The A-Z of Addiction

Birds have a reputation for being the most lovey-dovey animals, after all - most of them mate for life! Don't they? Georgia Mills has ruined the romance for all of us...

Georgia - However confusing, dramatic, or upsetting human relationships can be we can all take solace from that beautiful image of all the different species of lovebirds who stay true to each other forever and bond for life. Or do they?

Birds are unusual in that most of them do just have one partner. The most common pattern of mating in animals is called “polygyny,” and this is where one male has a relationship with two or more females. But many species of birds have a one on one relationship and we call this “monogamy.”

In fact, 90 percent of bird species are monogamous but this doesn’t always mean ‘till death do us part.’ Often this will just mean a pair will stay together for one breeding season to bring up their chicks before looking for a new partner. But there are some species like swans, geese, and cranes who do stay together for life. But are they true to each other? This is a bit more of a grey area. Because, you see, advances in genetics have shattered our illusions of feathered fidelity. Those birds have been playing away from the nests.

When scientists actually do genetic testing on a nest around 30 percent of the eggs in most species will not be related to the male lovebird. Those blue tits, herons and, unsurprisingly, shags have been out philandering while their partner isn’t looking.

And the ultimate adulterers are the superb fairy wrens. While they present the image of perfect familial devotion, 65 percent of their chicks will be from a different daddy. And this is because the females sneak off just before dawn to the territories of the sexiest males and then, well, ‘the early bird catches the sperm.’ And what female fairy wren could resist those bright blue males seductively dancing and presenting them with yellow flower petals.

All this debauchery shocked people when it first came to light, but there’s a good evolutionary reason for it. Females can only have so many eggs, so it’s a good idea to increase the genetic diversity of their broods so that at least some of them will survive. And, if you’re a male bird, it’s generally a good idea to have as many chicks as possible. And even so, there are still a small minority of bird species that, as far as we know, do mate with each other exclusively.

There are some other animals that do only mate with one partner their entire life but usually the reasons are less than romantic. Some very short-lived species simply don’t have the time, and for others mating is the last thing they ever do. Some species of male spider throw themselves into their special one’s jaws and get busy being eaten alive while they finish their romantic encounter. And, rather grotesquely, some species of reptiles, bees, and primates try and ensure their partner won’t mate with anyone else by gluing up the reproductive tract - it’s what's called a “mating plug.”

So, in summary, if you’re looking for inspiration on romantic relationships... don’t look too closely at the animal kingdom.

What are non-verbal vocalisations, such as roars, actually for? Georgia Mills has been investigating...

Georgia - Roaring is the domain of the lion, and the tiger, and the T. Rex. But perhaps not something you’d readily associate with people.

But if you’ve watched a football game or an episode of Game of Thrones you will have experienced the mighty human roar… but what are roars actually for?

Jordan Raine is a Behavioural Ethologist from the University of Sussex and he’s interested in non-verbal communication like roaring...

Jordan - Available evidence suggests that these non-verbal vocalisations essentially communicate the same types of information and influence our perceptions and our behaviour in the same way as vocalisations do in non-human mammals where these vocalisations are, essentially, the primary form of communication and are a big factor in what determines animal’s access to resources, their reproductive success, and their chances of survival.

Georgia - But do humans, with our added luxury of verbal communications, still use roars in a similar way to our animal cousins? It was time to conduct an extremely loud study.

Jordan -  In my paper, what I did was I got actors in training to immerse themselves in a battle or war scenario and to produce aggressive roars along with aggressive speech. And, essentially, the aim of what we were looking to find out was: is it the case that human roars communicate information about formidability, so our strength and our size, things that dictate our fighting ability? And do roars communicate information about these things in the same way that the roars and roar-like vocalisations in other mammals do?

Georgia - Jordan got some actors to come along and roar - here’s a clip…

Roar.

Georgia - Or yell an aggressive phrase like this one:

That’s enough, I’m coming for you.

Georgia - Our poor participants then had to guess if the person was stronger or weaker than them, and if they were shorter or taller…

Jordan - We found that listeners were pretty accurate at judging someone’s strength and someone’s size relative to one’s own. So, for example, listeners incorrectly judged vocalisers who were stronger than themselves as weaker on 18 percent of trials. And when they were judging vocalisers who were much stronger than them, that figure dropped to 6 percent.

Georgia - So why would linking a roar to someone’s size and strength be useful? Well, in the animal kingdom, creatures use this all the time as it can help avoid getting into a fight you’re pretty certain to lose. So if you here this…roar... and you sound like this...meow... you can act smart and run away and live to fight another day.

This way, grudge matches can be settled without actually having to enter a fight which could be dangerous to everyone involved, but animals will always try and trick the system.

Jordan - For example, the red deer is able to lower its larynx - its voice box - all the way down to its sternum and elongate it’s vocal tract, which is part of the vocal apparatus that provides cues to body size. And in our study in humans, what we found is that when male vocalisers roar they are much more likely to be perceived as stronger and taller than when the produce aggressive speech even though, obviously, their strength and their height are the same across those two stimuli.

Georgia - So roaring exaggerates the perceived strength of an individual. Back in our evolutionary history this probably came in handy when we were trying to scare off rival lovers or steal other people’s mammoths. But is roaring useful to us now?

Jordan - We’ve all heard the roars in battle scenes in Game of Thrones or Lord of the Rings, but humans don’t just roar in Hollywood films or TV dramas. Historical accounts have indicated that roars have been employed by soldiers in battle all the way throughout history from the Roman Army to the Red Army. And even now, the US National Parks Service recommends roaring as a defence strategy against bears, so it’s a useful weapon to have up your sleeve. I hope no-one ever needs to be in that situation where they have to defend themselves against a bear, but if you are in that situation then puff up your chest, make your arms wide, and definitely give as loud and as threatening a roar as you can.

Georgia - Can you do your best roar for me?

Jordan - I’ll give it a go. I’m a little bit under the weather but we’ll see what I can produce.

Roar!

Georgia - Ha ha. Amazing. I think you could definitely take me.

Jordan - We’ll see about that. Have you got one?

Georgia - Umm. Okay. I’ll move back so I don’t distort it.

Roar!

Jordan - I’m scared. I’m running away right now.

Georgia - I’ve never roared in an interview before so that’s a first.

Jordan - Well there you go - there’s a first time for everything.

What is addiction, and how does it work in the brain? Katie Haylor spoke to neuroscientist Amy Milton from the University of Cambridge...

Amy - So addiction, we normally think about in the context of drugs of abuse like opioids that we just heard about. In addiction, behaviour narrows very, very markedly to being really focused on drug seeking and drug taking behaviour and that’s to the exclusion of everything else. So people losing their jobs, their family, and so on. And the key characteristic of addiction is that there is a lot of control over that behaviour. So people are aware of the fact that these behaviours are hurting them, but they can’t do anything to stop doing it, and it’s a chronic and relapsing disorder. So people will often manage to get off drugs for a period of time but then they’re very at high risk of relapse for the rest of their lives actually.

Katie - Do we know how addictions work in the brain?

Amy - We have a pretty good idea. As you can imagine, for a complex mental health disorder there are lots of things that go wrong - there are a few key things though. One is that drugs of abuse massively increase the amount of dopamine within the brain, and dopamine is a really, really key chemical for learning about things that are motivationally relevant to you in your environment.

So we normally learn about rewards - natural rewards like food and mates and so on, with big increases in dopamine. Drugs of abuse increase dopamine massively more than natural rewards, so hundreds of times more. What this means is that the behaviours that lead to the drugs being obtained, are far more likely to be engaged in. There is a shift, very very quickly, because dopamine encourages this from goal directed behaviour - doing something because you want the outcome - to habitual behaviour where we just do it because that’s what we do in a particular environment.

Dopamine increases the influence that the environment has over behaviour, so cues in the environment that are predictive of drug rewards come to be far more attention grabbing and controlling of behaviour. And, the key clincher is that there is a loss of cognitive control mechanisms mediated by this area called the prefrontal cortex. Many drugs of abuse are very toxic to the prefrontal cortex, and people who tend to become addicted often have lower inhibitory control to start with and the drugs of abuse reduce that inhibitory control further. So that habit becomes a compulsive habit.

Katie - Can anything be addictive?

Amy - That’s a really good question. With drugs of abuse it’s very, very clear that there’s something unnatural in the body and that drugs of abuse hijack our natural reward system. When you’ve got a natural reward, so something like high fat, high sugar foods have been suggested as potentially addictive, gambling, other sorts of potentially behavioural addictions, it’s often harder to tell whether that’s a hijacking of a natural reward system, or it’s just a natural reward system itself. So sex addiction or food addiction is much, much harder to quantify and it really comes down to, is the behaviour having really adverse outcomes on the person who’s engaging in them.

Katie - So if someone is addicted to something, what happens if they don’t get their fix?

Amy - So they go into withdrawal, but there are at least two different types of withdrawal: physiological and psychological. Physiological withdrawal, it’s really obvious withdrawal signs. So if somebody stops using heroin for example and they have been using for a long time, they will show a particular set of symptoms like getting a really bad dose of flu, they often get quite bad diarrhoea, all these physical symptoms that are quite clearly there. What you get with psychological withdrawal is the system has been massively overstimulated for a really long period of time so the reward system has gotten used to being active at certain level. When the system like that is overstimulated, it becomes less sensitive. It's like the cells that are receiving the signal, kind of, put their hands over their ears. They are no longer listening unless they’re being shouted at.

So you take that drug away and you go back to normal physiological level of stimulation, those cells that are receiving the signal aren’t listening anymore. And so you get a rebound effect where people feel very depressed, they often feel very anxious. And the way of getting out of that state is by going and engaging in those drug seeking and drug taking behaviors again.

Chris - It was made as a joke at the Edinburgh festival by a comedian, but it sort of has a serious side to it which is this person said “why don’t you just take hundreds of drugs because then your body won’t know what to get addicted to”. But how do you, or how does your brain, make the association between a particular drug and you know you’re hooked on it?

Amy - All drugs of abuse, even though they all have very different actions in the brain, so nicotine, very different from heroin, very different from cocaine, all of them have this common action of increasing dopamine in a particular part of the brain called the nucleus accumbens. And every single drug that has abuse, that is addictive, has that effect, and you are very very good at learning in a completely unconscious way which environments or cues predict which particular outcomes and you can see variation. There are even experiments in rats showing that if you have rats who can self-administer cocaine or heroin in different environments, they tend to take heroin when they are in their home environment and they tend to take cocaine when they are out in a novel environment. So these environment really influence drug seeking and drug taking behavior as well in a quite a complicated way.

Chris - So if I fed someone pancakes, but also injected them with heroin without them realising it, would they form the addiction to pancakes so that they would then get the pleasure from the pancake because the reinforcement was there but they didn’t know it was heroin it was doing it, it was the pancake.

Amy - so I guess it would depend on how much experience they had with pancakes before. If they had experienced pancakes many times before and yet your pancakes are that much better, they will only seek out your pancakes and presumably you’ll give them heroin again. If they had not experienced pancakes before, then they may associate that euphoric rush with the taste of the pancakes. There may be a little bit of carry over to subsequent pancake experiences even without the heroin but i think they would very rapidly extinguish and just go back to normal pancake eating habits, unless they were getting your heroin laced pancakes again.

Katie - For someone who does have an addiction, what kinds of treatments are there?

Amy - So we are very limited in the treatments that we have at the moment. There are treatments that exist, like the 12 step programme, which don’t necessarily have a strong scientific understanding, but if they work for certain people then they should use them. But other drugs of abuse, like cocaine, there are no approved treatments. For other drugs like nicotine or heroin, we’re looking at replacement therapy as the alternative. For drugs like alcohol, there’s antabuse. But quite often people will stop using antabuse which produces hangover like symptoms rapidly when somebody drinks alcohol. What tends to happen is people will stop using the antabuse and carry on using the alcohol. So there is a real clinical treatment need and a real push for new treatment development, which is one of the things that my lab and other labs here in Cambridge are doing.

The World Health Organisation recently recognised “gaming disorder” as a mental health condition. So is this based on sound science, or are we turning an everyday behaviour into a disease, or providing parents of spoilt children with an excuse? Gaming is a multi billion dollar industry with a bigger turnover than Hollywood, and it’s enjoyed by millions of children and adults. So what’s the answer? Louise Theodosiou is a Consultant Child and Adolescent Psychiatrist, working with the Royal College of Psychiatrists in the UK...

Louise - As we heard before, gambling is about a narrowing of behaviour. And what gaming disorder from the World Health Organisation talks about is about people who have a pattern of gaming where they’re losing control of their gaming. They’re giving increased priority to gaming and carrying on gaming despite negative consequences, and one of the things that WHO emphasises is the fact that, actually, there’s an impact on people’s lives. Kids are struggling with their education, they’re not maintaining enough sleep, there is an impact on how healthy they are and their social interactions in the real world are suffering. So it’s about that impact on life and about the fact that this is carrying on for over 12 months, so we’re looking to see that impact and that narrowing of behaviour.

Chris - That seems to tick most of the boxes highlighted by Amy Milton a few minutes ago on what would be classified as an addiction.

Louise - I would agree that it does. And I think one of the brilliant things about the announcement is that we’re now starting to have a clear definition that will mean that we can focus our research more clearly. As I’m sure you’re aware, the American diagnostic system has had a slightly different definition, but a very similar condition: internet gaming, as an area of concern for about five years. And if we look at the literature we can see that there has been an increasing body of literature developing for almost 20 years now. So that situation of problematic internet use, and problematic gaming use has been around and is gathering momentum and I think that’s what makes this announcement so important.

Chris - Bryan Roth, when we opened this previous part of the programme said that, for millions of people, painkillers are a wonderful thing that have helped them over a painful episode and they’re only an issue for a small minority. In my introduction to you I pointed out that millions of adults and children use gaming as a diversion, as almost therapy. It’s a stimulus, it’s a distraction, it’s a way to relax and they do it quite healthily. So can we tell who are going to be the people for whom it is going to become a problem?

Louise - I think that’s an excellent question. And just to emphasise, yes, I think gaming can be very positive. I think it can actually be something that in a very short and very controlled way can really be a socially beneficial thing for children and I think the internet overall has huge benefits for mental health practice, and it’s about finding that balance, it’s about that moderation and, as you’ve said, lots of people benefit from painkillers. Lots of people benefit from gaming but there probably are doing it in the context of lots of other experiences at the same time, and it is about that group of people who lose control of their gaming.

And yes, while we are still needing to do more research, there do seem to be some of the same brain areas that were identified in the piece about addiction, that study areas that we need to look at more in people who have gaming difficulties. And there does seem to be a connection with people who, for example, who are suffering from depression and maybe have developmental conditions such as ADHD and some of the anxiety conditions.

So the fantastic thing is that now we’ve got this definition of “gaming disorder” we can start to narrow down our studies and to identify the groups of people more clearly, and identify how we can recognise them early. Because that’s the other good thing about having this definition of gaming disorder is by having a definition of depression in that same diagnostic classification, people like myself can help teachers and other people look at kids who might be at risk of getting depression, we can start to do the same thing now with gaming disorder.

Chris - Are there any sort of broad categories that the people who are susceptible tend to fall into: more boys than girls; teenagers than younger children? Do you have any idea?

Louise - What’s interesting is that there does seem to be slightly more boys than girls. But then what’s interesting if you look at the studies, in a number of studies boys are overrepresented. What’s also interesting is that a number of the studies have concentrated on pre-teens, teens, and university students, and yet a lot of people who may be struggling with their gaming may actually be older than that. So I think that’s something else we probably need to look at overall is to check that everybody who can potentially be affected is actually included in those research studies.

Chris - If we follow up these people; say we identify someone who clearly has a big problem, how do we help them?

Louise - What we need to do is we need to, I suppose, first of all make sure that there is that opportunity to have that dialogue with people. We need there to be more information; that’s why programmes like this are so important so that families, loved ones, carers can be identifying that people maybe are at risk because of their gaming. Then what we need to do is we need to make sure that people know who to talk to - speak to your GP. What we know is because of that connection with some of the mental health needs that I was talking about before, GPs can be really useful in telling you what difficulties in terms of knowing what difficulties you might have. And we also need to remember that there’s a lot of really good practical ways of addressing all mental health problems and that those common things will apply. You know, things about thinking about your anxiety, looking at what’s actually going on, looking at other strategies, interacting with other people, leaving the house. All of these really good sense, mental health, wellbeing things that we’re doing for all sorts of other conditions can also be useful in this condition.

Chris - Do you think this is a proportional label because, strictly speaking, the number of people who die of video gaming problems is not high is it compared with other drugs?

Louise - The internet has a potential to have a huge impact on people’s lives: sleeping, reversed sleep cycles, people not attending to their basic health care needs. If you fall and break you leg while you’re playing football you’re not going to be able to carry on. People can potentially damage their health while online and might not realise it in the same way, so I do think there’s a concern that we need to understand.