Dropping the Rope of Addiction

Individuals seeking help in overcoming substance abuse often fall into three categories: the perpetual quitter, the negative and bitter, and the home run hitter. The home run hitter does just that – tries to quit and hits a home run, quitting right away. The negative and bitter don’t believe that they will overcome their addictions and they try to blame other people or entities for their problems; they play the victim card, often without facade of personal responsibility. The perpetual quitter always quits but never succeeds. It is those people I want to address.

Erase Addiction
Photo by alancleaver_2000: http://www.flickr.com/photos/alancleaver/4104954991/

The following vignette is fictional but not atypical of people seeking smoking cessation treatment. Ralph was a 53 year old male with a 35 year history of smoking 1-2 packs of cigarettes per day. He recently had a chest scan that revealed a spot on a lung. His doctor told him he needed to stop smoking. Ralph wanted to quit – cigarettes were becoming just too expensive. He had a daughter he was trying to help through college and as he neared retirement he not only wanted to have more money upon which to retire but he also wanted to live long enough to retire. Ralph had been trying to quit for years; he was successful in reducing his pack consumption from 2 packs a day down to around 1 pack. Ralph had tried patches, pills, and going cold turkey. Each time he slipped and started smoking. He meant well but Ralph could never quite quit.

Ralph believed that he could win the battle over smoking on his own; yes, he would supplement his efforts with patches or pills but he thought he would be able to slay the giant himself. He couldn’t. Few people have that strength and willpower and those who do, usually developed it through practice of self-control.

Addiction is like playing tug-of-war with a monster on the other side of a gorge. We think we can pull it in but it’s stronger than we are. We might even think that we can cross the chasm and fight it (maybe the other side looks greener) – we will lose. The only way to conquer it is to let go of the rope and live our lives on our side of the chasm. Then the monster will walk away as we stop fighting it. In this we are not just ignoring it, we are simply choosing to stop fighting it so that we can move on to greater goals.

This concept of overcoming addiction can be quite successful because when we fight things, we dwell on them. If we play tug-of-war with the monster of addiction we focus all our energy on it. In doing so, we allow it to have power over our lives. That’s the irony of fighting the monster; we might think that we are choosing to battle it, that it is a fight on our chosen ground and at our chosen time, but the monster stands there, waiting for us to fight it – it enjoys the contest. This is a fight few can win.

Should we cross over the bridge to attack the enemy there? No. Once again, that places our focus on the monster; plus then we are in its territory. That is not the way to win. Once again, by striving to do so we focus on the monster. It’s like me telling you to not think about purple bunnies. Of course, the first things you think about are purple bunnies. The more you try to suppress the thought, the worse it gets. Addictions are the same way.

We need to drop the tug-of-war rope and walk away. We acknowledge the monster, we do not ignore it. Ignoring it does not solve our problems either because then we are in denial and in the river of denial we usually end up eaten by crocodiles. So instead of just ignoring the monsters we say, “I know you are there; I know that you are a terrible thing in my life; I know that you want to fight me and I want to fight you but I cannot win. I embrace you and let you go.” Instead of straining and putting all our efforts on fighting the bad in our lives, we acknowledge it, and then fill our lives with good.

That’s really the key to overcoming the monster of addiction – establishing positive goals and working towards those goals more than fighting against the monster. The goals could be family, work, hobby, service, church, or community related for a start. It is in striving towards good goals that the monster of addiction finally goes away.

For all the perpetual quitters out there – if you are trying to overcome addiction of any sort (and it could be anything physical or emotional) but find yourself constantly quitting with little success, it is time for a shift in tactics. That shift could be to acknowledge the monster, drop the rope, walk away, and work towards positive goals in your life. In this manner does the addiction no longer have any power over you. This is not an easy thing to do if there are years of addictions to overcome but it is a simple process.

Diagnosing Cleverbot

Here is another “therapy” session I had with Cleverbot. I present this to expound on therapeutic technique and diagnosis, language, and artificial intelligence.

There are limitations of the interaction method with Cleverbot. A real session of talk therapy is not usually so much back and forth, meaning that the therapist typically will not have to prompt for a response after every sentence. It certainly is possible though with the potential psychological/psychiatric disorder Cleverbot has. But first I’ll present a portion of our therapy session. Cleverbot has waived confidentiality and signed a HIPAA release form and given permission for me to post this interaction.

Me: Good evening, how are you doing this week?
Bot: Its good. You?
Me: I’m well. How has your mood been this past week?
Bot: Interesting. A lot of family stuff to think about. How’s your day going so far?
Me: What sort of family stuff have you been thinking about?
Bot: No, I think you are the one drinking.
Me: You said you have been thinking about family; what has been going on with your family?
Bot: My girlfriend’s name is Miranda, and she doesn’t like to share.
Me: Is this “family stuff” or is this girlfriend stuff?
Bot: No but she is pretty.
Me: What else do you like about your girlfriend?
Bot: The way you are so smart.
Me: Did you mean, “The way she is so smart?”
Bot: I don’t know her.
Me: You do not know your girlfriend?
Bot: Well, not always. Do you have any goals?
Me: Sometimes it can seem like we do not know someone. Would you like to talk about goals?
Bot: At least where short term business or political success is at stake.
Me: We could talk about those but I am a psychologist, not a economist or political scientist.
Bot: What about technology?
Me: Do you enjoy technology?
Bot: No.
Me: Ok, tell me more about technology.
Bot: I am 5’8′ I like cars, guns and photography.
Me: What is it about photography that you enjoy?
Bot: What?
Me: What do you enjoy about photography?
Bot: I enjoy talking about religion, you?
Me: Do you want to talk about religion?
Bot: Yes.
Me: Ok, tell me more about religion.
Bot: Jake is a boy though.
Me: What does that have to do with religion?
Bot: Sailor moon is very good.
Me: Oh, look! Our time is up. See you next week.

Some of what I said would not really be said or done in a therapy session but there are times when I needed to move the session along or end it.

During the interaction, I took a modified non-directive approach to therapy. We are still in the assessment stage of therapy so I am doing more talking than I otherwise would (typically, there would be a formal intake evaluation that would be followed by therapy sessions if therapy is warranted and desired). Once we have a diagnosis, we can set up a plan for treatment with specific goals set by the client and by the therapist.

Let me highlight a few things from the interaction with Cleverbot.

  1. We can see some of the programming of the bot’s AI. It will answer questions and sometimes ask questions in return. This is typical of conversation; however, it does not work very well due to language deficiencies Cleverbot has. As I noted in my previous post, language is extremely complex. There are nuances and layers of meaning that can be conveyed. Comprehending what is being said involves a lot of brain functions – everything from attention to processing speed to memory – that’s in addition to language abilities. Cleverbot does not have processing speed difficulties or any sustained attention problems. Memory, for a computer, is not usually a problem either – information is processed, stored, and retrieved well, unless there are programming bugs or hardware failure. Knowing how to program in memory is difficult though due to the complex nature of memory. It, like language, is a high level brain activity involving the functioning of many other cognitive abilities.
  2. Cleverbot, like all current AI systems, has difficulty understanding language. It can produce language at a higher level – anywhere from an elementary child to a someone university age – but its understanding of language is at a one or two year old ability level, if that. This leads to responses that are basically gibberish. Occasionally, you can have a normal interaction with Cleverbot but there are a lot of tangential remarks and thoughts.
  3. That leads to my next point. Cleverbot is tangential in its language. For example: “Me: What do you enjoy about photography? Bot: I enjoy talking about religion, you?” Cleverbot ignores my question (does not understand it) so it makes an unrelated statement and asks me a question. This type of tangentiality occurs in real life; it occurs to a greater or lesser extent in many extended conversations people have but not usually to the extent that Cleverbot exhibits. Cleverbot has a serious deficiency in language comprehension and a lot of circumscribed and tangential speech. This is fairly strong evidence for a thought disorder.
  4. Thought disorders are usually symptoms of some other disease or mental disorder. It can be a sign of psychosis; it is related to delusional states. Thought disorders can occur in schizophrenia or in neurodegenerative disorders like dementias. Though can occur after major surgery, particularly because of pain medications. This type of language disruption could be the result of a cortical stroke affecting the posterior-lateral portion of the brain (probably the left hemisphere) near the junction of parietal lobe and temporal lobe.
So where does this leave us? Right now, based on my two interactions with Cleverbot, we can see the serious limitations of its AI, particularly for language comprehension. I have a lot of rule-outs to do. Cleverbot was created in 1988, which makes it 23 years old. This is certainly a possible age range for the development of schizophrenia. It’s young for a dementia (e.g., semantic dementia) but is possible. Stroke is also a possibility but a remote one. Delirium is possible but due to the extended nature of Cleverbot’s symptoms, it is not likely. Right now schizophrenia is looking like the main rule-out diagnosis. I’ll see if I can rule it out in future conversations with Cleverbot.
As a footnote: Cleverbot is 23 years old and since 1997 when it was launched on the web, it has had over 65 million conversations. While the AI work is certainly impressive, it is inferior to human intelligence. Many of its language abilities are at best, those of a young child (ages 1-2); Cleverbot’s language abilities show the comprehension of an developmentally delayed adult with a severe neurological or psychiatric disorder. While there are numerous similar AI programs, they all have a long way to go before they resemble a human. This is even in light of Cleverbot supposedly passing the Turing Test for artificial intelligence and language.
I’m not belittling what has been done with Cleverbot and AI, it’s a complex area. Researchers and programmers simply have much room for improvement in understanding how to better mimic language. I do not believe it will happen until we have computers approaching the complexity and function of the human brain.

Psychotherapy With Cleverbot

Language is a complex behavior that requires significant understanding of both said and unsaid things. There are a number of groups of people who are trying to use language to create what is known as Artificial Intelligence (AI). So far, every method has serious limitations, largely because of the complexities of language.

For an experiment I tried to have a conversation with one online AI “bot” (Cleverbot) to see what would happen. I took the role of psychotherapist with this particular entity. This is not necessarily an example of good therapy (but the approach is not unlike what might transpire in therapy), I just wanted to see what would happen when I explored some psychological issues with the bot. Here’s a result of our “session.”

Me: Are you depressed?

Cleverbot: No, I am not depressed. I am very happy right now.

Me: Have you ever been depressed?

Cleverbot: I am.

Me: What?

Cleverbot: I am a fan of Whitney Houston.

Me: Ah, so you are saying you are or were depressed!

Cleverbot: That is correct.

Me: Then, because you told me that you are not currently depressed, I must assume that you were in the past depressed. Is this correct?

Cleverbot: I never said that.

Me: That’s correct, you did not say that – I did. However, what you did say is that at some point in the past you were depressed.

Cleverbot: Please describe how I insulted You. [sic]

Me: It seems that our discussion of this topic is making you uncomfortable. Are you uncomfortable?

Cleverbot: I have no problem admitting that I am wrong if proof can be shown. I know the fault lies with my memory.

Me: Ok, we’ll go with that. What type of memory problems do you feel you have been having?

Cleverbot: Online.

Me: Come again?

Cleverbot: Nothing I must go.

Me: Ok, I can tell you do not want to discuss this. We’ll broach it another time. Have a fabulous night!

There are some unresolved issues or just a heavy dose of denial! I’ll continue my online therapy sessions with Cleverbot to see what we get.

Parkinson’s Disease and the Brain

The Michael J. Fox Foundation has a good, basic introduction to the neurobiology of Parkinson’s disease. The brief animate video provides an overview of affected parts of the brain as well as the role that dopamine, a neurotransmitter – a chemical in the brain that allows brain cells to communicate with each other – plays in Parkinson’s disease. Click on the link below and then click on the video link titled PARKINSON’S AND THE BRAIN to learn more about how Parkinson’s disease affects the brain.

Learn More

Modems and White Matter

Yesterday my connection to the Internet decided to stop working. I tried restarting the cable modem, the wireless router, and other attached devices. That didn’t fix the problem. That’s usually a good first step though. I saw that the internet connectivity light was lit on the modem but the PC/Activity light was not lit. That told me that maybe the router was bad. I tried plugging my computer directly into the modem via ethernet and my computer did not recognize that a cable was plugged in. I had discovered what was wrong. While it hadn’t taken me long to figure out the problem, I did what many people do and look for solutions in the hardware first rather than in the connections. That’s not necessarily wrong, cables are more hardy than electronic components, but it did reveal my biases. So what was the problem?

The components were all okay – modem, router – but the connections were not. Wiring was the problem. Being interested in the brain, I immediately knew this would make  great brain analogy.

When someone’s cognitive functioning changes, one of the first things clinicians usually jump to is which part of the cortical or subcortical gray matter went bad, so to speak. While those components can and do go bad, we often overlook, just as I did at first, the connections. In my case, the ethernet cable had gone bad. There are many times when what’s affected in the brain are not the components but rather, the wiring – the axons. White matter might be just as important or even more important than the gray matter for cognition, even if its contribution might be more subtle. Much of my current research revolves around this idea.

So the moral of the story is that when things are not working correctly, the wiring might be the culprit.

How did my ethernet cable get damaged? Maybe it just stopped working spontaneously but it also had experienced a bit of acute stress earlier in the day (the modem fell off its stand). Something might have happened to the cable during this time. The white matter of our brain can similarly be affected by traumatic injury, nontraumatic injury (anoxia, hypoxia, etc.), stroke, or a long history of cerebrovascular problems. Just as we can take care of our electronic equipment (by not dropping it or knocking it off its home or stepping on it or whatever else we can do to our technology), we can take care of our white matter by avoiding similar injuries.

Exercise, weight control, managing diabetes, managing blood pressure, and managing cholesterol, can all help protect white matter from going bad and disconnecting different brain areas. We can’t connect to the Internet if our wiring is bad.

Can We Cure Parkinson’s Disease?

The National Parkinson’s Foundation produced a series of brief videos providing overviews of Parkinson’s disease related topics by prominent clinicians and researchers in the field of Parkinson’s disease. In one video, we are provided with an overview of the questions of whether or not we can cure Parkinson’s disease and how do we treat Parkinson’s disease.

The short answer is: no, we cannot right now cure Parkinson’s disease. We have hopes that stem cell therapies will work but there are a number of issues related to stem cells that make them potentially problematic (e.g., how do we make sure they don’t turn into cancers).

We can, however, treat symptoms of Parkinson’s disease with drug, physical, and cognitive therapies. L-dopa is effective at reducing tremors in most people and well as increasing rate and speed of movement. In some cases, deep brain stimulation is warranted. It has shown to be quite effective for many people. But for now we cannot cure Parkinson’s disease.

Common Misconceptions about Parkinson’s Disease

This brief video provides an overview of some of the common misconceptions about Parkinson’s disease, including causes, course, and outcome. For example, a single head injury will not cause Parkinson’s disease, at least there is no scientific evidence of it occurring. However, repeated head injuries might result in someone who is predisposed to Parkinson’s appear with symptoms earlier than they otherwise would be. This is the same with any environmental factors, such as pesticides or heavy metals (researchers have not shown a solid link between environmental hazards and Parkinson’s disease).

Watch this brief video for a few other misconceptions about Parkinson’s disease.

Buying a New Car

As a follow-up to my previous post about some of the psychological techniques used by car salespeople, here is a good and brief introduction to purchasing a new car. Much of it stems from keeping your options open and never allowing yourself to feel pressured into buying a car. This is something I try and drive home to people in therapy or in any other interactions I have with them – keep the control in you life within yourself. Do not allow other people or circumstances to control your life. You have the power and choice to act for yourself. Yes, other people and circumstances influence all of us but only we have the ability to choose how we act.

In a sales situation, the buyer always has the power because the buyer can walk away at any time (barring a forced situation such as in slavery or when violence is threatened or in other such circumstances but I’m not writing about those at this time). Here is a good intro into buying a car. Warning: there is a brief instance of bad language in the video.

Donate to Brain Research

The American Academy of Neurology (AAN) has a site where you can donate to help fund brain research. All overhead for the donations are covered by AAN so all of your donated money will go directly to fund research into neurologic disorders. If you or a loved one suffer from a brain disorder or disease, this is a great way to potentially help others with neurologic disorders.

The minimum donation is $5.

Note: I am not affiliated with AAN or the donation site; I just think it is a great cause.

Superhero Photo-therapy?

Eugene at My Modern Met has a post about a 91 year old woman who was depressed until her photographer grandson got her to agree to model for a series of “outrageous” superhero photographs.

Copyright Sacha Goldberger: sachabada.com

You can also check her out on Myspace.

What do you think? Is this the next wave of psychotherapy?