Last week I watched the independent film Race to Nowhere that has won numerous awards for its strong messages about our broken educational system. Through interviews with students, parents, teachers, and others, the movie illustrates the dark side of being a kid in school. The race to nowhere for students is paved with an over-scheduling of activities, too much homework, too little sleep, and increased stress that is resulting in health problems, drug abuse, eating disorders, and suicide. What is even more troubling, is that for all the effort kids are putting into their school work and extracurricular activities, many are being churned out of our educational system lacking some of the most important qualities of a good education, including:  the ability to reflect deeply on topics, handle difficult emotions in the face of stress, and successfully engage in a wide range of healthy relationships. The film points the finger at numerous perpetrators, but in the end, fails to hit home that no one individual person or group is to blame, but rather it is the entire educational system that we must examine more carefully if we are to find the truth behind the worrisome outcomes.

When I think about the fact that over 80 percent of those who end up struggling with addiction begin their behaviors prior to the age of 15, this film frightens me even more. When did school become so competitive and stressful? Much of the over-scheduling of extra-curricular activities and hours of homework is in response to the demands, both perceived and real, associated with getting accepting into a college or university. What is sad is that the stress and pressure begin long before high school. My wife and I spent a couple of years tearing our hair out (the little I have left) trying to identify and enroll our son in the best possible elementary school. I put more time and effort into researching options, attending open houses, completing enrollment packets that included writing lengthy essays, than I ever did applying to graduate school! The process was absolutely crazy, and I know we were not alone. And now I know it was just the beginning.

Race to Nowhere illustrates painfully many of the current antecedents to addiction, and why we absolutely must reexamine our understanding of what education means and how we are going about educating our children. Failure to do so will only lead to a new generation of addicts.

I have mentioned Dr. Robert Thayer before on this site, but have not dedicated a blog entry to his ideas until now. When I first read his book, Calm Energy: How People Regulate Mood with Food and Exercise, I was immediately impressed by the implications of his  work for those struggling with addiction. In a nutshell, he provides a very strong case that many of our moods and unhealthy eating habits have in common two biopsychological dimensions that he calls energy and tension. In an earlier book (The Origin of Everyday Moods, 1996) he describes how the dimensions can be used to create the illustration below.

The above four states represent different expressions of our energy and level of stress. Calm Energy is the quadrant where we find our best moods. We have energy and no tension. It is similar to the states people call flow or being in the zone. It is a place we want to be, where our attention is focused, we are productive, and we feel good about life. It is not a place where addiction is found, and in fact, is really the antidote to cravings and addictive appetites. The opposite of Calm Energy is Tense Tiredness. This unfortunately is the place many of us find ourselves these days, in large part due to the speed of life, decreases in sleep, and increases in stress. It is a place of low energy, bad moods, anxiety and depression. It is also the state where addiction thrives. When we feel tense and tired there is a natural tendency to want move away from this state, and addictive behaviors are among the most powerful, reliable, quick, and easy ways to disconnect from Tense Tiredness. I say disconnect because engaging in addictions does not really provide an antidote to this state. Instead, it may in the short run give us more energy, and change our mood, but only temporarily. When the addictive behavior ceases, chances are good that what follows will be more tension and lack of energy, perpetuating the relapse cycle.

I like to think about Calm Tiredness as a lazy Sunday afternoon. In general, it is a pleasant state, but often not as productive or positive as Calm Energy. Nothing wrong with it, and in fact we need down time to recharge our batteries. The final state, Tense Energy, is a state where we are quite productive and busy, often due to deadlines and being rushed for time. Many Type A personalities fit this state, as well as those who like to live on the edge and seek out thrills.

In my own life I find the model incredibly useful in helping me understand my own eating, exercise, sleep, and mood patterns. One of the best things you can do for yourself is take a day (or two) and track your level of energy and tension by the hour. Rate each on a scale of 1 to 10 and then plot the results on a graph. It is revealing to see just how significantly these states change in the course of an average day. The graph also helps to identify intervention points for: (a) preventing relapse, (b) developing optimal times for exercise, and (c) determining whether we are getting enough sleep. In addition, the graph can help you understand how time of day subtly influences how we think about life problems.

In sum, addiction most often shows up when we are tense and tired, but can also occur in the other states as well. Among the most significant points Dr. Thayer makes in his book is that the single best way to cultivate a life of calm energy is by developing a regular habit of exercise. Perhaps that is why the National Institute of Drug Abuse has already invested over 4 million in research into the connections between addiction and exercise.

“Addiction in the modern world can be best understood as a compulsive lifestyle that people adopt as a desperate substitute when they are dislocated from the myriad intimate ties between people and groups – from the family to the spiritual community – that are essential for every person in every type of society.”

Bruce K. Alexander, The Globalisation of Addiction: A Study in Poverty of the Spirit

In the previous post I discussed how adverse childhood experiences (ACEs) to a large extent play an important role in the development of addictions. Given that over 80 percent of those who develop addictions begin adaptive behaviors to cope with ACEs prior to the age of 15, we as a society need to place a greater emphasis on identifying at-risk kids and intervening as early as possible. But there is another insidious root to addiction that I believe goes beyond individual ACEs and plays an even greater role in the development of addiction – free market society.

Bruce K. Alexander spent decades as a distinguished addiction researcher in Canada before becoming so frustrated by a lack of progress in helping those who struggle, that he completly changed careers and decided to focus on teaching history instead. Despite doing everything he could to avoid topics around drugs and addiction, the more he studied history, the more he discovered insights that began to change his entire perspective on the nature of addiction.

In general, when we think about addiction, we think about it as an individual problem. Individuals are exposed to a host of risk factors, including ACEs, peer group influences, and the availability of objects of addiction in communities. The more risk factors an individual is exposed to, the more likely the chances are that he or she will develop an addiction. Conventional wisdom also suggests that the antidote to addiction is intervention and treatment. But when Dr. Alexander began studying history, he discovered cultures and societies where common objects of addiction were present (drugs, alcohol, sex, food), yet addictive behavior was minimal or nonexistent. ”Addiction can be rare in a society for many centuries, but can become nearly universal when circumstances change – for example, when a cohesive tribal culture is crushed or an advanced civilisation collapses (Alexander, 2008).” Throughout history, the primary factor responsible for the societal change leading to pervasive addiction is the introduction of free market society. Why?

When a society introduces free markets, exchange of goods and services optimally are not encumbered by family ties, cultural traditions, religious values, or anything else that may impede free play of the laws of supply and demand. In other words, free markets create an “every man (or woman) for yourself” dynamic that puts me in competition with everyone else for jobs, insurance, a house, goods, services and Lady Ga Ga tickets. One consequence of this system is that people become dislocated, or disconnected from one another because of the time and energy necessary to keep up with the Jones. Free markets are incredibly profficient at knowing how to keep people focused on stuff over experiences. Flashy ads, mass media, and the latest gizmo from Steve Jobs keeps us always wanting more. In the pursuit of the American dream, what many get instead is isolation, fear, and dislocation, which ultimately leads to compulsive lifestyles where people develop addictive relationships to stuff and get further and further disconnected from nurturing human relationships.

Dr. Alexander’s Dislocation Theory of Addiction is well documented in a paper titled The Roots of Addiction in Free Market Society (highly recommended reading) and a more extensive read: The Globalisation of Addiction: A Study in Poverty of the Spirit. His work is extremely important in helping us all understand many of our current societal ills beyond addiction, including: divorce, single parenthood, children in poverty, obesity, unemployment, and excessive time in front of the TV. Until we as a society place relationships and experiences over materialism, consumption and stuff, Thoreau’s observation that ”the mass of men lead lives of quiet desperation” will ring ever more true.

What is the solution to mass dislocation? I believe part of the answer lies in making some tough societal changes including ending the senseless war on drugs (a big topic for another time). But for the individual struggling right now with addiction, the answer is much more about restructuring life in a way that emphasizes relationships over stuff. To do this, one must have the developmental  capacities necessary to know how to initiate, develop, and maintain healthy human relationships.

I recently learned about the website Living Hero that produces podcasts of “living luminaries and mavericks” hosted by Jari Chevalier. Her most recent interview was with Dr. Gabor Mate, a Canadian physician with a broad range of life experience (and wisdom) on topics including: mind-body medicine, stress and trauma, ADD, and addiction. I first heard about Dr. Mate when a close therapist friend told me about his book, In the Realm of Hungry Ghosts: Close Encounters with Addiction. Shortly thereafter, another friend said he had been to Portland and spoke at a college campus. Then…the podcast interview. Call me slow, but eventually I do pay attention when the universe is attempting to tell me something – like pay attention to this guy!

After listening to the insightful interview by Jari (please go listen now), it is clear that much of what Dr. Mate believes is very much in line with the information on this website and blog. He advocates understanding addiction as a coping response to underlying pathologies, namely adverse childhood experiences. These early events impact brain development, as well as other developmental capacities, resulting in the need for relationships with objects that help regulate stress and emotion cycles. Although much of the discussion focused on addiction as a coping response (feel better), I believe Dr. Mate would also agree that addictive behavior is perpetuated because it feels good – the brain likes it!

I remember a case involving very successful business owner who decided to have lunch with her girlfriends at a local diner that just happened to also have newly installed video poker machines. Having no history of gambling behavior, she thought nothing of putting a buck in the machine to see what would happen. Minutes later she experienced a “big win” – a $600 dopamine rush. So…the following week she told her girlfriends they should meet again for lunch at her lucky restaurant. She put another dollar in the machine and amazingly she won the jackpot again, another $600 big win. That was all it took for her brain chemistry to rearrange some important neurons that led to an out-of-control gambling addiction. Her husband brought her to the clinic because she was unable to stop playing video poker, was blowing thousands of dollars per day, and neglecting her business and family. Although she did love how winning made her feel, in the end, her relationship with video poker machines was just another substitute for the human intimacy she so longed for, but struggled to obtain.

Addiction is a very complex problem with no easy answers. What I like most about Dr. Mate’s approach to healing is that it is humane, sensible, and incorporates harm reduction strategies. More information about his work can be found on his website. But if you can’t wait to read his book, then listen to the podcast byJari, it is well worth your time.

This past week I had a few minutes to spare in Washington DC, so I dropped by the National Geographic Society headquarters and discovered a project that has significant relevance to successfully solving the problem of addiction. Writer and photographer Dan Buettner embarked on a journey around the globe in search of communities that optimized lifestyle for longevity and happiness, places he calls blue zones.  He boiled down his research for the book Blue Zones into principles for living a long and prosperous life. Here is a great summary of the book he did for TED:

For those who struggle with addiction, the keys outlined in the book (and the speech above) provide a road map for translating the MRC solution into reality. Let’s look at how they line up:

Manage
Successfully dealing with addiction requires identifying those things in your life that are chronic issues, and then developing strategies that appropriately keep these things in-check. When we expect to permanently solve a chronic problem we set ourselves up for failure because there is no cure or end to these issues, they require ongoing attention. Addiction, diet, chronic medical issues, time and exercise are all things we must learn to successfully manage. In Blue Zones, the keys that line up with manage include:

• Learn to move naturally. Those who live to be 100 rarely engage in rigorous exercise. Instead, they incorporate  walking, gardening, yoga and other less body-stressful movements into their daily routine. Developing a healthy lifestyle free from addiction necessitates learning to move in the world in a new way, in a natural, physically and emotionally pain-free way.
• Slow down. Our culture perpetuates addictive behavior by encouraging lifestyles where multi-tasking, reliance on technology, and instant gratification become packaged in a speedaholic existence. Not so for those who live in blue zones. An important aspect of successful long-term management of addiction is learning to slow down, become conscious of how you spend your time, and align it with what is most important in your life.
• Eat and drink wisely. Food and drink are common objects of addiction, and although abstinence from alcohol is possible, we cannot stop our relationship with food. The same goes for those who struggle with sexual addiction. It is not possible to remain abstinent from sex, we are sexual beings by nature and healing requires finding healthy ways to express our sexuality. The key is moderation, balance, and of course, eating more fruits and vegetables. Red wine has also been shown to increase longevity, but if it creates more problems than benefits (e.g., abuse, relapse) it should not be on your list.

Resolve
There are some life problems that we should not manage, but solve, permanently. Homelessness, debt, acute pain, many developmental constrictions/deficits, legal problems, and suicide ideation. None of these things are healthy to manage over a long period of time, and our work should focus on resolution. Two significant problems most addicts need to resolve are lonliness and isolation. The key that lines-up with resolve is:

• Be Connected to Others. Those who live the longest put family and loved ones first. They belong to communities that nurture and protect each other. Many share their spiritual faith in community, and hang out with people that have healthy habits, both physical and emotional. I have written a lot about how the essence of solving the problem of addiction is disconnecting from object-relationships and learning to engage in healthy, intimate connections with people. But to do this very often requires resolving barriers to human relationships. These barriers include unresolved trauma that lead to isolation, developmental stuck points, and debilitating shame and grief. This work is not easy, but necessary for relationships to blossom.

Create
Many who struggle with addiction spend all their time on the pathological side of the equation. Treatments, interventions, fixes, cures, treatments….all intended to reduce or stop addictive behavior. This stuff is important, but at the same time it needs to be integrated with actions that optimize life.  Sometimes taking a break from intervening on addictive behavior and directing energy to what we want out of life can actually produce the outcomes we seek. Those who live in blue zones:

• Have a clear purpose. They call it “ikigai” – the reason for which you wake-up in the morning. If your ikigai is that you don’t want to drink, smoke,  or act-out today, well…this is not a very compelling reason to get out of bed, it just gets you to focus on what you don’t want! The key is redirecting your life energy towards creating what you do want.

For additional information on blue zones, checkout the author’s website: bluezones and the book.

I understand why Beautiful Boy is a #1 New York Times bestseller. It’s a very moving and insightful account of one father’s journey through his son’s addiction, a journey millions of parents have made. David (the author) does not hold back. His writing is powerful, emotional, lucid, and honest. He loves his son Nic to the ends of the earth, there is no doubt about that. Nic is more than just a beautiful boy, he is everything to David. And why wouldn’t he be, he is his son, even when high on methamphetamine and other drugs. At times I laughed, other times I cried. I did not want to be reminded that as a parent there are limits to my ability to protect my son. But it is one of the gifts of the book.

It is often overwhelming reading David’s account of his son’s addiction, and his tireless pursuit to save him. At one point in the book he asks the question: What would you do if a family member were addicted to this drug? He receives many answers from addiction researchers, drug abuse counselors, interventionists, friends, teachers, and members of Al-anon. He leaves few stones unturned, and in the end, realizes that no one person has all the answers. He must decide for himself how to deal with his son’s addiction (and his own addiction to his son’s addiction). I could not agree more. At the same time, I could not help but get frustrated by some of what he was told, and even more, by what he was not told. Here is my answer to David’s question.

Help for David

• I would utilize the Community Reinforcement and Family Training (CRAFT) approach for dealing with Nic and his addiction. When compared to the two approaches most discussed in the book (Al-Anon and doing an Intervention), CRAFT has been shown in clinical trials to be significantly more effective. In one trial, CRAFT resulted in 64.4 percent of addicts entering treatment compared to 22.5  for Interventions and 13.6  for Al-Anon. I would add that if it were me, I would likely skip Interventions, but utilize Al-Anon with CRAFT since there are many positive benefits to connecting with others who are going through similar challenges.
• For family members and friends trying to help an addicted loved one, the end result is most often perpetual trauma. David at one point says, “I have been so traumatized by his addiction that the surreal and the real have become one and the same.” There are many references throughout the book that support the painful fact that trauma pervades not only Nic’s life as an addict, but his father, family, and likely some friends. It is also a sad truth that good trauma therapy is hard to find, and rarely done to any significant degree in substance abuse treatment. For David, who clearly has engaged in a lot of therapy, I would want to explore the degree to which these therapies sufficiently addressed trauma. I have explored this topic in a paper I wrote about treating trauma, as well as in a section about core issues. Understanding trauma and its treatments are as complex as addiction, if not more so. One of my favorite trauma authors recently came out with a new book that I believe should be read by anyone who has experienced trauma, and in my book, that includes us all: 8 Keys to Safe Trauma Recovery. This is tough work, not for the faint of heart. But something tells me that after what David has been through with his son, trauma work would be a walk in the park.

Help For Nic

• David says towards the end of the book, “rehab isn’t perfect, but it’s the best we have.” I am not surprised he reached this conclusion given that when you go searching for help, it is really the only answer. Treatment works. Research says it does, even if you have to go multiple times. And Nic is a testament to this outcome: he goes to many residential (and outpatient) programs and does well for sustained periods of time following treatment before he relapses. I too believe in treatment, but also believe strongly that current treatment practices fall short of what is possible and necessary for long-term success.
• This entire website is dedicated to helping you understand the solution to addiction. My answer for Nic (and David) is summarized in the top five things you should know about addiction and the solution to addiction. David is right when he says in the book that there is no one right path for anyone, but there are specific things that can make a difference in whether a person continues to go through life cycling in and out of treatment, or progresses beyond their addiction.
• For Nic, among the most significant factors that will likely influence his future outcomes is the degree to which his developmental deficits and constrictions are addressed. Among the best frameworks for understanding how to assess development is Stanley Greenspan’s six developmental levels (or stages) of the mind. The deficits and constrictions resulting from early traumas, as well as drug abuse, can be healed over time utilizing developmentally-based psychotherapies. Although meth and other drugs of abuse can result is significant brain changes that impact emotional development, this type of therapy is really the best we have. Unfortunately, in my experience, it is not taught in graduate schools, is completely unknown in residential treatment facilities (and even if it was known, the therapy is done over years, not months or 28 days), and requires significant skill in delivery. It also is the right therapy following trauma resolution work. The good news is that there are some gifted therapists in most places that can do it, it just may require some effort finding them.
• David correctly writes that his son has a chronic, relapsing medical condition that will require long-term care. Yet sadly, it appears that Nic’s care has suffered from our treatment system being a patchwork of acute-based programs, where aftercare is self-help meetings and ”working a program.” Nic needs to stop going in and out of treatment, and instead engage in treatment for many years. The evidence is in the book. When he is in treatment and working his program he does very well, until he stops working his program and relapses. “Working a program” is a 12-step construct that does not include the work I believe is critical to long-term success (see previous bullet point). Staying in treatment for years makes sense when you understand that it is outpatient (not residential), involves resolving underlying drivers of addiction like trauma, is adapted to changes in development over time, and includes the exploration of more than just pathology, like the idea of Me to We. If we are to successfully help people move beyond addiction, we must get outside the black box of traditional addiction treatment and utilize what we know from a variety of fields (e.g., systems science, positive psychology, ecopsychology, education). We can and we must do better, for Nic, and everyone else that suffers.

I want to add that Nic published his own book about his experiences abusing methamphetamine and other drugs, called Tweak. I look forward to reading it in the near future, and hearing his side of the story.

One final comment is related to how David ends the book. He says “I believe we need an all-out war on addiction modeled on the war on cancer.” He goes on to suggest what such a campaign would look like, the funding it would require, and the benefits it could bring. He adds that a research network like that set-up for cancer could test out many promising addiction interventions, including new medications. The good news is that it has been done, and has been bridging the gap between practice and research for many years now. It is the National Drug Abuse Treatment Clinical Trials Network. Check it out.