Below is a talk given by Candice Shelby, Ph.D., at the 2014 LifeRing Annual Conference in Santa Rosa, CA. Dr. Shelby, an associate professor of Philosophy at the University of Colorado Denver campus, earned her M.A. and Ph.D. from Rice University. She served as Chair of the UC Philosophy Dept. for three years and has, in recent years, studied intensively the Philosophy of the Mind.She is well-versed in the biological aspects of the brain and in current thinking about addiction. See the talk she gave a few years ago at an earlier LifeRing Annual Conference labeled “Addicts Are Not Powerless” Here.
Addiction is not a thing, per se, but a family of complex dynamics that take many forms. This suggests to me that there will not be a “cure for addiction”, any more than there will be the “cure for cancer” or AIDS. There will instead be increasingly more complex and successful treatments, one addiction at a time. Conceiving of addiction in terms of “disease” and “cure” depends upon outdated nineteenth century models of medicine, and, in fact, of physics. Two often observed phenomena associated with addictions help to make this point: first, the systematic failure of communication between addicts and their friends and family, and second, the very concrete world-shifts that seem to accompany the transition into addiction (when the way things seem start to change), and the movement out of addictive ways of behaving and experiencing the world. Without appeal to meanings encoded into certain objects and activities, their repetitive use or engagement would not amount to what we think of as addiction. Consider some of the DSM V’s criteria for substance use disorders; they include 1)failure to fulfill major role obligations in school, work, or home 2) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the use 3) continued use when it’s physically dangerous 4) taken in larger amounts than intended 5) great deal of time and effort spent in obtaining and using the substance 6) important social, occupational, or recreational activities given up in favor of use. These are all criteria based on what the addict’s use or activity MEANS to him or her. (There are the physical criteria of tolerance and withdrawal, but those can exist both in cases of addiction and out of it, and so I will set them aside for now). Certain behaviors that are characterized as addictive in some countries, such as the U.S. and Western Europe, do not carry that meaning at all in other cultures, and so we will need to look into those a bit later on. The point is that meanings play critical roles at several levels of analysis in the development, maintenance, and attenuation of addictive responses, and the new scientific field of biological coding considers them all relevant. For instance, we have all heard of the genetic code, which, as we have come to understand is not instructions, or a mechanism for unfolding a pre-existing architect’s plan; rather, it is a coding system that signals the order of production of amino acids, in interaction with environmental and other factors. While we’re not going to go into the details of the operation of the genetic code here, the point is that signaling implies coding, and coding involves a meaning-making process in which a small but arbitrary system is used to connect two otherwise separate worlds. In a simple example, the alphabet, a set of squiggles and sounds, works to connect abstract facts about the external world to each of our thought (as we learn through reading, for example), and from one person to another (in conversation, lectures, etc.). And the fact that the system is arbitrary is obvious from the fact that many different languages do the job equally well. So you don’t have to be a poet or phenomenologist to find that meaning exists in the natural world, and that it plays an important role in the lives of organisms.
What I would like to consider specifically today is the way in which the processes of addiction and recovery are connected to processes of meaning development and change. The level of meanings that I’m going to focus on here are at the semantic, psychological, and social levels. These meanings are encoded into individuals through the interaction of their highly complex organic systems with the highly complex environments in which they are embedded. The correlation of the meaning shifts with the transitions into and out of what we generally call addiction is so close that we could reasonably call addiction essentially a phenomenon of meaning, were it not for the oversimplification that such a characterization would invite. But to make the case clear, let me cite for you an example. Among adult men in Korea, there exists a practice of after-work drinking together. These evenings often involve drinking games, so that regular heavy use of alcohol (to the point of passing out) occurs among a large proportion of the population. Nevertheless, this practice is not accompanied by statistical increases in dependence or the other criteria that we cited as marks of addiction. The cultural meanings surrounding these drinking games do not promote what we recognize as addiction–in the context, these are essentially social activities, very tightly circumscribed, in fact, nearly ceremonial, with very particular norms governing their occurrence. Such drinking would not be considered a problem in the context, and no one would think of taking it home alone.
We know that semantic meanings begin to be developed as soon as fetuses begin to be able to associate affect and sensation. By this I mean that every sensory experience is accompanied by some degree of pleasure or pain, of desire or aversion. All meanings are developed out of this combination of sensory data and feedback data from the brain’s own emotional areas. An extensive literature provides evidence that emotional stress (and in particular for humans, interpersonal or social stress) is a theme running throughout addicts’ lives, from gestation through childhood and adolescence in those who become addicted to something, and as a feature in relapse in adults after periods of abstinence. I would suggest that this can largely be explained because the meanings that social and physical interactions in the lives of stressed or traumatized individuals carry is different from those in the non-stressed Children, for instance, who live through adverse life experiences have an increased statistical likelihood of using illicit and prescribed drugs later, and of using them at a younger age than do people who do not have such childhood experiences. In the highly recognized ‘Adverse Childhood Experiences Study’ of 2003, retrospective research done on four different age cohorts revealed that with respect to 10 categories of adverse childhood experiences (called ACEs, and including such things as physical abuse, sexual abuse, neglect, substance abuse or mental illness in the household, etc.), for each ACE a person experienced, the likelihood that she would engage in early substance use was 2 to 4 times greater than for those who didn’t have such experiences. Compared to people with no such events in their childhoods, individuals with more than 5 of the listed life events were 7 to 10 times more likely to report drug use or addiction.
What are we to make of these observations? One thing that we know is that memories are not simple structures, laid down faithfully from experience. In fact, perception is itself no such simple process. Perceptions are, as Antonio Damasio puts it
as much creations of the brain as they are products of the external reality that prompts their creation…The image we see is based on changes which occurred in our organisms–including the part of the organism called brain–when the physical structure of the object interacts with the body…The neural patterns are constructed according to the brain’s own conventions…”
Every concept, then, that finds its way into the virtual reality that is our own private experienced world is emotionally laden, spun out of interconnected neural systems from various limbic structures activated by and activating other parts of the brain’s perceptual, conceptual, and motive apparatuses. Every concept is personal, depending on the unique connections and conventions previously established in a particular brain. From this perspective, the denotative element, or reference, of any concept, is not the concept’s meaning. The meaning of any concept is instead the place that the concept’s content occupies (with all its affective content) relative to everything else in the individual’s world, as carved out by her experience. Concepts form from similar experiences, enriched by the affective states and the expectations that after many repetitions begin to accompany it, inclining one to associate it with others usually connected to it. So this means that concepts are encoded over long experience with objects and events in the world, increasingly specified and strengthened in accordance with their linked affective responses.
So, at the semantic level, a newborn experiences mainly undifferentiated noise; but the smells, sounds, feelings in its own body of pressures here and there, and alarm or pain exchanged for pleasure and comfort (most basically for them, in the sensations perceived in the gut), as well as the visual inputs that all come together when it encounters its mother or caregiver, become recognizable as a group, or a package, standing out from all the rest of the goings-on in the world. The first concepts developed in this way, distinguished from the rest of the world, are certainly not symbolic, but are nevertheless meaningful and complex, and without doubt affect-laden. To do all of this organizing and meaning-making work, babies have to be motivated to interact with the world, given the significant effort and overcoming of fear that the task requires, and they are—through the same reward system that is activated when drugs of addiction are ingested. They begin to want to interact with the world because they get positive reinforcement from doing so. Positive and calming feedback provides rewarding experiences for the child who otherwise becomes stressed by the demands of a highly stimulating and unregulated environment. And rewarding feedback evokes repetition of the rewarding activity. Such feedback loops become internalized in the development of concepts, as expectations develop and operate in perception and categorization.
The very development of infants’ nervous systems is shaped by the character of their interactions with a caregiver; the patterns that form the child’s conceptual world are constrained by the more encompassing ones that form her emotional environment. As has been shown repeatedly in rodent studies, for instance, being separated just briefly from their mothers results in heightened stress responses in offspring. And the same thing happens in humans–people who experience heightened stress or trauma in their family relations as children live in a very different kind of world than do those who experience calm and pleasant nurturing. In addition, everyone’s sensory apparatuses and emotional processing systems develop uniquely, with differing degrees of sensitivity, so that the same degree of environmental stress will code differently for different individuals. The same physical encounters will then carry different meanings: “a hug feels tight and secure or tight and frightening; a surface feels cold and aversive or cold and pleasant; and a mobile looks colorful and interesting or colorful and frightening.” This sort of psychological coding of experience takes place throughout human development, and says something important about how various individuals become their particular version of addicted.
A person for whom the world feels dangerous and scary and who ingests a substance that has a calming effect (or has sex, or wins a gamble) will feel a vast difference between her norm and her state after use–a far larger difference than someone who already felt safe in the world. A shy or intimidated person who perceives social interactions as threatening will experience the uninhibiting effects of alcohol far differently than willAh. his more naturally extroverted counterpart. And a kid who has been threatened and constrained by a powerful parent will experience the effects of outwitting the enemy and reaching a new level in a video game, receiving awards and achievements, will feel that differently than a kid who has been supported and encouraged in exploring his developing powers. The more that these positive effects are felt as contrasting with unpleasant reference points, the more the substance or activity will come to mean relief, or safety, or exaltation. And these meanings affect the entire meaning structure of the individual’s world, so that experiences, objects, places, and people associated with the positive feelings take on increased significance, at the expense of other things. Not everything can be of equal importance in one’s conceptual state space, and so as addiction progresses that space shifts, in some cases dramatically.
As we have said, the larger social milieu also has a powerful effect on the meanings of objects, events, acts, and experiences. In the 1920′s, for instance, smoking outside the home was illegal for women. As a result, women didn’t buy many cigarettes. American Tobacco Company’s president hired Edward Bernays to open “that gold mine.” Bernays hired glamorous models to smoke cigarettes in the 1929 Easter parade in New York, paying them to present themselves as smoking in protest. In this move several instances of deliberate coding were deployed. First, the ostensible protest, presenting the campaign as news rather than advertising, sent a message of rebellion, empowerment and emancipation to women. Second, having glamorous models doing the smoking encoded smoking as a beautiful thing for women to do, countering current messages that smoking was dirty, inelegant, and immoral, an activity indulged in by “fallen women”. The coding of cigarettes as “torches of freedom” had its intended effect. Whereas in 1923 the percentage of cigarettes sold to women was around 5%, in 1929 it increased to 12%, and by 1935 had reached about 18%. By 1965, about a third of all cigarettes sold were sold to women. The strategy of associating smoking with power, youth, or uniqueness, depending on the values of the group to whom it is being sold, has proven effective in increasing smoking among women in Spain, South Africa, India, and Japan, to name just some well-documented cases.
Again, among adolescents, for whom strongly reinforcing substances are dangerous, due to other kinds of coding that are going on at lower biological levels, use of certain substances are construed socially as the marks of their independence from parents and other authority figures, and as marks of association with certain desirable peer groups. How many among us have choked down, or just choked on, cigarettes, pot, or beer as a sign of our throwing over the limitations imposed on us as children, or as a sign of being “cooler” than other more conservative kids? In the case of video games, it is often a situation of literally gunning down adults.
Meaning-making thus turns out to be essentially social, as well as emotional and perceptual, and biological. Social and physical environments play important roles in the development of an individual’s world, and shape her attitudes, beliefs, and behaviors with respect to specific stimuli. Understanding how meanings work can help us to understand a number of central elements of addiction that go totally overlooked by physical theories alone. Addicts, like everyone else, learn the meanings of their substance or activity of choice through the emotion-laden, socially tenored experiences that they have with it.
But nothing is linear in the phenomenon of addiction, and no strict causal principles can be found between socially embedded meanings and the meanings that particular experiences have for different individuals. Several studies have demonstrated, as we have said, that drugs have a significantly more powerful impact on an organism that is stressed, or that has experienced traumatic stress, than one that has not and is not. What is more, for those who are addicted but have become abstemious, stress is often associated with return to use. But adversity- induced distress has also been shown to be associated with increased creativity and personal growth. In other words, the meanings of these adverse situations are different for different people, and different for the same people in different contexts. The way in which such circumstances are coded by an individual has everything to do with the totality of her previous experiences in interaction with her natural sensitivities and current physical state. As we all know, many people who quit smoking can be successful for long periods of time, but if they have some drinks, or attend a philosophy conference (for some reason!) they may automatically seek a cigarette as well. If someone grew up with a parent belittling them or ignoring them, a less than enthusiastic reception of a proposal might mean that life is worthless, or that it is time to steal something, clean something, or take a substance to change the way that they feel. In a person with a different history, such a reception might mean that the people around them are particularly obtuse, and so the idea needs to be presented more forcefully. A camping trip, I have found, might stimulate an urge for drugs in one person, while insuring that another remain sober. Genetic coding, as well as personal history, is relevant here. For instance, although social rejection has in many experimental settings been shown to create powerful stress effects and even to impair memory and learning, a recent set of three studies showed that such rejection could result in an increased expression of creativity. It is important to note that this result was effected only in individuals who were more independent-minded to begin with. So, although social meanings are encoded, and we can say some general things about them, what meanings will be gleaned from interactions with others will be determined by a highly complex and dynamic interaction of genetic predispositions, current biological and psychological state, and social context.
We should not be surprised to see, then, that when one’s social context is competitive, consumerist, unsupportive, and alienating, we can expect to see an increase in the numbers of individuals who fall into repeated patterns of behavior of self-soothing or escape, even if that self-soothing or escape then in turn causes detrimental changes in those people’s bodies and brains, as well in their abilities to deal effectively with their environments. And when that culture simultaneously advertises the absolute unacceptability of discomfort, as has become the case at least in the U.S. over the past 50 years, and even more so recently, with direct marketing by pharmaceutical companies to patients, then the meaning of relief shifts, perhaps to a level of near-necessity. In contrast to typical characterizations, then, addiction is perhaps more appropriately seen as a consequence AS WELL AS a cause of social circumstances. “Addictive personalities” are bred at least in part by social signaling which says that poverty, isolation, stress, alienation, etc. are individual ills, rather than social ills, and so are up to the individual to alleviate. Much of this signaling is done through language, but much is also conveyed through images in advertising, television programming, and magazine portrayals of “normal” life. Any symptom whatsoever, the message seems to be, can be alleviated through pharmacology.
The fact that addiction is largely a function of encoding of meanings suggests that, since we all know that the meanings of things can change, addiction is not an essential state. But the transition out of addictive patterns involves a global shift in relations among the totality of elements that constitute one’s world, and cannot simply be insisted upon. That is, meanings, to paraphrase the philosopher David Hume, “must be excited by nature.” They involve bodily and psychological changes that cannot simply be imposed. The switch to a representation of self and world which values health, perky mornings, and freedom from feelings of compulsion is a true revolution in the relation of the individual to the world. And that switch is unpredictable, like a Lorenz (strange) attractor, although it can be encouraged. Since all meanings are what they are relative to the whole of one’s world, they all switch at once, and so there is no way from within the former modes of thinking to MAKE that switch happen. Like all revolutions, this switch in thinking requires stimulation from outside the system, and is characterized by change that cannot be accommodated from within the system. Perhaps it is for this reason that 12-step programs place such emphasis on “the grace of God;” such an overarching, revolutionary change seems to happen by miracle. The experience, though, it should be noted, can also be brought about by psycilicibin, ayahuasca, or LSD. It can also be brought about much more gradually, by significant personal adverse consequences of indulgence, interaction with others who display positive consequences of abstinence, changes in culture and the social meaning of use (I’m thinking of the diminution of the numbers of cigarette smokers in our culture over the past twenty years), or other, more subtle factors. What brings about the transition out of addictions seems mysterious, from our ordinary everyday perspective, and is no doubt manifold. But on the present analysis, it is the very essence of natural. It may well be that one has been changed through powers greater than one’s conscious self, but they are all natural powers of one’s own body interacting with its physical and social environment.
So what’s the takeaway from this analysis? One, we can learn to appreciate that no matter how much someone loves us, we can’t expect them to understand the world just as we do. This does not make them bad, selfish, or uncaring–it suggests, rather, that they are dealing with the world of their own experience. Appreciating that everyone’s system of meanings is unique should help us to understand that even though someone’s behavior, either with respect to their addiction, or with respect to interaction in support groups, has negative consequences, or hurts our feelings, or just seems wrong from our own point of view, doesn’t entail that it means the same thing to him or her. Truly reflecting on this point I think can help increase compassion in our families and in our recovery and larger communities.
Two, the fact meanings are biologically, psychologically, and socially informed also shows us that addiction is not a single phenomenon, but a large family of phenomena, a concept with fuzzy boundaries. In some cases addiction is created by meanings–until it was known that cigarettes were deleterious to health, there was no cigarette addiction in our culture, although there were people who noticed difficulty in kicking the habit, if there ever was occasion to think of stopping, just as there is no shopaholism among commodities traders today, although at some point there might be. In some cases addiction is controlled by social meanings–as is the case in Korea, where heavy drinking is contained within very specific contexts. Moreover, as several studies point out, most of those in our own country who are addicted to drugs and alcohol stop their addictive behaviors by their mid 30′s, when the value and meaning of jobs, families, and the responsibilities change. What was cool and funny in college just isn’t, anymore. The stigma that has come to be associated with cigarette smoking is at least partially responsible for the fact that cigarette smoking rates dropped from 20.6% in 2009 to 18% in 2012. Lighting up no longer means that “you’ve come a long way, baby”. Recent large increases in prices, the creation of smoke-free workplaces, and the institution of insurance penalties got the social message across, after decades of basically flat smoking rates. But of course anti-social meanings swing both ways; as we’ve seen, depending on a person’s history and temperament, the fact alone that smoking, or stealing, is socially unacceptable could be the very thing to give it its meaning and import.
Three, if we recognize that the meanings of events, choices, and objects are always in part a function of pretty universal human biases, we may come to understand ourselves and others better. For instance, a long history of psychological studies, including a raft of recent brain imaging studies show that when assessing the relevance of data to particular conclusions, our brains automatically include our preferences and desires. This happens not only in the case of confirmation bias, but with respect to relative weighting of evidence and assessment of relevant criteria for judgment. This means that not only addicts, who are so often blamed for “rationalizing” their behavior and “living in denial”, failing to see the obvious import of their actions, but everyone unconsciously (biologically) assigns meaning to bits of evidence based on what they (their bodies) want to do. Recognizing this should both do away with some of the shame rained down on addicts and give us tools for becoming mindful of how our brains are likely to code information, and respond accordingly. Likewise, knowing that not just addicts, but all of us experience ourselves as different and better than others (unless we’re depressed, in which case we are likely to have an unhappily more objective view of our uniqueness and superiority) can, if we take the time to ruminate on it, help us to counter some of that bias, preparing us for the hard work that it will take to create healthy, meaningful lives. And finally, recognizing that the tendency to underestimate the time and effort that it will take to accomplish something is not just a characteristic of contractors or writers, but of us as human beings, should help loved ones of addicts see that the promises and assurances that are repeatedly given about “never doing it again” are not empty, are not made simply in order to “get people off their backs”, but are actually offered on the basis of sincere judgments. This is another place where appreciating how meanings are involved in addiction might increase compassion and the ability of loved ones to cope. On the other side of the equation, appreciating the natural human tendency to underestimate the potential difficulties and effort involved in the project of changing our lives could help addicts to better plan, and encourage them to marshal positive forces on their own behalf, so as to be better prepared when the addicted self surges forth.
- Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home
- Recurrent substance use in situations in which it is physically hazardous
Continued substance use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of the substance.
Tolerance, as defined by either of the following:
- a need for markedly increased amounts of the substance to achieve intoxication or desired effect
- markedly diminished effect with continued use of the same amount of the substance
- Withdrawal, as manifested by either of the following:
- the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
- the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms
- The substance is often taken in larger amounts or over a longer period than was intended
- There is a persistent desire or unsuccessful efforts to cut down or control substance use
- A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
- Important social, occupational, or recreational activities are given up or reduced because of substance use
- The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
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