Author: dlende

Studying Sin

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?

Translation

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.

Continue reading “Studying Sin”

Craving and Compulsive Involvement Scales

By Daniel Lende

In the previous post Wanting to Craving: Understanding Compulsive Involvement with Drugs, I wrote:

Different domains of subjective involvement can be linked to dopamine [function] – wanting more and more, the sense of an urge or push to use (often not a conscious desire), and the heightened focus on places and actions and times that lead to using. The scale I developed showed good internal consistency, adding support that these three senses of compulsive involvement are linked. If you want to know more about the scale, I have done a separate post detailing the compulsive involvement scale in both Spanish and English versions.

So this post gives you those scales! But first a little information. The scale in Spanish consists of eight items and shows good consistency. For the English version I have not fullly tested the scale, and have deliberately included more items there (a total of 13). One aim of future research (collaboration, anyone?) would be to test the items and hopefully winnow the size down.

So without further ado, here are the scales themselves:

Lende Craving-Salience General

Lende Deseo-Salience en Espanol

If you don’t want to click on any version, some typical statements in English include: (a) At times I have started to use and use without thinking about anything else; (b) At times I have felt a powerful impulse or urge to go use; and (c) At times using feels like you want more and more.

If you do want to use these scales, please contact me (Daniel Lende) at dlende@nd.edu. I’d like to hear more!

Results with the Spanish version originally appeared in my 2005 article Wanting and Drug Use: A Biocultural Approach to Addiction (Lende Wanting pdf). Here are excerpts from that article that relate directly to creating the original scale and its use in my study:

Construction of the Incentive Salience Scale
Ethnographic Results
The incentive salience scale was created by drawing on the results of the questionnaire and the first interview. The first step in this process was identifying the common dimensions related to wanting and seeking drugs in the adolescents’ descriptions. One important thing that emerged early in this review process was that the dimensions of wanting, shifts in attention, and behavioral engagement applied to more than just anticipating and seeking out drugs, the main focus of Robinson & Berridge’s theory. The dimensions of incentive salience applied to both seeking out and using drugs, leading to a wider focus on how drugs and drug use were salient to users.

Based on this wider view of salience, six common elements were then identified in the adolescents’ descriptions. First, one of the most typical ways of describing addictive experiences in Colombia was “querer más y más,” to want more and more drugs. During my ethnographic research, this emphasis on wanting—the Colombian’s summary description of what addiction was—took on more relevance as I realized the diversity in positive appraisals and “rewards” from substance use, ranging from “forgetting everything” to riding a skateboard better. Other ways used to describe this experience included “deseo” and “sentir ganas,” to feel a desire to consume drugs. Overall, the emphasis on wanting and desire provided a clear indication of the relevance of the incentive salience approach to understanding drug abuse in this population.

Continue reading “Craving and Compulsive Involvement Scales”

Wanting to Craving: Understanding Compulsive Involvement with Drugs

By Daniel Lende

A long-time research project of mine has been to understand how adolescents get hooked on drugs. Querer más y más, as they say in Colombia, to want more and more. When people get addicted – whatever the substance may be – they often report urges, cravings, and obsessive thinking as a primary force in why they keep using or relapse. Knowing the consequences often doesn’t matter, especially in those moments when that desire feels hot as a knife.

The easiest analogy for me to help people understand this type of desire is to ask people to think about that one time they really craved something to eat. Yes, that time, when you just had to have it. Most people have experienced this one time or another. With substance abuse, craving like this often becomes an unpredictable constant, something that comes on in the morning or while walking by a favorite bar or seeing a friend who has that gleam in his eye and a crooked smile on his face.

So here is what I found in Colombia, reported in a 2005 Ethos article entitled Wanting and Drug Use: A Biocultural Approach to Addiction (click for the full paper: Lende Wanting pdf). The abstract goes:

The integration of neurobiology into ethnographic research represents one fruitful way of doing biocultural research. Based on animal research, incentive salience has been proposed as the proximate function of the mesolimbic dopamine system, the main brain system implicated in drug abuse (Robinson and Berridge 2001). The research presented here examines incentive salience as the mediator of the wanting and seeking seen in drug abuse. Based on field work with adolescents at a school and a drug treatment center in Bogotá, Colombia, this article addresses: 1) the development of a scale to measure the amount of incentive salience felt for drugs and drug use; 2) the results from a risk-factor survey that examined the role of incentive salience and other risk factors in addiction; and 3) the ethnographic results from in-depth interviews with Colombian adolescents examining dimensions of salience in the reported experiences of drug use. Incentive salience proved to be a significant predictor of addicted status in logistic regression analysis of data from 267 adolescents. Ethnographic results indicated that incentive salience applies both to drug seeking and drug use, and confirmed the importance of wanting, a sense of engagement, and shifts in attention as central dimensions of experiences related to drug use.

Several years later, I like to highlight several things about this research. First, different domains of subjective involvement can be linked to dopamine –wanting more and more, the sense of an urge or push to use (often not a conscious desire), and the heightened focus on places and actions and times that lead to using. The scale I developed showed good internal consistency, adding support that these three senses of compulsive involvement are linked. If you want to know more about the scale, I have done a separate post detailing the compulsive involvement scale in both Spanish and English versions.

Continue reading “Wanting to Craving: Understanding Compulsive Involvement with Drugs”

Wednesday Round Up #36

This week we have our featured pieces, then a round up on blogging, the brain, mental health, video games, and anthropology. Ah, the electric eclectic.

Top of the List

My Mind on Books, ‘Supersizing the Mind’ by Andy Clark
My Mind on Books features the just released Supersizing the Mind: Embodiment, Action and Cognitive Extension. Andy Clark’s earlier book Being There: Putting Brain, Body and World Together Again was foundational in the development of my thinking during grad school, so I am really looking forward to Clark’s latest.

Maximilian Forte, Anthropology’s Many Deaths and the Birth of World Anthropologies
A critical examination of North American anthropology and the emerging world of global anthropologies

Edge, A Short Course in Behavioral Economics
A “master class” from some of the best in the field under the guidance of Richard Thaler and Daniel Kahneman

Neurophilosophy, Memories Are Made of Molecular Motors
Long-term potentiation and receptor trafficking, with a close examination of myosin Vb

The Inoculated Mind, No More Pipetting Late at Night
Very funny video-mercial for a new pipetting machine. Now this is marketing!

Blogging

Technorati, State of the Blogosphere 2008-10-29
The blog search engine and source of blogging info provides its yearly take on all things blogging

Antropologi, George Marcus: “Journals? Who cares?”
Do journals still matter? Or new forms of publishing? And the esteemed George Marcus actually gives a lengthy comment!

Continue reading “Wednesday Round Up #36”

Four Stone Archaeoporn

four-stone-hearthThe latest Four Stone Hearth rounds up the best and brightest of recent anthropology blogging over at Archaeoporn. Two of the four fields – linguistic anthropology and archaeology – are put to use in remote central’s discussion of human migration and dispersal among Indo-Europeans. Over at Anthropology.Net, they combine biological anthropology and linguistic anthropology to examine the peopling of Melanesia.

Those are just a couple high-lights, but there is plenty more! So go check out some Four Stone Archaeoporn.

Social Programs That Work

That’s the name of this website – Social Programs That Work – run by the Coalition for Evidence-Based Policy. As they say, “U.S. social programs are often implemented with little regard to rigorous evidence, costing billions of dollars yet failing to address critical needs of our society — in areas such as education, crime and substance abuse, and poverty reduction. A key piece of the solution, we believe, is to provide policymakers and practitioners with clear, actionable information on what works, as demonstrated in scientifically-valid studies, that they can use to improve the lives of the people they serve.”

Thus, the site reports on “well-designed randomized controlled trials” across a range of important social issues. They also set out the criteria that they used for considering whether a study is worthy of inclusion on their site (they say only 40-50 studies meet these criteria). Partcularly important is their focus on outcomes:

-Reporting of the intervention’s effects on all outcomes that the study measured, not just those for which there are positive effects.
-For each claim of a positive effect, a reporting of (i) the size of the effect, and whether it is of policy or practical importance; and (ii) tests showing that the effect is statistically significant (i.e., unlikely to be due to chance). These tests should take into account key features of the study design, such as whether individuals or groups were randomized.
-If possible, corroboration of reported effects in more than one implementation site and/or population.

The site provides detail on each study by its theme. So in education, one example is SMART – Start Making a Reader Today; for crime there is Multisystemic Therapy for Juvenile Offenders; in substance abuse DARE – Drug Abuse Resistance Education is shown to be ineffective despite the program’s popularity. On the employment/welfare side there is Riverside’s Greater Avenues for Independence (GAIN), showing a “sizable increase in employment rates and job earnings, reduction in welfare dependency, and savings to the government, especially for single parents.”

I definitely support this sort of research, given the insight it provides into what works and what doesn’t. So it’s great to find a site gathering this information together. However, as an anthropologist, I might also add some caveats. First, there is an almost exclusive US focus, and what works here doesn’t necessarily work elsewhere. Second, the focus is on techniques and outcomes, and not on context, relationships, resources and other things that can also make an enormous social difference. Third, this sort of research is about the workings of specific programs, and not radical change – these programs don’t address the root causes of social inequality or the ideologies that support some in favor of others.

Finally, outcome studies are no substitute for creative thinking, program development, and innovative work. These are still very much needed, so for some ideas there, see some previous posts on Cellphones Save the World; CeaseFire: Violence Prevention and Why Gary Slutkin Is An Anthropologist and Successful Weight Loss.