Aaron White, PhD is a prominent Addictions Expert and Program Director at NIAAA, a division of the prestigious NIH. Dr White is most famous for discovering some fascinating parallels between inebriated rats and alcoholics that explain the heretofore poorly understood phenomenon known as the ‘blackout’. For example, he showed that a drunken rat’s inability to remember its location in a maze explains why the alcoholic will have absolutely no memory of smashing a chair over someone’s head in a bar fight until he is reminded of it or gets drunk again. Also, the intoxicated rat’s disinterest in cheese residue corresponds to the addict’s tendency to ignore otherwise obvious signs of STDs in sexual partners.
AddictionMyth recently sat down with Dr White via email to discuss his fascinating research and the exciting promise it holds for the treatment of alcoholism, the degenerative disease whose symptoms include unintentional naughty behavior and amnesia of that same behavior sometimes accompanied by close brushes with imminent death; and whose only known cure requires the humbling (if liberating) public admission that you have it.
AddictionMyth: You discovered some fascinating connections between rats and alcoholics. They are more alike then anyone previously thought. Did you also find that rats continued to crave alcohol even after the experiment was over? What happened when you restored them to a natural environment? Did they continue to demand access to their drug of choice, and use it compulsively until death?
Aaron White: Animals typically show little interest in their ‘drug of choice’ when restored to a natural environment, even if they were severely addicted and the drug is freely available (including meth and crack). So they are unlike humans in this regard. But they exhibit surprisingly human-like withdrawal symptoms such as fever, shakes, and vomiting. I believe the blackout phenomenon is also similar between species. I once saw a drunken rat mount a sober cage mate, and then the next day he completely ignored him as if nothing happened.
AM: According to your research, blackouts occur not just in middle age alcoholics, but in young college students who may not have built up much tolerance for alcohol. Their drinking often ended up in unprotected sex, vandalism, and fights, of which they had no memory until cued by a friend. What was their response to their memory? Regret? Horror? Delight? Glee? A little of each?
AW: I wasn’t the author of the research. But I would say a little of each, at least based on my own experience. I suspect they remembered more than they wanted to admit. Though one time I got really drunk at a party and my friend told me that I was talking to his sister in French, and I had absolutely no recollection of that. It was surprising to me as a brain scientist because alcohol has been shown to suppress activation of the inferior frontal region (Broca’s area also known as the ‘language center’). I probably shouldn’t have been able to talk at all, let alone French, given my BAC. But what was really weird was that I don’t even know French!
AM: After learning of their behavior, did they immediately promise not to drink excessively ever again? How well did they hold to this promise? Were they unable to resist their own cravings to alcohol, just like full-blown alcoholics? Is it possible that these college students experienced ‘instadiction’, a phenomenon hencetoforth believed to occur only with crack and meth?
AW: Instant addiction to alcohol is extremely rare. But yes, they often expressed regret about their behavior and a desire not to drink so much next time. Most people then moderate their drinking but some people will repeat the same behavior, not necessarily due to a craving for alcohol as much as a desire to prove to themselves that it won’t happen again. It’s like when you bomb a test because you were out late partying the night before and you really want to take it again because you’re sure you can do better. And keep in mind that judgement is impaired after just one drink, and that they may drink a little more in response to peer pressure or to reduce social anxiety, and furthermore, the particular susceptibility of some to the amnesiac dynamic that I discovered may prevent them from ‘learning their lesson’ as well as they should. Some researchers have proposed a pre-alcoholic syndrome as a ‘desire to drink less’ in comparison to the full-blown alcoholic’s ‘desire to stop drinking’, and in fact my AlcoholEdu program screens for this behavior to target this type of drinker for early intervention because it can get out of control very quickly, before they are even aware of any problems.
AM: Are they responsible for their behavior, knowing that excessive drinking might lead to it, but engaging in it anyway, repeatedly? Does extreme inebriation degrade our ability to distinguish right from wrong, or simply permit us not to care so much? Why would someone who is not yet dependent on alcohol engage in excessive drinking knowing that they would deeply regret it later?
AW: These are good questions, but they are moral issues which I don’t feel entirely qualified to answer. I’m just researching the science behind the behavior. I do know that once I drove drunk from a bar and I promised myself I would never do that again. Then guess what? I did it again some months later. I feel really bad about that and I haven’t done it again. Now I keep my parents’ number with me in case I need a pick up, and we have a ‘no-questions’ policy, and it’s really been working out great. One time I had forgotten that they were on vacation in San Francisco, but my dad actually called me a cab from the Ghirardelli Chocolate Factory! Our new understanding of the brain suggests that parents should take a morally nonjudgmental attitude towards their child’s drunken behavior no matter how bad it may seem, and forbid only the use of drugs and alcohol, at least until it becomes a problem at which point such prohibition is counter-effectual, and you should assume a nonjudgmental attitude towards the drug use as well. Please contact SAMSHA if you are unsure whether your child’s drug use has become a problem, and for referrals to qualified providers. (You shouldn’t panic, but keep in mind that drug use can spiral out of control quickly due to the biochemical interactions in the brain as elucidated by modern science.)
AM: Do you see any potential issues with the methodology used in the analysis of the blackout phenomenon, given that the subjects were highly inebriated and asked to report events that they didn’t remember? How do you know that the subjects are not simply ‘remembering’ dreams, given that the experience usually ended in sleep? Would you characterize this phenomenon as ‘medical’ or ‘spiritual’?
AW: I don’t think they were remembering dreams because alcohol suppresses REM sleep, which is when dreams typically occur. Therefore, they would not have any dreams to remember. But yes you bring up a good point about the methodology. How can someone really know they had a blackout? After all, if it was a blackout they shouldn’t remember it, and if they remember it then it wasn’t a blackout. I think of it as psychology’s version of the Heisenberg Uncertainty Principle: the more you recount the particular events of a blackout, the less you can say precisely about its timeframe and duration. And the more you know about the sequelae (e.g. bruises and missing personal items), the less you can say about exactly what might have happened. It’s an epistemological limitation on the science that we just have to accept. But it can’t stop us from doing our work, just as Uncertainty hasn’t stopped physicists, even if it casts doubt on their conclusions.
AM: Alcoholics drink because of an insatiable craving for alcohol, and then engage in violent or irresponsible activity while drunk, for which they may have absolutely no memory until reminded by a friend, with recurrent amnesia triggered by stress (such as questioning by law enforcement). Is it possible that they were simply possessed by demons, which are thought to favor mischief and ‘borrow’ memories?
AW: I think there is a simple scientific explanation for this behavior. The web site at NIDA goes into some possible mechanisms in great detail. And Nora Volkow is an expert on it, so you may want to talk to her as well. Nevertheless, you should never treat a drunk person as if they are rational. For example, if you’re at a party and your friend is drunk, you should divert his attention and attempt to swipe his keys to prevent him from driving. Do not ask for his keys, and do not threaten to contact an adult if he attempts to drive, because this may result in unpredictable or explosive behavior that while it may have a simple scientific explanation, can seem surprisingly ‘demonic’ during the moment it occurs. For example, tell him a cute girl he likes is coming. Make it into a game and then you can avoid a deadly crisis and everyone will have more fun at the same time. Of course, drunk driving isn’t the problem it used to be 30 years ago. Now we’re seeing a rise in sexual assaults following alcohol use, and in fact offenders may report feeling possessed when they raped someone (if they can remember it at all). Of course, some people find the inebriate state itself highly pleasurable, and I had a really touchy-feely spiritual friend at college who would get super drunk just to achieve it. He called it ‘enlightenment’, and would encourage me to share it with him. Which I did a few times though I kept waking up the next morning with inexplicable lower gastrointestinal pain, but he said that just meant I was successfully ‘filled with enlightenment’. We haven’t kept in touch, but I’ve heard he is now struggling with alcoholism. Which I’m not surprised, since the research shows it can be caused by habitual excessive drinking at a young age. If only I had known then what I know now, I might have been able to straighten him out!
AM: Alcoholics are well-known liars, as reported by other prominent addiction experts like Dr. Drew and Dr. Carl Hart, and will often start their drunkalogs with “I was a born liar”. Why are you so eager to believe their claim of ‘blackout’? Are other experts just overly skeptical?
AW: First of all, these are mostly college students and I don’t think it’s fair to characterize them as liars plus it would seem quite a conspiracy if they are all lying about the same thing. Furthermore, I’m not so sure that Drs. Drew and Hart would say they are all liars. Of course you meet a few creative characters in the course of addictions research but for the most part they are people like you and me who really are suffering from compulsive drug and alcohol use.
AM: Not all alcoholics are born liars. Some are self-proclaimed ‘master manipulators’. Could some aspects of their subjective experience of addiction be embellished?
AW: I’ve seen this type of self-derogatory language, and it is usually indicative of low self-esteem, which I believe can put people at risk of drug use in the first place, which then places them at greater risk of addiction. I don’t think that the subjective experience is embellished, especially considering the remarkable similarity in experience among alcoholics. It would be quite a conspiracy if they were all exaggerating in the same way! I mean it’s not like there’s some secret club that they all go to that tells them what to say. In my own practice, we focus on helping the client build a strong spiritual basis which we believe fortifies self-esteem and which the client can draw from when faced with cravings to relapse. We call it “Spiritual Platform®”. Here is more information on our counseling services: http://georgicounseling.com/what-we-do/counseling/. We find that young people with addictive diseases respond strongly to the spiritual component of our counseling, and we consider that to be an essential part of recovery. In fact, we find that clients who are disinterested in fostering spirituality tend to have greater challenges on the pathway to sobriety. But if you could see the transformation of our clients who incorporate spiritual practices into their daily activities, as I do on a regular basis, you would know that their subjective experience is very real.
AM: You speculate that sexual assaults on campus are under-reported due to the ubiquity of the blackout phenomenon. Is it possible that the sexual encounter itself upregulates activation of the mesolimbic neocortex which selectively depotentiates ion channels in the hippocampal striatum thereby reinforcing the anteretrograde amnesia of both the perpetrator and (osmotically) the victim?
AW: Um, what? Please leave the science to the professionals.
AM: You claim that crack and meth are highly addictive. Do you have any evidence for this?
AW: Yes we certainly do. It’s all on our website and like I said, Nora can give you all the info. It’s also explained on Wikipedia, complete with footnotes some of which reference the groundbreaking work we do right here at NIAAA!
AM: You claim: “alcoholism is a very insidious disease in that it can creep up on you if you’re not vigilant. So this level of binge drinking if it’s left unchecked, for a lot of people, could lead to alcoholism.” Is this disease also cunning and baffling?
AW: Very much so. Most people do not realize they’re in trouble until it’s too late, no matter how many cautionary tales they have heard. Furthermore, once the disease is contracted, replacing bad habits can be extraordinarily difficult, even after years of sobriety. Without treatment, people may spend the rest of their lives craving another sip. That’s no way to live. I go into this problem in detail in my book: Keeping Adolescence Healthy: Drugs.
AM: You recommend 12-Step based treatment for young people who take drugs and alcohol. Is there any evidence that AA doesn’t create or exacerbate substance abuse? Does attendance subject them to abuse and exploitation by the predators in ‘the rooms’? Does AA set up young people for a decades-long cycle of bingeing and abstinence that is actually more damaging physiologically than continuous inebriation?
AW: The evidence on AA simply isn’t clear on why it helps some and not others. But this is typical of any medical treatment, and doesn’t mean it shouldn’t at least be tried, especially in difficult cases. While continuous inebriation may sound like fun (and has been shown to be less dangerous physiologically than bingeing and abstinence), it is certainly no way to live the rest of your life (though most people naturally moderate after some time). We would certainly like to investigate AA further and figure out the mechanism of action, but unfortunately the internal politics at NIH prevent us from doing so.
AM: You claim that teenagers are very susceptible to alcoholism because it “lights up the brain like a pinball machine” and that even a low level of occasional drinking can result in later alcoholism. Do you have any evidence for this mechanism that seems highly plausible to anyone who knows even just a little about the brain? Do you prescribe abstinence for all high school and underage college students?
AW: Well that’s how Nora explained it to me. She actually explains it pretty well in her 60 Minutes interview. Yes we must require abstinence for underage people. Teens are unaware of problems from drugs and alcohol, and the ease with which they get out of hand. Despite all the education they’ve received. In fact, it sometimes seems the more we explain the neurobiology of the powerful and mesmerizing effects of drugs on the adolescent’s pliant and impressionable brain, the less they heed the warning. We are currently working on some exciting science-based multimedia presentations that we hope will really drive home the insidious effects of drugs and alcohol on their delicate neuroanatomy, and that these physiological hazards inevitably result in moral hazards: antisocial and risky behavior that teens otherwise strive to avoid. The goal is complete sobriety: abstinence for the whole family. Why should a child abstain when there is a fridge stocked with beer that a parent can plunder at will?
AM: My brain lights up like a pinball machine as I write these questions. Should I seek immediate medical attention, Doctor?
AW: Lol no I think you’ll be ok.
AM: AA claims to have saved millions of lives. In reality, they have killed millions by demanding the confession of ‘cravings’ to which they are powerless, and then they publicize the resulting deaths (of those “constitutionally incapable of being honest”) as proof of their ‘disease’ via NIAAA and NIDA. Why do you support such a deadly organization?
AW: Wait. What? I think you should seek immediate medical attention. Go to your county hospital and tell them what you just said.
AM: Who funds your research and pays to publish your propaganda?
AW: Wait… can you do outpatient?
- Dr. White specializes in young people’s health issues and can be reached at: firstname.lastname@example.org
- Nora Volkow is Medical Director at NIDA, where she oversees research and practices her Nobel acceptance speech. She is happy to answer questions about addiction and explain its remarkable similarity to demon possession: email@example.com
For more information:
- Powerlessness as Religion – Only the good die young
- You Are So Brainwashed It’s Funny – Who will pay for their sins?
- The Problem of the Jews: a Lesson in Brainwashing Propaganda – How AA bamboozled a country
- The Drinking Club – Watch what they do, not what they say
- I Call Blackout – I did what??
- Rat Addicts and the Science Of Addiction – The best of 60’s Science Fiction
- Cory Monteith: The Cult of Powerlessness Claims Another Victim – Fresh from a role as a drug addict
- The Man Who Almost Cured Addiction – Neuroscientist Dr. Carl Hart busts our cherished myths about drugs
- A Conversation with Dr. Drew Pinsky – 13% and proud
- AA is a Pagan Cult – You got a problem with that?
- School for Scoundrels – What you actually learn in the rooms
- The Little Psychopath Could: How the Addiction Myth creates new Drug Addicts
- Addict Science – A rising Tower of Babel