The Anthropology of Addiction

Can we ever integrate neuroscience and social science?

Bielefeld, Germany—
The last in a series of posts about a recent conference, Neuroplasticity in Substance Addiction and Recovery: From Genes to Culture and Back Again.  The conference, held at the Center for Interdisciplinary Research (ZiF)  at Bielefeld University, drew neuroscientists, historians, psychologists, philosophers, and even a freelance science journalist or two, coming in from Germany, the U.S., The Netherlands, the UK, Finland, France, Italy, Australia, and elsewhere. The organizing idea was to focus on how changes in the brain impact addiction and recovery, and what that says about the interaction of genes and culture. The conference co-organizers were Jason Clark and Saskia Nagel of the Institute of Cognitive Science at the University of Osnabrück, Germany.   Part One is here.   Part Two is here.  Part Three is here.


The disciplines of psychiatry and neurology are being brought intellectually closer to each other. One can foresee the day in the not-too-distance future when resident physicians in both disciplines will share a common year of training, comparable to the year of residency training in internal medicine for physicians who go on to specialize in widely different areas.
— Eric Kandel, In Search of Memory

Anthropology is arguably a perfect discipline within which to connect the two often-conflicting facets of addiction—its fundamental neuroarchitecture, and the socioenvironmental influences that shape this basic biological endowment. In The Encultured Brain, published by MIT Press, co-editors Daniel H. Lende and Greg Downey make an articulate call for a merger of interests, in an attempt to combine laboratory research with anthropological fieldwork. The term “neuroanthropology,” meant to denote this combination of anthropology and brain science, was evidently coined by Stephen Jay Gould. A number of thinkers have dipped into this arena over the years, including Melvin Konner, Sarah Hrdy, Norman Cousins, Robert Sapolsky, and Antonio Damasio. The term gained a more solid foothold when Lende and Downey began their Neuroanthropology blog, now at PLOS blogs. 

The term has the advantage of meaning exactly what it says: an integrative approach to the complicated matter of how our genetic endowment is influenced by our cultural endowment. Or vice versa, if you prefer. Here, from the introductory chapter, is the short definition of neuroanthropology: “Forms of enculturation, social norms, training regimens, ritual, language, and patterns of experience shape how our brains work and are structured…. Without material change in the brain, learning, memory, maturation, and even trauma could not happen…. Through systematic change in the nervous system, the human body learns to orchestrate itself. Cultural concepts and meanings become neurological anatomy.” From the point of view of actual study, there is no choice but to join these two when possible—a task make more difficult by the rampant “biophilia” found among anthropologists and sociologists, as well as the countering notion among biologists that anthropology does not make the cut as a “real” science.

Co-author Daniel Lende, an associate professor in the Department of Anthropology at the University of South Florida, was one of the presenters at the Bielenfeld conference. Lende did his Ph.D. work on adolescent substance abuse in Bogota, Colombia, and told the group that years of research “showed me that addiction is profoundly neuranthropological.” Lende told the audience that the “combination of neuroscience and ethnography revealed that addiction is a problem of involvement, not just of pleasure or of self.”

 This approach calls for applying a critical eye to strictly brain-based explanations that ignore both environmental influence and biochemical individuality. And it opens up the possibility that anthropologists may be incorporating neuroimaging technology into their working tool kit. While the neuroanthropology movement has been mostly a product of the anthropology side thus far, Lende said. But increasingly, cognitive scientists are joining in.

“As neuroanthropologists, we’re not trying to solve problems in the lab or in the clinic, but rather to take the results of that sort of work, and look at what’s happening to those brains in the wild,” Lende said.

Repeated patterning comes from social environments, he said. “We have to deal with how cultural practices and developmental experiences can shape and mold the brain, and how that has an effect on the production of human variation, not just sets of beliefs you can take on and put off.”  The cultural practice of skull shaping, for example, is “impossible to understand without taking into account both the cultural practices that drive it, and the early plasticity in bone formation that allows it biologically.”

Culture, said Dr. Lende, “can bring different elements into one package. It doesn’t have to be the biology side that does all the work. You can take the cultural strands and knit them into something really unusual that you wouldn’t necessarily see in the world. With cultural tools, we are using are brain in ways not necessarily built into it from the start.”

But attending to all of this requires thinking of neural plasticity in novel ways, Lende said. “Hardwiring isn’t quite as hard as we once thought. The lifespan of these circuits set early in life isn’t what we thought.” The brain can use sensory input in ways we don’t yet understand. Lende pointed to “significant recovery from stroke, which was not viewed as possible a couple of decades ago.”

“You have to be critical both of the neuroscience and some of its limitations, and also the anthropologists, who are sometimes saying, ‘it’s got to be all sociocultural.’ That’s not always a good explanation for something as complex as addiction.”

Lende believes that anthropology needs to pursue the impact of “biological embedding, or how experiences get under the skin” to alter human biological and developmental processes. “You can have differential vulnerabilities to biological embedding, coupled with differential environmental vulnerability.”

Dr. Lende points to the well documented clinical finding that exercise enhances neuroplasticity. “And exercising has been shown in various labs to reduce craving,” he said. “What’s important from my community-based orientation is, what sort of interventions or strategies can we have that are low cost and be used in non-professional settings. Can we motivate people to do it? What are the barriers?”

 Subjective experience is hard to get at, but that’s a problem anthropologists think about all the time. “I asked the kids in Columbia, if your drug use were a place, Lende said, “ then what sort of place would that be? Kids who’d never tried drugs didn’t get the question, but a kid with heavy cigarette use who had just quit, and who had recovered recently from using too much cocaine and crack, looked at his fingers, referring to cigarettes, and said, ‘a world in there? No. But with cocaine, yes.”

Addiction Trajectories: Book Review

Striving for that elusive middle ground.

For a journalist who covers neuroscience, the political and psychoanalytic focus of anthropology sometimes feels like a baffling trip to a foreign land. References to Foucault and Derrida abound, and Freud hovers in the middle distance. The investigative landscape is comprised of socially constructed experiences and environmental processes. Trained to seek out cultural and economic experiences as first causes, many cultural anthropologists have been fighting a rear-guard action against the advances of neuroscience for years now. Which is a shame, because anthropology, importantly, can serve to remind medical scientists of the multi-dimensional nature of addiction. “For psychoactive substances to transform themselves into catalysts for and objects of pleasure and desire,” writes anthropologist Anne M. Lovell, “they must circulate not only through blood, brain, and other body sites but also through social settings.”

It is anthropologists, for example, who have documented that “three-fourths of all state-licensed drug treatment programs in Puerto Rico were faith-based.” This study of faith-based healing in the addiction recovery community forms one chapter of a new volume, Addiction Trajectories, edited by Eugene Raikhel of the University of Chicago and William Garriott of James Madison University.

What anthropologists can do for addiction science is document these sociocultural attributes of addiction. In a chapter on buprenorphine and methadone users in New York City and the five boroughs, Helena Hansen, assistant professor of anthropology and psychiatry at New York University, finds that buprenorphine users live in predominantly white, high-income neighborhoods, tended to have college educations, and get their bupe from a private doctor. However, “others are directed to methadone maintenance programs with requirements for daily attendance, urine drug screens, surveillance, and control,” and there is little overlap between the two recovering populations.

There is a chapter devoted to a punitive form of addiction treatment known in Russia as “narcology,” and another that dwells on the semiotics of meth addiction. There are chapters taking drug counselors to task for their inadequate training and lack of nuanced background. And there is a chapter that views the advent of buprenorphine for heroin addiction as a step backwards, or, at best, a typical step sideways—addictive drugs for addiction, just like the old days when heroin addicts were offered alcohol as a cure.

A chapter by E. Summerson Carr is devoted to the treatment known as motivational interviewing, a technique with which she claims “drug users can talk themselves into sobriety regardless of whether or not they originally believe what they say to be true.” Irrespective of your view on M.I., Carr makes a useful point when she notes that sometimes a client’s refusal to admit drug use, even after a positive drug test, is not because of denial, but because of a logical understanding that their status as credible plaintiffs in legal proceedings could be on the line.

And there is simply no arguing Carr’s central point—while addiction science has been increasingly incorporated within the broad outlines of neuroscientific models, “the project of using talk to treat denial and demonstrate insight remains remarkably consistent” in the treatment practices used by the more than 13,000 outpatient addiction treatment programs across the U.S.

What else can anthropologists bring to the table? An understanding of “the loaded institutional and cultural conditions of clinical assessments, which inevitably and profoundly shape what drug users do and do not say.” Chief among these, Carr writes, is “the distinctly clinical terms of addicted denial, the chief organizing heuristic of mainstream American addiction treatment.”

The gap remains wide between addiction viewed as the neuroscientist’s disease entity, and addiction viewed as the anthropologist’s contingent outcome emerging from specific social settings. It’s easy to see why the attempt at an alliance between anthropologists and neurobiologists is an uphill struggle. Reading Addiction Trajectories, it becomes apparent how frequently the two disciplines are talking past one another. But I like to think there are enough bright and motivated anthropologists and neuroscientists around to forge some manner of middle ground; the elusive third way of viewing addiction, holistically, as a living blend of genetic and environmental influences, sensitive to both, and registering that dual sensitivity in the form of compulsive drug taking. (See, for example, anthropologist Daniel Lende’s recent post.)

The more invigorating contributions in this volume help us to zero in on “the popular representation of drugs as inherently criminogenic,” writes William Garriott, as well as the concomitant “lack of faith in the ability of the criminal justice system—and the state more generally—to address drug problems through the punitive management of the addicted offender population.” It is anthropologists, not neuroscientists, who dwell on the ramifications of this paradox: “The majority of Americans appear committed to fighting a war they feel cannot be won, using a strategy in which they no longer believe.”

The present volume is sometimes inclined to view biology with suspicion, and many of its contributors are quick to point out the hazards of attempting to meld social science and neuroscience. A similar but somewhat less skeptical collection—one that seeks to connect the socioenvironmental influences helping to shape how the biological disorder known as addiction will play out in the real world—was published last year by co-editors Daniel H. Lende and Greg Downey. In The Encultured Brain, Lende and Downey look ahead to a time when field-ready equipment will measure nutritional intake, cortisol levels, prenatal conditions, and brain development in the field. Predicting the future is a fool’s game, but it seems clear that the field of anthropology is aware of, and awake to, the controversial research avenues opened up by advances in contemporary neuroscience.

Graphics credit: http://www.culturalneuroscience.org/

The Encultured Brain: A Book Review

How biology and culture jointly define us.

Anyone who follows academia knows that the broad category of courses known as the Liberal Arts has been going through major changes for some time now. In a sort of collegiate scrum to prove relevance and fund-worthiness, disciplines like sociology, anthropology, human ecology, cultural psychology, and even English, have been subjected to a winnowing process. The clear winner seems to anthropology, which has expanded its own field by connecting with modern findings in neuroscience while simultaneously swallowing up what was left of sociology.

It makes sense. Take addiction for an example. Anthropology is a natural and accessible discipline within which to connect the two often-conflicting facets of addiction—its fundamental neuroarchitecture, and the socioenvironmental influences that shape this basic biological endowment. In The Encultured Brain, published this year by MIT Press, co-editors Daniel H. Lende and Greg Downey call for a merger of anthropology and brain science, offering ten case histories of how that might be accomplished. The case histories are lively, ranging from the somatics of Taijutsu martial arts in Japan, to the presence of humor among breast cancer survivors. These attempts to combine laboratory research with anthropological fieldwork are important early efforts at a new combinatory science—one of the hot new “neuros” that just might make it.

I have corresponded with Daniel Lende, one of the book’s co-editors, and I am happy to disclose a mention in the book’s acknowledgements as one of the many people who formed a “rolling cloud of online discussion” with respect to neuroscience and the new anthropology. I am pleased to see that the thoughts of Lende and Downey and others on the emerging science of neuroanthropology are now available as a textbook.

The term “neuroanthropology” was evidently coined by Stephen Jay Gould. A number of prominent thinkers have dipped into this arena over the years: Melvin Konner, Sarah Hrdy, Norman Cousins, Robert Sapolsky, and Antonio Damasio, to name a random few, but the term didn’t seem to get a foothold of note until Lende and Downey began their Neuroanthropology blog, now at PLOS blogs.

The term has the advantage of meaning exactly what it says: an engagement between social science and neuroscience. Lende and Downey look ahead to a time when field-ready equipment will measure nutritional intake, cortisol levels, prenatal conditions, and brain development in the field. As such, neuroanthropology fits somewhere in the vicinity of evolutionary biology and cultural psychology. As a potential new synthesis, it is brilliant and challenging, representing an integrative approach to that ancient problem—how our genetic endowment is influenced by our cultural endowment, or vice versa, if you prefer.

 Lende is no functionalist when it comes to the neuroscience he wants to see incorporated in anthropology. His approach calls for applying a critical eye to any and all strictly brain-based explanations that ignore both environmental influence and biochemical individuality. The possibility that anthropologists may be incorporating neuroimaging technology into their working tool kit is a heady notion indeed. Anthropology may be a “soft” science, but it has always been about the study of “brains in the wild.”

Here, from the introductory chapter, is the short definition of neuroanthropology by Lende and Downey: “Forms of enculturation, social norms, training regimens, ritual, language, and patterns of experience shape how our brains work and are structured…. Without material change in the brain, learning, memory, maturation, and even trauma could not happen…. Through systematic change in the nervous system, the human body learns to orchestrate itself. Cultural concepts and meanings become neurological anatomy.” From the point of view of actual study, there is no choice but to join these two when possible—a task make more difficult by the rampant “biophilia” found among anthropologists and sociologists, as well as the countering notion among biologists that anthropology does not make the cut as a “real” science.

We have come a long way from the simplified view of the brain as some sort of solid-state computer, or, alternatively, a lump of custard waiting to be endowed with functionality by selective pressures from “outside.” We know by now that neural resources are frequently reallocated; that “physiological processes from scaling to connectivity shape what brains can do and why.”  We need to stop viewing culture as “merely information that is transmitted over evolutionary time and recognize that enculturation is, equally, the ways that our interaction with each other shapes our biological endowment, and has been doing so for a very long time,” Lende writes.

At bottom, says Lende, it is a simple notion: “Biology and culture jointly define us.” For example, Lende points to the way tool use affects cortical organization. Monkeys trained to use rakes to fetch food “evidence increasing cortex dedicated to visual-tactile neurons.” Lende wants us to incorporate neuroscience into the broader study of man. He writes that “the activation of neural reward centers, such as the mesolimbic dopaminergic system, is inherently bound up in sociocultural contexts, social interactions, and personal meaning-making.”

As an example, Lende contributes a chapter on “Addiction and Neuroanthropology,” in which he describes research he conducted on drug abuse among young people during a decade he spent in Colombia. Lende found that the addictive spiral “was not merely a neurological transformation, but a shift in habits, clothing, friends, hangouts, and other external factors that re-cued drug seeking behavior, drove addicts to take drugs, even when the young people sought to stay clean. Addiction is not simply in the brain, but in the way that the addict’s brain and world support each other.” And now, he writes, “This combination of neuroscience and ethnography revealed that addiction is a problem of involvement, not just of pleasure or of self. That decade showed me that addiction is profoundly neuroanthropological.”

In other words, tolerance and withdrawal aren’t enough. It is fiendishly complex: “The parts of the brain where addiction happens are not single, isolated circuits—rather, these areas handle emotion, memory, and choice, and are complexly interwoven to manage the inherent difficulty of being a social self in a dynamic world.”

Trying to pick apart the relative influences of nature and nurture comes to look, ultimately, like a fool’s game, “because changes in behavior exposed users to situations in which specific neurophysiological effects were cued with greater frequency; both environment and biology were moving together into a cycle of addiction.”

In a chapter titled “Collective Excitement and Lapse in Agency: Fostering an Appetite for Cigarettes," Peter G. Stromberg of the University of Tulsa argues that the dissociative environment in which college students often try cigarettes for the first time can lead to the loss of “the sense of agency,” meaning that people sometimes carry out activities without taking full responsibility for the decision to do so. As Stromberg writes, “Early smoking experiences typically occur in effervescent social gatherings marked by a high level of excitement and highly rhythmic activities, such as conversation and dancing." Cigarettes acquire a “symbolic valence” in such settings, and the ability to handle a cigarette adroitly confers what Stromberg terms “erotic prestige.” Furthermore, “As anyone who has ever been in a conga line can attest, we humans can be strongly motivated to entrain with rhythmic activities, even if those activities might be judged as unappealing in other contexts.”

If young people smoke at parties for many of the same reasons that they dance at parties—a “desire to increase status” and enter into “joint rhythmic play”—then potential nicotine addicts will be gently nudged into a position of associating party feelings with cigarette feelings, regardless of the actual physiology of nicotine. And, by fostering a dissociative mode of consciousness, college parties help foster the conviction that the use of cigarettes is not completely under one’s volitional control (“I was going to leave, but we danced all night.” Or, “the next thing I knew, the pack was empty”). The smoker may falsely attribute these feelings to the direct effect of the drug, rather than the set and setting.

This is only one example of the many ways in which a combination of neurobiology and anthropology can lead to new questions and fresh approaches. Where might all this be heading? “As research continues,” write Lende and Downey, “greater recognition of neural diversity as a fundamental part of human variation will surely become an even more substantive part of the neuroanthropological approach.”