Language production and associated social dynamics have a very specific rhythm that can be pleasurable. Indeed, experiments have demonstrated that when speaking, people tend to choose words that fit rhythmically into their statement—a type of melodic intonation of spoken language. The pleasure some individuals find in poetry, which depends strongly on rhythm and meter, is another example of our attraction to repetition and rhythmicity.
Many nonmusical sounds of nature that are rhythmical are pleasurable to adults and children. Judging by their impressive sales, quite a few people fall asleep each night to the soothing beat of the ocean produced by a sound generator. Other options include the sound of crickets, rhythmic winds, flowing brooks, and birds. As long as there is sufficient variation in the sequence and the sounds are rich enough to reflect the natural world, the rhythm is very pleasing.
Although many studies have examined our proclivity to prefer temporal order to chaos, clearly there is a need for more systematic research to map out the full extent of the sensory domains involved. I suspect that we have just touched the surface in really understanding how this preference presents itself in everyday behaviors.
Hence we have fairly good evidence supporting conditions 1, 2, 3, and 6, and we need quite a bit of additional data to convincingly support conditions 4 and 5. But I am convinced that evidence will emerge if we make the effort to conduct carefully controlled studies.
To this point, we have discussed two very different examples—one spatial and one temporal—that illustrate the way the pleasure instinct can impact our everyday lives and behaviors. In the next chapter we will consider the manner in which the pleasure instinct places high costs on those individuals who abuse it. We are all equipped with brains that have evolved to face specific challenges and circumstances from our ancestral past. Many of these challenges and the conditions in which they originated are quite different from, and in some cases in direct opposition to, those that exist in the modern world. In a real sense, we are all of another time.The innate preferences that have been forged by the pleasure instinct to help facilitate brain growth and maturation have consequences far beyond our love of symmetry, proportion, rhythm, and repetition (to name just a few). Let us now turn toward the darker side of the pleasure instinct—addiction.
Chapter 11
Homo Addictus
Every form of addiction is bad, no matter whether the narcotic be alcohol or morphine or idealism.
—Carl Jung, 1963
Vices are sometimes only virtues carried to excess!
—Charles Dickens, 1848
Most people have no idea how much their brain changes on a daily basis.As you read these words, distinct neural ensembles are communicating with one another, shuttling electrical impulses across brain space. In the process some of these neural paths become strengthened and others are weakened. This collective pattern of brain activity creates a map or neural representation of the information being learned. As we have seen in previous chapters, some things are generally easy to learn if they are related to an organism’s overall fitness or survival. Information not directly related to important selection factors may be more difficult to learn if it has little or no fitness relevance. The degree of difficulty in learning something is generally measured by seeing how long it takes to master the new information. For instance, if you become nauseous after eating dinner at a particular restaurant, you do not need additional meals to form the association between sickness and the local greasy pit. This is true for all mammals. Rats that are made sick by ingesting tainted food will avoid the food and location where it was consumed after a single experience. In contrast, it takes much longer to learn and remember multiplication tables or word definitions, information that—one might argue—is not directly relevant to survival or reproductive success.
As a young professor, my scientific interests focused on understanding the changes that occur in the brain as something is learned and remembered. Deep in the medial portion of your temporal lobe, there is an area called the hippocampal formation, which lights up like Carnivale as you learn new information and begin to store it into long-term memory. A great deal is now understood about the cellular and biochemical changes that occur in the hippocampus and related structures during learning and memory. Changes of this sort are generally referred to as neural plasticity, a phenomenon associated with a host of normal and abnormal conditions.
Many scientists who study neural plasticity also study addiction, since it is believed that the transition from casual substance use to dependency is accompanied by distinct changes in the way disparate brain regions communicate with one another. A number of modern treatments for addiction, as we’ll see, focus on blocking these changes in neural communication. Such phenomena can be studied readily in mice and rats, although there are obvious limitations in making the conceptual leap from animal models of addiction to understanding the disease process in humans. My approach to help bridge this gap was to volunteer at a local adolescent facility for substance abuse to hear about the addiction process from people who have experienced it firsthand.
The building in which I was eventually to spend so many afternoons was an old converted Victorian house on the outskirts of downtown. I learned quickly that the treatment model at this facility was holistic. Kids aged twelve to seventeen years resided in the house for therapeutic periods ranging from roughly three to twelve months. A typical day included meals, four hours of school, individual and group therapy, medical appointments with physicians and psychiatrists, meetings with legal counselors if required, and family visits. Kids came from all over the West and for a variety of reasons. Some had been in trouble with gangs and been arrested repeatedly. Others were at the house for behavioral problems at school or home. A common theme among the kids was substance abuse that could involve alcohol and/or controlled substances, including prescription medicines.
From the beginning, I was deeply moved by the emotional stories I heard from the residents. Several common topics came up again and again, including childhood traumas such as physical, sexual, and verbal abuse. Other kids were impacted severely by a single early event such as the death of a parent or sibling. After several months I began to see patterns in an individual’s choice of drugs that seemed to map onto the particular circumstances that surrounded his or her life.
Alberto was a seventeen-year-old boy who had been repeatedly plucked off the streets of Phoenix by authorities for crimes related to gang activity. When I first met him, he didn’t seem violent, but I knew Alberto had been arrested at least once for assault on a rival gang member. He wasn’t a terribly big guy and, to me, he seemed almost easygoing. If anything, he projected a sense of detachment bordering on apathy.
Each resident participated in group sessions three times a week. A session typically began with each resident giving a brief update on his or her current state and bringing up any problems to the group. Alberto never seemed to have any problems. Like many new kids, he seemed to think of group therapy as a chore that was best done as quickly as possible or avoided entirely. After the update period, the group would focus on one person and explore the circumstances that brought them to the house. During his first turn Alberto seemed painfully uncomfortable. He appeared unable to focus and became more and more frustrated with each passing minute. The group, however, had seen this before and gave him time. Gradually he began to tell his story.
Alberto came to the United States from Mexico when he was eight years old. He and his mother moved into a small, two-bedroom apartment with other family members, including his aunt and uncle and their four children. He described his uncle as a chronic alcoholic with a quick temper who physically abused him and his cousins fairly regularly. Alberto attended school for a couple of years when he first immigrated to the States, but dropped out and got more involved in gang life in his early teens. By the time he was thirteen years old, Alberto had tried almost every drug available on the street and was selling methamphetamine with a crew of other kids and a connection out of Los Angeles that could be traced back to Mexico. His favorite drugs were methamphetamine and cocaine, both of which he consumed regularly.
One summer night, after a day of meth binging, he had a psychotic episode. He described the experience as a waking dream in which he heard angry voices yelling at him, but he could not understand exactly what was being said. He also felt worms crawling under his skin, and he picked violently at his arms, neck, and face until they bled. At some point in the night Alberto had a grand mal seizure and was raced to a local emergency room.The ER visit was followed by police custody. After several similar experiences, arrests, and detoxifications, Alberto was sent to our little house for full-time residential care.
The withdrawal state that he felt was fairly typical of cocaine and methamphetamine use: low arousal and a general sense of malaise. Almost all methamphetamine or cocaine users appear lethargic and extremely apathetic following detoxification. In contrast, Alberto described the feeling of a meth-induced high as being like a bull—strong enough to take on anything or anybody. It also gave him enough energy to keep him awake for days on end.The best part for him was often the anticipated high and then the feeling that nothing could go wrong once the drug took effect. In the year that I worked at the house, I saw many ex-gang members. Almost all of them were addicted to methamphetamine and described a sense of invincibility while on the drug that made it particularly attractive given the toughness of gang life.
Although the most common addiction in the house was to methamphetamine, there were also a number of residents addicted to heroin or morphine. Those addicted to heroin or morphine often had noticeably different life circumstances surrounding their drug use compared to those using methamphetamine.
Christine was a petite blonde who could easily be mistaken for the class valedictorian. She was often described by her peers as “bubbly,” instantly likable, and very smart. She came to the house from Las Vegas after running from three other rehabilitation programs. Her guardian hoped that bringing her out of state away from friends to a residential program might prove more effective in addressing her heroin addiction. I first met Christine in a group therapy session. Based on appearance alone, most people would have never guessed that she was a heroin addict. Nor would they likely be able to fathom the strange world in which she was immersed while using the drug.
Contrary to many of the kids at the house, Christine actually embraced the program and was eager to participate. In group sessions we began to learn about her surprising past. She was born just outside San Francisco, but moved with relatives to Las Vegas after her parents were killed in an automobile accident. In Vegas Christine often felt like an interloper, living with her grandmother and ailing grandfather. Shortly after arriving, her grandfather died and her grandmother sank into a deep depression. Christine was thirteen when her grandmother committed suicide, leaving her to fend for herself. She dropped out of school and lived on the street with a small group of other homeless teenagers. Her new life consisted of prostitution and just trying to stay alive. One day a friend showed up with several small vials of pure morphine stolen from a local hospital and asked if she’d like to join her. Christine had tried other drugs by then, including pot, methamphetamine, and a host of prescription drugs. She described her first morphine use as a turning point in her life. She had never had a high like this before and felt an instantaneous warmth come over her entire body—almost as if a security blanket was being tucked around her by her long-lost parents. She felt safe and, for the first time in as far back as she could recollect, less anxious and sad about her life. Before morphine, she constantly worried about everything; now all that was gone.
Christine quickly made the jump from morphine to heroin and started to get involved in petty theft, mostly stealing jewelry and wallets from hotel rooms on the less glamorous side of town. After her second arrest she was sent to a juvenile detention program that was followed by her first rehabilitation program. She was arrested a third time for prostitution less than three weeks after completing the initial rehab.
In group sessions, Christine described her gravitation toward heroin use as a logical choice, almost as if she were a pharmacist matching a treatment to a particular ailment. Her problem, of course, was extreme anxiety. The typical uppers such as speed, methamphetamine, and cocaine always seemed to worsen this state. Christine learned through her own trial and error that morphine, heroin, and sex were all ways to ameliorate this anxiety and unrest.This process was not altogether different from the experiences of Alberto, who learned that methamphetamine often made him feel more confident and brave in gang-related circumstances that can easily be described as perilous. Time and again I heard similar descriptions of how a resident came to focus on a particular drug or combination. It was not long before my understanding of addiction at the neural level started to align with what I was hearing from these kids, who had lived the experiences. The stories I heard mapped well onto theories about how different brain structures sensitive to addictive substances modulate the pleasure instinct.
At present, there are at least three major theories of addiction, each involving biological and psychological components.We will discuss these in a bit, but before we do, it may be instructive to first think about addiction as a process that interacts with emotional systems—both biological and psychological in nature.