Conquering Addiction By Milkman & Hill

Foreword – By Lloyd I Sederer MD

Why do we need yet another book on addiction? 

The groundbreaking research by Harvey Milkman and Wiliam Frosch (1973), more than half a century ago, “On the Preferential Abuse of Heroin and Amphetamine,” has had a profound influence on the field.

They demonstrated distinct personality types underlying drug preference. Simply stated, the drug of choice is harmonious with the user’s characteristic style of coping with stress. 

Shortly after publication of their seminal work in the Journal of Nervous and Mental Disease (Milkman, & Frosch, 1973), Milkman teamed up with Stanley Sunderwirth, an organic chemist with a specialty in brain science. In accordance with Milkman’s finding that compulsive users of heroin or amphetamine already displayed characteristics of addiction to distinct patterns of behavior, even before ever trying a psychoactive drug, in a flash, Sunderwirth proclaimed, “Of course, they’re becoming addicted to changes in their brain chemistry.”

......................................................

A new definition of addiction was born; self-induced (psychology) changes in neurotransmission (biology) that result in problem behaviors (sociology). Arguably, this multidisciplinary conception was the beginning of the commonalities approach to addiction. People are not getting addicted to drugs per se but with the neurochemical changes associated with three beacons of compulsion: arousal, satiation, and fantasy. The next step was to rejuvenate addiction science by introducing the construct of natural highs:self-induced changes in brain chemistry that result in positive feeling states, health, and well-being for the individual and society. 

The ripple effect of this concept is far reaching. Milkman’s innovative work as author and director of Project Self-Discovery, a Center for Substance Abuse Prevention, national demonstration model, demonstrated success in providing thousands of teenagers with natural highs through artistic, cognitive, and adventure-based alternatives to drugs and crime. Milkman refers to the behavioral alternatives that he made accessible to at-risk youth as “better than dope.” Moreover, influenced by the success of Project Self-Discovery, social scientists in Iceland developed a host of afterschool programs whereby children could experience positive changes in brain chemistry. Consequently, over a 20-year period, Iceland reduced teenage substance use from among the highest to lowest in Europe. 

The impetus of Conquering Addiction: Embracing Natural Highs over Alcohol, Substance Use, and Compulsive Behaviors is to remain current in the rapidly changing world of addiction science. Professor Katherine Hill, coauthor of this new work, brings scientific clarity to the field. Her expertise in behavioral neuroscience combined with pedagogical acumen makes this book a rare instance of readability eloquently combined with scientific clarity, Kenneth Axen’s ingenious biomedical and metaphorical illustrations bridge the gap between science and imagination, rendering complex physiological processes precise and evocative. 

Here are some critical examples of tidal changes in the world of addiction science: 

A “thriving” opioid epidemic is cutting a swath across all demographics. One person becomes ill and by the disease’s modes of transmission so do others. The virus invades a population; suffering and death prevails. Staying ahead of the virus requires a real-time, current appreciation of its biological and social features. Fentanyl has exploded as an adulterant to heroin, cocaine, and methamphetamine, and even adulterants to fentanyl itself (e.g., Xylazine, i.e., tranq). According to the U.S. Drug Enforcement Administration: “Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier.” (U.S. Drug Enforcement Administration. (2023, March 20). 

Alcohol is more than ever officially linked to cancer. U.S. Surgeon General Dr. Vivek Murthy released a new “Surgeon General’s Advisory on Alcohol and Cancer Risk.” Alcohol consumption is the third leading preventable cause of cancer in the United States, after tobacco and obesity, increasing risk for at least seven types of cancer and responsible for about 100,000 cases of cancer and 20,000 deaths annually. Slowly, maybe too slowly, the zeitgeist is turning more toward sober living and natural highs. Dry January and Sober October are well intended sound bites that most people have neither heard of nor considered. What better time than now to introduce students and the interested laity to the scientific basis for a healthy and “feel-good” brain chemistry? 

From what we have learned after more than a decade of legal weed, we may need to adjust some of our lofty expectations. The cannabis industry is the wild west, populated with corporate gold mines, comparable to industrial alcohol, tobacco and nicotine. Conquering Addiction provides a needed update on the world of cannabis. In 23 states more than one in three adults (35%) have obesity, with at least one in five adults in each state living with obesity. Compulsive overeating is certainly within the purview of addiction science. 

Some try to rise above mundane experience and psychological upheaval or fulfill a creative calling through traveling in, for better or worse, what might be considered the psychedelic renaissance. Aaron Rogers, who won the NFL MVP award four times, regarded as one of the greatest quarterbacks in NFL history, believes that psychedelics helped his NFL career. It is the most well-known secret that Silicon Valley tech geniuses are massively microdosing with psilocybin or other psychedelics. 

Although there are undoubtedly many neurochemicals underlying the positive feeling states in Milkman and Hill’s model, dopamine shines the brightest. Compelling activities—eating, sex, alcohol, drugs, gambling, pornography, and music, to name just a few—have been the solar system of pleasure planets, metaphorically orbiting the dopamine star. Intense gravitational forces support cravings that drive human behavior, for better or worse. 

What’s remarkable about this state-of-the-art volume by Harvey Milkman and Katherine Hill is their conceptual (and actual) approach to pleasure. Rather than retread conventional thinking on how to modify dopamine—enhance it, diminish it, block it—they have eloquently turned our attention to everyday, vital, sources of our pleasure. They not only explain how powerful forces can lead to compulsion and loss of control, but they show us how to safely and happily navigate around our pleasure planets. By intentionally and gracefully stimulating healthy target sites for dopamine, we eliminate its power to rule our lives. Milkman and Hill give us an utterly novel and comprehensive approach to understanding the problem of addiction and how to triumph over a world of counterfeit seductions. This book is remarkably timely and exceptionally relevant. You will want to read it, and you will enjoy the read.

Lloyd I. Sederer, MD

Psychiatrist, Public Health Doctor, Non-fiction Writer

www.askdrlloyd.com

Newly released edition.