by Adam Alter
Then Isaac made his biggest mistake. “I got through the rest of the program, my chest puffed up, and I was a little bit more confident in what I was doing. But when it came time to present my life balance plan at the end of the program, the one thing everybody criticized was my decision to go back to D.C.” Isaac describes this using the language you’d expect from a veteran gamer: “I just felt like I couldn’t leave something unconquered. I couldn’t leave American University without my degree—it just wasn’t gonna happen. Against medical advice I decided to go back east.”
Isaac’s experience differs from the lives of Lee Robins’ Vietnam vets. Instead of escaping the context of his addiction forever, Isaac returned to D.C. For two or three months, things went well. He got a job, he started working as a math tutor and made good money, and his guidance counselor admitted him back into American University. Things were looking up—until they weren’t.
Isaac told me that the most dangerous time for an addict is the first moment when things are going so well that you believe you’ve left the addiction behind forever. “You’re convinced that you’re fixed, so you can go back to doing what you were doing before. I let my guard down, and a buddy of mine sent me a text message that said, ‘Hey, you wanna play with us a little bit?’ And I went, ‘Hey, sure!’”
That was Thursday, February 21, 2013. Isaac is sure of the date, because it left an indelible imprint in his memory. Two days later he was scheduled to tutor a kid who had an algebra exam, but he missed the appointment. He didn’t go to class on Monday either, and then he spent five weeks alone in his apartment. He didn’t leave once and he didn’t shower. In exchange for a small tip, his doorman brought food he ordered by phone to his room. His place began to smell and empty containers towered around his desk. He played twenty hours a day and collapsed, numb, for a few hours of sleep before returning to the game when he awoke. He completed one mission after another, chatted with his guild-mates for days, and lost touch with the outside world. Five weeks passed quickly. He missed one hundred and forty-two phone calls (another number he says he can’t forget), but, for some reason that escapes him even now, he decided to answer the one hundred and forty-third call. It was his mother, and she told him that she was visiting in two days.
After one final binge, he decided to clean his apartment and take a shower. This was his “rock-bottom moment.” He was disgusted by what he saw in the mirror. He’d put on sixty pounds of pure fat, his hair was greasy, and his clothes were filthy. He described a recurring vision that, even eighteen months later, brought him close to tears:
When I was growing up, my dad didn’t have a lot of money. He started a business, and left for work at five in the morning and came home around nine at night. He was very happy when he got home. He’d give me a huge hug, grab a little glass of Scotch, go to his chair by the window and open it up so he could enjoy the breeze. And then he’d do it all over again, every single day.
I had this image of him walking into my apartment, and grabbing a little glass of Scotch, going to his chair, and crying. I had never seen my dad cry. He always had his chest up, and he was always strong. And I imagined him crying in his chair, wondering what he did wrong with me. It hurts just talking about it. It was this burning pain in my heart that he would feel that way for my fuck-up.
Isaac took his mom to dinner, where he broke down and told her he’d fallen off the wagon. He told her he needed to try reSTART again, but this time with a better attitude. He wouldn’t return to D.C., and after the six-week inpatient program ended, he’d enroll in a seven-month after-care outpatient program.
Isaac was true to his word. He embraced the inpatient program and felt comforted knowing that the outpatient program would give him extra support as he grew used to living and working outside the center. The outpatient program made all the difference. Like other outpatients, Isaac spent between twenty and thirty hours at the center each week, while also holding down a part-time job. He lived with several former inpatients, who supported each other and vigilantly ensured that their roommates didn’t relapse.
Isaac decided to stay in the Seattle area, near reSTART. He visits the center often, but now spends most of his time running a CrossFit gym. In April 2015, he bought the gym from its former owners, and after just four months under his care its membership tripled. The gym gives him a healthy way to fulfill his psychological needs: he has plenty of friends, remains active and healthy, and sets business-oriented goals that keep him motivated.
Isaac Vaisberg, like Robins, Milner, Olds, and their students, taught the world a profound lesson about addiction and its victims: there’s so much more to addiction than an addictive personality. Addicts aren’t simply weaker specimens than non-addicts; they aren’t morally corrupt where non-addicts are virtuous. Instead, many, if not most, of them are unlucky. Location isn’t the only factor that influences your chances of becoming an addict, but it plays a much bigger role than scientists once thought. Genetics and biology matter as well, but we’ve recognized their role for decades. What’s new, and what only became clear in the 1960s and 1970s, is that addiction is a matter of environment, too. Even the sturdiest of our ranks—the young G.I.s who were free of addiction when they left for Vietnam—are prone to weakness when they find themselves in the wrong setting. And even the most determined addicts-in-recovery will relapse when they revisit the people and places that remind them of the drug.
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Time has made a fool of the experts who once believed that addiction was reserved for a wretched minority, because, like Isaac Vaisberg, tens of millions of people in the developed world today exhibit one or more behavioral addictions. The very concept was foreign to Olds and Milner in the 1950s, and to Robins in the 1970s. People were addicted to substances—not behaviors. The feedback they got from behaviors alone could never rise to the euphoric intensity of injected heroin. But just as drugs have become more powerful over time, so has the thrill of behavioral feedback. Product designers are smarter than ever. They know how to push our buttons and how to encourage us to use their products not just once but over and over. Workplaces dangle carrots that always seem to be just out of reach. The next promotion is around the corner; the next sales bonus is one sale away.
As for Rat No. 34, hammering away at the bar in his cage, our brains host a flurry of electrical activity when we’re engaged with an addictive behavior. For decades, researchers believed this activity was the root of addiction: mimic the right brain patterns and you’d create an addict. But the biology of addiction is far more complicated than simply stimulating a clump of neurons. Addiction, as it was for Isaac Vaisberg, the Vietnam vets, and Rat No. 34, is a matter of learning that the addictive cue—a game, a place paired with heroin, or a small metal bar—treats loneliness, disaffection, and distress.
3.
The Biology of Behavioral Addiction
There’s a modern-day malady that affects two thirds of all adults. Its symptoms include: heart disease, lung disease, kidney disease, appetite suppression, poor weight control, weakened immune functioning, lowered resistance to disease, higher pain sensitivity, slowed reaction times, mood fluctuations, depressed brain functioning, depression, obesity, diabetes, and certain forms of cancer.
That malady is chronic sleep deprivation, which is rising in the wake of smartphones, e-readers, and other light-emitting devices. Sleep deprivation is behavioral addiction’s partner—the consequence of persistent overengagement. It’s a global problem that has recently attracted plenty of attention, including from entrepreneur and author Arianna Huffington. At the 2016 World Economic Forum in Davos, Huffington discussed her forthcoming book on sleep, titled The Sleep Revolution:
I got an email two hours ago from the official Davos establishment, which was a sleep survey of the world. It shows that people spend more time on their digital devices than sleeping . . . I think it’s really interesting to look at the relationship between technology and taking
care of ourselves. Because we’re obviously all addicted to technology. So how can we put it in its place? And not on your nightstand. That is the key guys—do not charge your phones by your bed.
Huffington was wise to focus on smartphone charging. Ninety-five percent of adults use an electronic device that emits light in the hour before bed, and more than half check their emails overnight. Sixty percent of adults aged between eighteen and sixty-four keep their phones next to them when they sleep, which might explain why 50 percent of adults claim they don’t sleep well because they’re always connected to technology. Sleep quality has declined dramatically in the past half century, particularly over the past two decades, and one of the major culprits is the bluish light that emanates from many of these electronic devices.
For millennia, blue light existed only during the daytime. Candles and wood fires produced reddish-yellow light, and there was no artificial lighting at night. Firelight isn’t a problem, because the brain interprets red light as a signal for bedtime. Blue light is a different story, because it signals morning. So 95 percent of us are inducing jet lag at night by telling our bodies that the day is beginning just before we go to bed.
Normally, the pineal gland buried deep in your brain produces a hormone called melatonin at night. Melatonin makes you sleepy, which is why people who suffer jet lag take melatonin supplements before bed. When blue light hits the back of your eyes, the pineal gland stops producing melatonin, and your body prepares for the day. In 2013, a group of scientists measured how much melatonin thirteen volunteers produced after using an iPad for two hours late at night. When those volunteers wore orange goggles—to simulate evening light—they produced plenty of melatonin, which prepared their bodies for bed. When they wore blue goggles (and to some extent when they used the iPad without goggles), their bodies produced significantly less melatonin. The researchers urged “manufacturers to design [sleep-cycle]-friendly electronic devices” with backlights that turned progressively more orange at night. A second study, this time without goggles, found the same effect: people produce less melatonin, sleep more poorly, and feel more tired when they use an iPad before bed. In the long run, our technology compulsions are damaging our health.
As much as blue light hampers our ability to sleep, the real damage of behavioral addiction happens when we’re wide awake, obsessively juggling laptops and tablets, fitness trackers and smartphones.
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The human brain exhibits different patterns of activity for different experiences. One clump of neurons fires when you imagine your mother’s face; a different clump when you imagine the house where you grew up. These patterns are fuzzy, but by looking at a person’s brain you can tell roughly whether she’s thinking about her mother or her first home.
There’s also a pattern that describes the brain of a drug addict as he injects heroin, and a second that describes the brain of a gaming addict as he fires up a new World of Warcraft quest. They turn out to be almost identical. Heroin acts more directly, generating a stronger response than gaming, but the patterns of neurons firing across the brain are almost identical. “Drugs and addictive behaviors activate the same reward center in the brain,” according to Claire Gillan, a neuroscientist who studies obsessive and repetitive behaviors. “As long as a behavior is rewarding—if it’s been paired with rewarding outcomes in the past—the brain will treat it the same way it treats a drug.” What makes drugs like heroin and cocaine more dangerous in the short-term is that they stimulate the reward center much more strongly than behaviors do. “Cocaine has more direct effects on the neurotransmitters in your brain than, for example, gambling, but they work by the same mechanism on the same systems. The difference is in their magnitude and intensity.”
This idea is quite new. For decades, neuroscientists believed that only drugs and alcohol could stimulate addiction, while people responded differently to behaviors. Behaviors might be pleasurable, they suggested, but that pleasure could never rise to the destructive urgency associated with drug and alcohol abuse. But more recent research has shown that addictive behaviors produce the same brain responses that follow drug abuse. In both cases, several regions deep inside the brain release a chemical called dopamine, which attaches itself to receptors throughout the brain that in turn produce an intense flush of pleasure. Most of the time the brain releases only a small dose of dopamine, but certain substances and addictive experiences send dopamine production into overdrive. Warming your hands by a log fire on a cold night or taking a sip of water when you’re thirsty feels good, but that sensation is dramatically more intense for an addict when he injects heroin or, to a lesser extent, begins a new World of Warcraft quest.
At first the upsides dramatically outweigh the downsides as the brain translates the rush of dopamine into pleasure. But soon the brain interprets this flooding as an error, producing less and less dopamine. The only way to match the original high is to up the dosage of the drug or the experience—to gamble with more money or snort more cocaine or spend more time playing a more involving video game. As the brain develops a tolerance, its dopamine-producing regions go into retreat, and the lows between each high dip lower. Instead of producing the healthy measure of dopamine that once inspired optimism and contentment in response to small pleasures, these regions lie dormant until they’re overstimulated again. Addictions are so pleasurable that the brain does two things: first it produces less dopamine to dam the flood of euphoria, and then, when the source of that euphoria vanishes, it struggles to cope with the fact it’s now producing far less dopamine than it used to. And so the cycle continues as the addict seeks out the source of his addiction, and the brain responds by producing less and less dopamine after each hit.
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As a kid I was terrified of drugs. I had a recurring nightmare that someone would force me to take heroin and that I’d become addicted. I knew very little about addiction, but I pictured myself frothing at the mouth in a bleak treatment center. As time passed I realized that drug pushers weren’t going to waste their time on a neurotic seven-year-old, but one part of the nightmare stuck with me: the idea that a person could become addicted against his will; that if you happened to come into contact with an addictive substance, you’d develop an addiction. If addiction were simply a brain disorder, my seven-year-old self would have been right: flood the brain with dopamine and you create an addict. But that’s not how addiction works at all. Since your brain fundamentally reacts the same way to any pleasurable event, there has to be another ingredient—otherwise we’d all develop crippling ice cream addictions from an early age. (Just imagine the dopamine shock that follows a toddler’s first taste of ice cream.)
The missing ingredient is the situation that surrounds that rise in dopamine. The substance or behavior itself isn’t addictive until we learn to use it as a salve for our psychological troubles. If you’re anxious or depressed, for example, you might learn that heroin, food, or gambling lessen your pain. If you’re lonely, you might turn to an immersive video game that encourages you to build new social networks.
“We have systems for parenting and love, and those systems push us to persist despite negative consequences,” Maia Szalavitz, a writer who focuses on addiction, explains. “The system that’s designed for that sort of behavior is the template for addiction. When this system becomes misaligned, you get addictions.” Each of the systems that Szalavitz refers to is a collection of instinctive survival behaviors, like the drive to care for your children or to find a romantic partner. The same instincts that push us to persevere in the face of pain and difficulty can also propel fanaticism and damaging addictive behavior.
In one article, Szalavitz explains that no one else can turn you into an addict. “Pain patients cannot be ‘made addicted’ by their doctors,” Szalavitz says. “In order to develop an addiction, you have to repeatedly take the drug for emotional relief to the point where it feels as though you can’t live without it . . . it can only happ
en when you start taking doses early or take extra when you feel a need to deal with issues other than pain. Until your brain learns that the drug is critical to your emotional stability, addiction cannot be established.” Addiction isn’t just a physical response; it’s how you respond to that physical experience psychologically. To underscore the point, Szalavitz turns to heroin, the most addictive and dangerous illicit drug. “To put it bluntly, if I kidnap you, tie you down, and shoot you up with heroin for two months, I can create physical dependence and withdrawal symptoms—but only if you go out and use after I free you will you actually become an addict.”
“Addiction isn’t about ‘breaking’ your brain, or ‘hijacking’ your brain, or ‘damaging’ your brain,” Szalavitz says. “People can be addicted to behaviors, and even to the experience of love. Addiction is really about the relationship between the person and the experience.” It isn’t enough to ply someone with a drug or a behavior—that person also has to learn that the experience is a viable treatment for whatever ails them psychologically.
The highest risk period for addiction is early adulthood. Very few people develop addictions later in life if they haven’t been addicted in adolescence. One of the major reasons is that young adults are bombarded by a galaxy of responsibilities that they’re not equipped to handle. They learn to medicate by taking up substances or behaviors that dull the insistent sting of those persistent hardships. By their midtwenties, many people acquire the coping skills and social networks that they lack in adolescence. “If you aren’t using drugs as a teenager, you’re probably also learning to deal with your troubles using other methods,” Szalavitz said. So you develop a degree of resilience by the time you emerge through the gauntlet of adolescence.
