Transcript TREATMENT EVALUATION ALCOHOL MOOD STUDY (TEAM)

Addiction and the Meaning of Life
A Climate for Change:
An International Summit for
Advancing Theory, Research, Policy and
Practice in Addiction
Doug Sellman
National Addiction Centre
Aotearoa New Zealand
Addiction
A contemporary psychiatric disorder
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Brain dysfunction
Psychological disturbance
Spiritual erosion
Physical damage
Social disruption
Addiction
A contemporary behavioural health
disorder
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Brain dysfunction
Psychological disturbance
Spiritual erosion
Physical damage
Social disruption
Addiction and the Meaning of Life
• The theory of evolution provides the strongest
explanation of life, as well as an understanding of
the neural basis to addiction
• Consumerism fuelled by Marketing Science
maintains our ‘addictionogenic’ environment
• Compulsive pursuit of pleasure and comfort is the
antithesis of a virtue-based approach to life,
character development and genuine happiness
• ‘God experiences’ in various forms will be useful
therapeutically when they strengthen the brain’s
higher executive functions – ‘higher power’
What is addiction?
How much ‘free will’ does a
person with addiction have?
Drinking Continuum
No
drinking
“Safe”
drinking
Hazardous
drinking
Problem
drinking
Mild
dependence
Moderate/severe
dependence
Drinking Continuum
No
drinking
“Safe”
drinking
Hazardous
drinking
Problem
drinking
Mild
dependence
Focussed behavioural
change related to “safe
drinking”
Moderate/severe
dependence
Drinking Continuum
No
drinking
“Safe”
drinking
Hazardous
drinking
Problem
drinking
Mild
dependence
Moderate/severe
dependence
ADDICTION
Focussed behavioural
change related to “safe
drinking”
Lifestyle change
related to abstinence
“Nothing in biology
makes sense,
Except in the light of evolution”
Theodosius Dobzhansky, 1973
(1900-1975)
ERA
PERIOD
EPOCH
Cenozoic
(65 mya - present)
Quaternary
Holocene
(8,000 - present)
Pleistocene
(1.8 mya - 8,000)
Tertiary
Mesozoic
(248 - 65 mya)
Cretaceous
Jurassic
Triassic
Paleozoic
(544 - 248 mya)
Permian
Carboniferous
Devonian
Silurian
Ordovician
Cambrian
Pliocene
Miocene
Oligocene
Eocene
Paleocene
Inhibitory
Dysfunction
Drug
Liking
Drug
Needing
Reward
Overdrive
What is addiction?
How much ‘free will’ does a
person with addiction have?
Not nearly enough!
But perhaps the deficiency
is the basis of what it is to
be human
What causes
addiction?
Nature vs Nurture Debate
EVIDENCE FOR A GENETIC
INFLUENCE IN CAUSING
ALCOHOLISM
Family Studies
Twin Studies
Adoption Studies
Animal Models
Molecular Genetics
Number of genes
1988
3 - 4 primary genes
2008
? 300 - 400 genes
“Nature via Nurture:
Genes, Experience & What
Makes Us Human” (2003)
Matt Ridley (1958-present)
Is addiction the result
of faulty genes?
‘Addictive genes’ appear to have origins at least as long
ago as the Ordovician Period and have been perpetuated
through natural selection, forming the very basis of our
being, but only very recently interacting with modern
human environments characterised by a steady supply of
food and technological advances
The gene/environment continuum is the new paradigm
Consumerism
• Consumerism is as old as civilisation itself; when
people purchase and consume in excess of their
basic needs
• What is different now is MARKETING and more
particularly the Science of Marketing, defining a
modern meaning to life
“Happiness will result from consuming a lot”
The Wharton Marketing Department
University of Pennsylvania
• In 1881, an iron manufacturer, Joseph Wharton, offered the
University of Pennsylvania $100,000 for the creation
of a Wharton School of Finance and Commerce
• The first marketing course, "Marketing Products," first
offered in 1904, by 1930 undergraduate demand had
made Marketing the second-largest aspect of the
curriculum
• The Marketing Department is now the most published
among Marketing departments worldwide.
• Its research draws on a variety of basic disciplines including
decision theory, economics, psychology, and
statistics
Marketing Science
May 2008
Building Brands
M. Berk Ataman, Carl F. Mela, Harald J. van Heerde
Rotterdam School of Management, Erasmus University, The Netherlands
Which marketing strategies are most effective for
introducing new brands?... This paper sheds light on this
question by ascribing growth performance to firms' postlaunch marketing choices... To achieve this aim we
formulate a Bayesian dynamic linear model (DLM) of
repeat purchase diffusion wherein growth and market
potential are directly linked to the new brand's long-term
advertising, promotion, distribution, and product
strategy…
Marketing Science
May 2008
Competitive Brand Salience
van der Lans R, Pieters R, Wedel M.
Rotterdam School of Management, Erasmus University, Rotterdam, The
Netherlands
Brand salience—the extent to which a brand visually
stands out from its competitors—is vital in
competing on the shelf… This study proposes a
methodology to determine the competitive salience
of brands, based on a model of visual search and
eye-movement recordings collected during a brand
search experiment…
Marketing Science
May 2008
Image Reinforcement or Impairment: The Effects
of Co-Branding on Attribute Uncertainty
Geylani T, Inman JJ, Ter Hofstede F.
University of Pittsburgh
Co-branding is often used by companies to reinforce
the image of their brands… In this paper, we
investigate the conditions under which a brand's
image is reinforced or impaired as a result of cobranding, and the characteristics of a good partner
for a firm considering co-branding for image
reinforcement…
What is the aim of Marketing
Science?
To use the power of scientific knowledge to
stimulate
excessive desires in people to consume
more than that which they require
The dilemma for our patients
• They have become exactly what you would
predict from their environment (the modern
‘addictionogenic society’) working on their genes
(if you had all the information)
• They have answered the call of the marketers, paid
by the corporations, supported by the Government,
benefiting the middle-class share-holders
• They not only suffer the indignity of developing
compulsive dehumanising behaviours, but then are
blamed and stigmatised for being victims
A new sin for Pope Benedict to declare?
“Stimulating mass gluttony”
Stimulating an inordinate desire in people to
consume more than that which they require
• H:\dsellman\Apps\Qualcomm\Eudoralight\
Attach\God4.jpg
The Future of God in Recovery
from Drug Addiction
“I will lift up mine eyes unto the hills:
From whence cometh mine help”
Psalm 121:1
Sellman, Baker, Adamson, Geering
Australian and New Zealand Journal of Psychiatry 2007;41:800-808.
God
• Belief in God is found across all human populations
• Self-transcendence is a universal heritable trait
• Dopaminergic cortico-limbic pathways from the
medial temporal lobe to the anterior cingulate and
prefrontal cortex, which mediate experience of
distant extrapersonal space and time, and probably
associated with dreams and hallucinations, may
represent the brain capability underlying
religiousness in humans (Previc 2006)
Recovery from drug addiction
• Personal transformation and spiritual growth
have been identified as important elements in
recovery (Vaillant 1988; Green et al 2005)
• But is a ‘supernatural’ experience necessary?
God and recovery
• Various Christian denominations in NZ: Anglican, Catholic,
AOG, Destiny but especially Salvation Army since William
Booth’s London ministry to the poor in 1852
• Strongest linkage between God and recovery is through
Alcoholics Anonymous
Bill’s “conversion” occurred on December 14th 1934, while in
a state of depression undertaking a fourth hospital
detoxification
“If there be a God, will he show himself”
Following this, Bill experienced what later he and others refer
to as his “white flash” or “hot flash” experience
God and recovery
• Rational Recovery - no place for a transcendent God
“To seek God while in the grip of addiction is absurd;
addicted people cannot conceive of a power higher than
their own addiction”
Instead, there is strong exhortation for people to use their
internal ‘higher power’ and act more responsibly
• No RCTs comparing Rational Recovery with AA but
anecdotal information indicates there is a similar recovery
rate through the two self-help group traditions (Galanter et
al 1993)
God and recovery
• Kaupapa Māori addiction services in New Zealand
a special case of growing indigenous spiritual
experience in recovery from drug addiction
• Tangata whaiora (patients) are helped to reconnect
with traditional culture, providing new cultural
identity and sense of self within whānau/hapu/iwi
structures of the Māori world
• The emphasis on ‘finding God’ within Christianity
is replaced by immersion in the Māori world
imbued by wairua (spirit), in similar fashion to the
spirituality of other indigenous peoples in the
world
Drugs and God
Hallucinogenic substances have been used
by humans for tens of thousands of years,
traditionally confined to religious
ceremonies to facilitate communication
with the ‘spirit world’ - “entheogens”
The rise of the ‘Abrahamic religions’
discouraged their use, but the
Enlightenment and subsequent development
of empirical science are behind a
renaissance
Drugs and God
William James (1902) recounts a chloroform experience of
the famous British writer JA Symonds:
“After the choking and stifling had passed away, I seemed
at first in a state of utter blankness; then came flashes of
intense light, alternating with blackness, and with a keen
vision of what was going on in the room around me, but no
sensation of touch. I thought that I was near death; when,
suddenly, my soul became aware of God, who was
manifestly dealing with me, handling me, so to speak, in an
intense personal present reality. I felt him streaming in like
light upon me…I cannot describe the ecstasy I felt.”
Drugs and God
• “Phantastica” Lewis Lewin (1924) and the re-discovery of
using various hallucinogenic drugs, including the two
long-standing ‘God finding drugs’, mescaline and
psilocybin
• LSD Albert Hofmann (1938) brought about renewed
interest in the West in therapeutic uses of hallucinogens,
although now outside traditional religious guidelines and
practices
• Extensive use of LSD in the treatment of alcoholism
during the 1950s and 1960s before political pressure,
largely US, brought about discontinuation in the 1970s
• Krupitsky’s (2002) work on ketamine and Sessa’s (2005)
editorial suggests a revival
Krupitsky et al (2002)
St Petersburg Research Center of Addictions and
Psychopharmacology
• Ketamine 2mg/kg vs 0.2mg/kg in heroin addiction
• “We try to help our subjects create new meaning and
purpose in life…the feeling of individual self dissolves. The
process of losing one's individuality can be horrifying and
felt as a real death. If the subject can relax and let go, this
process may be ecstatic. After the loss of the feeling of
one's individual self, the experience is indescribable. There
exists only ‘That which is aware of Itself’”.
• Five-fold increase in abstinence from heroin two years
following treatment
Recovery from drug addiction
So, is a ‘supernatural’ experience necessary
for recovery from drug addiction?
George Eman Vaillant, 1988
(1934-present)
“What is needed is that addicts alter
their whole pattern of living”
Recovery from drug addiction
• A transcendent ‘experience of God’ may be really
important for some but is obviously not mandatory
to recover from drug addiction
• However, development of internal ‘higher power’
is probably necessary in order to develop and
consolidate a new lifestyle
• If effective, therapeutic ‘higher power’
experiences (religious, spiritual, ethnic, natural,
‘entheogenic’) will result in neuronal changes in
the prefrontal cortex, the brain’s ‘higher power’
Four Phases to Recovery
Phase 1
Picking up the pieces from a failed lifestyle
TREATMENT
Phase 2
Assembling a new lifestyle
REHABILITION
Phase 3
Practising the new lifestyle
AFTER-CARE
Phase 4
Living the new lifestyle
SELF-MANAGEMENT
The self-management
escalator to recovery
Successful
new lifestyle
Failed
old lifestyle
1
2
Clinical Mx
3
4
Self Mx
“Change takes time”
Tenzin Gyatso,
HH The 14th Dalai Lama of Tibet (1935–present)
God and recovery from drug addiction
• Current treatment tends to be short-term orientated
and epiphanies are hard to manufacture
• Current treatment has modest effectiveness only
and most patients will relapse - 90%+
• Developing more predictable ways for individuals
to have ‘higher power’ experiences may be one of
our great challenges as a field
• Perhaps further development of ‘entheogenic
treatment’ offers hope for a more predictable path
to recovery initiation and consolidation
Addiction and the Meaning of Life
• The theory of evolution provides the strongest
explanation of life, as well as an understanding of
the neural basis to addiction
• Consumerism fuelled by Marketing Science
maintains our ‘addictionogenic’ environment
• Compulsive pursuit of pleasure and comfort is the
antithesis of a virtue-based approach to life,
character development and genuine happiness
• ‘God experiences’ in various forms will be useful
therapeutically when they strengthen the brain’s
higher executive functions – ‘higher power’
Te Mutunga
The End