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.”

Does Brain Research Obscure Addiction’s Root Causes?

Did Dickens Get It Right?

Breathe the polluted air, foul with every impurity that is poisonous to health and life; and have every sense, conferred upon our race for its delight and happiness, offended, sickened and disgusted, and made a channel by which misery and death alone can enter. Vainly attempt to think of any simple plant, or flower, or wholesome weed, that, set in this foetid bed, could have its natural growth, or put its little leaves forth to the sun as God designed it. And then, calling up some ghastly child, with stunted form and wicked face, hold forth on its unnatural sinfulness, and lament its being, so early, far away from Heaven—but think a little of its having been conceived, and born, and bred, in Hell!

That’s how Charles Dickens chose to put the generational question, in his 1848 novel, Dombey and Son. Poverty and bad mothering (there was hardly any fathering) stunted a child’s “natural” inclinations toward normalcy and love. As the reed is bent, and so on. It is a forceful and memorable literary case for the debilitating effects of childhood deprivation, illness, and trauma. And quite timely, given the ongoing backlash against the “disease model” of addictions and mental illnesses. Did Dickens have it right, more than 150 years ago? Has the research associated with the disease model—the brain breakthroughs, the MRI scans, and the neurotransmitter studies—all been giant detours away from root causes?

You would think so, listening to the cacophony of voices seeking to discredit the notion of addictions and mental illnesses as medical diseases. Medical and psychiatric opinion appear to be revolving away from a strict study of mechanisms of the brain, and back toward the study of society and the environment as root causes of conditions like schizophrenia and drug addiction.

Assuming that we avoid the drastic road of looking beyond the brain entirely for addiction causes—which would represent a true return to the past—what seems to be called for is some sort of “third way” of threading between the determinism of DNA and the fuzzy humanism surrounding the question of social causation, even as many researchers and commentators have become frustrated with the pace of new drug discovery for treating addictive disease, and are threatening to throw out the baby with the bathwater.

Recently, during a lively dinner in Amsterdam, I raised some of these questions with neuroscientist Marc Lewis, Professor of Human Development and Applied Psychology at Radboud University in Nijmegen, The Netherlands, and author of Memoirs of an Addicted Brain: A Neuroscientist Examines his Former Life on Drugs.

“Addictive drugs convert the brain to recognize only one face of God, to thrill to only one suitor,” Lewis wrote in that excellent book. Dopamine becomes “specialized, stilted, inaccessible through the ordinary pleasures and pursuits of life, but gushing suddenly when anything associated with the drug comes into awareness…. I wish this were just an exercise in biological reductionism, or neuro-scientific chauvinism, but it’s not. It’s the way things really work.”

Nonetheless, even Dr. Lewis is unhappy with the idea of calling drug addiction a “disease.” But why? Dopamine, says Lewis, is about craving and attraction, and not just about pleasure. There is too much going on with addictive behavior to fit neatly into the disease category, Lewis believes. Lewis doesn’t argue that brain structure is not causal—much of his book is devoted to proving that it is—but rather that the early brain, in the first two years of life, is so malleable that parent-child experiences shape the style of that young brain, so to speak. “There must be neural correlates to addiction,” he said, “ but this can occur in early childhood, and not from innate genetics.”

This idea has sweeping ramifications. It suggests that a person could become a drug addict entirely independent of his or her inborn genetic predilections. It suggests that a biological propensity for addiction may not need to be innate in order for the disorder to develop. The neurobiological preconditions may develop in early childhood, or even in the womb, and an individual’s basic chromosomal endowment may not be as predictive or protective as we have previously concluded.

I am not yet convinced on this point. Certainly there is evidence that addicted people have often had traumatic childhoods. Or, as we now refer to them: ACEs, or adverse childhood experiences. But should we be spotlighting parents and social setting, as we did for most of the 20th Century, or should we be paying attention to the disordered central nervous system, with associated behavioral traits such as impulsivity, low harm avoidance, and difficulty imaging future consequences, that characterize the behavior and cause much of the frustration in dealing with chronically “bad” children?

The Third Way could well be epigenetics, defined as the study of how gene expression can be modified without making direct changes to the DNA. Writing in Science News, Tina Hesman Saey explains that "epigenetic mechanisms alter how cells use genes but don't change the DNA code in the genes themselves.... The ultimate effect is to finely tune to what degree a gene is turned on or off. Often the fine tuning is long-lasting, setting the level of a gene's activity for the lifetime of the cell."  From a scientific point of view, epigenetics opened the door for a new way of thinking about addiction.

 An addict, as Lewis told me, “is like a starving animal.” You cannot talk that animal out of stalking it prey. However, Lewis believes it is time to do away with the dominant role that the chase for specific genes has played in addiction science. The endeavor resembles a classic needle-in-the-haystack kind of search, and is unlikely to come up with something simple but significant. Lewis believes that in many cases “womb trauma and infant trauma during the first two years” is sufficient to create the innate biological architecture responsible for addiction. Is this true in every case? The research pictures strongly suggests that it isn’t—sorry, Dr. Maté. It seems clear that some people are hardwired for addiction in a way that transcends family environment and social circumstances. We have all heard of the perfect young man or woman, with every advantage, and a loving home life, who succumbs, mysteriously, to the lure of addictive drugs.

We also discussed an article Lewis wrote for Perspectives on Psychological Science, called “Dopamine and the Neural Now,” in which he argues that “the disease-versus-choice debate creates a false dichotomy: Neuroscience does not have to frame addiction as a disease. Rather, it can help explain how addicts make impulsive choices in the moment and distort appraisal and decision-making habits in the long run…. repeated dopamine enhancement modifies brain structures to maximize the appeal of addictive activities, minimize the appeal of competing rewards, and undermine the cognitive capacities necessary to choose between them. I conclude that addiction is not a monolithic state but a recurrent series of choices that permit negotiation, and sometimes cooperation, between immediate and long-range goals.”

Despite the growing popularity of ACE hypotheses for explaining addiction, Lewis insists that addiction is neither a disease of choice nor a genetic imperative. In some ways, it is a meta-disease, calling into question, as all “mental” illnesses do, the very notions of personhood and autonomy. But a Third Way of thinking about addiction; one that incorporates both the innate propensities of our genetic endowment and the many ways early experience can shape the expression of our DNA, may help draw the addiction field out of the “either/or” thinking that continues to shape many of the debates.

 As Saey wrote in Science News: “Such findings suggest that medicines that interrupt or reverse epigenetic changes… could one day prevent or cure addiction." Drugs to treat drug addiction are going to be a central feature of future addiction research, no matter how we rejuggle the relationship between nature and nurture.

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