Is Dexter an Addict?

Compulsion, addiction, and TV serial killers.

With the hit cable TV show “Dexter” set to begin a new season, it seems a fitting time to consider the matter in its essence: What the hell is the deal with this guy? There is, in fact, a book—“The Psychology of Dexter”—which takes exactly this task as its mission.

Edited by Bella Depaulo, PhD, the “completely unauthorized” collection features essays by assorted psychologists, science writers, grad students, professors, and other brainy Dexter fans. For TV watchers unfamiliar with the show, Wikipedia describes “Dexter” as “an American television drama series that centers on Dexter Morgan, a blood spatter-pattern analyst for the Miami Metro Police Department, who moonlights as a serial killer.”

Got that? Whether you find the show to be a dark comedy or an outrage, its popularity is undeniable. One of the show’s themes is that Dexter is the victim of impulses beyond his control, and at one point, he becomes enrolled in Narcotics Anonymous. Is he exactly where he is supposed to be? Let us speculate for a moment, and assume that certain behavioral obsessions—gambling, shoplifting, perhaps even compulsive sex behavior—turn out to be legitimate addictions—addictions to a behavior, rather than a substance. Might not serial killing fall into the same category as other addictions mediated by a disordered reward system in the brain?

Okay, probably not. But the informed speculation that makes up much of the book is both funny and thought-provoking. Moreover, Adi Jaffe, friend of Addiction Inbox, soon-to-be doctor of psychology at UCLA, and the guiding light behind the AllAboutAddiction treatment site, contributed to the collection of essays about Dexter. Here are some of his observations:

“Although the specifics of his story might divide professional opinion on whether he fits the clinical definition of an addict, for the purposes of this essay it is safe to say that Dexter displays both addictive behavior and a personality disorder.”
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“Dexter’s misleading admission that he is, indeed, an addict, is not far from truth…. We find that addicts, like Dexter, often project an entirely false persona in the pursuit of disguising their true intentions and compulsions, as hiding behind a carefully constructed mask is essential to allow them to continue with the behavior that is often their biggest motivator. Indeed, addicts and their behavioral patterns tend to make us feel uneasy in much the same way that Dexter does.”
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“Although a series of vivid flashbacks to horrific childhood trauma has given us a wider view of the origins of Dexter’s dark compulsions…. addiction, as we know, owes much to genetics and biology. The extent to which serial killers are governed by inheritance is not known.”
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“However, we know a few things about addicts, beginning with the unshakably strong connection between addiction and personality disorders that brought Dexter Morgan to a narcotics anonymous meeting in the first place…. These two afflictions undoubtedly support one another, to the tune of a three times higher prevalence of personality disorders in addicts versus the general population.”
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“There is one last thing that Dexter has in common with other addicts. While Dexter seems to have thus far kept his omnipresent mask in place, the show continues to push him toward a point beyond which maintaining the façade and giving in to his dark compulsions will prove mutually exclusive. He would not be the first addict to face such a choice.”

Photo Credit: http://www.aceshowbiz.com/

The Absolutely True Story of the LSD No-Hitter

Dock Ellis, in his own words.

Dock Ellis, former pitcher for the Pittsburgh Pirates, speaking to inmates at Marantha Correctional Facility, Adelanto, California:

“When you get to the big leagues, you start getting big-league dope.

“So here’s what happened to me. I was functioning as a baseball player, but I was addicted to drugs and alcohol. I wanted you to understand that my life was no different than yours–my arena was just different. I was in baseball but I was in the streets too. Like I was saying, it’s all the same. We experience the same kind of stuff, some more than others, but it’s all the same.

 “I played baseball from 1964 to 1979. I was in two World Series…. After I got out of baseball, I ended up in treatment…. I went to school, the University of California, Irvine, to become a substance abuse counselor.

 “Yeah, I threw a no-hitter for the Pittsburgh Pirates against the San Diego Padres in 1970, under the influence of LSD. Want to hear the story? I was in Los Angeles, and the team was playing in San Diego, but I didn’t know it. I had taken LSD… I thought it was an off day, that’s how come I had it in me. I took the LSD at noon. At 1 PM, my girlfriend looked at the newspaper and said, “Doc, you are pitching today!”….

“I can only remember bits and pieces of the game. I was psyched. I had a feeling of euphoria. I was zeroed in on the catcher’s glove, but I didn’t hit the glove too much. I remember hitting a couple of batters, and the bases were loaded two or three times. The ball was small sometimes, the ball was large sometimes. Sometimes I saw the catcher, sometimes I didn’t. Sometimes I tried to stare the hitter down and throw while I was looking at him. I chewed my gum until it turned to powder. They say I had about 3 to 4 fielding chances. I remember diving out of the way of a ball I thought was a line drive. I jumped, but the ball wasn’t hit hard and never reached me. The Pirates won the game 2-0, although I walked eight batters. It was the high point of my baseball career.”

[From “The Harder They Fall: Celebrities Tell Their Real-Life Stories of Addiction and Recovery,” by Gary Stromberg and Jane Merrill.]

Graphics credit: http://slanchreport.com/

NIH Turf Wars

Combining Addiction Agencies.

For nearly a decade, the idea of combining the federal government’s two primary addiction research institutes has made good sense. Recently, an independent panel officially recommended a merger—but alcohol researchers opposed the notion, as they have in the past.

The National Institutes of Health, the nation’s premier biological research institution, is composed of 27 separate medical institutes, each fighting for its share of funding and recognition under the larger umbrella of the parent organization. If this seems like an unwieldy arrangement, that’s because it is. Duplication and overlap is inevitable in as vast an enterprise as the NIH. Yet the arrangement has produced some of the best medical and biological research in the world.

Former NIH director Harold Varmus complained, according to ScienceInsider (Sub req) “that the sprawl hobbles NIH’s ability to respond to new science.” The most obvious case for streamlining and cost-savings has always been the National Institute on Drug Abuse (NIDA) on the one hand, and the clumsily named National Institute on Alcohol Abuse and Alcoholism (NIAAA) on the other.

In 2006, Congress told the NIH to create the Scientific Management Review Board to recommend ways of overhauling the NIH structure. The obvious place to start was with the two overlapping addiction institutes.

It was not a new idea. In 2003, the National Academy of Sciences (NAS) recommended merging the agencies due to “overlapping missions.” Enoch Gordis, then director of the NIAAA, was adamantly opposed to the idea, and the undertaking fell away.

Recently, the Scientific Management Review Board of the NIH voted 12-3 in favor of the merger, and sent the proposal to the desk of NIH director Francis Collins. However, the board also recommended an outside search for a director, thereby eliminating current NIDA director Norah Volkow from consideration. Dr. Volkow has been an active and public advocate for addiction awareness. An obvious choice to head the combined institute, provisionally known as the National Institute on Addiction, she would be a significant loss to the NIH. A spokesperson for Dr. Volkow would only offer NIDA’s official stance on the matter: “NIDA’s position has always been that we should create an organizational structure that best serves the science of addiction. We appreciate the thoughtful process that preceded the Board’s recommendation, and we look forward to hearing about a final decision soon.”

For years, NIAAA supporters had a ready answer when asked what made their agency different from NIDA: the liver. NIAAA did research on the liver and other organs and metabolic processes involved in metabolizing alcohol. But over the past two decades, the meaningful research coming out of NIDA has been the primary focus for most addiction researchers. NIDA’s forceful and forward-thinking director, Norah Volkow, followed an equally outspoken director, Alan Leshner. At NIAAA, the most recent director, Dr. T.K. Li, came to the institute after a distinguished career as an alcohol researcher at the University of Indiana. Dr. Li recently retired and the position is being filled on an interim basis by acting director Kenneth Warren.

NIAAA has always been the weaker sister in the addiction research family. With only half of NIDA’s billion-dollar budget, NIAAA deals strictly with alcohol research, even if the NIAAA has at times seemed unsure of what constitutes its main area of study—alcohol the addictive drug, or alcohol the healthy beverage. The merger would represent a recognition that alcohol is just another drug, albeit a legal one.

However, in a Science (sub req) interview, Francis Collins, the current director of the NIH, noted that the advisory board was “not able to come to a consensus” on the NIDA-NIAAA merger. “I guess most people would have said, ‘Well yeah, of course.’ But when you look at the details…. and you consider that alcohol is after all a legal substance and 90% of us at some point in our lives are comfortable with taking it in while the drug abuse institute is largely focused on drugs that are not legal. So there's a personality of the institute issue here that people thought might be important to preserve, others thought would be good not to preserve.”

The director’s remarks reflect the turf protection responses that this seemingly straightforward move invokes. An article by Bob Curley at Join Together notes that last year, the advisory board “voted unanimously in favor of studying the merger despite the fact that every group and individual testifying live at the hearing opposed combining the two agencies.”

Every group and individual? Curley quotes Lawrence Tabak, former acting deputy director of NIH, who minimized the likelihood of significant cost savings, and said, “there are also some issues that NIAAA deals with that are not ‘addictive’ in nature, such as binge drinking.” Representatives from the Research Society on Alcoholism and the American Association for the Study of Liver Diseases said that NIAAA’s harm reduction approach to alcohol use was “fundamentally at odds with NIDA’s focus on illegal drugs.” The National Association of Addiction Treatment Providers also opposed the merger, citing fears of a “loss of focus” on the problems unique to alcohol.

Beyond the official testimony, many prominent drug addiction experts feel differently. “The basic biology of drug abuse and addiction are highly overlapping for all drugs of abuse,” according to Eric Nestler of the department of neuroscience at the Mount Sinai School of Medicine. “There’s a huge confusion—not only among the lay public but among some treatment providers too—that alcohol is ‘not a drug,’” he said in the Join Together article. “This is absurd, yet the current separation of alcohol into a separate institute provides credence to that notion.”

According to noted addiction researcher Charles O’Brien of the University of Pennsylvania’s department of psychiatry, “There’s no scientific rationale to have a separate institute for a single drug. Ethanol activates the reward system similar to opioids and other abused drugs using different mechanisms to act on the same structures.” In addition, O’Brien notes that most addicts use more than one drug, but that NIAAA funding limit researchers to projects for “pure alcoholics, despite the reality of the clinical populations.”

The dual agencies, by their very existence, imply that addiction to alcohol and addiction to other drugs are wholly separate spheres of inquiry and investigation—a notion damaging to scientific research and public health. The primary hurdle to the merger is political, not scientific.

On the face of it, the merger makes sense, and in fact is long overdue. To keep these agencies separate means continuing to perpetuate the myth that there is something crucial that separates alcoholism from drug addiction. And there isn’t. Treating alcoholism and alcohol abuse as a syndrome somehow apart from drug abuse and addiction is outdated and unwarranted. We know too much now about both conditions to maintain the pretense.

As DrugMonkey, a pseudonymous science blogger funded by the NIH, summed it up: “If Institutes are to be merged than NIDA/NIAAA is at the very top of the list. If these cannot be merged then I do not see how any other mergers can be accomplished.”

Graphics Credit: http://www.hbcprotocols.com/nihfunds.html

Exercise, Attention, Meditation

Drug treatment alternatives.

A prescription for aerobic exercise might seem trivial in the face of the life-or-death battle people wage against rampant addiction. But with or without anti-craving drugs, both diet and exercise—two non-pharmaceutical methods of altering neurotransmission—will have roles to play in recovery.

Exercise, attention to diet, and nutritional supplements are only three of the complementary avenues being explored as components of addiction treatment. Successes have been claimed for acupuncture as well.  The same can be said for hypnosis. It has its vociferous claimants, but it has not been widely tested and documented as an addiction therapy.

Meditation, in its many Eastern and Western derivations, is used by some recovering addicts as a means of dampening the panic and anxiety that often accompany detoxification. And again, there is a certain amount of good science behind the notion. Sources as disparate as Maharishi Mahesh Yogi and Harvard’s Dr. Herbert Benson have produced evidence that sitting meditation—in which the mind is either purposefully made blank, or else is focused on a mantra (the Maharishi’s mantras are Sanskrit, but Dr. Benson maintains that any soft-sounding set of syllables will do)—produces verifiable changes in blood pressure, heart rate, and oxygen exchange. Years ago, Dr. Benson named this phenomenon the “relaxation response.” Many addiction clinics use variations on this theme in an attempt to ease withdrawal symptoms.

All of these alternative modalities suffer from the same limitations: a lack of large scale clinical testing due to inadequate funding, and a lack of adequate insurance reimbursements. Nonetheless, almost anything goes in the sprawling treatment and recovery industry. There are, for example, numerous clinics and treatment centers based on the principles of naturopathic and homeopathic medicine. The 3HO SuperHealth program that bloomed in Tucson, Arizona, a “holistic substance abuse facility” inspired by the teachings of the Hindu Guru Yogi Bhajan, was accepted by Blue Cross/Blue Shield and other major insurance providers. (Gaining insurance accreditation is a major factor in the success or failure of many treatment providers and large-scale programs.) There are drug recovery programs based on the spiritual wisdom of American Indians, on the teachings of the German mystic Rudolf Steiner, on assorted holistic health practices such as yoga, guided imagery, lucid dreaming, biofeedback, massage, and other forms of “personal growth” work.

Alternative therapists maintain that recovery from addiction is as much a spiritual voyage of discovery as it is a path back to conventional health and sanity. Traditional psychotherapy in isolation is a frequently ineffective method of treatment, while anti-craving pills, congeners, and replacement therapies are still quite new.

 Any treatment that claims to work for all addicts all of the time, under all conditions, should be viewed with extreme skepticism. It is safe to say that any commercial treatment program advertising success rates of 50 per cent or more is very probably engaging in short-term follow-ups, and may be seriously misleading the buying public.

Photo Credit: http://steveroni.blogspot.com/

Put Down Your Cigarette Rag (Don't Smoke)

By Allen Ginsberg (1971)

Dont smoke dont smoke dont smoke

Dont smoke

It's a nine billion dollar

Capitalist Communist joke

Dont smoke dont smoke dont smoke dont smoke

Dont smoke

Smoking makes you cough,

You cant sing straight

You gargle on saliva

and vomit on your plate

Dont smoke dont smoke dont smoke dont smoke,

Dont smoke smoke smoke smoke

You smoke in bed

You smoke on the hill

Smoke till yr dead

You smoke in Hell

Dont smoke dont smoke in living Hell Dope Dope

Dont smoke dont smoke dont smoke

You puff your fag

You suck your butt

You choke and gag

Teeth full of crud

Smoke smoke smoke smoke Dont dont dont

Dont Dont Dope Dope Dope Dont Smoke Dont Dope

Pay your two bucks

for a deathly pack

Trust your bad luck

and smoke in the sack

Dont Smoke Dont Smoke Nicotine Nicotine No

No dont smoke the official Dope Smoke Dope Dope

Four Billion dollars in Green

'swat Madison Avenue gets

t' advertise nicotine

and; hook you radical brats

Dont Smoke Dont Smoke Dont Smoke

Nope Nope Dope Dope Hoax Hax Hoax Hoax

Dopey Dope Dopey Dope Dope Dope dope dope

Black magic pushes dope

Sexy chicks in cars

America loses hope

and smokes and drinks in bars

Don't smoke dont smoke dont smoke,

dont smoke dont dont dont dont dont

choke choke choke choke kaf kaf

Kaf Kaf Choke Choke

Choke Choke Dope Dope

Communism's flopped

Let's help the Soviet millions

Sell 'em our Coffin-Nails

and make a couple billions

Big Bucks Big Bucks bucks bucks

bucks bucks smoke smoke smoke smoke

smoke Bucks smoke bucks Dope bucks big

Dope Bucks Dig Big Dope Bucks Big Dope

Bucks dont smoke big dope bucks

Dig big Pig dope bucks

Nine billion bucks a year

a Southern Industry

Buys Senator Jesse Fear who pushes Tobacco subsidy

In the Senate Foreign Relations Committee

Dope smokes dope smokes dont smoke dont smoke

Cloak cloak cloak room cloak and; dagger

smoke room cloak room dope cloak

cloak room dope cloak room dope dont smoke

Nine billion bucks for dope

approved by Time and Life

America loses hope

The President smokes Tobacco votes

Dont Smoke dont smoke dont smoke dont smoke

Dont smoke nope nope nope nope

30 thousand die of coke or

Illegal speed each year

430 thousand cigarette deaths

That's the drug to fear

In USA Dont smoke Dont smoke Dont smoke

Get Hooked on Cigarettes

Go Fight the War on Drugs

Smoke any other Weed

Get bust by Government Thugs

Dont smoke dont smoke the official dope

If you will get in bed

and give your girlfriend head

then you wont want a fag

Nor evermore a drag

Dont Smoke dont smoke Hope Hope Hope Hope

O Please Dont Smoke Dont Smoke

O Please O Please O Please

I'm calling on my knees

Twenty-four hours in bed

and give your boyfriend head

Put something in your mouth

Like skin not cigarette filth

Suck tit suck tit suck cock suck cock

suck clit suck prick suck it

but dont smoke nicotine dont smoke

dont smoke nicotine nicotine it's

too obscene dont smoke dont smoke

nicotine suck cock suck prick suck tit

suck clit suck it But dont smoke shit nope

nope nope nope Dope Dope Dope Dope

the official dope Dont Smoke

Make believe yer sick

Stay in bed and lick

yr cigarette habit greed

One day's all you need

In deed in deed in deed in deed smoke weed

smoke weed Put something green

in between but don't smoke smoke dont smoke

hope hope hope hope Nicotine dont

smoke the official dope

Dope Dope Dope Dope Dont Smoke

Smoke weed indeed smoke grass yass yass

smoke pot but not nicotine no no

indeed it's too obscene

put something green

in between your lips get hip not square

listen to my wail don't dare smoke coffin nails

ugh ugh ugh ugh the government Drug

official habit for Mr. Babbitt

Dont smoke the official dope

dope dope dope dope don't smoke

Dont Smoke Dont Smoke.

Original version: First Blues: Rags, Ballads and Harmonium Songs

Extended version: http://www.youtube.com/

Photo Credit: http://berkshirereview.net/

Nicotine and the Humphrey Bogart Gene

You can lead a fish to water, but can you make it smoke?

Zebrafish embryo showing axon tracts in green, viewed from lateral (top) and dorsal (bottom) orientations------>

Common denizens of home aquariums, the humble zebrafish may dart about the tank like any other small tropical specimen, but zebrafish have become one of the hot genetic research tools of the moment. The lab rat may have met its match in the lab zebrafish, a popular non-mammalian organism that is currently playing a leading role in government-sponsored research on the genetic aspects of nicotine addiction.

Scientists are fond of these new fishy animal models because zebrafish are cheap, develop rapidly, and are more biologically similar to humans than anyone might naively assume. Their transparent embryos allow researchers to inject flourescent proteins into living animals, and in some cases to track the regulation of gene expression as it is happening.

Research funded by the National Institute on Drug Abuse (NIDA) and  published in the Proceedings of the National Academy of Sciences used zebrafish in a hunt for genes

affecting nicotine exposure. Like rats, the fish show characteristic behaviorial responses to low doses, high doses, and the nicotine sensitization process. According to NIDA, the scientists “induced mutations in particular DNA segments of the zebrafish and looked at changes in the nicotine response profile of mutant carriers compared to their siblings.” The changes in nicotine response observed between the groups were mediated by two genes, which the scientists dubbed bdav/cct8 (bette davis) and hbog/gabbr1.2 (humphrey bogart), named after “celebrities that suffered from tobacco-related cancers.” These two genes, when expressed, caused zebrafish to respond more positively to nicotine.

“We all know how hard it is to quit smoking,” Dr. Ekker told Mayo’s online research magazine, Discovery’s Edge. “What most people don’t know is that genetic differences significantly contribute to the degree of nicotine dependence. We want to understand the genetics behind different responses to nicotine and come up with more effective and individualized treatments for people addicted to nicotine.”

The Mayo Clinic in Minnesota has taken a leading role in developing the fish for research, having established the Zebrafish Core Facility in 2007 under the direction of Dr. Stephen Ekker. Mayo’s zebrafish are now being used in various research laboratories for research in the fields of developmental biology and functional genomics. The fish are now a crucial part of biological research on cancer and heart disease, as well as addiction.

Graphics Credit: http://www.ucl.ac.uk/

Petzold AM, Balciunas D, Sivasubbu S, Clark KJ, Bedell VM, Westcot SE, Myers SR, Moulder GL, Thomas MJ, & Ekker SC (2009). Nicotine response genetics in the zebrafish. Proceedings of the National Academy of Sciences of the United States of America, 106 (44), 18662-7 PMID: 19858493

National Alcohol and Drug Addiction Recovery Month

Presidential Proclamation

Each day brings new opportunities for personal growth, renewal, and transformation to millions of Americans who have chosen to forge a path toward recovery from addiction to drugs or alcohol.  While addiction can destroy self confidence, family ties, and friendships, recovery can restore the promise of a brighter tomorrow.  During National Alcohol and Drug Addiction Recovery Month, we express support for those living healthy and productive lives in long term recovery, we applaud those working to help struggling Americans break the cycle of abuse, and we encourage those in need to seek help.

This year's theme, "Join the Voices for Recovery:  Now More Than Ever!," calls us to an urgent mission to save lives from the hazards of addiction.  As we make quality and affordable health care more accessible to all Americans, we also resolve to build a healthier Nation by increasing access to treatment and recovery programs in our health care system.  To help achieve this goal, the Affordable Care Act supports services available to address addiction.  Together, we can reduce the harmful consequences of untreated addiction, such as violence, failure in school, job loss, child abuse, crimes, and death.  I encourage all Americans to visit RecoveryMonth.gov for more resources and information.

 The journey to recovery requires great fortitude and a supportive network.  As we celebrate National Alcohol and Drug Addiction Recovery Month, we also express our appreciation for the family members, mutual aid groups, peer support programs, health professionals, and community leaders that provide compassion, care, and hope.  Across America, we must spread the word that substance abuse is preventable, that addiction is treatable, and that recovery is possible.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim September 2010 as National Alcohol and Drug Addiction Recovery Month.  I call upon all Americans to observe this month with appropriate programs, ceremonies, and activities, and to celebrate the lives freed from addiction to illicit drugs, alcohol, or prescription medications.

IN WITNESS WHEREOF, I have hereunto set my hand this thirty-first day of August, in the year of our Lord two thousand ten, and of the Independence of the United States of America the two hundred and thirty-fifth.

BARACK OBAMA