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.

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Affect at the Interface: Silvan Tomkins

Affect from conference websiteI just slept in a bit, recovering from a long weekend at a conference, Affect at the Interface, at the University of New South Wales. Although I sometimes felt out of my element (pretty typical for conferences), it was a great discussion, even if over-stimulating at times. Thanks to Prof. Anna Gibbs and Dr. Jennifer Biddle for all the hard work organizing it — and also to the staff and other folks who put together a great, stimulating weekend (including the brilliant caterer!).

A host of folks presented diverse papers. I’m reluctant to list any because I’ll inevitably end up slighting someone I don’t intend to, but in addition to Prof. Gibbs and Dr. Biddle, a number of folks were very active guests over the two days: Robyn Ferrell, Anand Pandian, Melissa Hardie, Jim Wilce, and Adam Frank (sorry — couldn’t find a good link quickly to info about him) stand out, not just because of their presentations, but because of their comments on other people’s work. However, I have to admit, pretty much every reference to Gilles Deleuze went over my head (alright, I suffered so much with trying to get into Anti-Oedipus that I never attempted A Thousand Plateaus).

I presented second-to-last and made the mistake of entirely rewriting my paper the night before because in an ill-advised attempt to engage with what had happened on the first day. I’m going to post something like the presentation I aspired to give but failed to because of overly-quick turn-around, lack of sleep, and generally not being clever enough on my feet.

The discussion of affect revived my long dormant interest in the work of Silvan Tomkins, the psychologist and cybernetic theorist. Although I had consulted his work briefly when I was writing my dissertation and first book, especially because of his discussion of shame and my interest in the bodily-nervous effects of inhibition in dance, I hadn’t really taken him seriously enough. Although there weren’t a lot of biologically-inclined individuals at the conference (probably Jennifer Biddle and I were among the most enthusiastic about this line of thinking), it was great to reconsider his work with Prof. Adam Frank there, as he, together with Eve Kosofsky Sedgwick, were instrumental in encouraging a revival of interest in Tomkins’ work, outside the narrower group familiar with Tomkins in psychology (like the Silvan S. Tomkins Institute).

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Rats’ visual systems made plastic by anti-depressants

Blogging on Peer-Reviewed ResearchMy mind raced for potential titles to a post when I read the recent report from Science, ‘The Antidepressant Fluoxetine Restores Plasticity in the Adult Visual Cortex,’ by a team headed by José Fernando Maya Vetencourt (abstract), but I’ve opted to be demure, rather than go with some of my other options (like ‘Anti-depressants the “Cocoon” pool for brain?’ or something similarly outrageous).

The research team investigated wither fluoxetine, a selective serotonin reuptake inhibitor (SSRI), could restore plasticity in the visual system of adult rats. They chose fluoxetine because long-term regimens of the drug promote neurogenesis and synaptogenesis in the hippocampus and increased activity of neurotrophin brain-derived neurotrophic factor (BDNF) and its primary receptor, TrkB (close paraphrase to the original article). These effects have been shown essential to the drug’s effect; block one of these processes, and the anti-depressant doesn’t work nearly as well. In order to test plasticity, the team studied how rats responded to monocular deprivation — covering one eye — both the initial shift in ocular dominance and then the recovery of visual function after long-term monocular deprivation. In general, the fluoxetine-treated rats responded in exaggerated fashion to both conditions, suggesting that plasticity was greater with long-term administration of the drug. From the abstract:

We found that chronic administration of fluoxetine reinstates ocular dominance plasticity in adulthood and promotes the recovery of visual functions in adult amblyopic animals, as tested electrophysiologically and behaviorally. These effects were accompanied by reduced intracortical inhibition and increased expression of brain-derived neurotrophic factor in the visual cortex. Cortical administration of diazepam prevented the effects induced by fluoxetine, indicating that the reduction of intracortical inhibition promotes visual cortical plasticity in the adult. Our results suggest a potential clinical application for fluoxetine in amblyopia as well as new mechanisms for the therapeutic effects of antidepressants and for the pathophysiology of mood disorders.

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Testosterone and cortisol explain market behaviour?

There’s a fascinating post on Testosterone, Cortisol and Market Behavior on the website Pure Pedantry. Normally, I’d have a whole lot of caveats and snarky comments to add, but Jake Young does a great job of handling an original research article by Coates and Herbert, ‘Endogenous steroids and financial risk taking on a London trading floor’ (abstract). You should definitely check out Jake’s post if you find this material interesting, as he deals with the article in greater depth. Unlike in my last piece on ‘neuroeconomics’, Bad brain science: Boobs caused subprime crisis, in which I thought the science writer involved was really responsible, in this case, it looks like the authors of the original study are partly to blame, and Young does a good job of highlighting this issue.

The original research paper examines the links between market risk-taking behaviour among traders with endogenous steroids: testosterone and cortisol. Since both are linked to aggression and stress, this would seem to be a good place to study the body’s response to risk taking. But things don’t go brilliantly, as Young suggests: ‘Let’s file this paper under “wildly over-interpreted” because there are some big caveats that you have to remember before you can make a claim anything like [hormone changes lead to market changes and higher market volatility].’

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Antidepressants suppress identity?

Another interesting one from The New York Times, Who Are We? Coming of Age on Antidepressants, by Dr. Richard A. Friedman; I found this one really well done, asking more questions than it answers, but thought-provoking.

The introduction to the article lays out the central existential question posed by long-term treatment with anti-depressants, especially for patients who started on their regimens when very young:

“I’ve grown up on medication,” my patient Julie told me recently. “I don’t have a sense of who I really am without it.”
At 31, she had been on one antidepressant or another nearly continuously since she was 14. There was little question that she had very serious depression and had survived several suicide attempts. In fact, she credited the medication with saving her life.
But now she was raising an equally fundamental question: how the drugs might have affected her psychological development and core identity.

As Friedman points out, the medical testing for these pharmaceuticals doesn’t include long-term research anywhere close to the lengths of time that people are actually spending on the drugs: the longest maintenance study — done on Effexor — lasted two years.

But the more subtle issues that Friedman raises, as far as I’m concerned, are the questions of identity that are clouded by long-term anti-depressant use. He discusses one woman who was concerned about her ‘low sex drive’ and pressure from her boyfriend to have sex after eight years on libido-reducing Zoloft: ‘She had understandably mistaken the side effect of the drug for her “normal” sexual desire and was shocked when I explained it: “And I thought it was just me!”’ I can’t tell from the way Friedman writes this how he feels about the idea that an individual has a ‘normal’ sex drive, something that might exist ‘prior to’ or ‘independent of’ any outside influences, whether that influence be an anti-depressant or a particular life event or the effects of interpersonal dynamics with a partner.

The idea that the ‘anti-depressed’ state might become ‘normal,’ both in the medical sense that intervention seeks to create this state and in the sense that a patient spends so much time in the drug-influenced state that it becomes a kind of reference, suggests yet another way that cultural expectations might become biological ‘nature.’

Bad brain science: Boobs caused subprime crisis

I’m too busy to be blogging right now; I’m putting in an application for academic promotion, and like much else in academe, that means reams of paper must be offered up to the cruel, fickle gods of bureaucracy. But this example of the reporting on brain imaging research, drawn to my attention by Amanda Marcotte of Pandagon’s, Using 15 college age boys and some reactionary reporting, we are able to blame the coming depression on boobage, couldn’t pass by without comment. Thank YOU Amanda for getting me worked up enough that I won’t need a morning cup of coffee to get through several hours working on my promotion application, if I can just get back to that. (Thanks also to Echidne of the Snakes.)

The article which inspired this train of commentary is ‘Sex and financial risk linked in brain,’ by Seth Borenstein, who probably needs some sort of award for this piece. I’ll let you decide:

A new brain-scan study may help explain what’s going on in the minds of financial titans when they take risky monetary gambles — sex. When young men were shown erotic pictures, they were more likely to make a larger financial gamble than if they were shown a picture of something scary, such a snake, or something neutral, such as a stapler, university researchers reported. The arousing pictures lit up the same part of the brain that lights up when financial risks are taken.

“You have a need in an evolutionary sense for both money and women. They trigger the same brain area,” said Camelia Kuhnen, a Northwestern University finance professor who conducted the study with a Stanford University psychologist.

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