Instant gratification as a way out of addiction?

Impulsivity is often seen as a hallmark of addiction — acting without thinking about the consequences of your actions and valuing the immediate reward of a drug-induced high over the future long-term payout of a healthy lifestyle. This type of delay discounting has been linked to a greater risk for drug addiction, but new research suggests that this type of “myopia for the future” may also improve someone’s chances of staying sober when they’re trying to get clean.

My latest piece for The Fix investigates the research behind this paradox, which suggests that those who are the most impulsive have the most to gain from effective treatment, cognitive training successfully improving their self-control. But is this effect a result of the treatment program itself or just a regression to the mean? Check out the article here to find out.

The White Stuff

Whether it goes in our mouths or up our noses, we’re drawn to the powdery chemical confectionaries that can both give us pleasure and cause us harm — The White Stuff

I’m very excited to announce a new project I’m launching today on Beacon Reader, The White Stuff, where I’ll be writing about our favorite vices: food and drugs. I’m trying to bring some sense into the ongoing debate about what we put into our bodies, and my goal is to provide unbiased research-based reporting on the latest science and policy news on addiction, nutrition and everything in between.

Beacon is a new kind of journalism platform that, instead of being financed with ads or commissions, lets you fund my work directly. In addition to my own writing, you’ll get access to exclusive content from all of the other amazing journalists on the site who write about politics, technology, global issues, sports and more.

However, I need help getting the project off the ground. In order for the project to launch, I need 25 people to subscribe in the next 14 days. If you like what you’ve read on Brain Study, please help with my new endeavor by subscribing and sharing my project page for The White Stuff (there’s even a snazzy promo video).

I’ll still be writing from time to time on Brain Study, but most of the action is going to be over on Beacon, so if you want to stay up-to-date, please subscribe!

Drug use, decision-making and the blunders of Rob Ford

I’ve got a new piece in The Guardian today on the unfolding debacle that is Toronto Mayor Rob Ford.

His consistent pattern of bad decision-making – including death threats, drunken driving and public boasts about his sex life – have all the signs of problem drug and alcohol use. Substance-dependent individuals frequently show impairments in decision-making abilities, with difficulties in impulse control and executive function, as well as corresponding abnormalities in relevant brain regions.

However, as Mayor Ford has vehemently denied any accusations of addiction, it could just be incompetence.

Check out the full piece here.

Is Oreo addiction a thing?

No. No it’s not.

I wrote last week on the idea of having an “addictive personality“. This was meant in the context of common drugs of abuse, like alcohol, cocaine or heroin, but what about addictions to things other than drugs? Like your iPhone. Or the internet. Or Oreos.

The idea of food addiction is not a new one, and I’ve written on this trend before, both on Brain Study and in real science journals. But a new study released last week takes this claim to a whole new (and unsubstantiated) level, claiming that Oreos – and especially that all-enticing creamy center – are as addictive as cocaine.

I’ve written a rant that’s been published in The Guardian today critiquing the study and stating what exactly is so wrong with the research. I’ve also provided some much better links to articles on the topic.

Enjoy it with a cookie or two, but probably not a rice cake.

Thanks to Torey Van Oot for the tip on this study.

Do you have an addictive personality?

You’ll have to bear with me if this is a bit of a self-indulgent post, but I have some exciting news, Brain Study-ers: I’ve officially submitted my dissertation for a PhD in psychology!

In light of this – the culmination of three years of blood, sweat, tears and an exorbitant amount of caffeine – I thought I’d write this week on part of my thesis work (I promise to do my best to keep the jargon out of it!)

One of the biggest questions in addiction research is why do some people become dependent on drugs, while others are able to use in moderation? Certainly some of the risk lies in the addictive potential of the substances themselves, but still the vast majority of individuals who have used drugs never become dependent on them. This then leads to the question, is there really such a thing as an “addictive personality”, and what puts someone at a greater risk for addiction if they do choose to try drugs?

We believe that there are three crucial traits that comprise much of the risk of developing a dependency on drugs: sensation-seeking, impulsivity and compulsivity.

Sensation-seeking is the tendency to seek out new experiences, be they traveling to exotic countries, trying new foods or having an adrenaline junkie’s interest in extreme sports. These people are more likely to first try psychoactive drugs, experimenting with different sensations and experiences.

Conversely, impulsivity is acting without considering the consequences of your actions. This is often equated with having poor self-control – eating that slice of chocolate cake in the fridge even though you’re on a diet, or staying out late drinking when you have to be at work the next day.

While impulsivity and sensation-seeking can be similar, and not infrequently overlap, they are not synonymous, and it is possible to have one without the other. For example, in research we conducted on the biological siblings of dependent drug users, the siblings showed elevated levels of impulsivity and poor self-control similar to that of their dependent brothers and sisters, but normal levels of sensation-seeking that were on par with unrelated healthy control individuals. This led us to hypothesize that the siblings shared a similar heightened risk for dependence, and might have succumbed to addiction had they started taking drugs, but that they were crucially protected against ever initiating substance use, perhaps due to their less risk-seeking nature.

The final component in the risk for addiction is compulsivity. This is the tendency to continue performing a behavior even in the face of negative consequences. The most classic example of this is someone with OCD, or obsessive-compulsive disorder, who feels compelled to check that the door is locked over and over again every time they leave the house, even though it makes them late for work. These compulsions can loosely be thought of as bad habits, and some people form these habits more easily than others. In drug users, this compulsive nature is expressed in their continued use of the substance, even though it may have cost them their job, family, friends and health.

People who are high in sensation-seeking may be more likely to try drugs, searching for that new exciting experience, but if they are low in impulsivity they may only use a couple of times, or only when they are fairly certain there is a small risk for negative consequences. Similarly, if you have a low tendency for forming habits then you most likely have a more limited risk for developing compulsive behaviors and continuing an action even if it is no longer pleasurable, or you’ve experienced negative outcomes as a result of it.

Exemplifying this, another participant group we studied were recreational users of cocaine. These are individuals who are able to take drugs occasionally without becoming dependent on them. These recreational users had similarly high levels of sensation-seeking as the dependent users, but did not show any increase in impulsivity, nor did they differ from controls in their self-control abilities. They also had low levels of compulsivity, supporting the fact that they are able to use drugs occasionally but without having it spiral out of control or becoming a habit.

We can test for these traits using standard questionnaires, or with cognitive-behavioral tests, which can also be administered in an fMRI scanner to get an idea of what is going on in the brain during these processes. Behaviorally, sensation-seeing roughly equates to a heightened interest in reward, while impulsivity can be seen as having problems with self-control. As mentioned above, compulsivity is a greater susceptibility to the development of habits.

In the brain, poor self-control is most commonly associated with a decrease in prefrontal cortex control – the “executive” center of the brain. Reflecting this, stimulant-dependent individuals and their non-dependent siblings both showed decreases in prefrontal cortex volume, as well as impairments on a cognitive control task. Conversely, recreational cocaine users actually had an increase in PFC volume and behaved no differently from controls on a similar task. Thus, it appears that there are underlying neural correlates to some of these personality traits.

It is important to remember that we all have flashes of these behaviors in differing amounts, and it is only in extremely high levels that these characteristics put you at a greater risk for dependence. Also, crucially it is not just one trait that does it, but having all three together. Most notably though, neuroscience is not fatalistic, and just because you might have an increased risk for a condition through various personality traits, it does not mean your behavior is out of your control.

Oh, and I’ll be going by Dr. D from now on.

Ersche, KE et al., Abnormal brain structure implicated in stimulant drug addictionScience 335(6068): 601-604 (2012).

Ersche, KE et al., Distinctive personality traits and neural correlates associated with stimulant drug use versus familial risk of stimulant dependenceBiological Psychiatry 74(2): 137-144 (2013).

Smith, DG et al., Cognitive control dysfunction and abnormal frontal cortex activation in stimulant drug users and their biological siblings.Translational Psychiatry 3(5): e257 (2013).

Smith DG, et al., Enhanced orbitofrontal cortex function and lack of attentional bias to cocaine cues in recreational stimulant users.Biological Psychiatry Epub ahead of print (2013).

Beating the odds of addiction

An article I wrote for The Psychologist magazine based on my thesis research investigating risk and protective factors in drug dependence was published online this week.

This work all stems from a question I (and countless others in the field) have of why some people are able to use illicit drugs without becoming dependent, while others seem to quickly succumb to addiction.

While we’re still far from answering this question definitively, my lab at Cambridge, headed by Dr. Karen Ersche, has some theories on why this might be the case.

For example, it appears that there are underlying traits, like impulsivity, compulsivity and sensation-seeking, that can put someone at a greater risk for developing drug dependence. Some of these traits also correspond to differences in brain structure and function, such as smaller frontal cortex volume potentially making it harder for people to stop or inhibit a behavior.

If you’re interested in reading more, a full link to the article is here (the magazine kindly made it available open access). So please check it out, and as always I welcome any questions or feedback!

The second piece of chocolate

Imagine you have a piece of chocolate. Unwrap it, place it on your tongue. Savor its decadence as it melts in your mouth; relish the bitter and sweet coating your taste buds; indulge in its creamy texture. As the chocolate dissolves, signals are sent throughout your body. Chemicals are released, reinforcing its rewarding properties and preparing your body for the rush of sugar it is about to receive. You swallow. Immediately you want another piece.

The pleasure of eating is one of our most natural joys, be it savoring a perfectly cooked steak or delighting in that melt-in-your-mouth chocolate. But with the rise of obesity and related maladies – particularly cardiovascular disease, hypertension and type-II diabetes – such simple pleasures have been perverted, pathologized by experts and classed as a source of harm. With nearly 25% of English adults qualifying as obese, and with ensuing costs to the NHS reaching £5.1 billion each year, the UK is facing a self-induced public health pandemic. But how has this happened? And why can’t we all just put down that second piece of chocolate?

Added sugars have become the focus of widespread concern among doctors and researchers, their effects on our waistlines, livers, and even our brains, giving cause for alarm. Obesity specialist Dr. Robert Lustig has emerged as a crusader for the anti-sugar movement, contending that sugar, not fat, is behind the dramatic rise in ‘western diet’ conditions over the past 30 years. The problem stems from the way our bodies metabolize fructose – half of the refined sugar molecule, sucrose – as opposed to pure glucose, which makes up the other half and is found in foods like potatoes and white bread.

Glucose is metabolized by all cells in the body, whereas fructose is primarily processed by the liver. If the liver cannot adequately break down sugar into energy it is converted into fat, and the faster the body receives fructose, the more likely this is to happen. High fructose sugar solutions, like fizzy soft drinks, are particularly prone to this fat conversion, providing high volumes of fructose that reach the liver much more quickly. This inability to break down sugar and the subsequent rise in liver fat is believed to be at the root of insulin resistance, the main deficiency underlying type-II diabetes.

But regardless of doctors’ warnings and the evidence that increased sugar consumption leads to obesity, as well as liver and heart disease, our sugar intake continues to rise. This may be due to the seemingly addictive qualities of high-sugar foods themselves. For despite our best intentions to cut out the cake, doing so rivals quitting smoking in terms of difficulty. New research indicates that foods high in fat or sugar may qualify as addictive substances, causing similar neurochemical changes in the brain as drugs of abuse.

Researchers at Princeton University have demonstrated this phenomenon by intermittently exposing rats to a sucrose solution in addition to their regular food. After a month, rats began to show binge, craving and withdrawal-like behaviors for sucrose, self-administering extremely large quantities when it was available. Adaptations similar to those seen in cocaine-addicted animals emerged in the rats’ brains, with surges of dopamine released during a binge – a process linked to feelings of reward and novelty, and a key facet of drug addiction. An increase in craving was also seen in the test animals, demonstrated by greater sucrose-seeking when deprived of the solution, even in the face of punishment. Additionally, rats experienced withdrawal-like symptoms when the sugar was removed, exhibiting tremors, head-shakes and signs of anxiety and aggression. Such behavior is typically seen in animals going through opiate withdrawal, and is caused by the release of endogenous opioids in the brain by high-sugar foods, reinforcing their hedonic characteristics and creating a withdrawal effect when removed.

Given sugar’s apparently addictive properties, one proposed response to the obesity epidemic is to regulate its availability in much the same way as tobacco and alcohol. Labeling foods high in sugar and fat as ‘addictive’ could potentially remove the stigma attached to being overweight, re-characterising it as a complex medical condition rather than simply one of personal weakness and poor self-control. Furthermore, tougher regulations on the advertising and availability of junk food might help to reduce the proliferation of cheap high-fat/high-sugar snacks that has made diet control increasingly difficult. However, taking responsibility for diet out of the hands of individuals also diminishes personal accountability and the imperative for each of us to make positive food choices. The fast food industry certainly isn’t helping us to lose weight, but it’s also not forcing the food down our throats. Should we be trusted to control what we put into our bodies, or do we need someone to stop us from taking that second piece of chocolate?

*So this post is a bit cheeky. I originally wrote this as a submission for a writing competition, but seeing as how it was never published, I figured it made an apt piece in honor of New Year’s resolutions!

(Thanks to Paul Sagar for help in editing the original piece.)