Feeding the Hungry Ghosts: Addiction and Substance Use Disorder
By Ronnie Biemans, Dec 16 2016 06:19PM
The wisest sentence of the twentieth century was E.M. Forster's -- "only connect." But we have created an environment and a culture that cut us off from connection, or offer only the parody of it offered by the Internet. The rise of addiction is a symptom of a deeper sickness in the way we live -- constantly directing our gaze towards the next shiny object we should buy, rather than the human beings all around us.
- Johann Hari, Author of Chasing The Scream: The First and Last Days of the War on Drugs
Nearly every day we hear news of someone who is seriously ill or who has died as a result of drug or alcohol use. Sometimes we are compassionate, but more often than not we pass judgement on these individuals. However, it is not a lack of self-discipline that sets one on the addictive path but rather the powerful craving and biological drive to seek pleasure that causes the activation, over activation, and eventual exhaustion and depletion of the brain’s reward system. With substance use disorder, “Instead of achieving reward system activation through adaptive behaviors, drugs of abuse activate the reward pathways.” From a neurological perspective, drug use affects the way the brain functions in a number of ways. All of us have a reward pathway that is activated in part by dopamine, a neurotransmitter that serves a number of functions in the human body. In order to understand the powerful forces at play in addiction it is essential to understand the role of dopamine. Dopamine release is a key element in the human reward pathway. We depend on our brain’s ability to release dopamine in order to experience and to motivate our responses to the pleasures of everyday life, such as food and sex.
As Gabor Mate says in his book, In the Realm of the Hungry Ghosts, “We see that substance addictions are only one specific form of blind attachment to harmful ways of being, yet we condemn the addict's stubborn refusal to give up something deleterious to his life or to the life of others. Why do we despise, ostracize and punish the drug addict, when as a social collective, we share the same blindness and engage in the same rationalizations?” Buddhism describes this as the realm of the hungry ghosts, our human tendency to grasp, crave, and pursue pleasure. The hungry ghosts have large stomachs and very narrow, constricted throats. Hungry ghosts are limited in their ability to take in nourishment, and suffer from never-ending dissatisfaction and insatiable craving. This imagery aptly describes our common struggle as human beings and also captures the reality of this drive when taken to the extreme with substance use, abuse, and addiction. We all have a built-in pleasure-seeking drive. When we develop a substance use illness, we essentially have broken the neurological system. When viewed in this way, substance use disorders are more easily understood and the agony and the ecstasy of the disorder are less stigmatized. Research tells us that we can fix the broken drive system by appropriately feeding the ‘hungry ghost” and finding ways to mend the body and brain.
What is Addiction?
The DSM-5, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, now describes addictions more neutrally as “Substance-Related and Addictive Disorders.” The new diagnostic term allows clinicians to capture “the wide range of the disorder from a mild form to a severe state of chronically relapsing, compulsive drug taking.” The DSM-5 states, “The essential feature of a substance use disorder is a cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues using the substance despite significant substance related problems.” The diagnosis is based on a “pathological pattern of behaviors related to the use of the substance.” Diagnostic criteria include:
• impaired control,
• social impairment,
• risky use and
• pharmacological criteria that include tolerance and withdrawal.
“There is no danger anywhere. And in my striatum, opioid sponges are soaked with heroin, turning off the need to strive, turning on the glow of wellbeing, but also insidiously, revving up the dopamine pump that tops this dark lake with an electric sheen of attraction. This moment is lit up with glory. And soon dopamine’s urgings will progress from exhilaration to desire, from crowing to craving, leaving an incessant hunger in my cells.” - Memoirs of an Addicted Brain, Mark Lewis, PhD
Addiction affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and control over behavior. That is why addiction is a brain disease. One of the hallmarks of this brain based disorder is craving. Cravings are strong, powerful desires, and they are part of our wiring as living, biologically driven beings. Our brains are "hard-wired" to appreciate and to pursue natural rewards, such as food and sex, because they are essential to our survival and also provide pleasurable feelings. If we don’t eat, we can’t live. If we don’t have sex, then the species dies out. Drugs used by those with substance use disorders activate the same circuits that motivate the desire for food and sex.
“I have absolutely no pleasure in the stimulants in which I sometimes so madly indulge. It has not been in the pursuit of pleasure that I have periled life and reputation and reason. It has been the desperate attempt to escape from torturing memories, from a sense of insupportable loneliness and a dread of some strange impending doom.” - Edgar Allen Poe
I recently saw the documentary “Amy”, a classic story about the life and death of renowned British singer/songwriter Amy Winehouse. The film showcases her brilliant talent as well as the destructive illnesses that ultimately took her life. As a longtime fan of her music, I was impressed by the film’s depiction of her tremendous talent and unique musical gifts and also profoundly saddened at the course of her illness. In her early years, family and friends saw a gifted, sassy, spunky North London girl with tremendous musical ability who was prone to depressive mood and exhibited bulimic behavior. She was discovered by the music industry establishment in her late teens. Her singular songwriting and singing voice became known with the release of her first studio album, Frank, in 2003, and her fame grew.
Over time, her substance use became increasingly problematic and her behavior erratic. Hounded mercilessly by the paparazzi and eviscerated by late night comedians, her illness grow progressively worse. Despite several stints in rehab, her body became permanently damaged by the combination of her extreme alcohol and drug consumption as well as her bulimia. Her physician warned her that her body was unable to tolerate or process further alcohol or drug use. Although she had periods of sobriety, she eventually died from alcohol poisoning in 2011. Her family and friends were devastated, and the world lost a music icon. Amy’s tale is not unusual, except that we know her story on an intimate level due to her fame. Perhaps Russel Brand said it best, “Amy [Winehouse] increasingly became defined by her addiction. Our media is more interested in tragedy than talent, so the ink began to defect from praising her gift to chronicling her downfall. The destructive personal relationships, the blood soaked ballet slippers, the aborted shows, that YouTube madness with the baby mice. In the public perception this ephemeral tittle-tattle replaced her timeless talent. This and her manner in our occasional meetings brought home to me the severity of her condition. Addiction is a serious disease; it will end with jail, mental institutions, or death.” When Amy Winehouse’s life ended, the crazy circus also seemed to end, and those who loved her were left devastated and bereft. While her life ended prematurely and tragically, there is hope for others. There are many who are able to get help, get sober, and eventually lead healthy, happy, and productive lives. The agony and suffering brought on by this illness can be stopped. We must cease passing judgment and begin to treat substance use like any other life-threatening disease, educate ourselves about the course and serious nature of the illness, and insist on quality treatment for all who are in need.
Treatment – What We Know
We know so much more about the human brain, alcoholism, and substance use disorders now than we did 80 years ago when Bill W. and Dr. Bob first founded Alcoholics Anonymous (AA). While participation in AA or other self-help support groups is still considered crucial to getting and maintaining sobriety, we now know more about the nature of the disorder and how to treat it. Research has uncovered many evidence-based practices that are effective in treating mental illness and substance use disorders. There are certain components of effective treatment that have been validated over time. For instance, the National Institute on Drug Abuse (NIDA) has issued 13 principles of effective treatment for drug addiction. These principles call for the treatment of the whole person.
1. Addiction is a complex but treatable disease that affects brain function and behavior.
2. No single treatment is appropriate for everyone.
3. Treatment needs to be readily available.
4. Effective treatment attends to multiple needs of the individual, not just his or her drug use.
5. Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
6. Behavioral therapies – including individual , family or group counseling – are the most commonly used forms of substance use treatment.
7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
8. An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.
9. Many addicted or drug-abusing individuals also have other mental disorders (and should have both disorders treated in an integrated way.)
10. Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use.
11. Treatment does not need to be voluntary to be effective.
12. Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
13. Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection.
Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment.
Getting Sober/Getting Started
You may know someone who has a substance use disorder or be struggling with one yourself. If you are interested in finding help, keep the NIDA guidelines listed above in mind. Here are some other resources that may be helpful:
About the Author:
Informed by over 25 years of professional training and work experience as well as her many years of meditation and yoga practice, Ronnie Biemans, M.A., L.C.P.C., is guided by a core philosophy to focus on strengths, not deficits or pathology. By discovering, restoring and optimizing each person’s unique ability to thrive and meet the demands, of today’s fast-paced, stressful world, those who have encountered physical and emotional health challenges can discover ways to improve their lives and well being. Operating from her home office and in other community settings, Ronnie provides guidance and support to individuals, families and groups seeking to live healthy, balanced lives.