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Mar 23

There is a need for a brain hack to help with addiction - maybe we already have one.

Alcoholic Anonymous (AA) has been around since the 1930s in one form or another (co-founded by Bill Wilson), and has helped untold number of people (1,867,212 members in 2006).

While AA appears to have a simplistic approach it has helped (and it has branched out to cover more than alcohol addiction). David Foster Wallace novel, ‘Infinite Jest‘, partially centers around a number of characters going through various forms of AA (see death of a genius, DFW brain and information, what depression feels like).

A recent Nature magazine has a short article of the neuroscience of AA. There is a contrast between how AA members and scientist look at addiction, and how each group thinks addiction should be treated.

Perhaps unsurprisingly, given its spiritual
origins, this approach has had an uneasy
relationship with the evidence-based culture of
medical research. Both perceive addiction as
a chronic disease; but whereas scientists seek
rationally targeted interventions to blunt drug
cravings, AA and related programmes tend to
feature group therapy, tearful confessions and
the call to “surrender to a higher power”.

The idea of giving yourself up to a higher power, even if you really don’t believe in it, is heavily featured in David Foster Wallace’s Infinite Jest novel. If you are an drug abuser and can’t stop under your own power, then you have shown that you have no will power and hence you have no option but give yourself up to this higher power. This is one of the big struggles one of the main characters goes through - giving himself up to a higher power in which he does not believe even exists, but he has no option.

From his novel:

It’s suggested in the 3rd of Boston AA’s 12 Steps that you to turn your Diseased will over to the direction and love of ‘God as you understand Him.’ It’s supposed to be one of AA’s major selling points that you get to choose your own God. You get to make up your own understanding of God or a Higher Power or Whom-/Whatever. …His (Gately) sole experience so far is that he takes one of AA’s very rare specific suggestions and hits the knees in the a.m. and asks for Help and then hits the knees again at bedtime and says Thank You, whether he believes he’s talking to Anything/­body or not, and he somehow gets through that day clean. This, after ten months of ear-smoking concentration and reflection, is still all he feels like he ‘understands’ about the ‘God angle.’

The Nature article goes on to cover how neuroscientists are beginning to take a new look at AA:

Neuroscientists have begun to recognize that
some of the most important brain systems
impaired in addiction are those in the prefrontal
cortex that regulate social cognition,
self-monitoring, moral behaviour and other
processes that the AA-type approach seems
to target.

The article goes on to cover recent research that has gone beyond just the idea that the limbic system is singularly responsible for addiction, but adding the concept of enhancing the prefrontal ability to help control addiction.

The recognition that prefrontal systems might
need boosting in people with addictions has
helped fuel a new interest in whether AA and
similar behavioural treatments are already having
these kinds of effects.

…much of what is known about the AA
approach suggests that it aims to protect or
enhance prefrontal circuits. In the protected
environment of a rehab centre, drugs and other
cues associated with drug taking are gone and
stressful situations that suppress prefrontal
activity are minimized. Volkow notes that the
feeling of ceding control to a higher power is
also likely to “enhance your sense of security,
decreasing stress and anxiety”.

The article goes on to explore the touchy subject (especially for most scientists) of religion’s role in AA.

McCullough suggests that when a person
commits to any cultural system that regulates
behaviour, the psychological effort to conform
strengthens the brain systems that mediate
self-monitoring and self-control. “What
makes religion unique, I think, is that the code
of conduct isn’t just laid down by your parents
or your friends or your principal at school, but
ostensibly by the individual who is superintending
the Universe, so it has an extra moral
force.” Some religious rituals, he says, have been
shown to provoke enhanced activity in prefrontal
regions6. “It’s as if certain forms of prayer and
meditation are pinpointing precisely those [prefrontal]
areas of the brain that people rely on to
control attention, to control negative emotion
and resolve mental conflict.”

Scientist are now trying to take the general idea of prefrontal control to the next level by adding real time feedback of activity level of their prefrontal cortex.

Developed by researcher and entrepreneur
Christopher deCharms earlier this
decade, the technique involves placing drug
users in an fMRI machine and showing them
a symbolic representation — a flame — of the
fMRI-measured brain activity that corresponds
to their cravings. The users are then asked to
apply their own cognitive exercises, such as
imagining their child is with them, to quench
their cravings and douse the flame. After half a
dozen sessions with this feedback the user will,
in principle, develop cognitive circuitry that is
more efficient at suppressing craving and that
can then be used in ordinary life.

Some of this sounds like the lines spoken in Fight Club.

I find it interesting that an idea that grew out of a simple need to try to help people with addiction was largely ignored by scientists for 50 odd years but now they are finding that the AA approach has merit. And now they are trying to develop this approach ’scientifically’, and even forming companies based on this general approach.

…deCharms and his Silicon Valley start-up,
Omneuron, are currently running a small trial
in smokers…

I wonder what gains we as a society would have made in helping people with addiction if scientists had decided to study AA earlier? Maybe it would have made no difference since AA developed and grew without any help from us scientist (maybe even despite scientists).

Scientists (including myself) in general are always looking to come up with a pill, a molecular treatment, to fix everything and anything. So I thought the conclusion for the Nature piece was interesting.

the conclusion of the nature piece is:

As researchers come to understand the
neural mechanisms of addiction better, the
twelve-step approach may give way to more
secular strategies. But it seems unlikely that all
behavioural approaches will soon be replaced
by a pill.

I just hope we can further help people who have problems with addiction - but the answer might not be as simple as a pill.

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