Get ready to have your beliefs about addiction turned upside down (in a good way)!

Whether you're struggling with carb cravings or worried about a loved one who's battling alcoholism, this podcast could be the most important 39 minutes of your entire year. Seriously! So put your listening ears on...



Today, Escape from Caloriegate welcomes Dr. Lance Dodes, a Training and Supervising Analyst with the Boston Psychoanalytic Society and Institute and assistant clinical professor of psychiatry at Harvard Medical School. Dr. Dodes is also the former Director of the substance abuse treatment unit of Harvard’s McLean Hospital.

Dr. Dodes has developed truly revolutionary insights into the nature of addiction -- concepts he eludcidated in his books, "The Heart of Addiction" and "Breaking Addiction: A 7-Step Handbook for Ending Any Addiction." Dr. Edward Hallowell, a preeminent authority on Attention Deficit Disorder (ADD), called Breaking Addition a "groundbreaking work [that] should become the 'go to' handbook for anyone suffering with addiction."

Full disclosure: Dr. Dodes is also the father of one of my best friends in the world, Zach -- the guy who got me into this whole low carb mishegas in 2007 by insisting that I read Gary Taubes' Good Calories Bad Calories.



Here are some highlights from the episode:

• The way most people think about addiction is wrong: they think it's a physical problem; a spiritual or moral weakness; or a neurological problem


• None of these things = true


• Dr. Dodes has been talking to people with addictions for decades, and he's learned from them and tested his hypotheses


• He's come up with a new way of understanding addiction


• A case history to illustrate this new paradigm


• Man stuck waiting for his wife became frustrated - spotted a bar and went in


• When did you start to feel better? "When I was standing on that corner and I decided to get a drink"


• Illustrative of what he's heard from many people over the years - wasn't the drink itself when he felt better. Something happened when he made the decision.


• His problem was that he was helpless, trapped. When people feel overwhelmingly helpless, it precipitates addictive behvaior. Once he decided to drink, he wasn't helpless any more.


• Addictive acts are ways of undoing or reversing overwhelming helplessness.


• Addiction is not a "thing in itself" -- it's a symptom. It's an "unlucky solution" to the problem of helplessness.


• Triggers of helplessness are very personal and not conscious


• "F*ck it: I'm going to have a drink." What does the "f*ck it" mean? It's a fury at being helpless.


• Analogy to a cave-in. 300 tons of rock trap you in a cave, you're going to freak out. That's a normal reaction.


• The people who get depressed and inert when helpless don't do well -- rage at helplessness is innate and healthy.


• It's that power that makes addiction so powerful.


• This rage has certain properties which give addiction its properties.


• At the moment of the addictive feeling, nothing else matters. If you break your wrist trying to get out of a cave-in, you're not being self-destructive -- you're just not paying attention to the consequences.


• Instead of taking a direct action to deal with helplessness, he took an indirect action.


• All addictive acts are displacements. Helps to explain curious clinical features of addiction - e.g. that you can change focus of an addiction.


• Drinking alcohol is most common displacement, but people can switch to other drugs or even to gambling, shopping or eating.


• There is no difference between addictions and compulsions -- this should change the way we think about treatment


• We know how to treat compulsions! Figure out why they occur, when they occur, etc.


• Addictions can be treated by a psychologically sophisticated therapy. Conversely, 12 step models don't work well.


• Giant modern myth about addiction - that it's a chronic brain disease. Comes out of National Institute of Drug Abuse.


• Physical addiction is VERY different from addiction. Very clear and simple phenomenon.


• If you take enough of a drug in high enough dose, you become tolerant. To get same effect, you need to increase dose.


• Pull the drug away, you go into withdrawal -- in opposite direction of the drug.


• Not important because anybody can become physically addicted.


• Treat easily - by detoxifying them.


• You can't turn someone into an alcoholic by physically addicting them


• Vietnam veterans study - dramatic example. In 1960s, heroin epidemic in our country. After detoxing, huge recividism rate.


• Soliders in Vietnam also got addicted to heroin (high quality stuff).


• When soldiers got back, they detoxed, and over 90% never used heroin again -- the opposite of what happened with the stateside addicts.


• The difference was in their psychology. Solidiers used it because of stress of war. When they got home, they didn't need it and so didn't use it.


• What's the retort? There is no response from the conventional thinkers. It's unchallengable.


• Millions of people stopped smoking in the 1980s, once the Surgeon General's anti-smoking campaign started up. Similar to what happened with the vets.


• Scientists addicted rats to heroin and conditioned them, a la Pavlov's dogs, with cues.


• Rats releasing dopamine - the gas of the pleasure pathway. We see response from cue. Brain will create more dopamine - upregulate. The CW: "Now we know why people can't stop taking drugs. Their brains have been chronically changed."


• Why this is wrong: if that was true, the Vietnam study wouldn't have turned out like that, since the vets' brains would have changed.


• Also: people aren't like that at all! People wait hours to drive to the casino. They're not hyped up on dopamine.


• Chronic brain disease idea is a mistake -- even though rats and humans are similar, rats operate a simple system, so paradigm doesn't really apply.


• Also, doesn't explain non-drug compulsions -- no dopamine released when you arrange things parallel on your desk.


• 5% success rate of AA because it's approaching the problem without understanding it.


• The idea that there's a simple neurological basis of addcition misses