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Our Dangerous Obsession with Neurobiology
For many years, the public has been flooded by a mistaken idea – that addiction is a “brain disease” due to faulty neurobiology.
I will explain why this is false in a moment.
First, it’s important to realize that this mistake is part of a bigger misconception – that human psychology, the process of our minds that makes us human, can ultimately be reduced to the firings of neurons in the brain. This idea ignores knowledge that has become a key part of modern physics, Complexity Theory.
Complexity Theory arose from the recognition that all complicated systems develop new properties that cannot be explained or predicted from the individual elements that comprise the system. This happens because the individual elements of any complex system simply do not possess the properties found in the system as a whole.
A good example is water. (I have borrowed this example from the book Complexity by M. Mitchell Waldrop.) We know a great deal about individual water molecules. But all that knowledge does not enable us to explain or predict the properties that emerge when a few trillion molecules get together to form a complex system – properties such as “liquidity,” or fluid dynamics. A bigger example is life itself. All living things are composed of chemicals. Yet none of the chemicals is alive, and you could never predict or explain life no matter how much you knew about the individual chemicals.
Like every other instance of emergent properties in a complex system, psychology must be understood in its own terms.-Lance Dodes
So it is for psychology. The brain is composed of cells called neurons. None of them has any psychology. But combine a few billion of them into a complex system and a brand new property emerges which we call human psychology. As with life, it is foolhardy to try to reduce our human symptoms, emotional conflicts and behaviors to the firings of the brain’s neurons. Like every other instance of emergent properties in a complex system, psychology must be understood in its own terms.
Now let’s return to addiction. The “brain disease” theory claims that addiction is caused by alterations in the brain’s neurons and chemicals, which themselves are caused by previous drug use. This theory is based on experiments with rats that are similar to Pavlov’s famous experiments with dogs. You probably recall that Pavlov rang a bell when he fed his dogs, and discovered the dogs would eventually salivate just upon hearing the bell; he called this “conditioned reflex.”
What neurobiologists from the National Institute of Drug Abuse (NIDA) did with rats started the same way. They gave enough heroin to rats to make them addicted, and associated the drug with certain cues in the environment. Later, when the rats were exposed to those cues, they ran around looking for the drug. The experimenters called this conditioned response “automatic behavior.”
Next, they did something Pavlov couldn’t do – they examined the rats’ brains, and found they secreted high levels of the neurotransmitter dopamine when they were exposed to the environmental cues. They then looked at humans with addictions and found they had similar changes in dopamine levels when exposed to cues, as well as other, related brain changes. The researchers concluded they had discovered the basis for addiction: it was caused by people having an excessive dopamine response to drug-related cues, which drove them, like rats, to seek more drugs even when they were no longer physically addicted.
[NIDA] widely publicized this opinion even though there was (and still is) literally no evidence that their findings in either rats or humans had anything to do human addiction.-Lance Dodes
They widely publicized this opinion even though there was (and still is) literally no evidence that their findings in either rats or humans had anything to do human addiction. There are zero cases of human addiction that can be shown to be due to the mechanism proposed at NIDA. Their enthusiastic distribution of their theory, therefore, was unusual, because scientists are usually very cautious about claiming their findings can be generalized from a small sample, not to mention from rodents to humans. And, it turned out, by jumping to conclusions with insufficient thought or study, they were completely wrong.
Why the Neurobiology Theory Fails
The “automatic behavior” seen in rats has nothing to do with human addiction. Rats work on a very simple stimulus-response system. When they see a cue, they respond. (Rat brains are about half an inch long and weigh less than a tenth of an ounce.) People, on the other hand, do not run around seeking a drug when they see a related cue. For example, even if they decide to get a drink, they regularly wait before obtaining it (e.g. waiting until the end of the work day before going to a bar). This behavior is incompatible with the idea that addiction is based on release of a spurt of dopamine when exposed to a cue.
Had the neurobiologist researchers studied humans, they would have learned that addictive urges almost always arise in response to emotionally meaningful stresses.-Lance Dodes
Further, human addictive behavior is usually not in response to an environmental cue. Seeing a picture of a drink or another drug on TV is rarely the source of addictive behavior. Had the neurobiologist researchers studied humans, they would have learned that addictive urges almost always arise in response to emotionally meaningful stresses. Loss of relationships, fear of conflicts, defeats, humiliations, grief, and other psychologically important issues, are the kind of things that precipitate addictive action in people.
Even without knowing much about human addiction, the neurobiological researchers could never have reached their conclusions if they paid attention to the vast statistical evidence inconsistent with their idea. One of the first critical studies was made in the 1970s when returning Vietnam soldiers addicted to heroin were found to easily give it up when they came home, a result exactly the opposite of what was feared. This finding would have been impossible if taking high doses of heroin for a long time had caused them to develop a “chronic brain disease.” Put another way, the Vietnam veterans study showed that taking drugs causes only physical addiction, which is curable by detoxification. Taking drugs does not cause people to become addicts.
Similarly, the fact that tens of millions of people could decide to quit smoking cigarettes once they became aware of its dangers, despite years of inhaling the addictive drug nicotine, is inconsistent with the “brain disease” hypothesis of addiction. The same is true of the tens of millions of patients given narcotics for pain management who never become addicts.
There is still more evidence against the neurobiological theory. It is commonplace for people to switch from drug addictions to non-drug addictions, sometimes moving back and forth (gambling and alcoholism are common switches, but we know of many cases of people stopping drug use and starting to compulsively clean their house or shop instead). This is inconsistent with the drug-cue neurobiological model. And, of course, besides switching back and forth with drug addictions, the existence of numerous non-drug addictions which look and act exactly like drug addictions (compulsive gambling, pornography, eating, exercising etc.) cannot be explained by the neurobiological concept.
Besides being evidently wrong, the neurobiological idea is sadly reminiscent of the moralizing about addiction that we’ve had to deal with for thousands of years. Throughout history, people have believed that folks with addictions are pleasure-seekers, that they don’t stop because they are selfish. The neurobiological view of addiction is eerily similar. It says that people suffering with addictions are responding to excitation of their brain’s reward/pleasure pathway. It claims that people, like rats, are seeking an immediate reward. Even the least sophisticated student of human psychology understands that we are not cue-and-response creatures with miniscule brains. We are composed of not just drives but defenses against those drives; of ideals which we wish to honor; of inner conflicts between opposing feelings; of complex personalities capable of intricate distinctions when dealing with ourselves and the world.
We are composed of not just drives but defenses against those drives; of ideals which we wish to honor; of inner conflicts between opposing feelings; of complex personalities capable of intricate distinctions…-Lance Dodes
The neuroscientists at NIDA have done addicts and the addiction field a grave disservice by claiming their rat studies explain human addiction. To understand the compulsive symptoms we call addictions, we need to understand humans. In a previous article, I described the psychology of addiction.
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