Category Archives: Science

Book review: An Anatomy of Addiction

Warning: For persons concerned about “triggers,” this book has some specific descriptions of drug use.

Two medical pioneers — including pioneers in the potential medical use of, and actual personal misuse of, cocaine. Howard Markel paints a cautionary tale of addiction that powerfully resonates a century and more later.

Many people know a bit about Sigmund Freud’s history with cocaine, despite later attempts to cover up just how much he used (or abused), how long he used it, and how much it affected his general work habits and his psychological theorizing.

Markel gets behind the story, not just with Freud, but a somewhat older near-contemporary, William Halsted. Halsted, less familiar to many, was essentially the father of modern American surgery, a pioneer in antiseptic and operating techniques in surgery, mainly from his perch of director of surgery at Johns Hopkins School of Medicine.

When I was a kid, I read a mini-biography of Halsted in a compendium of lives of great doctors, so I had heard about his “sea cruise” attempt to overcome his cocaine addiction. But, the story closed with what Markel notes was long the “official line” about Halsted: that he had no major problems, or problems at all, after that.

How wrong I was, Markel shows.

I had no idea he was “committed” to Butler Hospital, a “sanitarium.” Nor that he was given morphine to “help” with cocaine withdrawal. Nor that he, as a result, apparently became a lifelong morphine addict. Nor that he apparently struggled to some degree with cocaine addiction for the rest of his life.

Markel, an M.D. and Ph.D. with addiction support help background, shows a clinician’s skill in diagnosing how addiction affected Halsted’s life, his work at Johns Hopkins, his relation to surgical interns and patients and more.

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Diet and weight: Not so simple an issue

Salt, fats and refined white flour: it's tempting/Image from Discover magazine

Especially with alcohol vs. drugs that have a strong physical addiction component, such as cocaine or nicotine, addiction is often a mix of physical, psychological and even sociological issues.

For persons struggling with weight, diet and eating issues, this seems to be at least as true. The flip side of that (as I’ve noted here before) is that modern western eating struggles do seem to have a physical component … that is, strong combinations of refined sugars, plus fats and salts, do seem to have some degree of something akin to physical addiction, even as this is still controversial to some.

At the same time, the mental side of food issues itself is complex.

Here’s a good, insightful article on just how much the brain has a large role to playin these issues.

Let’s take a look at some specific takeaways, after the jump

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Decision making and ego depletion

John Tierney has a very insightful article on these issues in the New York Times Magazine. While I don’t agree with all of it, I do agree with a fair bit, I’ll summarize its main points.
1. Our ego (as in our central “executive authority”) has limited energy.
2. Making decisions, at least to some degree due to the brain’s energy use in this, depletes some of this energy.
3. Multiple demands can increase this depletion, and the rate of it.
4. Modern society often tends to be heavy on demands for decision-making, often under the rubric of “choice” and accompanying trade-offs.
5. Without steering too much into political-type sociology, that demand and depletion can fall heavier on the poorer, or (I infer from the article) the more time-stressed.

My takeaway for sobriety-related issues?

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Addictive Personality? You Might be a Leader!

There was a fascinating piece in the New York Times that I found very interesting, both for the positive spin it put on the so-called “addictive personality” and for it’s discussion of some current thinking regarding the role of brain chemistry in addiction. See it HERE. In summary, the article asserts that the brain physiology of addicts is not defective somehow, but differs from most people’s in particular ways, leaving them less able to feel motivated by the pleasure that comes from what might be called the “normal spectrum” of pleasurable behaviors. They “must seek high levels of stimulation to reach the same level of pleasure that others can achieve with more moderate indulgence.”  This makes them [us?] more prone to “risk-taking, novelty-seeking and obsessive personality traits often found in addicts.” The author goes on to say that those same traits “can be harnessed to make them very effective in the workplace. For many leaders, it’s not the case that they succeed in spite of their addiction; rather, the brain wiring and chemistry that make them addicts also confer on them behavioral traits that serve them well.”

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Interesting Article on Addiction Research

The New York Times published an interesting article on July 10th that is worth a look. It talks about a growing trend to treat addiction as a medical problem rather than a spiritual, or psychological, disorder. The article speaks of addiction as a “disease” which will bother some. I’d prefer the word “condition.” It compares addiction to diabetes, which is interesting because diabetes is often the result of unhealthful behavior, just as is addiction, although both may have genetic factors. Diabetes is also often completely controlled, though not cured, by following certain dietary strictures, which is of course similar to what happens with addiction.

As a practical matter, moving addiction more firmly into a medical category could lead to both opportunities and dangers.  On the positive side, it would help in de-stigmatizing addiction and might lead to research on better treatments. But it also could conceivably make the downside of drinking/using seem even less threatening to people than is currently the case. Diabetes suffers from this phenomenon — even as treatments for type 2 diabetes improve, people ignore the evidence linking it to obesity and continue to overeat. Or look at obesity itself — virtually everyone views it as a serious medical problem, but vast numbers of people ignore the evidence and/or resist the obvious solution.

–Craig W.