Addiction Sameness

Alcohol, Opiates, Fat and Sugar are all Addictive Substances: this blog is about that "addiction sameness".

Sunday, July 7, 2013

How to Avoid the Temptations o

How to Avoid the Temptations of Immediate Gratification

Neuroscience hints at the power of imagining the future

red velvet cupcake
You know you want me. Image: iStock/Debbi Smirnoff

Happy New Year! It’s 2013 and you’ve vowed to cut sweets out of your diet. Despite your desire for a trimmer body, the sight of cupcakes in a cafĂ© window overpowers your good intentions. You cannot resist the small, sweet reward even though the larger, delayed reward of a healthier body is ultimately more desirable.

What leads some of us to give in to our immediate urges, while others are able to endure the wait for bigger and better outcomes? Neuroeconomists are investigating the brain to answer this question. They are interested in comparing the brain activity of individuals who act impulsively—those who choose rewards now over later—to that of patient folks.

Traditionally, the assumption of researchers in this field, and the related field of behavioral economics, has been that impulsive people choose immediate rewards simply because they dislike waiting. In these prior studies, when presented with a hypothetical choice between, say, $50 now or $100 in a year, impulsive individuals went for the $50.  Additionally, they showed a greater brain response to the immediate $50 reward—in the part of the brain that represents how much you are enjoying a reward (the ventral striatum)—than did patient people. Researchers interpreted this brain response as the impulsive individuals’ preference for immediacy. So while impulsive individuals would claim “carpe diem” and “strike while the iron is hot” as their life mantras, the less quoted “carpent tua poma nepotes” and “good things come to those who wait” are patient individuals’ words to live by.

However, impulsivity may not simply be due to how long people are willing to wait for gratification. A recent study by a team of researchers at Washington University in St. Louis found that when people waited for a reward, patient people were seen—through the lens of a functional magnetic resonance imaging (fMRI) machine—imagining the future. In more patient people, the researchers observed increased activity in the region of the brain that helps you think about the future (the anterior prefrontal cortex). The patient individuals, it seems, devoted more energy to imagining receiving their reward later.

What sets this Washington University study apart from previous studies is that researchers have never before focused on the brain responses of individuals after they make a decision and are waiting for their reward.  Instead, researchers have typically measured brain activity while people are making their choices. Prior researchers likely disregarded the waiting period because their studies used hypothetical rewards over long delays. Because people weren’t actually waiting in real time to receive a real reward, the researchers could not monitor the brain during this waiting period. This new study presented people with real rewards in the form of squirts of juice either immediately or at a delay of up to a minute. In fact, the researchers squirted the juice straight into the mouths of study subjects, in much the same way that animals have been rewarded in similar studies.

This future thinking, which is associated with the anterior prefrontal cortex (aPFC), has also been found in neuropsychological studies that focus on two different, but related phenomena: prospective memory—remembering to do something in the future, like fill up your gas tank on the way home from work—and episodic future thought—thinking about the future, such as imagining what you’ll cook for dinner later tonight.

Now, one more phenomenon can be added to the list of contexts in which people imagine a future outcome and activate their aPFC: imagining future rewards.

One problem with the future is its vagueness. While you are able to imagine in your mind going to the gas station or cooking dinner in general, the exact details of these activities are not clear. You don’t know which pump you’ll use at the gas station, or precisely what time you’ll remove the pizza from the oven. In this way, the future is fuzzy. This fuzziness can make the future less appealing. Remember the marshmallow experiment that tested the willpower of children to resist the temptation to eat a marshmallow placed on a table in front of them, so they could receive two marshmallows after they waited? Research suggests that if that one marshmallow was made more abstract—such as hiding it from view or just showing a picture of it—the reward would become less appealing and more similar in appeal to receiving two marshmallows at a future time. On the flip side, making the future less fuzzy by focusing on the details—eating double the marshmallows currently being presented—could also make the future marshmallows more attractive than the present singular marshmallow. In this way kids would have an easier time resisting the one marshmallow now in exchange for the two marshmallows in the future.

Perhaps a combination of this fuzziness research (i.e., delay of gratification research) with recent neuroeconomics research—linking impulsivity with a lack of future thinking—could be useful for clinicians who are developing treatment plans for impulsive individuals. Because the future is fuzzy and impulsive people have an especially hard time imagining it, clinical treatments could involve de-emphasizing the present, making it more abstract, and building a concrete image of the future. For example, while it may be quicker, easier, and cheaper to buy fast food for dinner—immediate rewards that are all very desirable—people could learn to visualize larger future rewards when deciding what to eat, such as avoiding ailments like obesity and Type-2 diabetes. They could also avoid driving past their favorite fast food restaurants and only stock their cupboards with nutritious foods so the most visually salient meal options are healthy ones. This could help shift the attractive light from being cast on the present desire for fast food to instead being on the future desire for a healthy body.

For impulsive individuals who repeatedly make decisions that satisfy their current desires at the expense of their future needs, the negative effects on their health can be significant. Given the host of public health issues that involve impulsivity, research in neuroeconomics could prove important. Future research could measure the effects of an intervention on the brain. Can we get impulsive people to produce activity in their brain that shows they’re thinking about the future in a concrete way, making them look and act more patiently in the laboratory? Do these interventions lead to real-life choices to invest in the future and not give in to present impulses? Not to mention, could adapting the mindset that the future is worth waiting for help the rest of us keep some of our New Year’s resolutions?

Are you a scientist who specializes in neuroscience, cognitive science, or psychology? And have you read a recent peer-reviewed paper that you would like to write about? Please send suggestions to Mind Matters editor Gareth Cook, a Pulitzer prize-winning journalist at the Boston Globe. He can be reached at garethideas AT or Twitter @garethideas.


Melanie Bauer is a graduate student in psychology at Washington University in St. Louis studying cognitive aging. She will write her dissertation on informal science education, and has also contributed to The Open Notebook. Connect with Melanie at or on Twitter @MelanieSBauer.

To inspire Alzheimer’s research

XPRIZE, which in 2004 awarded $10 million for the first privately built, manned spacecraft launched into space twice in two weeks, may soon be setting its sights on effective treatment for Alzheimer’s disease.
XPRIZE hopes to create a new Alzheimer’s XPRIZE to inspire the ingenuity of researchers and increase their interest in taking on the daunting task of stopping the disease. 
An Alzheimer’s prize was proposed by a team of experts co-directed by Eric C. Leuthardt, MD, associate professor of neurological surgery and biomedical engineering at Washington University School of Medicine in St. Louis, and Dean Ornish, MD, founder and president of the nonprofit Preventive Medicine Research Institute and clinical professor of medicine at the University of California, San Francisco.
The team’s proposal to tackle Alzheimer’s won a recent XPRIZE “Visioneering” workshop that drew proposals on topics of importance to society. 
“The presentation by Dr. Ornish and Dr. Leuthardt, and the vote of support by the Visioneering attendees, has certainly reaffirmed what we at XPRIZE deeply believe – that Alzheimer’s is one of humanity’s grandest challenges and that an innovative solution is urgently required,” said Eileen Bartholomew, vice president of Prize Development at XPRIZE. “We will continue to explore how an XPRIZE might catalyze such a solution.”
Leuthardt, who treats patients at Barnes-Jewish Hospital and St. Louis Children’s Hospital, said: “Basically, XPRIZEs are about making the impossible possible. They’re about giving innovators the incentive to achieve new breakthroughs that benefit society.”
A similar contest, known as the Orteig Prize, inspired Charles Lindbergh’s solo flight across the Atlantic Ocean in 1927, Leuthardt noted, and that led to the start of commercial air travel a short time later. 
At XPRIZE’s annual Visioneering event, more than 100 pioneering scientists, inventors, engineers, artists, philanthropists and business leaders met to propose new XPRIZE concepts.  
The attendees are divided into teams and assigned an area of research within which they create an XPRIZE proposal. The team led by Leuthardt and Ornish was given the topic of aging.
Noting that an epidemic of Alzheimer’s disease is on its way, the team compared the potential crisis to a meteor in space lined up to strike the Earth.
Populations are growing older around the world, and Alzheimer’s risk increases significantly with age,” Leuthardt said. “This will affect not only the elderly but also their families and loved ones, and it will have devastating emotional and economic consequences.”
The details of what qualifies as a cure for Alzheimer’s would be established if the foundation raises funds for the prize. As in other XPRIZEs, the winners of the award would retain the intellectual property rights for their breakthrough.
“I think everyone is touched or will soon be touched by Alzheimer’s,” Leuthardt said. “I think that’s part of the reason why our proposal won — everybody in the audience had a family member affected by Alzheimer’s or knew someone with a family member affected by this disorder.”
Other XPRIZEs include or have included a prize for the first “tricorder” (a handheld device that can non-invasively diagnose 15 health conditions like the tricorders featured on Star Trek); a prize for the first group to sequence the DNA of 100 100-year-olds for identification of genetic factors linked to extended lifespans; and a prize for the first privately funded team to send a lander to the moon.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish andSt. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.


Medical Marijuana

State Battles Federal Government for Independence in Medical Marijuana Case

04 Jul 2013   

Magistrate Maria-Elena James ruled that a cannabis dispensary in Oakland, CA, is free to stay open while local authorities fight federal prosecution to shut it down, reports Reuters.
The ruling came in on July 3rd, just under the wire for local supporters of the Harborside Health Center to celebrate their temporary medical marijuana freedom on the Fourth of July.
This long-standing court case between California and the US government is currently in an appeals stage, whereby the local government is contesting Magistrate James's February decision that the city has no right to interfere in a federal prosecutor's action to shut down or seize the property of the Oakland-based pot store.
Currently in the US, marijuana is not an approved drug according to the Federal Drug Administration (FDA), but rather an illegal narcotic. Still, the District of Columbia and 16 states have deemed cannabis to be legal if sold as a medicine prescribed by a doctor.

The medical world weighs in on marijuana

Outside of politics, the medical community has waged its own debate over the last decade about the health merits of marijuana. The Center for Medicinal Cannabis Research (CMCR), which is run by the University of California, has been conducting scientific studies for several years.
In one study involving effects of cannabis on pain from HIV-related peripheral neuropathy, the CMCR concluded that52% of patients who smoked marijuana had over a 30% reduction in pain, compared to 24% in the placebo group.
And in another study conducted by the CMCR and published by the Canadian Medical Association Journal (CMAJ), researchers found that smoked cannabis significantly reduced symptoms and pain associated with multiple sclerosis spasticity.

Cannabis for medical use is a polarizing issue

Still, the medical community is divided, with some professionals calling for more in-depth studies and research before medical marijuana is prescribed to patients.
paper published by the National Center for Biotechnology Information (NCBI) suggests that:
"over the longer term cannabis may have unwanted systemic and psychoactive adverse effects that must be taken into consideration in chronic pain populations, who have high rates of co-occurring medical illness and co-morbid psychiatric and substance use disorders."
Whether a medical or political issue, medical marijuana has strong supporters who are either for or against it.
In an act of solidarity with the state's physicians, the Medical Board of California published standards for physicians who prescribe medical marijuana to patients.
According to a statement from the Board, physicians who prescribe cannabis will not receive any ill effects toward their physician's license, so long as they follow good medical practice during patient consultation, including:
  • History and good faith examination of the patient
  • Development of a treatment plan with objectives
  • Provision of informed consent including discussion of side effects
  • Periodic review of the treatment's efficacy
  • Consultation, as necessary
  • Proper record keeping that supports the decision to recommend the use of medical marijuana.
Though the case involving the fate of Oakland's medical marijuana dispensary has yet to be resolved, Cedric Chao, the attorney representing the city in the case, remains positive, saying:
"The court has recognized that Oakland has legitimate interests in protecting its residents' health, in promoting public safety, and in protecting the integrity of its legislative framework for the regulation of medical cannabis. Today's order, coming right before the July Fourth holiday, reminds us all that one of the strengths of our country is its independent judiciary."
The state of California and supporters of the Harborside Health Center may be on the verge of a metaphorical Boston Tea Party scenario with the federal government, but for this Independence Day, they can hold onto their tea.
Or even smoke it.
Written by Marie Ellis
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

“Cannabis for Treatment of HIV-Related Peripheral Neuropathy”, Donald Abrams, M.D., CMCR, published online. Link to Results.
“Medical Board Reaffirms its Commitment to Physicians Who Recommend Medical Marijuana”, Medical Board of California, published online 13 May 2004.
“Medical Marijuana: Clearing Away the Smoke”, I. Grant, J. Atkinson, B. Gouaux, B. Wilsey, Bentham Open, NCBI, published online 2012 May 4; DOI: 10.2174/1874205x01206010018
“Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial”, J. Corey-Bloom, T. Wolfson, A. Gamst, S. Jin, T. Marcotte, H. Bentley, B. Gouaux, CMAJ, published online 14 May, 2012, DOI: 10.1503/cmaj.110837

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7 Jul. 2013.
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