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Quick: What do you get when you mix a Nobel Prize winner with a MacArthur genius? You get this: “The claims of some heavy drinkers and smokers that they want to but cannot end their addictions seem to us no different from the claims of single persons that they want to but are unable to marry or from the claims of disorganized persons that they want to become better organized.” Yes, Gary Becker and Kevin Murphy, in the rich tradition of University of Chicago Economics, believe that much-if not most-of human behavior can best be understood by assuming that people are behaving rationally, to maximize their best interests. Unemployment? A rational choice according to another Chicagoan, Nobel winner Robert Lucas: “To explain why people allocate to unemployment, we need to [know] why they prefer it to all other activities.” Addiction? Also a rational choice. Thus, even though many addicts are miserable, this misery doesn’t mean that their use of heroin or crack is irrational. As Becker and Murphy put it: “People often become addicted precisely because they are unhappy. However, they would be even more unhappy if they were prevented from consuming the addictive goods.” Why should any of us care that a particular school of economic thought considers human beings to be largely rational? Because this same school of thought has, by no coincidence, been home to some of the most prominent libertarian thinkers of the last century-people like Friedrich Hayek and Milton Friedman, men whose ideas have influenced politicians around the world. Convinced that people are largely rational, these influential thinkers have argues that we should severely limit the scope of government and rely on the power of free markets to maximize people’s best interests. After all, if people are largely rational-if they know what’s in their best interests and possess the willpower to act upon this knowledge-then the best any government can do is to step aside, and let them pursue the good life. As a physician trained in behavioral economics, I cannot reconcile either my clinical experience or my research findings with a view of addiction as being completely rational. True: if the price of heroin rises dramatically, people will use less heroin. Some people won’t take up the habit. Some hard core addicts will try to cut down their use, or will switch to other drugs. In other words, there is some rationality to the behavior of drug addicts. But as readers of this website no doubt recognize, there is also some desperately irrational behavior contributing to the actions of drug addicts. Why does this matter? Simple. The more convinced we are that human beings behave in ways that promote their own best interests, the less we should look to the government to protect our interests. If crack makes people happy, we should allow people to use it. No rules, no regulations. If people want to take out mortgages that are beyond their means, and if lenders want to give them such mortgages, the government should step out of the way and let the market place punish anyone that makes bad decisions. If a twenty-year-old doesn’t want to buy health or disability insurance, and experiences a crippling automobile accident, we should step aside and let her experience the consequences of her decision. But if you, like me, believe that human nature is a mixture of rational and irrational forces-if you recognize that we consumers are often prey to manipulation by people who know our weaknesses-then you will be open to exploring ways the government can help us make wiser decisions. Trust me; I’m not talking about big brother. I’m ecstatic to have grown up in the USA rather than the USSR (okay, my wife disputes that “grown up” part!). But cigarette taxes? Free market enthusiasts think they are a bad idea. Tax dollars to help drug addicts go through rehab? Market evangelists don’t to approve of that either, especially if, as Becker and Murphy say, crack is making these people happier. Government dollars spent on anti-obesity programs? Why do that when, according to some Chicago-based scholars, the term “overweight” is a misnomer, since people have rationally decided how much they want to eat and exercise. In this world of perfect rationality, no one is overweight, because everybody has achieved their ideal body mass. We need to be very careful about adding any layer of government bureaucracy to our lives. But we should be equally careful about stripping away government regulations, when such regulations promote our best interests. Our policies need to recognize that we humans aren’t always as rational and strong willed as we’d like to be. To learn more about my new book, Free Market Madness , check out my website: http://www.peterubel.com/ .

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Heroin and Happiness

If you hold a small water balloon between your two hands and squeeze one side, the water has to go somewhere. This is a lovely global metaphor, as it is perfectly descriptive of the human experience. If we have a pattern of behavior and we clamp down on it without actually addressing its genesis, as well as its applicability or necessity in our lives, it tends to come out sideways. What this speaks to, in part, is our degree of mindfulness. If we are paying attention, we understand where things start and where they have the potential to go. Should we have a trying day at work and don’t shake it off, someone is going to get the brunt of it. If we are irresponsible — intentionally or unintentionally — and suffer the consequences of that irresponsibility, we are likely to act out our frustration in some way, even though that frustration is, ultimately, with ourselves. And so it goes. Without attending to our lives and our experience, we lose the equanimity that provides us balance, as well as a sense of control and safety. Without attending to the underlying patterns of behavior that create, and therefore drive, our lives and our experience, we can end up constantly spinning in repeated patterns of behavior. Scenario 1 : A client of mine is driven by a compulsive need to "fill a space" that he feels in his life. That space has, over the years, been filled with productive, non-productive and destructive things, but, no matter their character, those things become consuming for him. On the productive side, we have a man who never finished high school getting a GED, going back to college and getting a Bachelors degree, then a Masters, all in record time. On the non-productive side, we have a man who has spent hours on the Internet surfing for collectables on E-bay. On the destructive side, this compulsion to "fill the void" has led to a pattern of serial addiction and all its attendant behavior that ranges from alcohol, to pain meds, to gambling, to spending, to porn, to an emotional affair. What has never been addressed by this fellow is the sense of lack or emptiness; what I have often referred to as the " God-shaped hole ". Productive, unproductive or destructive — the lack of redress regarding the underlying issue continues to prompt the obsessive-compulsive complex that prompts his addictions, which persist unabated. Scenario 2 : Another client of mine has been sober for 17 years. He came to me for some career counseling and, during the course of our conversations, his father, who had been ill, began to decline toward imminent death. My client confided in me that, when he went to Hospice to speak with his father, he would drink a nip of Vodka and a beer before going inside. He was quick to point out that he was not drinking in any other circumstance and that his drinking was confined to the nip and the beer. His father died and he stopped drinking that day. That was 3 years ago. In the first case, the individual is not attending to his underlying patterns of behavior, and, in clamping down on them or completing a cycle of activity, the obsessive-compulsive complex that is the mechanism for soothing his sense of emptiness pops up somewhere else – there’s the water balloon. In the second case, the individual had learned a number of effective coping mechanisms that disallowed his engaging in the numbing/avoiding behavior of his addiction. When confronted with a situation that was too overwhelming for those new coping mechanisms, he fell back on old behaviors. But when the situation ceased to be an issue, those old coping mechanisms were taken out of play. That’s not the water balloon – it’s a conscious act. This circumstance is not confined to addictive behavior – these examples were both convenient and coincident – but is reflective of all instances where an underlying template or pattern comes into play for us repeatedly, to whatever effect. The key for us is attending to the cycles, responses, reactions and self-created circumstances that define our experience. The "take away" here falls back on the old adage of forensic psychology that says, " The way that people do one thing is the way that they do everything. " What this intones is that people are nothing if not consistent.  If we are to evolve and change, we need to be introspective, mindful and attentive to our patterns, templates and cycles of behavior — as well as the genesis of our actions — bringing all of this under the umbrella of mindful and conscious control, rather than letting those things run free…and run us in the process.   © 2009 Michael J. Formica, All Rights Reserved My Psychology Today Therapists Profile My Website Email Me Directly Telephone Consultations   © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Mindfulness and Unaddressed Patterns of Behavior

Addiction is like the tail wagging the dog, or person, with the tail being a habit that dominates the person’s whole life. Addiction therapy concentrates on the tail – cutting it off in abstinence therapy, making it smaller in behavioral treatment. But the real task is for the person to build a life – body and soul – that can’t be wagged by even a very powerful tail. Here are the five elements to effective addiction treatment and successful recovery: 1. Tapping values . Traditional treatment involves cajoling, convincing, or coercing people to quit the addiction – often by dictating to them what their values should be. Successful treatment – like motivational therapy – instead encourages people to discover personal values that will anchor them against the pull of the addiction. Sometimes these countervailing values are quite evident in people. Sometimes deep exploration is required to find and resurface them. When addicts in Moments of Clarity see their true selves in visions or in coffee cups, it simply means they’ve make contact with their own value structures. Reconnecting to their core values makes it much more likely that people will maintain their recovery. 2. Savoring rewards . To get through the immediate recovery period the person has to appreciate the benefits sobriety brings – better health, more productivity, gratitude of family and friends. People must refocus to see the deep background to their lives rather than the immediate stimulus of the addiction. Successful treatment and recovery involve learning how to focus on these rewards and to savor them. 3. Enhancing resources . People already have resources in their lives – families, skills, experiences – like the ones James Frey relied on to create a new identity as a writer after his treatment. Some people have more resources than others for this task – good educations or job skills, strong families, rich experiences in dealing with the world – resources they often seem bent on ignoring or even destroying. Others need to develop essential skills – through further education, skills training (e.g. communication skills), family therapy, etc. – to add to the solid life foundation they will need. 4. Finding meaning . People need to be motivated to proceed with their lives. This requires something more than just getting to the end of each day. It means uncovering deeper purposes in life – spiritual or altruistic or artistic or professional or family goals. Investing life with greater meaning allows people to shrug off the momentary discomforts or challenges that otherwise could drive them back to addiction. 5. Touching base . People need to recall the rewards from – and their motivations for – achieving sobriety. Research finds that it is often not the kind of therapy that matters as much as continuing contact with the client. Thus, successful treatment touches base regularly with graduates – even if only briefly and at intervals – to rekindle the spirit, the methods, and the goals of recovery. These five key elements in successful therapy and recovery all contribute to a fulfilling, self-sustaining life. Indeed, recovery isn’t about successful therapy, or kicking a habit, or belonging to a support group. It’s about getting a life. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Real Recovery Requires Life-Building

The physical world we have created and within which the incidence of depression is most rapidly rising is the densely populated Western city. It is made of concrete, steel, glass and asphalt. Most of us breathe hydrocarbon polluted air, eat nutritionally harmful or vacuous food (see your local fast food menu or supermarket tomato or strawberry for details), and drink plasticized bottled water. The National Institute of Health is studying over 900 new-to-nature chemicals, thought of as hormone interrupters, to see what effect they have on us. If we are fortunate, we may have an ocean retreat from the man-made. If we are less affluent we may make special trips to connect to nature, be it at the zoo, or the botanical gardens. But for most of us in most of Western civilization, nature is absent from our daily life. We and nature are strangers, distant relatives, and therefore we have become estranged from an important and deep aspect of our own natures. We do not, in a personal sense, understand nature as Thoreau came to, when he was at Walden Pond. I experienced this for several years as an avid mountain biker. Year after year I would bike the same trails. I was foolishly surprised when, after a winter away, the forest had changed. Year after year, bit by bit, storm by storm. I began to notice the death and new growth, the re-working of the bike trails around natures events. Most of us do not know, in our bones, the slowly changing rhythms of the forest, through the seasons, and year after year. We can only see time passing in the faces of our loved ones, or the mirror, but we do not experience the naturalness of the passage of time via a changing, slowly morphing landscape around us. We have lost the mirroring experience which the natural world provides us around the experience of time, the naturalness of it, as we might experience, if we lived connected to nature. And so we are left with an experiential void which is filled by a tremendous existential aloneness and anxiety about the strangeness of death, which seems quite disconnected from our lives, and therefore fails to inform our lives with meaning and value. We are no longer chaperoned through the stages of our lives by nature. And so we cling to youth, attempting to freeze time. In the purely physical universe, where there is no inherent meaning, and no dialogue with nature, we seek solace in the physical. We buy what we don’t need, because it is supposed to make us feel good. We work harder to buy more, because it may make us feel better. Safer. In the process, we become alienated from our families (too much time at the office, too much pressure on performance which translates into money and purchasing power and ultimately, safety from financial anxiety), our coworkers (who are generally viewed as competition). Furthermore, as a culture, western society seems to have lost its center, and seems disoriented, and without a higher purpose. The capitalistic ethos seems to have replaced a constitutional, higher purpose or imperative. And finally, we, as a society remain largely unconscious of the issues I have raised above, about our effect on other cultures, and on our planet. In the last 90 years, two world wars, multiple holocausts, threatened nuclear annihilation, and now a massive global imbalance are in the consciousness of each person on the planet. It is all very real, yet we, as individuals, as political parties, as families, communities and as a culture, are quite willing to be unconscious of the clear evidence that our current approach to human existence is failing. What is often said to alcoholics-the definition of insanity is doing the same thing over and over again and expecting a different result-can certainly be applied to Western civilization. Perhaps, with the current economic crisis, we have ‘hit bottom’. And so, to circle around to the point at hand-if one is living in a fundamentally imbalanced and insane culture, is it surprising that greater and greater numbers of individuals are presenting with depression? Should we be so myopically focused on the individual? Is that individual focus not part of the reductionsitic thinking that has limited the effectiveness of the current treatment approach? Can and should the individual carry the full burden for recovery from depression? It seems that on a collective level, higher numbers of depressed non-functioning individuals are already causing a braking, or a negative feedback loop to the growth of the culture, via excessive health care costs, comorbid conditions such as diabetes and heart disease, and reduced viability of the individual, the family unit and therefore the community-all known sequelae of depression. If we can learn about and understand the links between the brain and the immune system, and between diet and mood, must we not wonder about the links between the culture and individual behavior, between the stresses of Western psychology and the craving for something to satisfy the inner emptiness? Is there not then a link between this craving, and the purchase of material goods (and the attendant stresses of paying for them), just as there is between the intake of sweets and the subsequent inflammatory response? Ultimately, reduction of the incidence and prevalence of depression on the public health scale will not come from anti-depressants, individual psychotherapy, or from fish oil. It will come from a re-connection of the individual with the larger whole of the family, the community, a purposeful culture, and a dialogue with nature and meaning. This will require a rebalancing of the male-dominated, individualistic, domination oriented culture (in which reason and logic are the only way of knowing) with the feminine, wholistic, interactive and participatory approach to life. We, as human beings need a balance of both to thrive. Socioeconomic and political efforts to incorporate such an integrated view of ourselves, the world and our futures are the therapy which this culture requires, if we are to stem the rising tide of depression. In the many older cultures (e.g., Jewish, Indian), the collective community is responsible for the well-being and good behavior of the individual. So too, must the larger Western society and culture be held accountable for its role in the mental health and wellbeing of individuals. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. 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The Culture of Depression: Nature, Materialism, and Depression

I have created this blog to increase awareness about high-functioning alcoholics (HFAs) and to help to change the stereotype of the "typical" alcoholic. Alcoholics all suffer from the same disease, but it manifests in different ways. The homeless person and the high-powered executive can both be alcoholics-alcoholism does not differentiate among socioeconomic class, race, education level and appearance. However, because the HFA has the ability to perform and succeed, the treatment often comes too late or not at all. This blog came to fruition as a result of my book Understanding the High-Functioning Alcoholic: Professional Views and Personal Insights to be released March 1, 2009 ( www.highfunctioningalcoholic.com ). Professionally as a therapist, I hope to help others make sense of their own alcoholism or that of a loved one, because they do not fit the "skid row" alcoholic image that remains so pervasive in our society. I want to show that being successful and being alcoholic are not mutually exclusive, but that HFAs need help regardless of their seeming exterior success and functioning. My aim is to help end the denial that so many HFAs and their loved ones have, because these individuals are able to succeed in so many areas of their lives. Personally as a sober alcoholic, a blog such as this and my book are something that I could have used throughout my recovery. I welcome your feedback, questions and discussion around this topic. It is through our stories and truths that lives may be touched and hopefully the seeds of change will be planted. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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The High-Functioning Alcoholic: Blog Goals and Intentions

Aside from being a psychologist in nursing homes, I also had the pleasure of being a caregiver to my own aging parents–as a consumer of the same services I provide, the personal meets the professional. I work both sides of the streets. My father spent the last years of his life in a nursing home descending into deeper and deeper dementia. It’s time for the quarterly care plan meeting at Dad’s nursing home. My father, who has a right to be there, is not there. He wouldn’t have a clue. I’m sitting at a table squeezed into an office not meant for conferences, fiddling with my cell phone. My brother, Robert, attends via speakerphone. I chat up a nurse about her golf game. This is the functional equivalent of a parent-teacher conference. We’re going over the functional equivalent of a report card. The golfing nurse–the care plan coordinator–chairs the meeting. Every three months, each of the departments files a report for Dad’s chart. Usually the staff moves along the agenda along minus the impediment of family, like my brother and me. First up, the dietitian. But before she begins, we hear an impediment from Robert on the speaker. "I was in town from Boston last weekend, and there was a banana on my dad’s lunch tray." Dad’s kidney has been slowly failing for most of his adult life–slowly enough so something else will likely kill him first. But bananas and other high potassium foods are poison. He loves bananas. "Sorry, I’ll look into it," says the dietitian. I’m personally not at the top of the charts when it comes to caregiving time; I’m not spending hours a day or even every week with Dad, but I worry about the bad kidneys of residents whose families never show up. The doctor never attends care planning. Unlike the nurse, he might be actually golfing. A nurse drones on about Dad’s vital signs and the ups and downs of his meds. There’s no physical therapist, either. My dad has "plateaued." There is no hope of additional progress for his fractured hips. Medicare won’t pay for plateaus. Exercise would still be good for his hips, but he’ll have to get someone other than Medicare to pay for him to walk across a plateau. Pushing ninety, he’s a Medicare orphan. My brother and I pester the recreational therapist and the social worker about exercise, having the aides walk him. This is when we get the lines about staffing shortages, and how he doesn’t want to go on walks, anyway. Neither does he want to go to recreation. "Forget about his rights and just wheel him down to the damn sing-along!" I implore. They write that down. Reminds me of the patient who asked, "Do you write down everything I say?" "What do you think?" I ask, as I write that down. For those who remember Lawrence of Arabia, "Everything is written." Maktub in Arabic. You may think you’re in something like a home, but you’re a 24/7 patient for the rest of your life. It is written. Maktub . To mix metaphors. Sysiphus has nothing on me. *                                           *                                            * This post was adapted from my forthcoming book, Nasty, Brutish, and Long:Adventures in Old Age and the World of Eldercare (Avery/Penguine, March 2009). © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Maktub: It is Written

A famous poster released by the National Institute on Alcohol Abuse and Alcoholism depicts a range of people from every kind of background and claims that each represents the "typical alcoholic." The point: there is no typical alcoholic and, by extension, everyone is equally susceptible to alcoholism and addiction. Unfortunately, the science of epidemiology knocks this idea for a loop. But we don’t need epidemiology to tell us what everyone already knows.  Do you believe that Native Americans living in poverty are no more likely to become alcoholic than doctors? Really? Have I got a bridge to sell you – or else, you can become an addiction and alcoholism expert.  These worthies tell us that, since addiction is a disease, it can just as readily befall people in any social situation. In fact, the reliable ways social factors predict addiction and substance abuse prove addiction is not a disease. "Well," you say, "there are more drugs in poor neighborhoods, and that’s why there is more addiction in these places." Really? Have I got a National Survey on Drug Use and Health for you. The better-educated you are and the higher your socioeconomic status, the more likely you are to drink, but the less likely you are to drink unhealthily. And kids from better-off economic backgrounds are at least as likely to use drugs as kids in poor neighborhoods. People with more control of their lives don’t avoid substances – they control their substance use. It really is Psych 101. Yes, successful, smart people succumb to addictions. And don’t we love to read about them! They prove that "perfect" people are not perfect. But, more often than not, being raised under comfortable economic conditions, growing up in an in-tact non-violent family, doing well in school, living in a good neighborhood, not having a major emotional issue – you’re unlikely to be sidetracked by substance abuse and addiction. And the opposites of all of these characteristics are risk factors for addiction. As I point out in Addiction-Proof Your Child , everyone in school knows who the high-risk children are – that’s why they’re called "high risk" – the ones who don’t fit in, who have troubled home lives and their own emotional problems, who get poor grades and don’t participate in school activities, and who early on get in trouble with authorities. "Now, wait a second," you say – "that sounds like me as a kid, and I turned out fine." Really? You had a bad economic and family situation, poor study habits, frequent emotional distress, no constructive interests? This last distinguishes many who fall outside the high-risk pale. If you had a strong motivation to pursue something as a kid, you were the opposite of high risk.  This is why any good school administration will encourage whatever positive predilections kids exhibit, even if they’re not the kind that lead to careers in medicine, law, or nuclear physics. You only need one strong set of skills and interests to build a life. But even if you don’t translate a childhood interest into a career, it teaches you to focus and to marshal your resources in ways that provide lifelong lessons, values, and skills. Why do addiction experts love to tell us the opposite of what every school teacher – every sensible person – knows is true? We’ve already seen that they want to sell us a bill of goods. But the delusion that addiction is unrelated to an individual’s social and personal resources is critical because it causes us to misallocate our resources in worrisome ways. For example, United States government agencies are now honeycombed with addiction prevention and treatment programs. Who would vote against more addiction programs? But these programs and expenditures come at the cost of downplaying fundamental job training, housing support, education, skills training etc. – programs which address the foundation for non-addicted lives. We are actually systematically undermining the basis for preventing addiction in our society with our focus on addiction! I know what you’re thinking – I must have been one of those high-risk children who didn’t get along in school. Ask me one night when you catch me in a bar, and I’ll tell you all about it. © 2008 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Lies Addiction Experts Tell, #1 — addiction is an equal-opportunity despoiler

The other day I was teaching a whole passel of high school students about cocaine and the brain. I usually give them choices about what they want to hear about, and they ALWAYS pick cocaine. I was so happy when someone picked anxiety disorders I must have looked like a total geek, but seriously, I’ve given that dang coke talk at LEAST 100 times. I suppose it is perfected by practice. Anyway, I’m talkin’ along, and I’m telling them that we think that dopamine is responsible for the initial reinforcing (making you want to do it again) and stimulating effects of cocaine (in a very simple way, of course). And it occurred to me, how do we KNOW that? I was taught this as a little first year like it was gospel, and in my field (with exceptions), it is. Of course dopamine isn’t the whole story, but the peak in dopamine after that first ht of cocaine is what you look for when you study cocaine. It’s the confirmation that your drug is there and that it’s working. And who found this out? And how? I went to the history. And I didn’t have to go very far back. Addiction has been a known phenomenon for hundreds, if not thousands of years now, but the study of it, the neurons involves, the chemicals, and the rats pressing levers, has only been around for about 30 years or so. I went back to 1977. Roberts et al. “On the role of ascending catecholaminergic systems in intravenous self-administration of cocaine.” Pharmacology, Biochemistry, and Behavior, 1977. Read the rest of this post… | Read the comments on this post…

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‘Historical’ Science: Cocaine and Dopamine [Neurotopia (version 2.0)]

Seriously… I’m totally amazed. I’ve seen pigeons play ping pong (well more like real life pong). But this is amazing. Check it out: Read the comments on this post…

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The worlds smartest mouse [Of Two Minds]

"….because I can’t forget no matter how hard I try………." Corporal Cloy Richards , PTSD sufferer. Cannabis has often been proposed to treat posttraumatic stress disorder (PTSD) and rates of marijuana use are significantly higher in PTSD sufferers. However like all medical marijuana issues it’s controversial and complicated. I will try and explain some of the science behind the issue. The basic rationale is this; a defining feature of PTSD is that sufferers cannot "forget" a traumatic event such as combat or rape. It is well established that cannabis use impairs certain types of memory and may help sufferers "forget". Additionally cannabis often reduces anxiety and promotes sleep, both of which are beneficial for PTSD where elevated general anxiety and sleep disturbances are very common. Cannabis acts upon receptors in the brain called, appropriately enough, cannabinoid receptors. The first and best described of these is called CB1, or cannabinoid receptor-1. CB1 is found throughout the brain. These receptors don’t exist to get people high! What this means is that there are substances produced naturally by the brain, called endocannabinoids, that act at cannabinoid receptors. The best described endocannabinoids are called anandamide and 2-arachidonyl glycerol (2-AG). These endocannabinoids are flighty molecules, they are rapidly synthesized only when required and don’t stick around for long, being swiftly broken down by an enzyme by the name of "fatty acid aminohydrolase", less tongue-twistingly known as FAAH. Endocannabinoids are involved in many biological processes including appetite regulation, pain, anxiety, mood, nausea and blood pressure. All of which are also affected by marijuana. One of the most interesting things these endocannabinoids appear to do, according to research in rats and mice, is stimulate the ability to forget about bad things. The basic research paradigm used is called "fear conditioning" and works on the same principle as Pavlov’s dogs; rodents are played a sound, usually a beep, just before a very slight electric shock. This shock, much like a threat in the wild, causes the animals to freeze in their tracks. Although the shock is mild and brief, the animals obviously don’t like it and learn very quickly that the beep means a shock is coming. After a short time, just the beep (without the shock) causes the animals to freeze and, crucially, causes the production of endocannabinoids in the brain . The relevance of this model to the human condition is obvious. PTSD symptoms are often triggered by exposure to something in the environment that reminds the sufferer of trauma. After a while, rodents, like most people, will learn that the beep no longer means that a shock is coming and will no longer freeze when the beep is played. If animals are treated with a drug that blocks CB1 receptors then they show a profound inability to forget. The same result is found in mice genetically engineered to not have CB1, playing the beep causes them to freeze long after normal animals have learned to forget. Again, the relevance to PTSD is obvious; only some people who experience an extreme trauma will develop PTSD. Could genetic differences in their endocannabinoid system help explain why this is? Perhaps most interestingly, animals given an extra booster of endocannabinoids find it easier to forget. Drugs which inhibit the breakdown of endocannabinoids by blocking FAAH have the same effect , suggesting that medications which stimulate the endocannabinoid system may be beneficial in the treatment of PTSD. Exposure therapy is a commonly used treatment for PTSD; patients are repeatedly re-exposed to those triggers which precipitate their symptoms, much like the rodents and the beep. This tactic is completely at odds with the intuitive response of PTSD sufferers, who will actively avoid these triggers. As I mentioned above, basic research findings indicate that exposure to these triggers causes the brain to produce it’s own cannabinoids, which then help the brain to forget. Perhaps the brains of PTSD sufferers have impaired cannabinoid synthesis, or maybe they break it down more quickly. Thus maybe cannabis treatment would be the most effective when given during exposure therapy? That’s the basic science. Sounds simple right? In fact it should be a no-brainer that cannabis use will be beneficial for PTSD sufferers? Well, as so often occurs in science, it’s not that simple. A major problem is that the cannabinoid system is found in almost all part of the brain and as such is involved in many different biological processes. A sobering example of this is the weight loss drug Acomplia TM from Sanofi-Aventis. The rationale behind this drug is reasonable enough; smoking pot gives people "the munchies", suggesting endocannabinoids promote eating. Blocking the CB1 receptor (with Acomplia TM ) should therefore reduce food intake. Sure enough, it does. But it also makes people depressed and has other psychiatric side effects. These side effects are so severe that Acomplia TM has been withdrawn. Cannabis also has a lot of potential side effects, many of them undesirable; apathy, psychosis, respiratory problems associated with smoking, prenatal toxicity, addiction (although this is controversial). One of the most troubling side effects of cannabis is that high doses can, in some people, trigger bouts of extreme anxiety. Not something any PTSD sufferer would want. Another problem is that THC, the major active ingredient of cannabis, is not the same as the endocannabinoids found normally in the brain (otherwise we’d all be high all the time). It’s not entirely clear that THC has the same "memory-erasing" effects as the brains natural endocannabinoids. In fact some researchers even think that treatment with pure THC may have the opposite effects, delaying an animal’s ability to forget . Nevertheless, a holy grail of "medical marijuana" programs for cancer and pain is the design of drugs which have the beneficial effects of marijuana without these undesirable side effects. Drug design programs based upon this reasoning may themselves eventually have a very beneficial side effect; drugs which can help PTSD patients forget.   © 2008 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Posttraumatic Stress Disorder and Cannabis. A Potted History