Depression, Pain and Addiction: The Connection

Because of cold weather in America, Longform (the website) linked to a 1995 article about the death by freezing of Teresa McGovern,  daughter of George McGovern. She was drunk and fell down. Her alcoholism was intractable. She went for treatment dozens of times. I have a theory about what causes alcoholism and other addictions and why they resist treatment.

Let me start with the fairly obvious part. People go to their addiction (alcohol, gambling, smoking, whatever) to escape pain. The addictive activity provides a hit of pleasure that eliminates the pain for a while. It is difficult to endure pain and after a while, if you can escape, it is impossible — your “willpower” runs out. An addict keeps feeling pain, keeps doing the addictive activity to get rid of the pain. Pain triggers the addiction. Addictive activities, such as drinking, often produce cravings, which are an additional source of pain. This makes the problem worse — makes the total pain even harder to endure — but it is not the whole problem. The addiction started when there were no cravings. This is why abstinence alone — which does get rid of the cravings — is not a good solution. It does not get rid of the sources of pain that were/are the ultimate cause of the problem.

The McGovern article illustrates the pain-reduction aspect of addiction:

I can numb the pain, says a voice. “It doesn’t sound like an evil voice. It sounds like a friend, telling you the truth.” Teresa’s younger brother, Steven McGovern, is describing the voice of alcohol, as it whispers to you when you are feeling tense or dissatisfied or empty: Here’s your old pal, I can get you through this. ”I have experience with this,” he explains. Like Teresa, Steven has struggled for years with addiction.

At the end of Double Down, a great memoir by Frederick and Steven Barthelme, about loss of a large inheritance due to gambling addiction, the authors say something similar, that their addiction derived from depression. I haven’t talked with addiction specialists but I doubt any of these ideas would surprise them.

The less obvious part of this comes from my discovery that seeing faces in the morning caused a large oscillation in mood: happy during the day, unhappy at night (while asleep). The effect of being happy during the day was that small amounts of badness (e.g., bad news) made me less happy but did not push me all the way to feeling bad (= painful). I had a buffer. If I feel very happy and then something bad makes me feel less happy — only slightly happy — this has no effect on my behavior. I don’t go out of my way to increase my happiness. Only when the border between happy and unhappy is crossed, and I start to feel bad (pain), not merely less happy, do I feel any desire to reduce the pain.

Life is full of pain-causing stuff. Everyone should have a buffer of happiness provided by morning faces but almost no one does. For almost everyone, as far as I can tell, most of the time they are in a neutral state, neither happy nor unhappy. When something bad happens, lowering their mood, they don’t go from very happy to slightly happy, they go from neutral to unhappy (= painful). And when in pain they seek ways to escape it. This makes all sorts of pleasure-causing activities, including drinking alcohol and eating “comfort food” (= food with a strong flavor-calorie association  – the stronger the flavor-calorie association, the more pleasant a food tastes), more attractive.

Long ago, people had this buffer of happiness during the day which made it possible for them to forage together in spite of problems, such as hunger and thirst and yesterday’s disappointments. In the evening, the buffer disappeared as your mood went down. The problems indicated by pain became more urgent and were dealt with. If you were thirsty, for example, you would drink something. Modern life has reduced or eliminated many sources of pain but it has also (a) eliminated the buffer, our natural protection, and (b) provided many short-term sources of pleasure (such as drinking) harmful in large doses. Because we live in a world that is inevitably painful now and then — no treatment can change that — the combination of (a) and (b) causes addiction. Treatments for addiction, at best, push people away from one short-term source of pleasure. They never restore the buffer, the natural protection.

When The Shangri-La Diet was published, many SLD dieters said it had become easier for them to stop smoking. My explanation is that because their hunger (one source of pain/discomfort) went down, they had more willpower left over to deal with another source of pain/discomfort, craving a cigarette. As my sleep has improved in recent months, due to bedtime honey and related changes, I have found it easier to do everything. My explanation is essentially the same. No longer having to use willpower to overcome tiredness — I am less tired — leaves more of it to do everything else.

33 Responses to “Depression, Pain and Addiction: The Connection”

  1. dearieme Says:

    The Theory of Conservation of Willpower. And why not?

    But I used to propound a Theory of Conservation of Fretting: if you solved some social problem that people were whining about, the same people would just start whining about another. In other words, the problem isn’t the problem, the problem is the people.

  2. Gina Says:

    Addiction treatment is another area where the experts haven’t made any progress whatsoever, yet they don’t seem interested in innovation.

  3. Therapsid Says:

    This is interesting. Since reading on this blog about the morning faces phenomenon, I’ve been turning to it as alternative to heavy drinking.

    However, if morning faces exacerbates night unhappiness, and if heavy drinkers drink disproportionately at night, it might only help reduce drinking insofar as people go to sleep very early.

  4. Alain Says:

    It can all be related to a better equipped, less disturbed/stressed out, better functioning decision power “muscle”, if I may. I’ve seen this before. Trivial and abnormally frequent decision making does typically wear out any kind of willpower we have left to make more important decisions throughout the day.
    Should we have to exert that willpower on overcoming other people’s frowns, sad faces and bad temper, we will (I assume) end up with impaired decision making capabilities at the end of the day.

    A quote from an NPR article on how Obama deals with decision making processes:

    “He had very self-consciously sought to eliminate all trivial decision-making from his life, such as what he wears to work,” Lewis tells NPR’s Renee Montagne about his interviews with the president for his piece in the October issue of Vanity Fair. “So, he says, ‘I got rid of all the clothes I have except for gray suits and blue suits, so I don’t even have to think about what I put on.’”

    Why? The president “started talking about research that showed the mere act of making a decision, however trivial it was, degraded your ability to make a subsequent decision,” Lewis says. “A lot of … the trivial decisions in life — what he wears, what he eats — [are] essentially made for him.”

    http://www.npr.org/2012/09/11/160898373/inside-obamas-decisions-from-libya-to-lunch

  5. Alex Chernavsky Says:

    Addiction-treatment is probably the most backward, pseudo-scientific sub-specialty within psychiatry. As writer Maia Szalavitz once put it, “In any other area of medicine, if a physician told you the only cure for your condition was to join a support group that involves ‘turning your will and your life’ over to God (AA’s third step), you’d seek a second opinion.”

  6. George Says:

    I don’t think its pain so much as it is boredom. Most people don’t really experience pain but boredom is the great scourge of life for many people especially in modern times. People turn to the bottle out of boredom.

  7. Jack Says:

    In China, the age old cure for alcoholism is putting one to three teaspoons of dried tiger feces in an alcoholics favorite drink. This makes the patient’s favorite drink taste absolutely terrible… so terrible that the brief negative flavor associiation of the feces with that of their favorite drink is never forgotten. Usually the alcoholic only needs to take this “medicine” only once or twice, and they will never, ever touch the stuff (any alchoholic drink) ever again. No expensive “therapy” sessions are ever needed. (Of course, the alcoholic patient is not usually told what the medicine actually is.) Tiger feces is very expensive in China for this reason. Probably regular dried house cat feces powder would work as well, but without the mystique of being from a Tiger. The Chinese have been involved in self experimentation and natural cure research for thousands of years. The West would do well to learn from the Chinese.

    I would trust natural Chinese cures and/or treatments that have been proven to work for thousands of years over modern poisonous medicines and treatments developed only in the past few to hundred years anytime. I think any sane person would. I believe most of modern medicine is harmful and should only be tried as a last resort; when natural cures and those discovered from self experimentation have not born fruit.

  8. Nancy Lebovitz Says:

    I like the idea of a happiness buffer, though I believe faces in the morning aren’t the only way to fill it.

    See Heal Thyself, also published as The End of My Addiction, by a surgeon who found that Baclofen (a prescription muscle relaxant) stopped his cravings for alcohol and incidentally cured his addiction to spending money.

    A number of commenters at amaxon have found that Bacofen stops their addiction.

    A detailed description of raising a happiness set point:

    http://lesswrong.com/lw/20l/ureshiku_naritai/

  9. Joe Says:

    Alex: Addiction-treatment is probably the most backward, pseudo-scientific sub-specialty within psychiatry. As writer Maia Szalavitz once put it, “In any other area of medicine, if a physician told you the only cure for your condition was to join a support group that involves ‘turning your will and your life’ over to God (AA’s third step), you’d seek a second opinion.”

    Joe: If I ever experienced the horrible PAIN that Seth attributes addiction to, I’d try just about anything to rid myself of it. That is, if I heard of a program that had the best success at dealing with addiction (i.e., AA, http://www.burningtree.com/effectiveness-12-step-programs/), and all the PAIN associated with it, I’d try praying to Bugs Bunny if that was part of the program. Hell, I’d turn my life over to Kanye West, if doing so would just rid me of that awful PAIN. When a person has hit rock bottom (Step 1), I don’t think that would be that hard to do. By then, the person would probably have already sought second, third, fourth, fifth, etc. opinions anyway.

    Ditto for other disorders that produced great PAIN. Successfully turning off the horrible PAIN by turning your life over to God (pick the diety or program of your choice) would be an example of negative reinforcement, wouldn’t it?

    Maybe some kind of “spiritual change” is exactly what’s needed by some folks? What’s the downside? Probably leading a better life?

  10. Alex Chernavsky Says:

    Joe: AA has a host of problems associated with it. See: http://www.orange-papers.org/

  11. Seth Roberts Says:

    “if morning faces exacerbates night unhappiness, and if heavy drinkers drink disproportionately at night, it might only help reduce drinking insofar as people go to sleep very early.”

    Morning faces make me tired much earlier, like 2 hours earlier. It is a huge effect.

  12. Seth Roberts Says:

    Re AA. My research suggests that AA meetings (a) should be held only in the morning (b) quite early, like 7 am. Maybe the seating arrangements should be changed, too, so that people are closer together. Or the meeting should be preceded by 30 minutes of simple socializing.

  13. Gina Says:

    “If I ever experienced the horrible PAIN that Seth attributes addiction to, I’d try just about anything to rid myself of it.”

    Saying that 12 step treatment is the best we can do is a pretty grim view. You see how well it worked for Teresa McGovern.

    When someone has been to rehab 10 times, right now all the experts can recommend is an 11th trip to rehab. The rehab industry has absolutely no motivation to find better treatments. They would lose all the repeat business.

  14. Joe Says:

    Alex: For every orange paper there is a green one. :)

    http://www.green-papers.org/

    This is just a guess, but I wouldn’t be surprised if AA’s success rate was as good as psychotherapy’s alone. Done together, they appear to be the best thing we currently have to offer.

    Gina: “Saying that 12 step treatment is the best we can do is a pretty grim view.”

    I didn’t say that, of course. I’ll refer back to my posts on various diets and say again that there are many ways to skin a cat. And lots of cats have lost their skins to AA. We should be thankful for that, while we look for even better ways to help people in distress and pain.

    Seth: That sounds like an idea worth testing! The trick, as I see it, would be to get them up that early. :)

  15. Sara Lake Says:

    Seth, have you heard of the ‘rat park’ experiments? I think you must have.

    Addicted rats were put into a happy rat environment (about 200x the size of a regular rat cage with both space and privacy tunnels), and allowed to do things rats like to do (have sex, socialise, eat, sleep, play with toys). Most detoxed themselves, even when their substance of abuse was freely available.

    Seth: No, I haven’t heard of them. Thanks.

  16. Gina Says:

    “Re AA. My research suggests that AA meetings (a) should be held only in the morning (b) quite early, like 7 am. Maybe the seating arrangements should be changed, too, so that people are closer together. Or the meeting should be preceded by 30 minutes of simple socializing.”

    My grandfather spontaneously quit drinking after years of having to be frequently hospitalized to “dry out” and severe liver cirrhosis. He had a job where the older guys would show up an hour or so early to work and sit at benches outside, drink coffee, chew tobacco and socialize. Now I’m wondering if his habit of going to work early came first. It’s interesting.

  17. Karen Says:

    Sara Lake or anyone:
    Do you have a link or citation for the paper describing the “rat park” experiment?

  18. Alex Chernavsky Says:

    Journalist Anne Fletcher wrote an excellent book about addiction. It’s called, Sober for Good: New Solutions for Drinking Problems — Advice from Those Who Have Succeeded. She interviewed hundreds of people who had been sober for at least five years. Turns out (not surprisingly) that people quit using a variety of different approaches. And some people had not actually quit but rather moderated their drinking (which is a big “no no” in 12-step circles).

  19. Joe Says:

    A story about addiction:

    I quit smoking 41 years ago. I was a 4-pack (Lucky Strikes) a day smoker. Before I turned off the alarm clock in the morning, I would light a cigarette. I HAD to have a cigarette. Yeah, it was that bad. I only needed a few matches to get through an entire day – and 4 packs of Lucky Strikes.

    I tried to quit dozens of times. I would try cutting back, try filters, even menthols (yuck!). I might make it two weeks, then back to puffing like a locomotive. Nothing worked. I LIKED smoking. I NEEDED to smoke.

    Then a lucky thing happened to me while confined to a hospital bed with double pneumonia. My second bout of pneumonia in just 6 months. I almost died. Some do-gooder doctor wheeled in a movie projector and showed me a film about what smoking can do to you (okay, I already knew it could kill me, but that apparently wasn’t enough). The film was of an autopsy of a person who died from lung cancer. And the mere sight of the cancerous lung, and the horrible damage the smoking had done (imagine the sight of someone peeling hot asphalt off a roadway), and I was done with smoking. Forever. Haven’t had a cigarette since. Not one. Do I still get urges to smoke? Yes. Especially when having a drink. But I will never smoke another cigarette. Period.

    Haven’t had pneumonia since, and rarely even get a cold.

    The dumbest thing I’ve done in my life was to start smoking. The smartest thing I’ve ever done was to stop.

    Thank God for do-gooder doctors!

  20. as Says:

    Teresa never married. She had two children with a man she lived with for four years. The article said that she was sober during those years and that she broke up with her boyfriend when she started drinking again.

    Maybe lack of a good stable family life leads to addiction?

    Sara Lake’s “rat park” comment was interesting.

  21. Alex Blackwood Says:

    I believe the Rat Park experiment Sara Lake is talking about is discussed here: http://sub.garrytan.com/its-not-the-morphine-its-the-size-of-the-cage-rat-park-experiment-upturns-conventional-wisdom-about-addiction

  22. anon Says:

    Have you heard the Radio Lab (the NPR radio program) that discusses a woman taking a medication (for parkinson’s tremors, if i recall) that makes her a gambling addict, and then her symptoms go away when she stops the medication?

    Seth: No I haven’t heard it.

  23. Sara Says:

    Apparently hypnosis works quite well for smoking.

  24. John Smith Says:

    According to the gospel of John (me!) addiction has two components, one physical the other spiritual, mental or psychological (you choose one from those three or add the correct one).

    No one can administer any help, pill, advice, or whatever, that will work for any individual until that individual is ready to accept the challenge and make changes. Depending on the addiction, it will take more than just a little effort.

    AA did well as long as it was alcohol and cigarettes it targeted. When Overeaters Anonymous came along (same problem, addiction to food) the ‘cold turkey’ the ‘never another mouthful of food’ type of logic, simply wasn’t enough. The overeaters had to learn a better way, as quitting eating proved to be fatal.

    They found that following the 12 steps was all it took, just that they had to dig deeper into the psyche to work out why they were so unhappy, fix that, then curing the addiction was easy going. In the 12 steps programs, reference to god is somewhat ambiguous as it speaks to “god as you understand him or perceive him (something to that effect).” Which is erroneous, of course, as it assumes god is a male, humanoid, personalized etc., but worst of all ‘perceivable.’ It denies the fact that we are god unto ourselves.

    Replace god with yielding to the other side of your head as in ‘right brain’ would work for me. The opposite is true also, yielding to the ‘left brain.’ Addiction cannot be cured without the assistance of both hemispheres. Males in particular are loathe to go into right brain stuff, females equally, do not care to live by logic (as a generalization). But it is all in our head, both the problem and the solution.

    If you read the Book, Feed Your Brain First, by Dr. Fessenden (Co-Author with McInnes in The Honey Revolution) you will discover the energy used by the brain is not always full speed ahead. As the health deteriorates or the day wears on, energy level get low, the voltage to the brain falls and the survival lobes get the first pick with the cerebrum (higher brain) taking what is left over. Chronic Depression always includes the condition of chronic partial brain starvation.

    So to cure any addiction especially those leading to depression, get the body energized (using natural foods and herbal medicines) so the brain is fully powered. Then one can think straight about using the decision making process intelligently. However, until that individual is ready to make the big change, nothing will work on a permanent basis. Making the big change will always work, even if the body lags behind. Fixing the body only will only partially work…………. With the problem reoccurring further down the track.

    Another good book (which I haven’t read) is called “The Pleasure Trap.” I think there are several of a similar title, so can’t speak for them all.

  25. Alex Blackwood Says:

    Accounts of people wrecking their lives with gambling and compulsive sexual behavior while taking dopamine agonists go back years. Here’s one: http://www.houstonpress.com/2005-09-15/news/overstimulated/.

  26. James M. Says:

    Socializing more, talking fully about issues to someone, exercising at least three times a week, regular long sleep, going Primal/Paleo, has helped with my depression.

  27. Tam Says:

    Matt Stone talks about similar ideas in a few differnt articles. One, about Rat Park, and another about 1811 Eastlake, in Seattle. 1811 is a very successful so -called “wet house” for the homeless that allows its residents to have alcohol. The success is measured in taxpayer money saved and also by how much drinking has declined. It seems to point to the idea that seeing a human, or even a rat, as who they are, and allowing them to be seen and take care of their most basic needs which includes socialization and acceptance, can make all the difference in addiction healing.

  28. Charles Says:

    RE: Morning faces…one of my favorite jobs over the years was being a breakfast cook. I got to see a lot of morning faces. And looking back, it seems to me that the regulars, who would come in every morning (a common breakfast joint phenomena) were basically pretty happy. Hardly any regular “grumps.” And I still love going out for breakfast, it’s my favorite meal to go out for. And I don’t think it’s just the coffee that makes people feel good, based on Seth’s hypothesis.

    As to addiction, there is a major neurochemical component to it, and it can be turned on and off with various amino acids (for a lot of people, not everyone). That can be related to the happiness buffer, too, of course. If your neurochemistry is screwed up, by environment or genetics, and you’re always fighting that, it doesn’t take much to push you over the edge. Fix that, and it’s a lot easier to deal with other habitual behavior. And yes, I worked with a chemical dependency program to do just that, and it helped a lot of folks.

  29. Alex Says:

    Dearieme, the “The Theory of Conservation of Willpower” is in fact laid out, with neurochemical basis, in Willpower: Rediscovering the Greatest Human Strength, by Roy F. Baumeister and John Tierney. Baumeister makes the case that what we call willpower is glucose availability in the brain. Tierney also wrote a piece about Baumeister’s work in the NY Times: http://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all.

    I don’t have a country to run, but I have found it useful, as Obama mentioned doing in the Michael Lewis piece, to reduce the number of trivial decisions I make throughout the day.

  30. Sara Lake Says:

    The original rat park paper is this one: http://www.ncbi.nlm.nih.gov/pubmed/98787?dopt=Abstract

    and here is an interesting article by the lead researcher
    http://www.parl.gc.ca/Content/SEN/Committee/371/ille/presentation/alexender-e.htm

    Here is a list of some of his other publications. It’s not hidden research, just didn’t get a lot of attention. I think it’s easier for governments to focus on ‘the drug’ rather than ‘the addictive society’.
    http://www.ncbi.nlm.nih.gov/pubmed?term=Alexander%20BK%5BAuthor%5D&cauthor=true&cauthor_uid=98787

  31. Sara Lake Says:

    Also, if you look at the ‘related citations’ in pubmed, you’ll see that it’s not exactly an untested hypothesis (that the drug is not the root cause of the addiction).

  32. Seth Roberts Says:

    “I think it’s easier for governments to focus on ‘the drug’ rather than ‘the addictive society’.”

    I agree. Easier for governments and professors who need to publish regularly. Just as it is easier to focus on “which is the best treatment for Disease X?” rather than “What causes Disease X?”

  33. Alex Chernavsky Says:

    Just saw this interesting article about Alcoholics Anonymous:

    After 75 Years of Alcoholics Anonymous, It’s Time to Admit We Have a Problem“, by Maia Szalavitz