On neural plasticity.

On neural plasticity.

After discussing several forms of parasitic mind control during our poetry class in the local jail, somebody asked – somebody always asks – whether there’s some sort of parasite that makes people want to use drugs.

A few guys looked down at the table and nodded.  People are in there for a variety of reasons – domestic violence, burglary, DWIs, dealing or possession – but no matter the charge, many of the guys in jail were dealing with substance use that got out of hand.

I gave the same answer as always.

“Drugs do it on their own.  Chemicals can remodel your brain to make you want them again.  Like cocaine, it’s a dopamine re-uptake inhibitor, so if something makes you happy after coke, it’ll make you more happy than it would’ve … but your body responds by down-regulating the receptors, and then you’re stuck feeling less happy all the time unless you take it again.”

1024px-Crystal_Meth

But it’s not all bleak.  Drug addiction takes hold because the brain is plastic – our minds change and we want that rush again, potentially to the exclusion of all else – but neural plasticity allows people to recover, too.  Dopamine receptor levels fall during periods of excessive drug use, but they’ll rebound during sobriety … and this rebound should attenuate the desire to use again.

Dopamine_D2_Receptors_in_Addiction.jpg
Repeated exposure to drugs depletes the brain’s dopamine receptors, which are critical for one’s ability to experience pleasure and reward. From Wikimedia Commons.

(Unfortunately, the lecturers in our area’s court-mandated rehab courses have been telling people that, “After you take methamphetamines, it takes eight years of sobriety before your dopamine receptor levels come back.”  This sounds wrong to me – I don’t know the half-life of dopamine receptors, but the timing of sensitization and de-sensitization in conditions like bipolar disorder and antidepressant-induced mania suggests that it’s on the order of a month or so, not years – and it’s definitely unhelpful to say.  If you’re trying to help someone quit taking drugs, you want their goals to be feasible.

A former co-teacher tattooed “Day By Day” on his arm because quitting forever seemed impossible, but getting through one more day without drugs sounded like something he could do.  He’s now weathered five years of single days.  But if I felt like garbage and an instructor told me, “You’ll only feel like this for eight more years!”, I’d give up immediately.)

I don’t really understand Scientology – all my current knowledge comes from a single episode of South Park and a few minutes spent skimming through the Wikipedia article – but I was intrigued by the practice of using “E-meters” to measure a person’s cognitive development in the faith.  It made me wonder whether the sort of person who was interested in biofeedback and numerical metrics – somebody who tracks steps with a Fitbit or the gasoline saved on a Prius console – could use self-administered polygraphs for cognitive behavioral therapy.

800px-Scientology_e_meters_green_black_cropped
An E-meter.

It’s well-known that polygraphs are fallible – you can fail them when you’re telling the truth, and you can learn to pass them while lying – but I imagine that the easiest ways to pass a polygraph is to convince yourself that whatever you’re saying is true.  There many physiological correlates to dishonesty – skin voltage, electroencephalogram patterns, eye movement, vocal tones – and by convincing yourself to earnestly believe whatever you happen to be saying, you could pass any of them.

Because you can cheat, U.S. courts generally don’t trust the results of lie detector tests.  In the pursuit of justice, cheating would be bad.  But as self-administered therapy, cheating is the whole point.  You cheat at lying until the lie becomes the truth.

“I like myself and I am worthy of love and self-respect.”

Rig up your polygraph and say something like that until the machine stops dinging you.  Do it daily.  Your brain is plastic, designed to learn and change.  Your words will become true.

On psychedelic drugs as medicine.

On psychedelic drugs as medicine.

We are creatures of habit.

learning_to_walk_by_pushing_wheeled_toyLife would be excruciating if we were not.  Can you imagine: consciously remembering to breathe every few seconds?  Concentrating with the intensity of a toddler each time you stand and walk across a room?  Carefully considering the rules of grammar and conjugation when you stop to ask someone for directions?

Our brains zip through so much unconsciously.  Most of us can drift into reverie while driving and still go through all the motions correctly, stopping at red lights, making the appropriate turns, our mind set on autopilot.

We live, and we learn, and our brains constantly change – neurons reach out to form synaptic connections to one another.  Other connections wilt away.  The resultant network determines who we are.  More precisely, the pattern of connections determines which thoughts we are good at having.  Thoughts we’ve thunk before come easily.

But our propensity for habit can hijack our lives.  In David Foster Wallace’s Infinite Jest, viewers of the highly-addictive titular film are unable to think of anything but watching it again.  One taste and you’re hooked!

otto_wegener_vers_1895_2Or, in an example closer to most humans’ experience, Marcel Proust writes of the way our shared experience with a lost love causes the brain to ache each time a similar experience must be forded alone.  Over and over we hurt: going to sleep alongside her was a habit.  Chatting in the evening was a habit.  Walking to the store hand in hand was a habit.  The brain is still wired such that it could effortlessly zip through these tasks, but… she is gone.

In an example that is – unfortunately! – increasingly relevant today, William Burroughs writes that powerful opiates do not hook users right away.  It takes many recurrent episodes to rewire the brain.  In his (overly cavelier) words:

4306771895_1eda6d6e9d_z
Painting by Christiaan Tonnis.

The question is frequently asked: Why does a man become a drug addict?

The answer is that he usually does not intend to become an addict.  You don’t wake up one morning and decide to be a drug addict.  It takes at least three months’ shooting twice a day to get any habit at all.  And you don’t really know that junk sickness is until you have had several habits.  It took me almost six months to get my first habit, and then the withdrawal symptoms were mild.  I think it no exaggeration to say it takes about a year and several hundred injections to make an addict.

. . .

You don’t decide to be an addict.  One morning you wake up sick and you’re an addict.

And then, depression.  To perceive the world a shade darker than it ought to be comes easily… to someone who is depressed.  A depressed person’s brain has been rewired through perhaps a lifetime of rumination and pain.  Suicidal ideation gets easier and easier and easier… unless it goes too far, and then it becomes impossible.  Dead matter doesn’t think.

thenightmare
The Nightmare by John Henry Fuseli.

Cognitive behavioral therapy attempts to use the brain’s own habit-forming capabilities to battle depression.  Because today’s depressed thoughts enable tomorrow’s depression, a conscious effort to find joy and beauty today could ease tomorrow’s struggle.  Phrases like “virtuous cycle” are bandied about.

My wife, each evening, asks me to list four good things that happened during the day; if we forget the ritual through a harried week or two, it’s difficult to start again.  I lay in bed, pondering, “What was good about the day?”  Which should always be easy.  I have two loving children whom I am graced to spend time with.  I am not in jail.  I have a warm, safe place to sleep.  I have enough to eat.  I live near phenomenal libraries.

But the habit of depression digs the mind into a rut.

lsd-clinical-trial-bottleWhich has caused several researchers to wonder, “Would cognitive behavioral therapy work better if a patient could be jolted out of the rut first, then trained in a new virtuous cycle?”  We have access to several potent chemicals that wrest the brain out of its routines.  Psychedelic drugs like lysergic acid diethyl amide, dimethyl tryptamine, and psilocin are powerful beasts.

Which is not to say that, if you’re feeling sad, you should go find that raver dude you know and ask what he’s holding.  For one thing, most psychedelics are illegal in the United States.  This contributes to the dearth of high-quality clinical information about their uses – obtaining permission to run clinical trials with Schedule I compounds is difficult, and drugs can’t be downgraded from Schedule I status without reams of data from clinical trials.  Nonsensical bureaucracy at its best!

Plus, high-quality clinical trials must control for the placebo effect – neither patients nor doctors should know whether an individual is receiving the treatment or a control.  But I’m guessing most recipients recognize the difference between an injection of DMT or saline.  Did your visual field suddenly fragment into geometric patterns?  Did you feel an out-of-body sensation akin to alien abduction?  Did your memories begin to unfold like interlocking matryoshka-doll puzzle boxes?  Those are sensations I rarely experience from salt water.

LauretaAnd the sheer power of psychedelic drugs also makes them dangerous.  Dr. Lauretta Bender, whose least harmful contribution to science was the idea that emotional disturbances could be diagnosed by asking a child to reproduce pictures of geometric shapes, assumed that LSD would cure autism.  If she’d been right, this sort of baseless cognitive leap would’ve been heralded as brilliance.  She injected large doses into the muscles of children as young as five.  Daily.  When that “cure” proved insufficient, she combined it with electroconvulsive therapy: high currents to overwhelm their little brains.

Enforced acid trips in nightmarish environs of total control can ruin lives.

Especially since Dr. Bender was diagnosing autism in routinely-abused orphans based on symptoms like “avoids eye contacts” and “difficulty forming trusting relationships.”

5009548522_6701801dcb_oAcid trips can end lives, too.  At least one involuntary research subject ensnared in the CIA’s efforts to use LSD as mind-control reagent committed suicide.  And there are innumerable horror stories of murders committed by people mired in psychedelic trips.  Then again, most murders are committed by people who haven’t taken psychedelics.  In Ronald Siegel’s Intoxication he writes that:

Many bad trips are a function of personality; not everybody is a good subject for a mind-altering experience.  And even experienced users can have a bad day.  … Harold, a veteran of one thousand LSD trips, wanted to volunteer to be a psychonaut but he had a history of violence, both on and off the drug.  “Ever since I was small,” confessed Harold, “I go ape when I’m bothered.”

.. [a grim description of Harold murdering two hikers outside Santa Barbara in 1984 follows.  Yes, Harold had “drank some beer, smoked a little marijuana, and swallowed a few amphetamine tablets along with a full dose of LSD.”  But he’d also “been bothered by financial problems.  He was passing bad checks and had failed to make child-support payments to his ex-wife.”  So I’m not sure the drugs were at the root of his malaise.]

Cases like Harold’s tend to confuse the issue of intoxication and violence.  Violent people are often intoxicated but the violence is usually rooted in the personality, not the drug.  . . . What seems difficult for us to understand is that despite overt behaviors, the subjective experience can still be fun.  In other words, one’s inner feelings and sensations can be under the influence but such influence may not extend to outside acts in the real world that remain chillingly sober.  This is most difficult to accept if users are obviously intoxicated when they commit criminal acts.  The subjective intoxication can remain an enjoyable experience, despite our desire to blame the fires inside for the destruction outside.

Used incorrectly, psychedelic drugs are awful.  They disrupt habits, seeming to dissolve the mental filters that allow humans to function despite constant bombardment by thoughts and memories and myriad sensations from the world.  This newfound wonderment & reset can help, of course, but for someone in a bad place, it can be horrible.

mdma1Then again, for someone with post-traumatic stress disorder, the world might be horrible already – even if the chance that psychedelics could help were low, they’d be worth investigating.  Thankfully, the FDA finally granted permission for a trial to be run on the use of methylene dioxy methamphetamine (ecstasy – when I was a TA for undergraduate organic chemistry at Stanford, I wrote most of the quizes.  After they learned about acetal protection of ketones, all 200 or so pre-meds wrote out a partial synthesis for MDMA.  The reactants and products were unnamed, so I don’t think the students or the other TAs noticed) to treat PTSD .

In other experiments, LSD and psilocin seem to help terminal cancer patients overcome depression.  Ayahuasca is also being tested as a treatment for depression and those seeking to quit substance abuse (peyote has long been used for the latter), although these studies are far from the FDA clinical ideal.

Many people, as they live, drift into routine and no longer consider the implications of their actions.  I’m well aware that drugs can wreck lives, but sometimes we need a jolt.  I wish people weren’t shunted to jail for drug addiction – and obviously the dudes in there wish they were almost anywhere else – but a surprising number are grateful that something interrupted their habits.  Junkies don’t want to look back on a wasted life, either.

pills-750x400I’m not super keen on the rich & entitled using psychedelics for fun & games, and psychedelics certainly should not be used often.  But these molecules, treated respectfully, can heal damaged lives.

Even in the ostensibly healthy, psychedelics can do good.  Does the way you choose to spend your time benefit the world?