II.10.2020 - Addiction & Surfing in the R.A.I.N
In 2003 I dropped by the first supervised injection facility, Insite, located in the Downtown Eastside of Vancouver, British Columbia. We had just rolled off of a project in Toronto to overhaul the Shelter, Support and Housing system that served people experiencing homelessness in the city and I was interested in the intersection of mental health and addictions in the background of at least 40 percent of the people who were clients of the system. During my visit to Insite, I took the opportunity to meet with Gabor Maté, the author of 
In the Realm of Hungry Ghosts: Close Encounters with Addiction. Gabor helped me to understand that addiction wasn’t only about drugs, and his personal story has inspired me over the years. I’m still curious and learning, especially with recent breakthroughs in neuroscience that provide evidence to support Gabor’s theory.
We are vulnerable to becoming addicted to anything. The compulsion to fill your closet with shoes, pick your eyebrows, use plastic surgery, shop online, check social media, binge eat, smoke, drink excessively or, like Gabor Maté, collect countless CDs of classical music that he never listened to. The repetitive behavior can deliver temporary gratification, but it can also result in declining health, fractured relationships, financial hardship, or other negative outcomes.
In the late 70s, I became addicted to running. I felt disappointed — perhaps even depressed — if I didn’t lace up my running shoes every day in any weather and log a minimum of eight kilometers in my Jim Fixx journal. I was an avid follower of Fixx, who wrote the seminal book, The Complete Book of Running. I lost weight, ate better, and became a better squash player as a result. But I was obsessed to the point that if anything got in the way of my daily run, I would feel bad and make those around me quite annoyed when the rest of life’s events passed me by. In 1984, Jim Fixx died from a heart attack at the age of 52 while running. His death was a shock to me. I recalibrated my “positive addiction” to an appropriate frequency and time that fit into my life as opposed to displacing my life. But it took several months for the urge to log consecutive, daily runs to pass.
Seventeen years after my visit to Insite, we have a much better understanding of the root causes of addiction. Studies facilitated in real-time with subjects using fMRI technology have shown how the posterior cingulate cortex (PCC) is lit up by drug use (or the anticipation of using) but also by a range of triggers that can lead to life-threatening or life enlightening behavior. Triggers are highly personalized, based on genetics and individual experience. Your grandfather’s Old Spice aftershave or the smell of an old baseball mitt can result in a hit of dopamine that lights up the PCC and makes you smile. Some triggers result in behaviors and rewards that are positive or harmless, and can make you feel good, like the smell of your child’s teddy bear. Other triggers and the accompanying behaviors and rewards can lead to impaired judgment, failed relationships, poor health, or even death. Addiction is directly linked to the TBR cycle and is often described as being “hooked.” It is also characterized as continued use despite adverse consequences.
The Trigger, Behavior, Reward (TBR) cycle can be set in motion by using drugs or even thinking about using drugs. Addiction to substances creates a physical feedback loop that needs to be closed to avoid the pain of physical and emotional withdrawal. The treatment of physical addiction is possible by swapping out harmful substances for less toxic substances. For instance, methadone has replaced heroin for many people and, when combined with therapy, can lead to a substance-free life or, at least, reduced harm. But what about the emotional withdrawal? A recovering alcoholic can be vulnerable to falling off the wagon if exposed to friends drinking and having fun. Their physical dependency can be reawakened through triggered feelings of wanting — no, needing — to belong.
People experiencing addiction will continue to use drugs, shop until their credit cards are maxed out, seek sexual partners always without an emotional connection, collect anything until space or resources are exhausted, etc. despite the adverse consequences. There are two tracks of addiction with different paths to recovery, and this is a breakthrough in our understanding of the complexities of addiction and potential treatment.
These neurological studies informed by data from $3 million magnetic resonance imaging machines have revived ancient practices of meditation and mindfulness. Our brain has 83 billion neurons and as many connections as there are stars in the Milky Way. This mass of 1400 grams is supported by a few vertebrae at the top of our spinal cord and is responsive to our consciousness — Hey Siri. As the aphorism goes, that’s the good news as well as the bad news. The good news is that we can reroute the neural pathways that promote and reinforce addiction. The bad news is that it takes awareness, action, and discipline to program the kind of life that leads to positive outcomes — health and happiness being just two.
In his book, The Craving Mind, Judson Brewer explains how mindfulness can achieve the re-programming that is necessary to break the cycle of addiction. I can summarize his technique by describing it as Surfing in the RAIN.
When the craving begins, find a comfortable, quiet, and safe place to sit or recline. Close your eyes. Imagine that it’s an overcast day with a light rain, and you are watching the wave from your surfboard a few hundred meters offshore (the wave is the craving or the itch you need to scratch). You paddle over and catch the wave so you can ride it out to the beach. That is where the acronym RAIN kicks in:
• Recognize what is happening with the craving & relax into it - you have no control over the wave, but you are committed to riding it out.
• Acknowledge / Allow / Accept the wave as it is. Don’t ignore it, distract yourself, or try to do something about it. This is your experience, so find a way that works for you, such as a word or a phrase, or a nod of your head that acknowledges your consent to allow the experience to happen.
• Investigate the wave as it builds. What does your body feel like right now? Don’t go looking - see what arises most prominently. Let it come to you.
• Note the experience as you follow it. Keep it simple. A flood of uncontrolled thoughts; restlessness in your stomach; rising sensation; burning; etc. Follow those feelings until the wave subsides, and you approach the shore. It’s over.
Addiction comes in many forms and degrees of severity as measured by the impact on our lives and how we want to “be.” As the sun breaks through the clouds, let your surfboard take you safely to the sandy shore. Be well.