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roquet
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Marc Lewis: the neuroscientist who believes addiction is not a disease 3
#22163500 - 08/30/15 05:53 AM (8 years, 4 months ago) |
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http://www.theguardian.com/culture/2015/aug/30/marc-lewis-the-neuroscientist-who-believes-addiction-is-not-a-disease
Lewis, famous for detailing his own years of drug addiction in a book, divides the medical profession by arguing it is a behavioural problem, not a medical affliction
For decades the medical profession has largely treated addiction as as a chronic brain disease. The US government’s National Institute on Drug Abuse characterises addicts as compulsive drug seekers and users who continue taking drugs despite harmful and unwanted consequences. “It is considered a brain disease,” the institute says, “because drugs change the brain; they change its structure and how it works.” 'No one starts with a needle in their arm': a police chief fights drugs with empathy
Dr Marc Lewis, a developmental neuroscientist – perhaps most famous for detailing his own years of drug addiction and abuse in Memoirs of an Addicted Brain – strongly refutes this conventional disease model of addiction. His new book, The Biology of Desire: Why Addiction is not a Disease, argues that considering addiction as a disease is not only wrong, but also harmful. Rather, he argues, addiction is a behavioural problem that requires willpower and motivation to change.
Lewis’s theory has divided the medical profession and those suffering from addiction. He has been lauded by some for putting the theories challenging the disease model together into one book; others have labelled his ideas dangerous, and him a zealot.
Guardian Australia sat down with Lewis before his appearance at Melbourne writers festival on Sunday and the festival of dangerous ideas in Sydney to talk about the controversy, as well as his theories on how addiction can be treated and overcome.
Through your years as an addict, were you questioning the idea that addiction was a disease you were suffering from? Or is this book purely a result of your later studies and expertise in this area?
Well my training was as a developmental psychologist, so I studied child development, cognitive development, emotional development, and personal development. So I really had a strong developmental framework for thinking about all human psychological phenomena.
When I started thinking about addiction in my first book, it was more or less descriptive. So, ‘This is what happens to your brain when you become addicted,’ and, ‘This is what drugs do to your brain.’ But in this latest book, I wanted to really try to explain addiction, and it just came crashing down that this was a developmental phenomenon. You grow into addiction. It takes place in a sequence or a progression through repeated trials, through repeated exposure, repeated actions, and through practice.
So it wasn’t until you started writing about what addiction is that you really began to think describing it as a disease didn’t make sense to you?
When I was doing drugs, I wasn’t thinking about it in any kind of analytical way, well except, you know, trying to analyse, ‘Why the hell am I doing this to myself?’ But no, I think in writing The Biology of Desire … put it this way. It never occurred to me that addiction was anything other than a developmental phenomenon. The whole idea that addiction is a disease never made sense to me either personally, scientifically, nor through my discourse with other people who are addicted.
Have people been supportive of your arguments that addiction is a behavioural problem, but not a medical one?
It’s been mixed. There’s certainly been negativity. I just had a review in the Washington Post where I was called a “zealot”.
But what really moves me is the addicts who get in touch and say, ‘Don’t take this away from me. If you take away the disease label, then basically I won’t be able to get better, if you don’t let me understand myself as having a disease.’ It’s a very strange argument, to have to think of yourself as having a disease because that’s the only way you can live with yourself and deal with the addiction. And then I feel badly, because I don’t want to harm these people or take away something that they need conceptually or motivationally. Advertisement
There is this idea that the addiction label is the only thing that is going to save them and stop them from being blamed and denigrated as addicts by society. They feel that if it is a disease, they don’t have to feel that burden or shame, because it’s not their fault. It’s hard to pull the rug out from under that without causing some upset.
Is there anyone for whom addiction is a disease? Are there a small portion of people who are unable to stop taking these drugs, who are wired to be reliant no matter what kind of treatments or motivation they have? Or do you believe that for anyone, addiction should not be labelled a disease?
That’s a really good question. I guess that’s why I’ve been called a zealot in the last day or so. I guess there is a point where the devastation of addiction, combined with the situation of people’s lives – whether through poverty or crime and social isolation – and when those factors hook up they get really hard to stop, really, really hard to stop.
I was in Vancouver a couple of weeks ago at a supervised injecting room, so these were the most down and out people, really long-term street people. Most of them had grown up in foster homes, they had no property, no money. They didn’t connect with the world like most normal people, they lived on the street and their whole lives were organised around getting the next fix.
Given the way their lives are structured I think its very, very hard for them to stop. Does that make it a disease? Well, no, I don’t think it does. I think that makes it a social problem that’s terribly entrenched. It has to do with dislocation, alientation, poverty and all these sort of factors and a lack of care by the larger society for people who are suffering. When you put all those factors on the table, then you don’t have to use the disease label to explain why some people can get really deeply stuck in addiction.
OK, but there are also high-functioning, middle-class and wealthy people with jobs and social support who would describe themselves as addicts, and for whom those social factors you talk about don’t resonate. Despite having all the resources in the world available to them, they feel they can’t stop.
Well I think those people have a better chance of quitting. They have family, they can afford therapy, they can talk to people. But of course no, I don’t want to say people who are riding high in society can not become very deeply addicted. So what’s left then in the formula? Probably the fact that addiction includes a very strong compulsive property, so when people have been addicted to something for some period of time, the psychological process moves from impulse to compulsion.
And that also involves in part, brain changes. The parts of the brain that become activated when craving is triggered by cues changes. So there’s something going on that makes it hard to stop for very good neurological reasons. So then, do you want to call addiction a disease? Well, maybe, then you’re getting close I think, because you could call it a pathology I guess. Because obsessive compulsive disorder, that’s a pathology right? So yeah, I think there is a point at which the line betweens those definitions starts to blur.
So it sounds like it comes to a point where perhaps addiction does fall into disease territory then?
[Pauses]. I wouldn’t say disease. I would call it disorder. Or even the adjective, “pathological”. But I just don’t like those words because there’re all part of this particular framework, and that’s the dominate framework in the US and parts of Europe, that this is in fact a chronic brain disease. It’s hard to talk about it as if sometimes it’s a disease or sometimes it’s not. Then the argument starts to get kind of mushy. But when you are in the grips of compulsion, yeah, there is a process going on that of course isn’t healthy and requires a certain amount of cognitive and emotional and probably therapeutic work to get out of. So yeah, OK, I’ll grant you that you could call that, certainly, a disorder. Advertisement
Why does it matter? Disease, disorder, behavioural problem? Does it affect the way we might think about treating those suffering from an addiction?
It sure does. The whole campaign to see addiction as a disease is that it works against people’s sense of empowerment. If you have a disease, you’re a patient. If you’re a patient, you have to take instructions from your doctor and do what you’re told. So people line up for rehabilitation centres and often have to wait for a long period of time, long after they’ve lost the motivational rush to actually quit.
Then if you do get into rehab, you’re putting yourself in somebody else’s hands and you’re going with the program. But the best way to combat addiction is through setting different goals for yourself and setting your own goals. “I want this for my life, I don’t want that, I want to change.” That kind of self-perspective change and self-development of future goals and orientation is critical.
That’s been an argument against rehabilitation, that it doesn’t always set people up to meet personal goals and readjust to society.
That’s right. It really hinges on the idea of who is setting the goals here. Who is telling you what to do? Are you telling yourself what to do, or are you being told? If you’re being told what to do, you fall into a position of helplessness or disempowerment, which makes it hard to develop this head of steam, this effortful strength and self-control and willpower. I mean really, a lot of it is about willpower to master this thing, to take it in hand and change it. The best way to combat addiction is by setting goals for yourself.
Different types of rehab programs are needed for different types of drugs, for example it might take someone longer to get off ice than say, heroin, and therefore programs should be tailored to recognise that. But given what you’re saying, would the model of treatment be relatively the same across all drugs, because it’s more about willpower and setting goals than the type of drug being abused?
A good question. I don’t think so. Even though it has those goals in common, people are very different and there are many ways to quit. Some people will need to focus more on cognitive tricks to self-program to modify their behaviour, others will need to change their environment to make sure they don’t drive home past the liqour store, and for other people it’s much more of a motivational thrust, more mindfulness and meditation. For others, it’s about deeply connecting intimately and honestly with loved ones. Those are really different ways of getting better, even though what they all have in common is that theme of empowerment of self-motivation.
I can see why people with an addiction resist this way of thinking. No one likes to think of themselves of having a lack of willpower, or being to blame. Some members of the medical establishment are resistant to this idea too. Why do you think that is?
I think it’s partly ownership, it’s partly they way they’ve been trained to operate. I don’t hate doctors, there are wonderful doctors. But doctors are trained to look at things in terms of categories, diagnoses, which have a certain set of possibilities for treatment or certain sequence of things to try. It’s a really strongly inbred way of looking at very serious problems. And it’s hard for them to shake it.
Right, but we need some kind of diagnostic framework. Are you criticising the medical profession for needing to label patients? Because don’t we need to label people to some extent in order to narrow down treatments?
Sure we do. I’ve had a number of medical issues in the last few years and I’m damn glad my doctors have had a diagnosis and a treatment strategy. So yes, doctors do need to function like that. But it’s just I don’t think addiction is a medical problem. It has a medical side to it. So doctors should be involved in an adjunct capacity, particularly with drugs that produce withdrawal systems when you stop taking them. So doctors should help people with the medical problems associated with addiction, but addiction itself is not a medical affliction.
So what would you say to those who read your book, have an addiction, and have taken in what you have to say and want to know what to do? 'Drug addiction comes with huge amounts of stigma attached'
I’ve had dozens of emails specifically to ask that. People saying, “My son is addicted to heroin,” or “I’ve been addicted for many years.” I say that well, there are many different ways for people to kick their habit and it is important to think about where that habit comes from and social factors. The person’s developmental stage is important, for example addiction is a different beast for someone in their 20s compared to in their 40s. Some people outgrow addiction and spontaneous recovery is just another way of saying people stop when it gets too much. They can’t handle it, and that often taken place when emerging through their 20s and into their 30s and wanting to start taking responsibility for their life in a different way. Treatment depends entirely on who I think they are, and what they are going through.
• Marc Lewis: Learning Addiction; Sydney, Sunday 6 September, 2pm, Playhouse Theatre
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dark3st
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: roquet]
#22164313 - 08/30/15 11:13 AM (8 years, 4 months ago) |
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...Treatment depends entirely on who I think they are, and what they are going through.
Sounds like its about the money to him.
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: roquet] 1
#22164353 - 08/30/15 11:24 AM (8 years, 4 months ago) |
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Disease is just a word.
The disease model of medicine posits that
- there is an organ
- there is a defect in the organ
- there is a consistent set of symptoms associated with that defect
In addiction, the organ is said to be the brain. The defect is said to be a certain kind of neural pathology. This pathology involves glutamate pathways projecting from the cortex to the ventral tegmental area, and in active (not clean and sober) cases of addiction, a state of dopaminergic allostasis in the VTA and an excess of dopamine reuptake transporters in the nucleus accumbens. The symptoms associated with this pathology are craving for the drug, environmental triggers to use the drug, and decreased pleasure sensitivity to the drug.
The pathology is not a matter of debate. Rats with the genetic potential to exhibit this pathology have been used in laboratory experiments involving addiction for over three decades. So the argument boils down to whether or not you want to call this brain pathology a "defect". If we do, then it is appropriate to characterize addiction as a brain disease. The following advantages result from considering addiction to be a brain disease:- addicts are more likely to realize that relapse can be a fatal mistake
- addicts are treated as patients rather than problems
- brain research on addiction is more likely to be funded
- pharmacological solutions to addiction have a sensible foundation
I agree that the solution to addiction is largely behavioral, but I think this man stands is an extreme outlier in the field when it comes to his opinion.
http://www.jneurosci.org/content/34/16/5529.abstract Cannabis Use Is Quantitatively Associated with Nucleus Accumbens and Amygdala Abnormalities in Young Adult Recreational Users
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Marijuana is the most commonly used illicit drug in the United States, but little is known about its effects on the human brain, particularly on reward/aversion regions implicated in addiction, such as the nucleus accumbens and amygdala. Animal studies show structural changes in brain regions such as the nucleus accumbens after exposure to Δ9-tetrahydrocannabinol, but less is known about cannabis use and brain morphometry in these regions in humans. We collected high-resolution MRI scans on young adult recreational marijuana users and nonusing controls and conducted three independent analyses of morphometry in these structures: (1) gray matter density using voxel-based morphometry, (2) volume (total brain and regional volumes), and (3) shape (surface morphometry). Gray matter density analyses revealed greater gray matter density in marijuana users than in control participants in the left nucleus accumbens extending to subcallosal cortex, hypothalamus, sublenticular extended amygdala, and left amygdala, even after controlling for age, sex, alcohol use, and cigarette smoking. Trend-level effects were observed for a volume increase in the left nucleus accumbens only. Significant shape differences were detected in the left nucleus accumbens and right amygdala. The left nucleus accumbens showed salient exposure-dependent alterations across all three measures and an altered multimodal relationship across measures in the marijuana group. These data suggest that marijuana exposure, even in young recreational users, is associated with exposure-dependent alterations of the neural matrix of core reward structures and is consistent with animal studies of changes in dendritic arborization.
http://www.ncbi.nlm.nih.gov/pubmed/24082084 Loss of metabotropic glutamate receptor 2 escalates alcohol consumption.
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Identification of genes influencing complex traits is hampered by genetic heterogeneity, the modest effect size of many alleles, and the likely involvement of rare and uncommon alleles. Etiologic complexity can be simplified in model organisms. By genomic sequencing, linkage analysis, and functional validation, we identified that genetic variation of Grm2, which encodes metabotropic glutamate receptor 2 (mGluR2), alters alcohol preference in animal models. Selectively bred alcohol-preferring (P) rats are homozygous for a Grm2 stop codon (Grm2 *407) that leads to largely uncompensated loss of mGluR2. mGluR2 receptor expression was absent, synaptic glutamate transmission was impaired, and expression of genes involved in synaptic function was altered. Grm2 *407 was linked to increased alcohol consumption and preference in F2 rats generated by intercrossing inbred P and nonpreferring rats. Pharmacologic blockade of mGluR2 escalated alcohol self-administration in Wistar rats, the parental strain of P and nonpreferring rats. The causal role of mGluR2 in altered alcohol preference was further supported by elevated alcohol consumption in Grm2 (-/-) mice. Together, these data point to mGluR2 as an origin of alcohol preference and a potential therapeutic target.
http://www.ncbi.nlm.nih.gov/pubmed/10986361 Changes in hippocampal morphology following chronic treatment with the synthetic cannabinoid WIN 55,212-2.
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Learning and memory are often correlated with cellular changes within the hippocampus, and drugs or environmental factors which affect learning and memory will thus often induce observable morphological changes in this structure. Like tetrahydrocannabinol (THC) itself, many synthetic cannabinoids such as the CB-1 receptor agonist WIN 55,212-2 will induce learning and memory changes. In the current study, we investigate whether or not these changes could be related to structural changes within the hippocampus. Adult male Sprague-Dawley rats were injected twice daily (12:00 and 0:00 h) subcutaneously with WIN 55,212-2 (2.0 mg/kg) in DMSO or DMSO for 21 days. On day 22, animals were perfused and stained immunochemically for the dendritic marker MAP-2, or with cresyl violet. Morphometric analysis showed dendritic rearrangement with increased staining of MAP-2 in CA3 and the lower blade of the dentate gyrus. However, a loss of staining was observed in CA1. Counting of cresyl violet stained sections showed an apparent increase in granule cell number in the lower blade of the dentate gyrus. This work shows the potential for cannabinoids to influence hippocampal morphology. The pattern of changes may be similar to that seen after ischemic or toxic damage, but may be opposite to changes seen in stress.
http://www.ncbi.nlm.nih.gov/pubmed/23966583 The effects of cocaine self-administration on dendritic spine density in the rat hippocampus are dependent on genetic background.
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Chronic exposure to cocaine induces modifications to neurons in the brain regions involved in addiction. Hence, we evaluated cocaine-induced changes in the hippocampal CA1 field in Fischer 344 (F344) and Lewis (LEW) rats, 2 strains that have been widely used to study genetic predisposition to drug addiction, by combining intracellular Lucifer yellow injection with confocal microscopy reconstruction of labeled neurons. Specifically, we examined the effects of cocaine self-administration on the structure, size, and branching complexity of the apical dendrites of CA1 pyramidal neurons. In addition, we quantified spine density in the collaterals of the apical dendritic arbors of these neurons. We found differences between these strains in several morphological parameters. For example, CA1 apical dendrites were more branched and complex in LEW than in F344 rats, while the spine density in the collateral dendrites of the apical dendritic arbors was greater in F344 rats. Interestingly, cocaine self-administration in LEW rats augmented the spine density, an effect that was not observed in the F344 strain. These results reveal significant structural differences in CA1 pyramidal cells between these strains and indicate that cocaine self-administration has a distinct effect on neuron morphology in the hippocampus of rats with different genetic backgrounds.
Edited by morrowasted (09/01/15 10:29 AM)
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dark3st
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: morrowasted]
#22164386 - 08/30/15 11:34 AM (8 years, 4 months ago) |
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I agree that the solution to addiction is largely behavioral
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In addiction, the organ is said to be the brain
Behavioral changes are In response to brain chemistry, and conditioning. If They are both unchanged nothing changes.
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: roquet]
#22164597 - 08/30/15 12:24 PM (8 years, 4 months ago) |
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morrowasted
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: dark3st] 2
#22164891 - 08/30/15 01:41 PM (8 years, 4 months ago) |
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dark3st said:
Quote:
I agree that the solution to addiction is largely behavioral
Quote:
In addiction, the organ is said to be the brain
Behavioral changes are In response to brain chemistry, and conditioning. If They are both unchanged nothing changes.
Which is why in rehab programs you often hear the phrases, "If nothing changes, nothing changes." and "Change your people, places, and things."
Rehabs these days operate on the genetic/environmental/metabolic model of addiction. An environmental trigger, like exposure to a chemical such as alcohol or prescription painkillers, causes an anomalous release of dopamine for some people. This is typically explained in terms of a genetic predisposition that has resulted in an atypical neural physiology between the ventral tegmental area and the nucleus accumbens. Whenever this dopamine spike occurs, glutamate pathways are formed connecting the cortex to the VTA. These pathways are involved in memory. The evolutionary function of a glutamate pathway being formed in this way was to help you remember activities that increased what is technically termed "fitness": eating, sex, finding shelter, etc. But when drugs cause a dopamine spike and a strong glutamate pathway is formed, this process is hijacked, so that the brain mistakes drug use as a survival mechanism.
Thus, environmental cues that activate the glutamate pathways ought to be avoided. In rehabs these are called "triggers". If you are an alcoholic, this would mean not going to bars, barbecues, or whatever it is you associated with drinking. The strength of these connections is variable and depends on genetic influences, length and frequency of use, type of drug used (meth and other stimulants are the hardest to recover from). Only time away from the drug and positive associations with new people, places, and things can heal the brain.
So he is right to say that behavioral changes are needed, and this is already the way that addiction is treated. But arguing that addiction isn't a disease doesn't seem to have many advantages.
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dark3st
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: morrowasted]
#22164944 - 08/30/15 01:58 PM (8 years, 4 months ago) |
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Quote:
morrowasted said:
Quote:
dark3st said:
Quote:
I agree that the solution to addiction is largely behavioral
Quote:
In addiction, the organ is said to be the brain
Behavioral changes are In response to brain chemistry, and conditioning. If They are both unchanged nothing changes.
Which is why in rehab programs you often hear the phrases, "If nothing changes, nothing changes." and "Change your people, places, and things."
Rehabs these days operate on the genetic/environmental/metabolic model of addiction. An environmental trigger, like exposure to a chemical such as alcohol or prescription painkillers, causes an anomalous release of dopamine for some people. This is typically explained in terms of a genetic predisposition that has resulted in an atypical neural physiology between the ventral tegmental area and the nucleus accumbens. Whenever this dopamine spike occurs, glutamate pathways are formed connecting the cortex to the VTA. These pathways are involved in memory. The evolutionary function of a glutamate pathway being formed in this way was to help you remember activities that increased what is technically termed "fitness": eating, sex, finding shelter, etc. But when drugs cause a dopamine spike and a strong glutamate pathway is formed, this process is hijacked, so that the brain mistakes drug use as a survival mechanism.
Thus, environmental cues that activate the glutamate pathways ought to be avoided. In rehabs these are called "triggers". If you are an alcoholic, this would mean not going to bars, barbecues, or whatever it is you associated with drinking. The strength of these connections is variable and depends on genetic influences, length and frequency of use, type of drug used (meth and other stimulants are the hardest to recover from). Only time away from the drug and positive associations with new people, places, and things can heal the brain.
So he is right to say that behavioral changes are needed, and this is already the way that addiction is treated. But arguing that addiction isn't a disease doesn't seem to have many advantages.
That's a great way to put it, I have a funk keyboard so its hard for me to type much
-------------------- Back.. I'm going to do it...I'm getting sober from opiates ... I got weed, gabapentin, propranolol, and GHB, I have 100mg tramadol left. I can do this. I can do this. OFINTQWGVGAKGCYKBUBX free dark P. Tampanensis prints to ODD members.
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DragonChaser
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: roquet]
#22165998 - 08/30/15 07:06 PM (8 years, 4 months ago) |
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I don't know, from the very beginning when I started drinking I drank like an alcoholic. I was 15, and the drunker I got, the drunker I wanted to be. I'd drink until I was in a blackout state, and if I puked up some booze, I drank more.
Got alcohol poisoning the third time I got drunk. From that first experience, I was obsessed with altered states. Not like my friends, who could take it or leave it. I always wanted to be fucked up, and as fucked up as possible.
You'll hear a lot of people in NA and AA say that they believe they had the personality of an alcoholic/addict before they ever touched a drink or a drug, and I think that's true for me. All the personal defects they talk about in the program were in my from puberty onwards.
-------------------- My name is Mud
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morrowasted
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: dark3st]
#22166032 - 08/30/15 07:14 PM (8 years, 4 months ago) |
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http://onlinelibrary.wiley.com/doi/10.1002/hbm.22474/abstractAbstract
Substance use disorders (SUD) have been associated with dysfunction in reward processing, habit formation, and cognitive-behavioral control. Accordingly, neurocircuitry models of addiction highlight roles for nucleus accumbens, dorsal striatum, and prefrontal/anterior cingulate cortex. However, the precise nature of the disrupted interactions between these brain regions in SUD, and the psychological correlates thereof, remain unclear. Here we used magnetic resonance imaging to measure rest-state functional connectivity of three key striatal nuclei (nucleus accumbens, dorsal caudate, and dorsal putamen) in a sample of 40 adult male prison inmates (n = 22 diagnosed with SUD; n = 18 without SUD). Relative to the non-SUD group, the SUD group exhibited significantly lower functional connectivity between the nucleus accumbens and a network of frontal cortical regions involved in cognitive control (dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, and frontal operculum). There were no group differences in functional connectivity for the dorsal caudate or dorsal putamen. Moreover, the SUD group exhibited impairments in laboratory measures of cognitive-behavioral control, and individual differences in functional connectivity between nucleus accumbens and the frontal cortical regions were related to individual differences in measures of cognitive-behavioral control across groups. The strength of the relationship between functional connectivity and cognitive control did not differ between groups. These results indicate that SUD is associated with abnormal interactions between subcortical areas that process reward (nucleus accumbens) and cortical areas that govern cognitive-behavioral control. Hum Brain Mapp 35:4282–4292, 2014
http://www.diss.fu-berlin.de/diss/servlets/MCRFileNodeServlet/FUDISS_derivate_000000015482/Wiers_Corinde.diss.pdf
In these paradigms, it has been shown that BOLD activation in mesocorticolimbic structures is increased in drug-users as compared to non-addicted individuals (for a review in 8alcohol addiction: Heinz et al., 2009; for meta-analyses: Kuhn and Gallinat, 2011; Schacht et al., 2013).
All drugs release dopamine in the mesocorticolimbic system, a response that becomes sensitized after repeated drug use. Because of Pavlovian drug cue–reward associations, drug cues acquire incentive sensitization and consequently both grab the drug user’s attention and elicit approach behavior (Robinson and Berridge 1993, 2003).
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morrowasted
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: DragonChaser]
#22166056 - 08/30/15 07:18 PM (8 years, 4 months ago) |
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DragonChaser said: I don't know, from the very beginning when I started drinking I drank like an alcoholic. I was 15, and the drunker I got, the drunker I wanted to be. I'd drink until I was in a blackout state, and if I puked up some booze, I drank more.
Got alcohol poisoning the third time I got drunk. From that first experience, I was obsessed with altered states. Not like my friends, who could take it or leave it. I always wanted to be fucked up, and as fucked up as possible.
You'll hear a lot of people in NA and AA say that they believe they had the personality of an alcoholic/addict before they ever touched a drink or a drug, and I think that's true for me. All the personal defects they talk about in the program were in my from puberty onwards.
I don't think he is arguing that there aren't people who are genetically predisposed to drink like that. I think he is arguing that we simply shouldn't treat addiction as a disease, but rather as a behavioral problem. I am not convinced, but I'd have to read his book.
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DragonChaser
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: morrowasted]
#22166430 - 08/30/15 08:26 PM (8 years, 4 months ago) |
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Even I don't know which camp I fall into. Before I went to rehab I was 100% certain it wasn't a disease, but I quickly learned that most of what I thought about addiction was false.
I certainly believe it's a disorder somewhat like depression and anxiety, and that people can't simply "snap themselves out of it" any more than they could force themselves to be happy and calm.
I dunno, "chronic, progressive, and fatal"... if that's the only criteria of a disease, I guess it fits. Either way, for me, the debate between whether it's a disease or not is moot, because I am an alcoholic and an addict, and pondering the nature of it won't do me much good. I certainly would like to know, but what's more important to me is staying away from alcohol and hard drugs.
-------------------- My name is Mud
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morrowasted
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: DragonChaser]
#22166459 - 08/30/15 08:29 PM (8 years, 4 months ago) |
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Quote:
I dunno, "chronic, progressive, and fatal"... if that's the only criteria of a disease, I guess it fits.
No. Addiction is often called a chronic, progressive, and often fatal disease, but the criteria according to which it is characterized as a disease are a result of the general medical disease model, which I outlined in my first reply:
Quote:
The disease model of medicine posits that there is an organ there is a defect in the organ there is a consistent set of symptoms associated with that defect
In addiction, the organ is said to be the brain. The defect is said to be a certain kind of neural pathology. This pathology involves glutamate pathways projecting from the cortex to the ventral tegmental area, and in active (not clean and sober) cases of addiction, a state of dopaminergic allostasis in the VTA and an excess of dopamine reuptake transporters in the nucleus accumbens. The symptoms associated with this pathology are craving for the drug, environmental triggers to use the drug, and decreased pleasure sensitivity to the drug.
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Cognitive_Shift
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: morrowasted]
#22166703 - 08/30/15 09:09 PM (8 years, 4 months ago) |
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He has an inhereint bias one way or the other about this subject since he is an addict himself so I take this with a grain of salt. I don't know what addiction is but if I had to guess I would say it probably isn't a disease but then again I also have a bias myself so take that with a grain of salt.
-------------------- L'enfer est plein de bonnes volontés et désirs
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DragonChaser
Ice in Her Ass and Pussy



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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: morrowasted]
#22166832 - 08/30/15 09:31 PM (8 years, 4 months ago) |
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Derp, I'm sorry Morrow.
You're an alcoholic too, aren't you? I think we've talked before.
-------------------- My name is Mud
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morrowasted
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: DragonChaser]
#22166904 - 08/30/15 09:49 PM (8 years, 4 months ago) |
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Yes, but I'm clean and sober.
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DragonChaser
Ice in Her Ass and Pussy



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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: morrowasted]
#22167144 - 08/30/15 11:01 PM (8 years, 4 months ago) |
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I smoke a bit of grass, but that's all, and it's only occasionally (like every coupla weeks).
-------------------- My name is Mud
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Bitter Cactus
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: DragonChaser]
#22167453 - 08/31/15 01:43 AM (8 years, 4 months ago) |
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Addiciton is not a disease. That is such a cop out and takes away all personal responsability from the addict to get better. Nobody shot you up the first time or made you smoke that crack. I think addiction has to do with whether you are poor or have a lot of friends or simply have the willpower to stop.
Like imagine a smoker saying the only reason he smokes cigs is because disease is an addiction and he can't help himself. Guess what, that person started smoking on their own choice and of course they end up addicted nicotine itself is addictive and even a rat will get hooked on it.
I think saying it is a disease and you have no part in it is such an excuse and a bad way to go about it. Lots of it has to do with whether or not you have a good life in the first place. Imagine if you were taken captive and they hooked you up to a machine shooting you up with heroin for a year then you were flown back home. Imagine you were a millionaire with a huge house and a family and friends. You wouldn't go out to seek more of the heroin you would be like fuck that I have a good life.
-------------------- Taking acid and thinking you are a better man is a lot different then actually becoming a better man.
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morrowasted
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: Bitter Cactus]
#22167627 - 08/31/15 03:56 AM (8 years, 4 months ago) |
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Quote:
Bitter Cactus said: Addiciton is not a disease. That is such a cop out and takes away all personal responsability from the addict to get better. Nobody shot you up the first time or made you smoke that crack. I think addiction has to do with whether you are poor or have a lot of friends or simply have the willpower to stop.
Like imagine a smoker saying the only reason he smokes cigs is because disease is an addiction and he can't help himself. Guess what, that person started smoking on their own choice and of course they end up addicted nicotine itself is addictive and even a rat will get hooked on it.
I think saying it is a disease and you have no part in it is such an excuse and a bad way to go about it. Lots of it has to do with whether or not you have a good life in the first place. Imagine if you were taken captive and they hooked you up to a machine shooting you up with heroin for a year then you were flown back home. Imagine you were a millionaire with a huge house and a family and friends. You wouldn't go out to seek more of the heroin you would be like fuck that I have a good life.
Watch this documentary.
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morrowasted
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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: morrowasted]
#22169275 - 08/31/15 01:52 PM (8 years, 4 months ago) |
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In the end though most people are just going to believe whatever is easiest and most comfortable for them to believe, as with most things in life. Doing research and coming to carefully discerned conclusions takes too much effort for most people.
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fapjack
Title



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Re: Marc Lewis: the neuroscientist who believes addiction is not a disease [Re: morrowasted]
#22170127 - 08/31/15 05:18 PM (8 years, 4 months ago) |
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Quote:
morrowasted said:
Quote:
I dunno, "chronic, progressive, and fatal"... if that's the only criteria of a disease, I guess it fits.
No. Addiction is often called a chronic, progressive, and often fatal disease, but the criteria according to which it is characterized as a disease are a result of the general medical disease model, which I outlined in my first reply:
Quote:
The disease model of medicine posits that there is an organ there is a defect in the organ there is a consistent set of symptoms associated with that defect
In addiction, the organ is said to be the brain. The defect is said to be a certain kind of neural pathology. This pathology involves glutamate pathways projecting from the cortex to the ventral tegmental area, and in active (not clean and sober) cases of addiction, a state of dopaminergic allostasis in the VTA and an excess of dopamine reuptake transporters in the nucleus accumbens. The symptoms associated with this pathology are craving for the drug, environmental triggers to use the drug, and decreased pleasure sensitivity to the drug.
Defect in this instance is entirely subjective. Can the brain and body work perfectly fine with a substance addiction? Does that definition include addiction to certain behaviors? By your definition would someone that is physically dependent on any drug be suffering from a disease?
Addiction isn't a disease. Calling it one is politicizing medicine. It's psychology, not biochemistry. It's a theory without conclusive evidence. The brain functions normal when psychologically addicted to a drug, the problem is behavior so it isn't a neurological disease it would be a behavioral one. It is also a behavioral issue than cures itself for many people as a large % of drug addicts stop at some point without any treatment at all. It's a behavioral issue for people, not the result of a pathology. Smokers and caffeine addicts don't suffer from disease, and when you word it that way your argument looses a lot of credibility.
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