By Daniel Lende
“You study sin,” my dinner companion said with a smile at a recent conference. I reached for my wine, and after a modest sip (really!), replied, “Vicio. In Colombia it’s called vicio. Vices.”
In Colombia vicio covers a whole range of activities—video games, playing pool, and yes, drugs. Even better, when vicio becomes the adjective “enviciador,” favorite snacks and sweets come into the picture. People start to eat, and it’s hard to stop until every piece of candy is gone.
I like the Colombian category of vicio, because I see something common in the way people get hooked on things, the way they want and crave this or that. I have seen it with food, with sex, with gambling and smoking cigarettes in both the United States and Colombia. But I have seen “getting hooked” best with drugs.
In today’s world drugs stand in for sin pretty well. Just in April Pope Benedict XVI declared drug use a deadly sin. In the United States drug users are often seen as moral degenerates. In this moral model of addiction, people lack willpower. As the tagline to a recent HBO series on addiction went, Why can’t they just stop?
But with addiction, the disease model has slowly come to the fore, highlighted by Alan Leshner, the then-head of the National Institute of Drugs Abuse, declaring in Science that “Addiction Is a Brain Disease, and It Matters.”
Morals versus brains. Or culture versus biology. Just yesterday in a talk someone asked about gender, “So is this biology or is this culture?”
How can we escape this constricting dichotomy? As I discussed in an interview with Jonah Lehrer over at Scientific American’s Mind Matters, I think a focus on concrete problems is the way to go. Specifics will help get us to where we need to go, not theories based on old ideas.
Indeed, grand pronouncements of consilience or some over-arching theory forget about Newton and his very concrete apple. As the poet Lord Byron wrote:
When Newton saw an apple fall, he found
In that slight startle from his contemplation –
‘Tis said (for I’ll not answer above ground
For any sage’s creed or calculation) –
A mode of proving that the earth turn’d round
In a most natural whirl, called “gravitation;”
And this is the sole mortal who could grapple,
Since Adam, with a fall or with an apple.
Today we’ve got the physics of an apple down, and we are turning back to the problem facing Adam. The tree of knowledge is both tempting and sweet. So just how are we to understand the apple of my eye?
My concrete problem has been craving, that compulsive desire drug users can experience and which plays such a powerful role in relapse in excessive use and relapse. In both the popular accounts and scientific literature on addiction, dopamine often takes the blame for addiction. In understanding dopamine function, two prominent ways have been developed over the past decade – one focused on incentives and motivation, and the other on computation and learning. With addiction, the incentives and motivation approach has gained more traction, largely through the “incentive salience” work of Terry Robinson and Kent Berridge. Robinson and Berridge have often glossed dopamine function as “wanting” – and wanting just needs a little push to get to craving.
Their elegant work and sophisticated hypothesis testing have helped tease out a particularly thorny problem around addiction, that of pleasure versus desire. Earlier behaviorist theories largely assumed that pleasure was the ultimate reinforcer; no other mechanism was necessary to account for why animals went towards something rewarding. The work by Robinson and Berridge helped separate “wanting” versus “liking,” or as I explain to my students, the difference between that late-night craving for pizza, just a phone dial away, and that first exquisite bite of cheese and sauce and dough.
So the leap from lab to real life can be perilous. It’s a leap that I think anthropologists are better equipped to make than most. For my research on compulsive wanting and craving, what really made the difference was the combination of two strange bedfellows – evolution and ethnography. While for many that combination would be sinful in itself, the two helped take research on dopamine function and translate it into something I could use.
Evolutionary theory placed a brain-centered theory in the context of how people make adaptive decisions. Rather than an evolutionary naïve view that drugs only signal “false fitness benefits,” evolutionary theory brought a concern with the adaptive design of the mesolimbic dopamine system and with the behaviors involved in addiction (Lende 2007 in this edited volume). This linking of decision making with specific behaviors provided a framework to then think about what “compulsive wanting” actually looked like on the ground.
That is where ethnography – or qualitative research more broadly – came into the picture. Ethnographers talk to people, we spend time with people, we understand things from their point of view. That helped me solve the translation problem, as I detailed in the posts on craving and how I came to measure it.
Neuroscientists, much like anthropologists, want to see their field as causal – the brain causes addiction or culture causes addiction. To get beyond this one-cause approach, we can take the translation model one step further. Neuroanthropology presents different data about what matters with a particular behavioral phenomena and offers ideas about how to integrate disparate areas of research. Our focus on practices, meaning, embodiment, inequality, social contexts, relationships, language and knowledge matches up well with the move in brain sciences away from a hard-wired, determinist approach to a more interactive and dynamic view of brain function.
Let me take a couple lines from a 2008 Robinson and Berridge review article (pdf): “[A]ddiction is caused primarily by drug-induced sensitization in the brain mesocorticolimbic systems that attribute incentive salience to reward-associated stimuli. If rendered hypersensitive, these systems cause pathological incentive motivation (‘wanting’) for drugs (3137).”
Here the case of Giovanni, discussed in the Scientific American piece, highlights other ways to understand the causes of craving. The interaction with a bus driver, the tough situation he faced at that moment, his desire for his past life—these were as much a part of his craving as the surge in dopamine.
Similarly, as I wrote in the compulsive involvement piece:
What I found was that both cultural symbols and an individual’s sense of self impact what users experience. One girl who smoked marijuana nearly every day explained what she sought from using: “estar en un video,” to be in a video, where attention was shifted away from how she felt in her traumatic yet culturally valued family environment. Sure, the dopamine helped produce that shift in attention, but the idiom of “a video” was something cultural. In the end that was what she really wanted, to feel those “so present sensations” from marijuana that put her in a video that seemed, for a moment, far from home.
Understandings of our brain have undergone a major shift over the last decade. Instead of hard-wired circuits and innate modules, we see a growing emphasis on plasticity, embodiment, development, and interaction. These views excite many social scientists, because they provide us ways to take brain research and use it in creative fashion in our own work. Economics, history, sociology – all these fields have seen recent books and articles drawing on neuroscience research.
What makes neuroanthropology different are the historical strengths of anthropology – evolution, culture, variation, and ethnography. These make an ideal partner for the advances in neuroscience. Evolution deepens out insight into dopamine function and why people get hooked on drugs in societies marked by both excess and inequality. Culture helps us get at patterns of excess and inequality, and how different societies manage our various vices in such contrasting ways.
Comparative variation gets us beyond a disease model, a one-size-fits-all to recognize what is a basic fact about drug use: most people who try never get addicted. Why is that? And ethnography gets us out of the lab. Take hard-core methamphetamine users in Atlanta, who used drugs in a functional way, not just to get high or self-medicate (Lende et al 2007). Thus, anthropology challenges brain research with contrasting theories and insight into people’s everyday lives; that work can enrich what brain science tells us about ourselves. That is neuroanthropology, combining everyday life and our cultural brain.
So I study sin, as I said. Los vicios, the things that get us hooked. When those vices turn destructive, we try to explain that destruction using either a moral model of addiction or a brain model of addiction. I am looking forward to the day we have a people model of addiction. That is the apple in my eye, the neuroanthropologist who can move between brain and morals, function and imagination, nature and nurture, biology and culture.