Category: Addiction

Addiction and Our Faultlines

Blogging on Peer-Reviewed ResearchDrugs are what cause drug addiction, or so is the story we often hear in the United States.  But what if social conditions mattered as much or more in who used and abused drugs?

 Many anthropologists and other social scientists have shown that social conditions matter, including Phillippe Bourgois, Merrill Singer, and Elliott Currie.  Bourgois’ book In Search of Respect, Singer’s article Why Does Juan Garcia Have A Drinking Problem, and Currie’s Reckoning are powerful testaments to a basic point: Addiction runs along the fault lines of society.

 However, it has been relatively easy for neuroscientists to isolate themselves from that view, and to argue that drugs run along the pharmacological fault lines of the brain, generating terrible problems on their own.  Social conditions are one thing, drugs and brains are another.

 The research by Michael Nader, Morgan Drake and colleagues shows convincingly that social conditions matter, and matter a great deal, at the basic level of the brain.  This same line of research also highlights that individual differences, whether genetic or social, make a difference in addiction.  The trick is that the research is done with monkeys.

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The Rat Park

Here’s a great article on some of my favorite research, how creating a Rat Park (i.e., paradise for rats), leads to remarkably low rates of spontaneous drug use rates among animal models.  As the article goes, this research by Bruce Alexander “led him to conclude that drugs — even such hard drugs as heroin and cocaine — do not cause addiction; the user’s environment does.”  The Rat Trap piece over at The Walrus Magazine goes on to examine the Rat Park research, and then Alexander’s subsequent work on environmental causes for addiction.

One good quote: “Alexander’s research reveals that addiction rates are low when societies are stable, and they rise at times of social disruption. ‘The extreme case is the aboriginal people,’ he says. ‘You don’t have anything identifiable as addiction until you screw up their culture, and then alcoholism becomes a major problem. In extreme cases, addiction rates can go from zero to close to 100 percent.’  Such spikes suggest that environment is a stronger determinant of addiction than chemistry. As Alexander puts it, if you put a carton of eggs under a hydraulic press, it’s true some of the eggs will crack before others, but the problem isn’t the eggs. It’s the press.”

Still, understanding which eggs will crack, and why; and how and why specific cracks happen, and not other cracks, all provide an important role for more proximate research.  It is that mix, of environment through individuals down to mechanisms and then back out, which is particularly challenging but interesting in addiction.  And, in the end, that type of research might lead us to develop theoretical models that will go beyond treating either environments or genetics as hydraulic press models, imprinting us with their forms.  In any case, for getting started, it is crucial to recognize the context, the overall lay of the land, and Alexander’s work provides us one good (though not complete, for me at least) perspective on that.

Denial

Today I will lecture to my students in my Alcohol and Drugs class on denial.  We had a provocative discussion of the topic last Thursday, building off our reading of the wonderful and powerful memoir Drinking: A Love Story by Caroline Knapp. 

A group of students opened last Thursday’s class with a presentation that framed denial in the two ways it is generally discussed in addiction (in the US).  As I wrote to this group to help in preparing their presentation, “There is a basic debate in the addictions field (particularly alcoholism) on the role and importance of denial in addiction and recovery.  On the one side, denial is seen as a defining feature of addiction and breaking through denial as a core component of successful recovery.  On the other side, denial is seen as a marginal feature of addiction, likely the result of some other internal problem or even of social relations.  In this approach, attacking denial can backfire, causing anger in the substance abuser while not addressing either addiction itself or the promotion of therapeutic change.” 

After the students gave their presentation, I wanted to encourage class discussion, and used a technique I often employ, getting them to reflect on their own everyday lives and what that can tell us about ourselves.  I asked the class to write down an example of someone they knew “in denial,” and then give their gut reaction about why they think that person reacted that way.  In other words, I wanted some ethnographic data and some culturally-framed “explanations” to generate discussion.  It worked. 
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Dopamine and Addiction – Part One

By Daniel Lende 

The Pathway 

In your brain you have a system that comes up from some of the oldest evolved parts of your brain to some of the most recently evolved parts.  Reptile parts to ape parts.  In brain research on addiction, it’s generally called the mesolimbic dopamine pathway or system.  All the main addictive drugs affect this system, making the mesolimbic pathway a core component in addictive behavior.  Addictive experiences—gambling, shopping, eating and sex—also impact the mesolimbic dopamine system. 

In both scientific research and the popular press, the dopamine system is often cast in the role of “bad boy,” a hard-wired brain circuit that has gotten out of control, self-indulging in an orgy of pleasure.  That neat story tells us a lot about how we cast our own morals onto the brain, selectively picking out research to provide a nice scientific sheen.  Hard-wired for hedonism, we have to work even harder at self-control.   

It strikes me as the same sort of story that addicts know how to spin so well.  So let’s be blunt.  Denial! 
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Drugs and Biosociality

By Daniel Lende 

There’s an article in the NY Times today, “Drugs Offer No Benefit in Curbing Aggression, Study Finds.”  Here’s the lead-in: “The drugs most widely used to manage aggressive outbursts in intellectually disabled people are no more effective than placebos for most patients and may be less so, researchers report.” 

What’s particularly interesting are quotes from the article such as “the message to doctors should be, think twice about prescribing, go with lower doses and monitor side effects very carefully…  Or just don’t do it. We know that behavioral treatments can work very well with many patients.” 
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On Stress-Part One-Sapolsky

Blogging on Peer-Reviewed ResearchBy Daniel Lende 

In my research in Colombia, I dealt with teenagers across the spectrum—kids from good families with futures they could see, kids who had gone through more shit than most people will see in their lifetimes.  One kid, let’s call him Rafa, came from a small town outside of Bogotá, his family not in the best circumstances.  In my talking with Rafa, he dwelled on the horrible process of social exclusion that he went through—first the whispers and bad looks, then problems at school, the violence and rejection at home, and the final demand from a coalition of men, powerful and dangerous men, that he simply leave.  Sure, Rafa was no saint himself, but that’s not the point.  The dwelling on what other people did, that was the hard thing in his life when I met him.  He didn’t deal with that in the best way either, finding support in hate-filled ideologies and drug-using friends.  I don’t think many adults had ever just taken the time to talk with him, to get to know him.  And he still got kicked out of the school, a school that took in kids that had had problems elsewhere, during that year I knew him.  I remember that administrative meeting well.  No teacher spoke up for Rafa, and I didn’t count as the anthropologist.  So Rafa ran out of chances once again.  Except that is the wrong expression—he ran into chances that bopped him around like the ball on a roulette wheel, only to end up on zero.  It was people that did that. 

So that’s the ethnographic moment. 

Let’s turn to some other research. Robert Sapolsky’s work is widely known.  His best-selling book, Why Zebras Don’t Get Ulcers, is now in its third edition, and his Perspectives piece in Science has been cited 485 times according to Google Scholar.  He is acclaimed in biological anthropology circles because of his concern with mechanism, the elegance of his naturalistic studies with baboons in Kenya, and his consideration of the heavy stress-related costs of inequality.  The back cover of the Zebras book summarizes the core argument of the book, “When we worry or experience stress, our body turns on the same physiological responses that an animal does, but we usually do not turn off the stress-response in the same way—through fighting, fleeing, or other quick actions.  Over time, this chronic activation of the stress-response can make us literally sick.” 

Michael Blakey is better known for his critical archaeology work and his leadership with the New York African Burial Ground.  The work I will discuss, Blakey’s chapter “Beyond European Enlightenment” in the edited volume Building a New Biocultural Synthesis, has been cited 5 times according to Google Scholar.  His earlier chapter “Psychophysiological Stress as an Indicator of Disorder in Industrial Society” in the book Diagnosing America: Anthropology and Public Engagement has been cited all of once.  But it is Blakey’s work that has turned my mind around in the past few days in ways that Sapolsky never quite has.  These two posts will explore why the blurb on Sapolsky’s book is wrong and why that is important to what neuroanthropology can do. 

Today I will start with Sapolsky’s recent Science review “The Influence of Social Hierarchy on Primate Health.”  The article begins with the familiar “socioeconomic gradient,” where the “stepwise descent in socioeconomic status (SES) predicts increased risks of cardiovascular, respiratory, rheumatoid, and psychiatric diseases; low birth weight; infant mortality; and mortality from all causes.”  Sapolsky then provides a traditional review of the stress response—there are physical and psychosocial stressors, and both activate an “array of endocrine and neural adaptations.”  These adaptations are generally mobilized in response to challenges to homeostasis.  In response to “an acute physical challenge,” the stress response works through mobilizing energy, increasing cardiovascular tone, and inhibiting unessential anabolism; in other words, the classic “fight-or-flight” framing of stress.  Chronic activation, particular by chronic psychosocial stressors, can increase or worsen health problems ranging from “hypertension, atherosclerosis, insulin-resistant diabetes, immune suppression, reproductive impairments, and affective disorders.” 

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