Addiction and the Meaning of Life A Climate for Change: An International Summit for Advancing Theory, Research, Policy a

1. Addiction and the Meaning of Life A Climate for Change: An International Summit for Advancing Theory, Research, Policy and Practice in Addiction Doug Sellman National Addiction Centre Aotearoa New Zealand

3. AddictionA contemporary psychiatric disorder • Brain dysfunction • Psychological disturbance • Spiritual erosion • Physical damage • Social disruption

4. AddictionA contemporary behavioural health disorder • Brain dysfunction • Psychological disturbance • Spiritual erosion • Physical damage • Social disruption

5. Addiction and the Meaning of Life • The theory of evolution provides the strongest explanation of life, as well as an understanding of the neural basis to addiction • Consumerism fuelled by Marketing Science maintains our ‘addictionogenic’ environment • Compulsive pursuit of pleasure and comfort is the antithesis of a virtue-based approach to life, character development and genuine happiness • ‘God experiences’ in various forms will be useful therapeutically when they strengthen the brain’s higher executive functions – ‘higher power’

6. What is addiction? How much ‘free will’ does a person with addiction have?

7. No “Safe” Hazardous Problem Mild Moderate/severe drinking drinking drinking drinking dependence dependence Drinking Continuum

8. No “Safe” Hazardous Problem Mild Moderate/severe drinking drinking drinking drinking dependence dependence Drinking Continuum Focussed behavioural change related to “safe drinking”

9. No “Safe” Hazardous Problem Mild Moderate/severe drinking drinking drinking drinking dependence dependence ADDICTION Drinking Continuum Focussed behavioural change related to “safe drinking” Lifestyle change related to abstinence

10. Theodosius Dobzhansky, 1973 (1900-1975) “Nothing in biologymakes sense, Except in the light of evolution”

11. ERA PERIOD EPOCH Cenozoic Quaternary Holocene (65 mya - present) (8,000 - present) Pleistocene (1.8 mya - 8,000) Tertiary Pliocene Miocene Oligocene Eocene Paleocene Mesozoic Cretaceous (248 - 65 mya) Jurassic Triassic Paleozoic Permian (544 - 248 mya) Carboniferous Devonian Silurian Ordovician Cambrian

12. Inhibitory Dysfunction Reward Overdrive Drug Drug Liking Needing

13. What is addiction? How much ‘free will’ does a person with addiction have? Not nearly enough! But perhaps the deficiency is the basis of what it is to be human

14. What causes addiction? Nature vs Nurture Debate

15. EVIDENCE FOR A GENETIC INFLUENCE IN CAUSING ALCOHOLISM Family Studies Twin Studies Adoption Studies Animal Models Molecular Genetics

16. Number of genes 1988 2008 3 - 4 primary genes ? 300 - 400 genes

17. “Nature via Nurture: Genes, Experience & What Makes Us Human” (2003) Matt Ridley (1958-present)

18. Is addiction the result of faulty genes? ‘Addictive genes’ appear to have origins at least as long ago as the Ordovician Period and have been perpetuated through natural selection, forming the very basis of our being, but only very recently interacting with modern human environments characterised by a steady supply of food and technological advances The gene/environment continuum is the new paradigm

19. Consumerism • Consumerism is as old as civilisation itself; when people purchase and consume in excess of their basic needs • What is different now is MARKETING and more particularly the Science of Marketing, defining a modern meaning to life “Happiness will result from consuming a lot”

20. The Wharton Marketing DepartmentUniversity of Pennsylvania • In 1881, an iron manufacturer, Joseph Wharton, offered the University of Pennsylvania $100,000 for the creation of a Wharton School of Finance and Commerce • The first marketing course, "Marketing Products," first offered in 1904, by 1930 undergraduate demand had made Marketing the second-largest aspect of the curriculum • The Marketing Department is now the most published among Marketing departments worldwide. • Its research draws on a variety of basic disciplines including decision theory, economics, psychology, and statistics

21. Marketing Science May 2008 Building Brands M. Berk Ataman, Carl F. Mela, Harald J. van Heerde Rotterdam School of Management, Erasmus University, The Netherlands Which marketing strategies are most effective for introducing new brands?... This paper sheds light on this question by ascribing growth performance to firms' post-launch marketing choices... To achieve this aim we formulate a Bayesian dynamic linear model (DLM) of repeat purchase diffusion wherein growth and market potential are directly linked to the new brand's long-term advertising, promotion, distribution, and product strategy…

22. Marketing ScienceMay 2008 Competitive Brand Salience van der Lans R, Pieters R, Wedel M. Rotterdam School of Management, Erasmus University, Rotterdam, The Netherlands Brand salience—the extent to which a brand visually stands out from its competitors—is vital in competing on the shelf… This study proposes a methodology to determine the competitive salience of brands, based on a model of visual search and eye-movement recordings collected during a brand search experiment…

23. Marketing ScienceMay 2008 Image Reinforcement or Impairment: The Effects of Co-Branding on Attribute Uncertainty Geylani T, Inman JJ, Ter Hofstede F. University of Pittsburgh Co-branding is often used by companies to reinforce the image of their brands… In this paper, we investigate the conditions under which a brand's image is reinforced or impaired as a result of co-branding, and the characteristics of a good partner for a firm considering co-branding for image reinforcement…

24. What is the aim of Marketing Science? To use the power of scientific knowledge to stimulate excessive desires in people to consume more than that which they require

25. The dilemma for our patients • They have become exactly what you would predict from their environment (the modern ‘addictionogenic society’) working on their genes (if you had all the information) • They have answered the call of the marketers, paid by the corporations, supported by the Government, benefiting the middle-class share-holders • They not only suffer the indignity of developing compulsive dehumanising behaviours, but then are blamed and stigmatised for being victims

26. A new sin for Pope Benedict to declare? “Stimulating mass gluttony” Stimulating an inordinate desire in people to consume more than that which they require

27. H:\dsellman\Apps\Qualcomm\Eudoralight\Attach\God4.jpg

28. The Future of God in Recovery from Drug Addiction “I will lift up mine eyes unto the hills: From whence cometh mine help” Psalm 121:1 Sellman, Baker, Adamson, Geering Australian and New Zealand Journal of Psychiatry 2007;41:800-808.

29. God • Belief in God is found across all human populations • Self-transcendence is a universal heritable trait • Dopaminergic cortico-limbic pathways from the medial temporal lobe to the anterior cingulate and prefrontal cortex, which mediate experience of distant extrapersonal space and time, and probably associated with dreams and hallucinations, may represent the brain capability underlying religiousness in humans (Previc 2006)

30. Recovery from drug addiction • Personal transformation and spiritual growth have been identified as important elements in recovery (Vaillant 1988; Green et al 2005) • But is a ‘supernatural’ experience necessary?

31. God and recovery • Various Christian denominations in NZ: Anglican, Catholic, AOG, Destiny but especially Salvation Army since William Booth’s London ministry to the poor in 1852 • Strongest linkage between God and recovery is through Alcoholics Anonymous Bill’s “conversion” occurred on December 14th 1934, while in a state of depression undertaking a fourth hospital detoxification “If there be a God, will he show himself” Following this, Bill experienced what later he and others refer to as his “white flash” or “hot flash” experience

32. God and recovery • Rational Recovery - no place for a transcendent God “To seek God while in the grip of addiction is absurd; addicted people cannot conceive of a power higher than their own addiction” Instead, there is strong exhortation for people to use their internal ‘higher power’ and act more responsibly • No RCTs comparing Rational Recovery with AA but anecdotal information indicates there is a similar recovery rate through the two self-help group traditions (Galanter et al 1993)

33. God and recovery • Kaupapa Māori addiction services in New Zealand a special case of growing indigenous spiritual experience in recovery from drug addiction • Tangata whaiora (patients) are helped to reconnect with traditional culture, providing new cultural identity and sense of self within whānau/hapu/iwi structures of the Māori world • The emphasis on ‘finding God’ within Christianity is replaced by immersion in the Māori world imbued by wairua (spirit), in similar fashion to the spirituality of other indigenous peoples in the world

34. Drugs and God Hallucinogenic substances have been used by humans for tens of thousands of years, traditionally confined to religious ceremonies to facilitate communication with the ‘spirit world’ - “entheogens” The rise of the ‘Abrahamic religions’ discouraged their use, but the Enlightenment and subsequent development of empirical science are behind a renaissance

35. Drugs and God William James (1902) recounts a chloroform experience of the famous British writer JA Symonds: “After the choking and stifling had passed away, I seemed at first in a state of utter blankness; then came flashes of intense light, alternating with blackness, and with a keen vision of what was going on in the room around me, but no sensation of touch. I thought that I was near death; when, suddenly, my soul became aware of God, who was manifestly dealing with me, handling me, so to speak, in an intense personal present reality. I felt him streaming in like light upon me…I cannot describe the ecstasy I felt.”

36. Drugs and God • “Phantastica” Lewis Lewin (1924) and the re-discovery of using various hallucinogenic drugs, including the two long-standing ‘God finding drugs’, mescaline and psilocybin • LSD Albert Hofmann (1938) brought about renewed interest in the West in therapeutic uses of hallucinogens, although now outside traditional religious guidelines and practices • Extensive use of LSD in the treatment of alcoholism during the 1950s and 1960s before political pressure, largely US, brought about discontinuation in the 1970s • Krupitsky’s (2002) work on ketamine and Sessa’s (2005) editorial suggests a revival

39. Krupitsky et al (2002) St Petersburg Research Center of Addictions and Psychopharmacology • Ketamine 2mg/kg vs 0.2mg/kg in heroin addiction • “We try to help our subjects create new meaning and purpose in life…the feeling of individual self dissolves. The process of losing one's individuality can be horrifying and felt as a real death. If the subject can relax and let go, this process may be ecstatic. After the loss of the feeling of one's individual self, the experience is indescribable. There exists only ‘That which is aware of Itself’”. • Five-fold increase in abstinence from heroin two years following treatment

40. Recovery from drug addiction So, is a ‘supernatural’ experience necessary for recovery from drug addiction?

41. George Eman Vaillant, 1988 (1934-present) “What is needed is that addicts alter their whole pattern of living”

42. Recovery from drug addiction • A transcendent ‘experience of God’ may be really important for some but is obviously not mandatory to recover from drug addiction • However, development of internal ‘higher power’ is probably necessary in order to develop and consolidate a new lifestyle • If effective, therapeutic ‘higher power’ experiences (religious, spiritual, ethnic, natural, ‘entheogenic’) will result in neuronal changes in the prefrontal cortex, the brain’s ‘higher power’

43. Four Phases to Recovery Phase 1 Picking up the pieces from a failed lifestyle TREATMENT Phase 2 Assembling a new lifestyle REHABILITION Phase 3 Practising the new lifestyle AFTER-CARE Phase 4 Living the new lifestyle SELF-MANAGEMENT

44. The self-management escalator to recovery

45. Successful new lifestyle Failedold lifestyle 1 2 3 4 Clinical Mx Self Mx

46. “Change takes time” Tenzin Gyatso, HH The 14th Dalai Lama of Tibet (1935–present)

47. God and recovery from drug addiction • Current treatment tends to be short-term orientated and epiphanies are hard to manufacture • Current treatment has modest effectiveness only and most patients will relapse - 90%+ • Developing more predictable ways for individuals to have ‘higher power’ experiences may be one of our great challenges as a field • Perhaps further development of ‘entheogenic treatment’ offers hope for a more predictable path to recovery initiation and consolidation

48. Addiction and the Meaning of Life • The theory of evolution provides the strongest explanation of life, as well as an understanding of the neural basis to addiction • Consumerism fuelled by Marketing Science maintains our ‘addictionogenic’ environment • Compulsive pursuit of pleasure and comfort is the antithesis of a virtue-based approach to life, character development and genuine happiness • ‘God experiences’ in various forms will be useful therapeutically when they strengthen the brain’s higher executive functions – ‘higher power’

49. Te Mutunga The End