Thursday, July 19, 2007

Book Reviews: The Craving Brain

The Craving Brain

The Craving Brain: The Biobalance Approach to Controlling Addiction, by Dr. Ronald A. Ruden, with Marcia Byalick
ISBN 0060186984
Reviewed by Katy P.

The mystery of alcoholism and addiction is one that has plagued us for years. Is it a disease? Is it a choice? Physiological or psychological? Experts and researchers have published various theories and thoughts on the subject, some easier to understand and digest than others. Those of us seeking answers to these questions are left to consider all possibilities and draw our own conclusions based on personal opinions and experiences. In Dr. Ronald A. Ruden's book "The Craving Brain," the scientific theory of biobalance is introduced as a key to understanding and treating substance abuse. Applying scientific explanations to the questions of addiction and alcoholism is nothing new. But Ruden is able to break his theory down and present medical and scientific concepts in a simple, non-threatening style. We're still left to draw our own conclusions on the issues, but Ruden gives us something attainable and cogent to mull over.

The title of the book comes from Ruden's handle for what society has historically referred to as alcoholism and addiction. He says these are "craving disorders" of the brain, caused by a "craving response" to life experiences and environment. A craving brain is a brain chemically out of balance, and the solution is to put it back into balance, or "biobalance." Along with alcohol and drug abuse, Ruden applies his theory to all addictions, including overeating, gambling and sex.

In the first section of the book, Ruden examines the brain and how this complicated organ works. The author keeps his explanations clear and palatable. He starts with defining survival instincts as they apply to the human brain, and goes on to describe how and why the brain releases certain chemicals, or neurotransmitters, to accommodate our human urges and needs. The two main chemicals Ruden refers to are dopamine and serotonin. He says these two work together to both regulate our urges and satisfy our needs.

Ruden goes on to explain his theory of where addictive behavior comes from. Depending on our early experiences, and the god-given layout of our brain, the neurotransmitters may not release correctly, and what is normally a self-regulating system is now disrupted. This could happen for any number of reasons, but the author cites experiencing "inescapable stress" for a prolonged period of time as one possibility. In this case, the landscape of the brain has been altered, sometimes permanently, and cannot balance itself. The person is now left to balance his or her brain manually, i.e. with substances or behaviors that stimulate the neurotransmitters.

If all of this sounds confusing, trust that Ruden does an excellent job of presenting these theories in a graspable, step-by-step manner. The author also uses bold type for words and phrases that may need further explanation, and he includes a glossary in the back of the book.

With his theory now uncovered, Ruden explains that an addict's craving response, the abuse of a substance or behavior, becomes the automatic response. This, he says, accounts for the "I can't stop myself" feelings most addicts experience. According to Ruden, if our brain landscape is severely primed for craving, no social or moral constraints will stop us. But the author makes it clear that once we understand these responses, and understand the landscape of the craving brain, we can then learn to balance the brain (biobalance) by adopting healthy, serotonin-boosting habits.

Ruden offers several methods for arresting the craving response. He gives brief explanations of ideas behind Buddhism, 12 step programs, rehabilitation centers, and drug therapy. Ruden says each of these possible solutions can offer the craving brain a new method of producing the correct amount of serotonin to interact with dopamine and achieve biobalance. According to the author, the brain is a primitive system designed to ensure survival. One of the ancient survival instincts humans are known to possess is the need to "herd," or come together with a close community of people for comfort, safety and support. Support groups, or "herding," can produce the needed chemicals for biobalance. Similarly, this can be achieved through the Buddhist approach of liberation from the self and from desire, and other spiritual teachings. Ruden also mentions service to others as a means of boosting good feelings and balancing the brain.

The section on drug therapy in treating the craving response is the one troubled section of this book. Ruden includes information on the now illegal diet drug Fen-Phen, along with personal accounts from food addicts who have used it. This was obviously published before the dangers of the drug were publicized. Ruden also quickly glosses over antidepressants, and addiction-specific drugs such as Antabuse, Naltrexone, and Methadone. But compared to the rest of the work, this section falls short in facts and explanations.

The final section of the book includes an extended bibliography that not only cites Ruden's sources, but also "offers (the) reader a glimpse into the scientific process and explanations that led to this new understanding."

Overall, Ruden's work makes an impressive argument for the physiological rationale behind alcoholism and other addictions. His thoughts are organized and clear. The work is peppered with personal accounts from addicts, which helps take the edge off the scientific nature of the book and adds some personality to the work. Throughout his theorizing, Ruden maintains that no one method of achieving biobalance is the right method, but that there is hope for every person with a craving brain to find a solution that will work. With a simplified presentation of his theory and a realistic opinion on how to achieve recovery, this book is an enjoyable, thought-provoking read.
Comment: I was immensely move by Ruden's Book: The Craving Brain, especially his clear vivid description of the craving brain and the roles of dopamine {gotta' get it!} and seratonin {ahh, got it!} that helped me greatly understand the vicious circle of dope addiction. Plus, the power of the brain and its positive and negative potentials. ~Brother Peter S. Lopez ~aka Peta

Another Review:

The Craving Brain
Ronald A. Ruden with Marcia Byalick
Second Edition
Quill, HarperCollins, New York, 2003.
ISBN 0-06-092899-9
Paperback. 277 Pages.

School/perspective: Scientific/medical

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This is not a ‘self-help’ book, or guide to recovery from someone in recovery, but a book on the science of addiction. As it includes a discussion of AA and Buddhism, has a title like The Craving Brain and comes from a completely different angle, we believe it is worthy of inclusion on this list. Ruden is a clinician-scientist working in the field of medicine. He asserts that imbalances in the neurochemicals dopamine and serotonin create a craving landscape in the brain. He quotes research that indicates meditation can ‘biobalance the brain’ by raising serotonin levels. I was interested in this, because as a mild sufferer of OCD I have read that the disorder has been related to serotonin deficiency. Ruden’s guided tour of the research being conducted into addiction includes the science that demonstrates that addiction is not a matter of will (if there is anyone you know that needs convincing). In fact the cover and spine proudly proclaim ‘Addiction is not a matter of will’.
NB For those interested in Buddhist engagement with modern science I enthusiastically recommend the book Destructive Emotions, a dialogue with The Dalai Lama narrated by Daniel Goleman (Bloomsbury, 2004). It describes a week long conference that took place in March 2000 between the Dalai Lama and a panel of distinguished scientists and philosophers about human behaviour. This has led to a great deal of further research. Meditators may not need ‘proof’ of the benefits of meditation, but we live in a society dominated by science, and this sort of work can only serve to legitimise our practice. Buddhism, which is also about truth, has nothing to fear from science. Wasn’t Albert Einstein one of the tradition’s greatest admirers?

This book looks at the scientific approach to addiction, examining the root cause of our addictive behaviour. Dr Ronald Ruden presents his concept of a unified theory behind addiction. The book is certainly somewhat interesting and presented in a remarkably clear manner for what is a largely a scientific approach. However, though scientists can theorize all they like about why I am an alcoholic, it does not change the simple fact that I am one. It is my sincere desire that such ongoing research may one day lead to better treatment and understanding of people with addiction, but for me at this point of time in my recovery I question its personal relevance. So I applaud his work, but I fail to see how any of this ultimately changes anything for me, a recovering alcoholic already living within a solution.

Chapter headings:

  1. Survival
  2. Landscaping the brain
  3. The craving response
  4. Battling for control
  5. Biobalance
  6. Biobalance to mindfitness
  7. Curing sobriety
  8. Response and responsibility
    The Scientific Foundation
    Postface etc

Selected excerpt:

“Craving is the force behind the drive to survive. It can produce an unstoppable involuntary behavioral response. Why are some of the approaches we’ve mentioned earlier sometimes successful in battling these powerful commands? Can we understand their success in terms of the biology of the brain? Will this understanding lead us to a new approach to treating addictive behavior?

As we said before, the earliest recorded method to stop craving was developed by Siddhartha, the founder of Buddhism. Siddhartha understood very well the impossible task of preventing pattern recognition from inflaming the passions. It is even possible that Siddhartha himself suffered from a craving brain. He tried the road of abstinence, he tried the road of excess, neither worked. What he ultimately found was that by following the Eightfold Path, he could avoid the conditioned responses of the brain that led to craving……

Buddha’s clever solution was not to fight the craving response once it occurred, but instead to prevent the pattern recognition process before it began. He explained that we had to fill our minds with the right thoughts, do the right things, and act the right way so that nothing that might possibly stimulate the brain’s craving response can enter the forefield or the backfield…..

Buddha also understood that if a pattern recognition process was initiated, it was important for us to have the ability to empty our minds of everything. Here he suggests meditation, which results in a conditioned rise in serotonin and constraint of neural transmissions. The high serotonin level would prevent matches, leaving the mind empty. The pattern recognition process would be unable to lead to a craving response. As we mentioned previously, Buddha’s teaching, which prevents and extinguishes conditioned learning, made him the perfect example of an unconditioned man.” (pp 89-91)

© 1997, 2000, 2003 Ronald A Ruden & Marcia Byalick

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