here’s an explanation of an important part of the study, as recounted by Maia Szalavitz:
All participants were tested on one predictor of addiction: the ability to control one’s own impulses. This is the ability that most of us practice on an hourly basis: It stops you from spilling a friend’s juicy secret, lets you resist a second trip to the dessert bar and keeps you from telling your boss what you really think of her.
In the lab, one type of impulse control is tested using something called a stop-signal task, an exercise in which you are asked to respond quickly and repeatedly one way — for example, by pressing a button in response to an on-screen prompt — then are suddenly required to resist that behavior.
I need to step in here for a moment. The stop-signal task doesn’t actually test your ability to inhibit your own impulses. Rather, it tests your ability to carry out or inhibit a goal determined by someone other than yourself – namely, researchers, lab technicians, and a computer which randomly chooses when to tell you to stop. Addiction is about chasing happiness – albeit a primitive form of happiness – but happiness nonetheless in the form of physical sensation, relief of pain, or escape from an unenjoyable reality. The pursuit of happiness, and our beliefs about what will make us happy, is an extremely personal matter – a matter which, dare I say, bears little relation to sitting in a lab pushing (or not pushing) a button at the command of a computer program. Essentially, my point is that I can’t see how one’s performance on the stop-signal task is relevant to much weightier decisions about how to pursue and attain happiness in one’s own life.
Szalavitz continues:
When researchers tested participants on the stop-signal task, they were surprised to find that both the addicted people and their siblings showed significantly reduced performance, compared with controls. Typically, scientists are used to seeing these kinds of deficits only in those who are addicted. The finding suggests that poor impulse control is not a result of drug use, but something that arises from an inborn predisposition.
Brain scans also showed that siblings had similar abnormalities in the connections between their inferior frontal gyrus, an area of the brain involved with self-control, and other regions that are critical for inhibiting impulses. In both addicted people and their siblings, these connections were weaker than in control participants; the more feeble the connections, the worse they did on the stop-signal task.
“The inferior frontal gyrus is really one of the main ‘brakes’ of our brain,” says Dr. Nora Volkow, director of the National Institute on Drug Abuse, who wrote a commentary accompanying the study in Science. “[Drug users and their siblings] have less connections that are linking the rest of brain with the inferior frontal gyrus [and other key regions] that form a network that allows you to inhibit responses.”
Interestingly, the authors note, these connectivity problems are similar to those seen in the brains of teenagers, a group that is characterized by impulsive behavior. It is almost as if the brains of addicts are less mature. “They look as if they are at an earlier developmental [stage],” says Volkow.
So what they’re essentially telling us here is that their very significant results, are not really significant at all – even Volkow sort of explicitly admits this in some of her comments – and this was one of Stanton Peele’s main points in his criticism of the sensationalized conclusions drawn from the study:
Run that by me again. A study showing a brain dysfunction that somehow causes addiction led half of siblings to drug abuse but not the other half? Doesn’t that make us want to learn what accounted for the siblings with the brain anomaly not becoming addicted?
The most casual reading of these results points to a fundamental problem with the conclusion that brain function causes addiction. Let’s grant that we can reduce impulsivity to a single brain structure (which isn’t itself true*). Instead of saying this study provides evidence that addiction is inborn, it is equally true — truer — to say that it suggests that impulsivity and brain structure have no impact on addiction. After all, only a coin flip could tell you the chances of two people who share these traits becoming addicted or not.
So as you can see there’s more than one way in which this study fails to be the smoking gun in the disease debate which it promised to be. Both Stanton and I seem to agree that this business about a reduced inhibitory ability is probably irrelevant. The point is, if this deficit (or difference) in brain function actually caused addiction, then the siblings would be addicts too. The entire point of the brain disease model of addiction is that addicts are unable to control their behavior, that they don’t choose to use drugs of their own volition, that some malfunction of the brain simply causes them to repeatedly use substances without their conscious permission. Does this study prove such a thing? I think not – nor does Simon Rippon of Oxford University:
These findings sound impressive, especially when they have not been translated into plain English. But in fact they show almost nothing about the nature of the choices that drug addicts make, or do not make. What they suggest is that inherited traits (or traits produced by early environments, which siblings also typically share) contribute to addiction, which is completely unsurprising. They fail to show that the traits cause addiction. They also fail to show that the relevant traits constitute any kind of disorder in the brain.
Suppose someone sent Science a study purporting to show that abnormalities in the bodies of certain individuals caused them to become Olympic swimmers. Various “abnormalities” of the bodies of Olympic swimmers and their siblings compared to the average could doubtless be established: greater height, broader shoulders, more fast muscle fibres, a certain type of fat distribution, and so on. But of course there are inherited factors in whether one is likely to become an Olympic swimmer: indicating what they are shows exactly nothing about whether Olympic swimming is a choice or not. Nor does it show that there exists an “Olympic swimmer disorder” in the bodies of Olympic swimmers, or “non-Olympic swimmer disorder” in (most of) the rest of us. This imagined study of Olympic swimmers would be laughed directly into the editor’s waste paper basket.
Why are we, then, so easily bewitched and befuddled by neuroscientific studies that establish just about as much, and just about as little?
This is much the same logic I use in breaking down the brain disease model elsewhere, and even more directly. Differences in brain activity, connectivity, and mass, can and have been shown among all sorts of subgroups of people involved in various activities, for example -musicians and taxi drivers – as compared to their non-musician and non-taxi-driving counterparts. Yet it would be downright silly to propose that playing the piano or driving a taxi are diseases, and that such behaviors are actually compulsive (involuntary) – yet this is the logical grand canyon over which we leap when we conclude that addiction is a disease and compulsive behavior simply because we can note some differences between the brain of a substance user and a non substance user.
What Impulses?
Now here’s the most personal point for me, and I think most important for all people struggling to change a substance use habit: ‘impulse inhibition’ has nothing to do with long term change of a substance use habit. I challenge the entire premise that studying impulse control can really lead us toward a solution for problematic substance use – and in fact, the focus on such nonsense is essentially a red herring, sending us down a dead end street – hurting troubled people in the process. Let me explain.
There was a time when I tried furiously to ‘control my impulses’ to use heroin and cocaine. This was of course a horribly painful period for me, and happened to coincide (that’s sarcastic for ‘was caused by’, in case you can’t decipher the tone) with my involvement in the recovery culture. It was a 5 year period in which I was involved with addiction counselors, rehabs, therapists, 12 step meetings, and methadone treatment. This recovery world taught me that I was different and doomed to live with the disease of addiction which would cause me to crave drugs for the rest of my life (unless of course I could secure a miracle from god). I was taught that I was defective, and could only hope to resist the urge (or craving, or impulse) to use drugs for one day at a time.
Luckily, I escaped that nonsense. I went through a Cognitive Behavioral Education program which taught me that I was not diseased or defective, and that I was simply choosing constant drug use in an effort to find happiness. This made sense to me, and it was so great to hear it from professionals in a helping role – it was the opposite of what every other helper had ever told me. The solution then, was to decide between the kind of happiness brought by drugs, or to commit myself to the belief that I might have better options for happiness in other activities, ways of thinking, and ways of living. That’s exactly what I did.
I let go of the belief that drugs offered the best possible feeling I could have in life. I let go of the belief that I would live with cravings forever. I let go of the belief that I was broken or fragile. As soon as I put effort into finding happiness in other ways, any ‘impulses’ to use heroin or cocaine literally disappeared. I haven’t had such an impulse since those first few weeks when I was abstinent and learning this new approach to substance use problems – and it’s been 10 years now! It is with this experience that I reject the basic premise of this study: that ‘inhibitory ability’ or ‘impulse control’ is at all relevant to problematic substance use.
You see, an ‘impulse’ of the type they’re talking about (to use a drug) is not as simple as a physical reflex – the ‘impulse’ to use a drug is more complex than that. It involves conscious thoughts and beliefs, it involves a perceived value judgment in the mind of the beholder about the benefit of the drug effects. If this judgment sincerely changes (by expanding one’s awareness of options for happiness, and/or by becoming more specific about the type of happiness one pursues – short term or long term) so as to move down one’s priority list – then there is no more ‘impulse’ (or more appropriately ‘want’) to do it. As long as we chase impulse control strategies and differences in brains, we’ll miss this basic truth about the functioning of a whole person in the real world, and no one will be helped.
* Abnormal Brain Structure Implicated in Stimulant Drug Addiction. Ersche, et al. Science 3 February 2012: 601-604. DOI:10.1126/science.1214463
