Current Research on Addiction

Last week I indulged in one of those extended side conversations bloggers get into, in the comments on an original post about some other subject. In this case, Curtis Faville, the blogger at Compass Rose Books, expressed his personal pleasure in drinking Cadenhead's Classic Green Label Rum, and in the course of the comments expressed an opinion on the subject of alcoholics and their fate with which I chose to disagree. Then followed a long discussion on what does and doesn't characterize an alcoholic, during which another poster, who signed himself Georgie, expressed a wish for links to some current research on the subject.

I personally am not an expert - I just live with a recovering alcoholic, which only classifies me as an interested party - but my resident alcoholic is a very studious sort and he does keep up with the literature, so I asked him if he could give me some useful links to pass on to Georgie. He gave me the following email, which is such a comprehensive review of good current sources that I'm reproducing it here in full, in hopes that Georgie and anyone else may find it useful:

Here are all sorts of links. Read through them and decide what to send along to Curtis and company.

As I think I mentioned, the best popular introduction to the physiology of addiction I've seen is in the book that went along with the HBO Addiction Series. Much of that information is on the HBO addiction website: http://www.hbo.com/addiction/ Follow the button on top labeled "Understanding Addiction". It's been a while since I read the book and I don't think I ever did more than skim the web site but I think the basics are there.

I remember being fascinated by this 45 minute video presentation: http://videocast.nih.gov/ram/ccgr121306.ram

The common thread in both of the above is Dr. Nora Volkow, who is the director of the National Institute on Drug Abuse and did a great deal of pioneering brain imaging work on addiction while at Brookhaven National Lab.

This article in SF Gate was pretty good too: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/02/11/MNGDEO2QOC1.DTL&feed=rss.news The picture is great. It's complex but it captures all the basics. This came out right after Gavin Newsom sought help with alcohol.

To understand what the addiction feedback loop is working on, it is helpful to know how the brain operates. I found this article on "normal" brain function really interesting: http://findarticles.com/p/articles/mi_m1200/is_18_156/ai_57799547/ There is nothing on addiction here, but this article clearly lays out that the brain operates by having a bunch of default habits and an interrupt system to cut them off where they are not appropriate. It this seems very natural for addiction to work by the any mix of mechanisms that builds drug-reinforced habits and/or weakens the interrupt mechanism.

The single biological factor that's been most linked with addiction has been an allele associated with the brain chemical dopamine and in particular the D2 dopamine receptor. These are highly involved in the brain's pleasure and reward system that plays a role in those drug-reinforced habits. Dopamine shows up in that SF gate picture. A 1990 paper all but said there was an alcoholism gene (well, allele). This article (http://www.faqs.org/abstracts/Health/D2-dopamine-receptor-gene-is-associated-but-not-linked-with-alcoholism.html) is part of the follow-on discussion, and a far as I can tell, this is not too far from the view today: it's part of the explanation but not the whole explanation. As you can imagine, there has been lots of back and forth since in the research community. Do a search on "D2 dopamine receptor alcoholism" and you'll find a very mixed story. And having done that search, I like the discussion that starts at the bottom of the page here: http://books.google.com/books?id=UzhXJ4l3OBYC&printsec=frontcover#PPA97 I'm going to order the book.

At a slightly more complex level is this Scientific American Article: http://www.sciam.com/article.cfm?id=seeking-the-connections-alcoholism-and-our-genes&page=1

And if anyone believes there is one type of alcoholic, I think this http://www.nih.gov/news/pr/jun2007/niaaa-28.htm puts that simple notion to rest. I've got the whole article, not just this press release.

Success!

It's always a pleasure to finish something you've been building, try it out, and have it work the first time. (Given the amount of testing I did on the thing, "the first time" is a little misleading here.)

For the last 7-8 months, I've been rebuilding a web site - the bookstore at the site lifering.com, which is the eCommerce arm of LifeRing Secular Recovery. This is the group that has helped my husband stay clean and sober; and the web site sells their small list of publications, and is one of their sources of income. The organization wanted to move it to a different hosting company and to a different "platform" (different set of management tools) - so instead of just calling the new hosting company and saying, haul it over (which takes about 3 days), I had to rebuild it from scratch using a new set of tools (ZenCart, an open source shopping cart) to make it do all the things it used to do.

Last Friday, I renamed it and "brought it live" - until then, people going to lifering.com went to the old site. Now it's up and running and working, and I'm astoundingly pleased with myself. We toasted my success in Calistoga water, Saturday night. I've learned a great deal, and enjoyed it; but I was really spending a lot of time on it (one reason I've been blogging less), and I keep reminding myself, I don't have to work on the web site today... (Don't worry, I'll find something else to do.)

Beer Tax

Every so often one rolls by that just makes you say, "What??" (I've been reading the wonderful comic strip Candorville, in which people regularly say "What?")

As reported in the invaluable San Francisco Chronicle, a group of students in San Jose is revolting (that's an active verb, not an adjective. Yet.) over the fact that one of California's proposed ways to close the budget deficit is to increase the tax on beer by as much as $1.88 per six-pack. Assemblyman Jim Beall, D-San Jose, proposes to raise the beer tax from 20 cents per gallon to $2.88 per gallon.

The San Francisco State Republicans are marching around outside Assemblyman Beall's offfice in San Jose, complaining about "a tax on poor students." They're waving signs reading, "Students Opposed to Unjust Taxation!", and (I really can't believe this one) "No taxation on intoxication."

OK, let's rephrase this in simple English. A group of self-identified Republican students complain that an increase in the tax on beer is an infringement of their right to get drunk at the end of a long day of studying, because they're too poor to afford an additional $1.88 a six-pack. These are college students, so only the graduate students and some seniors can even drink beer legally; but they're acting as if they were the Sons of Liberty, dumping tea into Boston Harbor.

It's perfectly true that sin taxes, like this one, are regressive taxes on the poor, if only because all sales taxes are regressive taxes on the poor. I just find it hard to put the words "poor" and "Republican" in the same phrase, although I realize I am stereotyping. Still, "poor" and "student" are normally coupled, so we'll let that one pass.

"Fight for your right to party!" they complain. I knew the educational system was bad, but in this case it has clearly failed miserably, because these yokels can't distinguish between a "right", like life, liberty, and the pursuit of happiness, or the right to be free of unreasonable search and seizure, and a "privilege", which means that, if they are over 21 years old and have the money, they are allowed to buy and drink beer, as long as they don't drive a car afterward.

Students under 21 have no "right" to buy or drink beer at all, under any circumstances. Period. Regular readers of this blog know that my husband is a recovering alcoholic. Alcoholism is no joke, and there were reasons it was once prohibited, even though the cure turned out to be worse than the disease and was eventually repealed. There's a level at which society can't protect people from their own stupidity; but there's no social obligation to make that stupidity affordable. Or easy.

The article contains some serious statistics about the effects of underage drinking, which unfortunately these kids are not reading. One of the protest organizers says that "some of his fellow students spend as much as 60 percent of their paychecks on beer." Based on my experience, frankly, those students are at very high risk for alcoholism right now. I hope they wake up to the problem and stop before they do themselves real damage.

Hangovers

My husband just sent me a link to a NY Times op-ed piece that was making the rounds of his recovery group, and it's interesting enough that I want to share it here.

The Hangover That Lasts

Go read it - you have to have a login to NYTimes.com but they're free and they've never hassled me with spam. It isn't very long.

I'm fascinated by the conclusions (from studies on rats) about rats which engaged in the laboratory equivalent of binge drinking during adolescence, and then stopped drinking. They're capable of learning - but they're not capable of relearning. They can't admit they were wrong. They show "a tendency to stay the course, a diminished capacity for relearning and maladaptive decision-making." They "fail to recognize the ultimate consequences of [their] actions." And all this is present even after a long period of sobriety.

The one good thing the study mentions is that, in "former alcohol-drinking mice", exercise clearly stimulates "the regrowth and development of normal neural tissue". So - exercise is good for the formerly drunken brain.

And neither I nor the article's author have ever mentioned the name you're thinking!

Now how do we explain Dick Cheney?

Lies, Damned Lies, and Alcoholism

This post was inspired, as sometimes happens, by Jon Carroll's column in today's San Francisco Chronicle. Mr. Carroll wrote an extended fantasy on what might have been the process by which Marion Jones chose to take performance-enhancing drugs, and the mental processes by which she supported and justified not only the drug-taking but the fact that she had to hide it (because it was illegal). I recommend the column, the analysis is brilliant. But it startled me, because on the same day it was published, I read and commented on my husband's extended (29 page) analysis of his life, and his experiences with compulsive/addictive behaviors (first bulimia and then alcoholism), how he got into them, and how he has gotten out of them.

The scary thing about the fantasized thinking of the person lying about sports drug abuse and the real thinking of the bulimic or alcoholic, documented in my husband's account, is how close they are.

It isn't really that bad. People make too much of this. Besides, I'm in control; I don't really have a problem.

I seem to recall from Mr. Carroll's much earlier columns that he himself had an issue with alcoholism, which he has overcome; I wonder if he consciously remembered any of that when he wrote this piece.

The question, of course, is: to what was Ms. Jones addicted? She seems to be displaying addictive behavior, but the substances she took aren't addictive in the normal sense. I've never heard that you get withdrawal symptoms from quitting taking steroids, or whatever. I have to conclude that she was addicted to: fame. She liked being Numbah One. She convinced herself that she would have been Numbah One anyway, and the drugs didn't really make that much difference. Except that they did.

Alcohol Dependency, and Recovery

On Tuesday October 2 it will be exactly 6 months since my husband had his last drink of alcohol.

I have his permission to blog about his alcohol dependency and his recovery; he's been very open about it with everyone; but the fact remains that, six months ago, I suddenly had to deal with the fact that the man I've been married to for twenty-one years is an alcoholic.

How could I not realize something like that (you ask)? Well, that's a good question. I'm not stupid; I knew he always drank wine with dinner (I only drink with dinner occasionally); I knew there were days when he drank too much, and woke up the next morning hung over. (He's very hard to deal with when hung over.) But we don't spend our entire lives watching what other people do; I was working full-time, in a high-stress job that took a lot of my energy and attention, and - frankly - I'm not always that observant, and I didn't realize how far it had really gone. Also, even though I wished he wouldn't do it, I realized that there was nothing I could do about it. I knew couldn't make him stop drinking; all I could do was nag at him about it, which would make both of us miserable, because I dislike confrontation. So, I chose not to do that. Also, frankly, I didn't want to think about it too much. It's just social drinking, I thought - but it wasn't.

What's really bizarre about the situation is that his alcohol dependency, which is a Bad Thing, has led to his alcohol recovery - and that is a really Good Thing. I didn't realize until he started talking about his recovery that he had almost completely stopped talking to me - or anyone else - at all. I didn't realize until he started going to nightly (now, weekly) recovery group meetings, that except for work, and his solitary hiking trips, it had been months since he left the house at all, and years since he attended any kind of social gathering.

So what happened? He says he finally realized that his alcoholism was affecting his ability to hike and take pleasure in nature, which is probably his major passion; and therefore it had to stop. Also, at my suggestion (I cheerfully admit), he talked to the Employee Assistance Program at his job - and the lady there read him the riot act about the characteristics of an alcohol dependent personality, and he had every one of 'em. So she enrolled him in the Kaiser Chemical Dependency Recovery Program, and he enrolled himself in a secular chemical dependency support group called LifeRing, and he hasn't had a drink since. In fact, we no longer have any wine or beer in the house, and I'm negotiating to get rid of some old bottles of spirits that date from before we got married. But they're not critical because on his worst day he never drank spirits.

I feel like I've gotten back the man I married. He's chatty, he's cheerful, he's lost a lot of weight (many empty calories in booze), he makes awful puns again, he can go to parties and talk to people - a few years ago, we went to a New Year's Eve party at a friend's house, and he walked out after half an hour, leaving me to explain that he just didn't like crowds. I didn't realize then that the drinking was already a problem.

So where did this come from? When we married he was a social drinker, nothing more. Well, several personal things - we think it's been going on for about 6 years - and a genetic predisposition. His mother died of Alzheimer's disease in 2003, just before Christmas, after a ten-year "long goodbye." It hit him really hard. He was the caregiver, and he was very fond of his mother, and he had to watch her turn into a vegetable. That's one; the party he walked out on was right after that. Just about the time she died, his job became very very stressful. That's two. And finally, I knew that he had a history of weight problems in his youth, and he lost a lot of weight in graduate school; but I learned during the recovery discussions that he was bulimic at that time; he thinks the two behaviors are related (alcoholism and earlier bulimia), apparently there is some clinical evidence for it.

As for the genetic predisposition: I'll refer you to a book called Under the Influence, by Milam and Ketcham. Amazon has it; Barnes and Noble, or your local public library, probably has it. It's been around for a while, it came out in 1981. If you think that alcoholism is caused by moral decay or lack of will power or some variant of the "Demon Rum", you need to read this book. There is a small part of the population, I think around 10 percent, that simply metabolizes alcohol differently than everyone else. If people with this chemistry get into the habit of drinking regularly, for whatever reason, they find that they have to continue drinking in order to feel well enough to function; and the more they drink, the more they have to drink. They can recover if they stop drinking altogether; but after a certain point, they can't stop drinking without outside help. It's a startling and eye-opening book.

My husband, very fortunately, made the decision to stop before he reached the point where he had to go into detox - he just stopped drinking, assisted materially by the Kaiser CDRP, which provided him with different things to do instead of drinking. As people trying to quit smoking know, the habit patterns are as hard to break as the chemical dependency. He'd been coming home from work and drinking; now he came home from work and went to a meeting, and talked about it. In fact, some nights he went to two meetings: Kaiser's, and LifeRing's. He's now down to 2-3 meetings a week; he really enjoys the discussions.

I won't go too much into LifeRing here - I've linked their web site, you can read it for yourself - but he prefers them to AA because AA is just too Christian-tinged religious for him. He's a very religious person, but he doesn't consider himself a Christian (as I don't). In case you didn't think AA was a Christian organization, I'll refer you to the LifeRing leader's blog post on a recent court case, where a Buddhist convict objected to being forced to attend AA as a condition of parole. I've added the New Recovery blog to my links.

I've been mulling this post over for 6 months. I don't know if I'll post on the subject again; but I wanted to put this out on the table for discussion.