The Compass of Pleasure

Posted on July 7, 2011. Filed under: addiction, Addiction Resources/Support, Parent of an Addict | Tags: , , , , , , , , |

While driving in my car a week or so ago, I heard a fascinating interview on NPR (National Public Radio) of David Linden about his new book: The Compass of Pleasure: Why Some Things Feel So GoodLinden is a professor of neuroscience at the Johns Hopkins University School of Medicine and the chief editor of the Journal of Neurophysiology.

What does it really mean for the brain to experience pleasure? That’s the question neuro-scientist David Linden asks in his new book The Compass of Pleasure: How Our Brains Make Fatty Foods, Orgasm, Exercise, Marijuana, Generosity, Vodka, Learning, and Gambling Feel So Good. In it, he traces the origins of pleasure in the human brain and how and why we become addicted to certain food, chemicals and behaviors.

When Linden spoke with Fresh Air‘s Terry Gross, he explained that the scientific definition of addiction is actually rooted in the brain’s inability to experience pleasure. I urge you to listen to David Linden’s interview and read the transcript.  I learned so much about the pleasure circuitry of the brain, and how simple ‘likes’ become full blown addictions.

Here are some thought-provoking excerpts from the interview:

 In reference to addiction: we now can better understand addiction from a brain neuroscience perspective.

•While most people are able to achieve a certain degree of pleasure with only moderate indulgence, those with blunted dopamine systems (addicts) are driven to overdo it. Linden explains, “In order to get to that same set point of pleasure that others would get to easily — maybe with two drinks at the bar and a laugh with friends —(an addict/alcoholic) . . . needs six drinks at the bar to get the same thing.”

•Drug (or any kind of addictive substance/behavior) addicts are not motivated to ‘use’ because they get more pleasure – but because they get less pleasure; their sense of pleasure/relief is blunted;  their dopamine center is defective to an extent – and is not the same as ‘normies’.  In order to experience the same level of pleasure as ‘normies’, they need more;  and they build a tolerance level more quickly.  They were born this way; just as a diabetic was born not being to handle normal sugar loads.

Linden explained that the scientific definition of addiction is actually rooted in the brain’s inability to experience pleasure. Liking becomes wanting which becomes needing, just to function, to not experience feeling physically ill, to be able to face the day like a more normal person.

“What I’m seeking here in The Compass of Pleasure is a different type of understanding — one less nuanced, perhaps, but more fundamental: a cross-cultural biological expla­nation. In this book I will argue that most experiences in our lives that we find transcendent — whether illicit vices or socially sanc­tioned ritual and social practices as diverse as exercise, meditative prayer, or even charitable giving — activate an anatomically and biochemically defined pleasure circuit in the brain. Shopping, or­gasm, learning, highly caloric foods, gambling, prayer, dancing ’til you drop, and playing on the Internet: they all evoke neural signals that converge on a small group of interconnected brain areas called the medial forebrain pleasure circuit. It is in these tiny clumps of neurons that human pleasure is felt. This intrinsic pleasure circuitry can also be co-opted by artificial activators like cocaine or nicotine or heroin or alcohol. Evolution has, in effect, hardwired us to catch a pleasure buzz from a wide variety of ex­periences from crack to cannabis, from meditation to masturba­tion, from Bordeaux to beef.”

I struggle a bit with the disease model of addiction.  I keep looking for what it was that caused my daughter, Hayley, to become a heroin addict at age 31.  Did I, as her mother and we, as her parents, not give her enough of something – or too much of something else? What signs along the way did we miss as she was growing up? Did the trauma of her father’s and my divorce when she was 17 contribute to her serious drug addiction? Or was it a gradual building of life stress factors that culminated in the ‘choice’ to smoke crack cocaine or inject heroin in to her veins?  Was it inevitable – and she was genetically predisposed to addictive behavior, as evidenced by her eating disorder at age 20, smoking, and gradual onset of substance abuse?

Linden goes on to say in his interview:

•Any one of us could be an addict at any time. Addiction is not fundamentally a moral failing — it’s not a disease of weak-willed losers. Understanding the biology of the pleasure circuit helps us better understand and treat addiction, Linden says. It is important to realize that our pleasure circuits are the result of a combination of genetics, stress and life experience, beginning as early as in the womb.

I found this next tidbit rather surprising, as did my daughter, a smoker (she’s trying to quit – and has gone for up to 30 days without smoking) and recovering heroin addict:

•30 % of those who first inject heroin, become addicted, whereas 80% of those who start smoking become addicted to nicotine.  With heroin, there is a large immediate reward – that will satiate the user for up to 12 hours, depending on the dose. The”high” of heroin is considered to be “intermittent” because there is usually a period of several hours between doses –  similar to eating a big steak and being sated until the next meal.

However, nicotine is actually more addictive due to the use process.  With smoking, there are small reliable rewards that are more constant – liking cutting up a steak into 200 bite-sized pieces.  There is almost a constant infusion of nicotine in to the system which creates a more addictive type of learning.

And here, again, is what seems to be a partial answer to my question of how/why my daughter became a heroin addict:

 Addiction may be ~ 40% genetic involving a defect in brain chemistry; but the rest is life experience and most importantly stress. “There are variants in genes that turn down the function of dopamine signaling within the pleasure circuit,” Linden explains. For people who carry these gene variants, their muted dopamine systems lead to blunted pleasure circuits, which in turn affects their pleasure-seeking activities”, he says.

 Now there is a biological explanation for addiction, which can have profound implications for addicts trying to stay clean; stress often is THE determining factor for use and relapse.  However, behavioral strategies to reduce stress, such as those listed below, can be quite effective in preventing relapse:

            –regular prayer/meditation

            –exercise; pleasurable physical activities, like playing with or even petting a pet

            –support groups and a structured recovery program, like AA

This is all very interesting – and terrifying.  Will my daughter ever be able to deal with the ‘normal’ stresses of life – the peaks and valleys of work, personal relationships, health issues – of LIFE?

Unfortunately, with addiction, there are permanent physiological changes in neurons of the pleasure center; the brain has been rewired and is forever changed, which means that an addict will always be an addict and will need to deliberately work at staying sober.

Linden maintains that “Addiction is not fundamentally a moral failing — it’s not a disease of weak-willed losers. When you look at the biology, the only model of addiction that makes sense is a disease-based model, and the only attitude towards addicts that makes sense is one of compassion.”

Now, with new developments in the field of neuroscience and new knowledge about the role brain chemistry plays in the disease of addiction, will we, as a society, be able to change our attitudes about drug addicts – and convert the stigma, guilt, blame, and shame to compassion? Shouldn’t our country adopt policies based on the public health aspect of drug addiction – and effective treatment/support programs for addicts versus our current more punitive approach?  Proper/effective treatment of drug addiction and alcoholism should be declared one of our most acute and chronic public health issues with resources appropriated accordingly.  Ultimately, our country could be saving billions of dollars now dedicated to law enforcement, legal/court costs, incarceration, and the social/health services and issues funneled towards drug addicts.

I don’t really know how we can accomplish this and shift the culture’s paradigm from punishment to treatment of drug addiction. It’s not a simple ‘fix’, obviously.  And with the increasing numbers of drug addicts, who may have children themselves, we potentially face a growing pool of genetically pre-disposed people to addiction, draining our educational, legal, health care, social services systems and work force.

What are your thoughts on how neuroscience is changing our view of and approach to dealing with drug addiction – not only from a personal perspective (as the parent of a drug addict/alcoholic) but also as a citizen of this country, with its limited financial resources and global priorities?

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20 Responses to “The Compass of Pleasure”

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What Gabor Mate says in his book “the Realm of the Hungry Ghosts” is that the root of ALL addiction is attachment issues in the infant. He has a whole chapter on it. He doesn’t blame the mother, but essentially the theory is if we were stressed/unhappy/anxious/in a bad marriage, etc, etc. the infant feels these emotions. Also mothers bring their own family of origin issues to child rearing. He explains that it is our fault, but it’s not really our fault. It’s called being human. Great stuff, I did not feel like he was trying to make me feel guilty at all.

He is a compassionate, sensitive doctor who works with people society has given up on. He is a big believer, as am I, in harm reduction for a certain kind of addict.

On the subject of attachment….A wise Tibetan monk tells me that there is something between attachment and detachment (neither of which is desireable) called non-attachment. This is in line with the Buddhist concept of “the middle way” which is central to Buddhist teaching. Our clinging to pleasure, comfort and the familiar leads us to constant struggle. If we can let go, we can find serenity. It is our ignorance and fear that lead us to believe that we must choose between attachment and detachment. What looks like a razor-thin line between these is actually a wide boulevard, if we could only wake up and see it.
Perhaps the Alanon concept of “detachment with love” is the same as non-attachment. I’m not sure.

Thanks for this comment, Lou. I need to get Gabor’s book and read it. In retrospect, I do believe there could have been some attachment issues with Hayley. As a baby, she was very ‘colicky’ for the first three months of her life. She had a lot of GI distress – could only nurse for a few minutes at a time before she would draw her legs up and fuss. She would never take a bottle or pacifier, but started sucking her thumb at 6 weeks, which was great. She thrived and gained weight well – and grew out of her ‘colick’ by about 3 months. I think I may have detached a bit to cope with her constant crying – and, as you mentioned, my own family of origin issues were, most likely, underlying everything. I was so determined to create a different kind of family than I had as a child – and ’empower’ my daughter, that things probably got entangled and emeshed. My own mother was very narcissistic – and did not ‘mirror’ me at all. I probably unintentionally replicated this model. I am always interested in learning more about my own family dynamics and how they shaped who I am, who my kids are, and even how they affect my grandchildren. Knowledge and understanding can lead to change – and becoming a better person, daughter, sister, wife, mother, grandmother, friend.

Sounds like a good book—thanks for the review. … There are a couple of things I don’t understand. One of them being, if only some people were born with a predisposition to addiction (and if “normal” people can handle chemicals without becoming addicted), how can he claim that all of us could become addicted at any time? … Another of them being the analogy to diabetes. Which I’m sick of. Most diabetics today are NOT born with diabetes—they activate the disease by eating too much sugar. This is the where any similarity with addiction and diabetes ends, imo. Diabetes can be managed through insulin treatment, but the underlying food addiction needs more than JUST medication.

But it sounds as though this author understands that…

Like Bill above, I’m reading Gabor Maté, who is also in the PNW and who talks about adverse childhood experiences activating addiction. He also has one of the sanest and most compassionate meditations on the 12 steps that I’ve ever seen. I’ll be reviewing his book soon.

One last comment for readers who love addicts: instead of waffling between detachment and compassion, why can’t we have compassionate detachment? Al-Anon teaches me that I can “detach with love,” not anger or resentment.

Thanks again, Peggy… cheers G

G – what book of Gabor Mate’s are your reading right now?

Where can I find his meditations on the 12 steps?

Thanks for your comments. You raised some good points. I tend to agree, that the ‘genetics’ factor lets a lot of people off the hook.

But what about my daughter – who had a very privileged childhood and life, only two great-grandparents who were alcoholics – (and who knows prior to that) – but not a lot of addiction in the family. There was no abuse or traumatic event in my daughter’s childhood, as far as I know.

What was it that ‘pushed’ Hayley to ultimately inject heroin at age 31?
This will always baffle me – and I seem to be on a quest to find out the answer.

I think it’s wonderful that neuroscience is beginning to inform other sectors about addiction. I know that some courts are creating ways to respond to addiction with compassionate programs rather than just locking people up. On a personal level, I still struggle with the balance between detachment and compassion. And I have the same question as you: will my son be able to handle the stresses of everyday life? Still, the information is wonderful. Thanks for sharing.

We have lost a courageous woman who spoke out about her own addictions, at great personal risk, and helped to provide compassionate care for others with addictions. Rest in peace, Betty Ford.

Thanks for this acknowledgment, Donna. Betty Ford was a leader in helping to remove the some of the stigma and barriers associated with the diagnosis and treatment of not only addiction, but breast cancer, as well.

Nice piece. I’m reading Gabor Mate at the moment and see some similarities; basically, this notion of predisposition. Why can some drug abusers use narcotics for a long period of time and walk away, while some fall into a bottomless pit of no return. There is something medically important there. I’m definitely, seeing a different distinction between substance dependence/abuse and substance addiction, not the least, a background of relatedness or origin. I don’t think the addicts we deal with are an island unto themselves. I’d like to comment more after I finish Mate’s book and peek into Lindens. Bill

Ultimately, we’re all going to be “pre-disposed”, with the level of substance abuse and addiction in our society. Depressing, I know. So perhaps we need to focus on the “life experiences and management of stress” components that comprise the other 60 % of a person’s make-up and behavioral outcome? Prayer/meditation, regular exercise, a ‘life program’ to deal with the ups and downs of life, are all strategies that could be taught in the schools, if we had the social/political will to do so. Unfortunately, THAT kind of coming together and consensus as a nation will probably never happen. What will it take to adequately address this epidemic of addiction?

Yes, yes, yes! Thanks for the info; I need more hours in each day to read and digest the awesome volume of information that seems to be popping out. I do appreciate having folks like you providing such great pointers. In building a new website, http://www.shatterthestigma.com I reach into the world of folks who have lost children (as I have) to the disease of addiction. We want to help be part of the change to give those coming into addiction, hopefully, a better chance. Stigma is not a friend when it comes to addiction – this is not news. Every bit helps as we educate and open our hearts with compassion for all who are touched by this nasty disease. Barbara.

PS I enjoyed reading your goals. My mission statement is: to reduce suffering in the world through grace, ease and dignity for all. Continued blessings to your efforts and for your precious daughter.

Hello, Barbara. Thanks for your comment. Yes, the stigma of addiction is one of the major barriers to getting help and support – of family members as well as the addict her/him self. Maybe some of the new brain research will start to dissipate the shame, guilt, blame directed towards addicts.

I just tried to visit your blog/website, and couldn’t get there. Is it up and running yet?

Best, Peggy

Peg, I really appreciate the information in this post. I’ve always believed my daughter’s addiction is linked to her obvious chemical imbalance – an imbalance that was apparent long before heroin came into her life. Call it bipolar, clinical depression or a lack of dopamine, it is a constant threat to my daughter’s sobriety. It weighs her down in frustration, because the depression takes control. She’s learned enough to know to head for a meeting as soon as she can peel herself out of bed. Plus, she sees a counselor weekly. She works full time, lives on her own and she’s paying her own bills, but a cloud of anger and sadness colors her days. I pray for more effective meds to be developed, because everyday life is often so hard for her. Yes, I feel compassion.
-Gal

Gal – wish there was something to help your daughter get some relief from her depression, etc. Have you ever read about the work of Dr. David Amen? I think he’s based here in the PNW. He does brain scans that can DX bi-polar and other disorders. A friend of mine sent her son to Dr. Amen when he developed severe depression and and mood disorders as a young adult. I think he’s on Lithium now, but it’s dosage is tricky and he’s constantly fiddling with it.

Thanks for your comment, Gal. I always enjoy hearing from you. I wonder what role depression/mood and personality disorders play in addiction? And which comes first – kind of a chicken-or-the egg conundrum.

This is a fantastic post, Peg. I, too, heard David Linden on NPR and was fascinated by his research and conclusions. I didn’t go any further at the time, but your post makes me want to read and learn more. I find his conclusion that we must treat addicts with compassionate medical care to be correct. As far as the money, it seems to be the case that our society is not farsighted in allocating money for health and education. We want quick, cheap fixes and a lot of punishment when things don’t immediately improve. What I know of public health issues tells me that there is no political or social will to act in a preventive and caring way for any of us, and especially not for those who are not socially successful and behave in exactly the “right” ways. It is sad. I don’t know how this might be changed, but Linden’s insights can only help. I admit that I am very frightened by his conclusion that stress, transitions, crises and changes in life pose huge risks to addicts. Life is filled with just such events. There is no possible way to avoid them. A friend recently told me of hearing about middle age women who develop or relapse into eating disorders during middle age crises and transitions in their lives. Makes me scared for my daughter.
Thanks again for this great post, Peg and the terrific links it contains.

wow….what an amazing post ! thank you for this ! I just hope that many, many people will read this…especially those early in the learning curve about addiction. I only wish that all of what you’ve posted was by now, general knowledge of our society….sigh. I’m hoping/praying, as times goes on, that we will find that this is well understood in general by most people…not just those that study addiction.

How our society deals with and uses its resources (think $) regarding the treatment of addicts needs to change….and it all begins with understanding what addiction really is, …and is not,..and the progression of it and all of its effects. Again,..thank you for this.

I love NPR. I skimmed this and am going to read the rest from work, it will give me something to do.

(Keven used yesterday, almost had 6 months. I am kind of numb.)

Barbara – so sorry to hear about Keven’s relapse. Maybe he would find some insightful info and support in the NPR interview and neuro-science of addiction? If the brain chemistry of drug addicts is permanently changed and requires constant/diligent behavioral strategies to stay sober, is long term recovery possible? I’ve been told that relapse is an expected and ‘normal’ part of recovery. Keven knows more now than he did prior to his most recent use. Maybe he can build on that knowledge – and start afresh – stronger and even more deliberate on his journey towards recovery? Hoping . . .

I’m wondering how we can become effective advocates for a shift in our country’s policies regarding drug addiction?

Visit the blog DadOnFire (click on link under my “Recovery Blogs” listing) for advocacy info – and lots of great addiction resources. Thanks for your comment. Peggy


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