Thursday, July 23, 2015

Addiction, Suffering, and Compassion

If you have been reading along so far, it should be pretty clear that we live in a very addicted country (world?). I looked up "Types of Addictions" online and up popped a website, listing them A - Z!(1)  Seriously.  Besides things I have discussed in previous blogs, like television, alcohol, and sugar, and the obvious villains, the 'bad drugs' like heroin, cocaine, crack,  and PCP, and tobacco, there are SO many other things to which we can be addicted: food, shopping, shop-lifting, sex, gambling, gaming, porn, plastic surgery, exercise, risky behavior, and on and on and on...

Addictions and the Brain

Before we go farther down this road, let's take another look at brain chemistry.  In the last post I was talking about the dopamine-reward brain circuitry.  This circuit developed to guide evolving humans towards natural rewards like food, sex, and bonding.  In today's world, however, "extreme versions of natural rewards have a unique ability to capture us." (2)   When we are exposed to high calorie foods, or the constant novelty of endless numbers of beautiful, potential 'mates' having sex on a screen, or anything on the above list, each occurrence gives us an extra dopamine hit to the brain, too much of which can override our natural satiation mechanism.  In addition, there is a protein which Wilson (see reference 2) describes as a molecular switch, called Delta Fos B, which is released when dopamine surges.  This protein accumulates in the brain's reward circuit over time, and causes cravings for more... of whatever 'it' is.  This cycle - excessive consumption and dopamine surges, followed by accumulation of Delta Fos B, followed by cravings for more - ends with structural changes to the addict's brain: it numbs their pleasure response, it gives them a hyper-reactivity to whatever they're addicted to, and it erodes their willpower. (2) 

Why?  What do ALL of these 'things' have in common?  Some of them are behaviors, and some are substances.  Some people can use these substances and/or participate in these behaviors without getting addicted - but many cannot.  For example, there are an estimated 2 out of 3 Americans who are overweight (this statistic is shock to me, btw), and about half of them are obese.(3)   So the rate of becoming 'addicted' to food seems pretty high.  On the other hand, hard drugs like cocaine, crack and heroin only hook about 10% of people who try them.  So the things in and of themselves are not necessarily the cause of the addiction. What is going on that makes some people more likely to become addicted?

What Causes Addiction? 

Dr. Gabor Maté has an excellent You Tube video out entitled "What is Addiction?" (4)  that answers precisely this question, in my opinion, anyway.  His view is that all addictions are attempts to soothe the pain of life, to get away from distress.  Interestingly, according to Maté, the brain does not distinguish between physical pain and emotional pain.  When a person suffers from an emotional rejection, it lights up or activates the same part of the brain as if they had been stabbed with a knife.  

In his work with severe addicts, Dr. Maté begins not by asking "Why the addiction," but instead, "Why the pain?"  And in this work, with thousands of addicts, this question is always, every single time, answered by emotional loss or trauma experienced as a child.  In his video, Maté quotes Keith Richards, guitarist (and famous heroin addict) from the Rolling Stones, who says, "All the contortions we go thorough (are) just not to be ourselves for a few hours."  So why would anyone not want to be themselves?  Because of the pain.  Because it hurts.  Because anything is better than having to face THAT...

Or is it?  Sadly, trying to get away from the pain, to escape or avoid it, just causes more pain.  The Tibetan Book of Living and Dying says "Whatever you do, don't try and escape from your pain, but be with it."  My medicine tradition is big on teaching about surrendering to 'what is' in the moment, believing that by surrendering (as opposed to fighting against), we can move through the pain.  Easy to say - and NOT so easy to do, especially when we feel our pain is going to overwhelm us.  I can remember years ago worrying that if I started crying I would NEVER be able to stop.  I would just shut it down if tears came up, get angry, push it away, and then reach for that next cigarette, next shot, etc...

We are also not taught how to do this - how to be with our pain, with ourselves.  Our parents didn't know how, or if they did, it was minimal.  Nor did their parents before them.  So each new generation gets to hold the unresolved pain of the last one, plus the layers passed down from our lineage, as well as our own stuff layered on top, with no tools with which to cope.  We are not taught emotional intelligence as kids in school, and are in fact more likely to be further traumatized by bullies, gossip, cliques, and negative stereotyping.  My peers mostly taught me about rejection, and to be more mistrustful of others and protective of myself.  I can't speak for every religious tradition, but speaking personally, I was not taught how to be with myself and my pain in my Methodist church groups or though sermons.   We live in a culture, as already written about in this blog, that is about instant relief, ' a pill for every ill.'   We live in a culture that prizes distraction, surface beauty, and external symbols of success.  As Dr. Maté says, "...we live in a culture that is based on, both economically and psychologically, on not supporting people to be with themselves."    Thus, we live in a culture of addicts.

Scientists are still looking for the reasons why some people become addicted and some don't. 

How Can People Be With Themselves (with their Pain)? 

Buddhists believe that the way to start to end suffering (dukkha) is to first admit to oneself that suffering is unavoidable and is a natural part of life. (5)  Christians believe (in part) that the way to end suffering is to turn over ones troubles to God, letting the burdens go, then praying and remembering to be thankful for all of it.  

Dr. Maté says that people CAN learn to be with their pain, but only if there is an 'other' present, from whom they can sense some compassion.   He says, "So addicted people need a compassionate presence which will permit them to experience their pain without having to run away from it." 

Compassion means "to suffer together." (6)  It basically let's the sufferer know that they are not alone.
I like this treatment of the issue: (7)

Benefits of Suffering

A good friend once commented on suffering (and I am paraphrasing here), "Suffering is like water flowing through a canyon: the more water that flows, the deeper the canyon is gauged into the rocks; the deeper the suffering, the more it gauges out your heart, making more room for you to be filled with empathy, compassion, joy, happiness, faith, hope, and gratitude."  Most spiritual traditions agree that suffering has many benefits, including teaching us greater humility, expanding our natural capacity for wisdom, increasing our creativity and resourcefulness, providing us with greater compassion, and (in our best moments) helping others who are struggling by our example. (8)

A Way Out

If you or someone you know is addicted, consider using a mindfulness technique to focus on the present moment, and not on regrets from the past or worries about the future.  "Where we put our focus on is what our mind grabs onto," says Dr. Paul Gilbert. (5)  If we are always focusing on the problems in our lives, we will feel worse and worse.  If we instead can focus what is true in this moment ("I am safe," "I have a warm home," I have food to eat," etc), and even better, on what we are grateful for in the moment, our minds will start working like that - towards the positive.   One very simple and helpful mindfulness practice: noting thoughts that come through as 'past,' 'present,' or 'future,' whenever you think of it during your waking hours.  This can help to connect our conscious mind to our unconscious mental habit of living in the past or the future.  I also highly recommend The Presence Process by Michael Brown as a mindfulness primer and as a way to get in touch with and release stored negative emotions.(9)

Finally, remember that none of us - and yet paradoxically, all of us - are alone.  We all feel alone with our pain, but we are not.  There are people who can understand how it feels, who can listen, who can empathize without criticism or judgment.  And this small grace can help us, can shine a tiny ray of light into the darkness of our pain.  Sometimes that's all it takes.  If you are addicted and want help, or you're suffering and are not sure how to cope, please reach out to your neighborhood community, to your religious circle, to your co-workers; go to the library and look for support circles, for meditation classes, for a way to connect with others.  If you are not addicted or suffering, reach out and find someone who needs a supportive, compassionate presence in their life.  Become a mentor, a hospice worker, a meals-on-wheels driver... there are many opportunities to give back to the world when we are in a place of fullness.  And this just in: listen to a great spiritual teacher speak on the subject of compassionate listening. (10)

This tradition of which I am part is one such supportive community.  And this medicine path, although not for everyone, is one way to learn how to be more present with all of it.   May all sentient beings find and share compassion in this lifetime!

(2) Wilson, Gary. "The Great Porn Experiment."   TED Talk,  TEDxGLASCOW.
(3) "Overweight and Obesity Statistics." NIH.
(4) Mate, Gabor, PhD.  "What is Addiction?"
(6) Scharff, Constance, PhD.  "Cultivating Compassion in Addiction Recovery."  Psychology Today, 9/9/13.
(8) "Benefits of Pain and Suffering."

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