Addictions and the Dynamics of Altered States of Consciousness

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CHAPTER 8
Addiction and the Dynamics of
Altered States of
Consciousness
Andrea E. Bla
¨tter, Jo
¨rg C. Fachner, and
Michael Winkelman
Drugs, Addiction, and Altered Consciousness
One of the foremost methods for producing altered states of consciousness
(ASC) is the consumption of drugs (Tart, 1969). The basic form of commu-
nications for neurons, the basic building blocks of our nervous systems, is
electro-chemical, allowing exogenous drug sources to play a role similar or
identical to that of our central nervous system. Major bodily neurotransmit-
ters such as acetylcholine, monoamines, noradrenalin, serotonin, GABA,
anandamide, and dopamine (Maisto, Glizio, & Connors, 2004, p. 45; see
Presti and various chapters on psychoactive substances, this volume) have
exogenous analogues found in drugs such as tobacco, opium, cocaine, and
cannabis. When a drug has a similar chemical structure to that of an endog-
enous neurotransmitter, the drug can bind with the receptor cells, duping
the receptor cells into reacting as if the original neurotransmitter was stimu-
lating the neuron. Drugs can increase or decrease the synthesis of neuro-
transmitters, they can interfere in the transport, storage or release of
neurotransmitters, and they can influence the breakdown of neurotransmit-
ters, block the reuptake, or manipulate activity or blockage (Maisto et al.,
2004). As Previc [this volume] shows, these exogenous stimulants of our
endogenous reward systems can play a major role in a variety of cognitive
and emotional processes. Using and misusing drugs is an old phenomenon
and seems to be a biological universal of humankind like eating, drinking,
sex, and aggression.

Drug consumption can have many dysfunctional effects, from acute
intoxication leading to bodily or mental damage to psychopathologies,
economic and social loss, accidents, and criminality. On the other hand,
many commonly used drugs have a variety of adaptive advantages. Smith
(1999) reviews evidence that fitness benefits accrued to our ancestors as
a consequence of their ability to respond to these psychoactive substances.
Across the diverse classes of plant drugs there are effects of enhanced vigi-
lance, the ability to ignore pain in the interest of survival activities,
increased access to mating opportunities, reduction of apprehension and
stress, feelings of detachment and euphoria, increased endurance and
self-confidence, enhanced sensory and mental acuity, reduction of defen-
siveness, and reduction of depression and self-defeating activities. Clearly
many adaptive mechanisms could have been involved in humans’ physio-
logical and cultural adaptations to environmental sources of
consciousness-altering chemicals that provide relaxation, strength, anxiety
reduction, pain endurance, enhanced bonding, nutrients, and many other
effects. Sullivan and Hagen (2002) review evidence of a long-term evolu-
tionary relationship between psychotropic plant substances and humans’
cognitive capacities that indicate there were selective benefits of substance
use. They characterize these benefits in terms of the ability of plants to
provide neurotransmitter analogues that served as substitutes for endog-
enous transmitters that are rare or otherwise limited by dietary constraints.
These are primarily in the monoamine neurotransmitters such as sero-
tonin, as well as acetylcholine, norepinephrine, and dopamine that are
crucial for normal brain function and require dietary precursors. These
neurotransmitters are central to managing stress, exerting selective pres-
sures for metabolic systems that utilize these exogenous sources of precur-
sors for these neurotransmitters.
Although drug taking is a universal phenomenon, it manifests a wide
range of culturally learned patterns that dramatically affect drug reactions,
including addiction (Bla
¨tter, 1990; Schivelbusch, 2002; Vo
¨lger & von
Welck, 1982). These cultural set and setting factors partly determine drug
experiences, including alterations of consciousness and addictions.
Although basic biological mechanisms involved in addictions are illustrated
in the many animals that can share our drug preferences and dependencies
(McGovern, 2009; McKim, 1991; Siegel, 1979, 1989), reactions to drugs
are nonetheless variable. Some, but never all of the people who try a drug,
develop a habit, resisting or adopting occasional consumption patterns,
but because of compelling biological effects most users tend to take more
than one kind of drug (e.g., coffee and alcohol, betel and tobacco), and
many do so daily. Users are generally aware of the risks from the drugs they
168 Altering Consciousness

are taking, but for some the risks do not deter the addictive impulses. For
example, the recognized horrors of the addictive experience are ignored
by the user in the repeated search for the noted pleasurable effects associ-
ated with the high of a cocaine rush. To the outsider, the drug-intoxicated
users do not always seem to be in pleasurable states. People who try drugs
often first get dizzy or sick, some even vomit. Users have to learn to like their
intoxicated states of consciousness (Becker, 1963). Some writers
1
have
described the addict’s dramatic indifference toward everything but his or
her favorite drug and refer to the paradox of addiction: Intoxication is not
an euphoric or pleasurable state anymore (Diekhoff, 1982; Plant 1999).
Consequently, some cultivate highly polytoxicomanic daily consumption
patterns of stimulants to work and depressants to relax, a typical feature of
modern societies. Consumption of drugs and their effects on consciousness
are at the core of one of the most serious problems of modern societies, that
of addictions.
The Constructions of Addiction
Across time and cultures, views of what constitutes addiction and its
causes have varied widely. Protestant (Calvinistic) conceptions of addic-
tion provided the roots of the modern view of addiction (Nolte, 2007,
p. 52). This Reformation perspective of addiction as a moral failing was
succeeded by different phases leading to the systematization and institu-
tionalization of the modern medical concept of addiction. The contempo-
rary view of addiction as a phenomenologically perceivable disease with
many facets has evolved, but although religious-scientific discourse trans-
formed into medico-scientific discourse, the main ingredients have
remained the same. The drunkard of Reformation times was defined as
ill because he did not live a holy life; the drunkard of the industrial era
is defined as ill because he does not meet standard norms such as produc-
tivity, functionality, and success, the keywords both of Calvinism and
capitalism (Nolte, 2007, p. 53). The addict of today suffers from a multi-
faceted and varied disease of compulsions and wanting with fixations as
diverse as sex, gambling, food, fetishes, and of course a bewildering vari-
ety of natural and synthetic substances.
Addiction and the Dynamics of Altered States of Consciousness 169
1
Several artists (see Volume 1) have described their experiences with drugs and addiction.
William Burroughs, Aleister Crowley, Thomas de Quincey, Eric Clapton, and Keith
Richards, to name just a few, have used drugs for inspiration and were known for their
excessive consumption (Diekhoff, 1982; Fachner, 2006; Plant, 1999; Shapiro, 2003).

In the 19th century, the addictions of alcohol were expanded to the
opiates, which since then have been recognized as dependency forming.
In the course of time, more substances were included under addiction
theory. Since the second half of the 20th century, a dematerialization of
addiction has taken place and immaterial dependences (e.g., gambling,
sex, work) have proliferated. A new sensibility for nonsubstance addic-
tions has come to public consciousness, and a new field of social problems
emerged (Schetsche, 2007) in this new phase of the concept of addiction
(Nolte, 2007, p. 54). Since 1990, another change has been visible, mainly
in European politics in the trend toward a more accepting drug policy of
risk reduction, especially in case of opiate addicts (Valentine, 2007;
WHO, UNODC, & UNAIDS, 2004), but the farewell to the radical goal
of abstinence in favor of risk reduction strategies has not yet reached other
areas, like tobacco or cannabis consumption (Hess, Kolte, & Schmidt-
Semisch, 2004).
Since the second half of the 20th century, addiction has been
perceived as one of the great social problems of modern societies, and in
the 21st century, nearly every behavioral problem has been thought of as
an addiction. Nonetheless, the concepts of addiction and dependence
remain vague and value bound. By WHO standards, the term addiction
was officially replaced by dependence in 1974 because of the negative con-
notation of the term addiction. In its popular meaning, addiction “carries a
moral tone of reproach, suggesting weakness or absence of the will and
lack of discipline” (Luik, 1996, p. 23). In this sense, addiction involves a
value judgment and, strictly speaking, is no more of a scientific term than
dependence. Today the two terms are used virtually synonymously, as we
do in this paper.
The dominant medical models of addiction have come to emphasize a
genetic susceptibility, absolving both the individual addict and society of
responsibility for the problems. This biological dependency model ignores
both the set and setting dynamics of dependence as well as the underlying
philosophy of the dominant treatment models. The medical view of
dependence as reflected in the medical classificatory systems Diagnostic
and Statistical Manual of Mental Disorders (DSM-IV) and International Clas-
sification of Diseases (ICD10) frames addiction as a psychopathological dis-
order characterized by a habitual behavior with main features of tolerance,
withdrawal, and craving. The DSM-IV definition of dependence is based
on a spectrum of possible criteria ranging from acute intoxication to with-
drawal with attacks of sudden cramps. There is no consistent picture of
dependence, but there are many different types and widely varying
degrees. Dependence therefore is a multifactor phenomenon that is not
170 Altering Consciousness

limited to a single substance or object or situation. Notably, the medical
definitions of drug dependence, abuse, and habituation are based on
descriptions of habitual behavior, and they do not specify the role of drugs
(Maisto, Galizio, & Connors, 2004, p. 15ff ). Drug-related behaviors and
experiences such as physical and psychological dependence (requiring
the drug to function), tolerance (requiring increasing doses of the drug
to achieve the same effect), abuse, withdrawal syndromes (negative symp-
toms after discontinuing the use of the drug), craving, and cognitive and
psychotic disturbances used in DSM-IV for diagnostic purposes remain
vague and imprecise and include a moral, disapproving tone. The one col-
lective and most important feature of addiction is craving,thestrong,
sometimes irresistible desire to consume a drug, a rather subjective feature
not measurable in clinical settings; it remains an extremely vague concept.
There are no objectively observable behavioral standards, and craving
might be applied to any significant behavioral change (Luik, 1996,
p. 27) as a kind of focused consciousness.
The core biological concept of addiction implies that an entire set of
feelings and behaviors is the unique result of one biological process (Peele,
1985), but it is difficult to separate physical and psychological depen-
dence from overpowering desire and habituation. Many critics conclude
that the definitions of dependence employ terms that are virtually inde-
finable and heavily value laden. Only physical tolerance can be a straight-
forward measure of addiction, while psychological dependence is less
inevitably manifested and more susceptible to the elements of set and set-
ting (Peele, 1985; Zinberg, 1984).
Although addiction is a heterogeneous group of pathologies or disliked
behaviors that exceed simple generalities (Luik, 1996, p. 21), there are
nonetheless noteworthy commonalities in the dominant perspectives of
medicine and science. One is the conviction that addiction, including tol-
erance, withdrawal, and craving, involves biochemical processes that leave
the organism no choice but to act in the stereotypical ways of addiction.
This process is thought to be inexorable, universal, and irreversible, inde-
pendent of individual group, cultural, or situational variations, whether
animal or human, whether child or adult (Peele, 1985, p. 1).
Total Drugs Effect and Set and Setting
In contrast to the medical emphasis on the biological effects of drugs, the
concepts of environment, setting, expectations, and culture are central con-
structs in addiction theories of the social sciences (Dollinger & Schmidt-
Semisch, 2007; Maisto et al., 2004; Uchtenhagen & Zieglga
¨nsberger,
Addiction and the Dynamics of Altered States of Consciousness 171

2000). Acceptance and use of a certain psychotropic substance in a popula-
tion, a subcultural group, an occupational group, and so forth involve
learned behaviors determined by personal characteristics and socio-
cultural factors (Becker, 1963; Bla
¨tter, 2007). Expectations shape personal
behavior and experiences, and drug use involves significant others that
facilitate access and participate in producing the experience. Use, abuse,
and addiction are seen as phenomena of conformance to a behavior that is
(sub)culturally accepted and assisted (Becker, 1963). Even the felt effects
of consumption are culturally formed (Bla
¨tter, 2000, 2007).
Individual and cultural variations in responses to drugs reflect “total
drug effects,” how the physiological effects of substances are mediated by
personal, social, and cultural influences. Helman (1994) makes the dis-
tinction between macro and micro context effects. Macro context drug
effects involve influences from the sociocultural system; these include
social, political, economic, and moral factors and influences from family,
other users, advertising, and sales processes. These are illustrated by the
greater effectiveness of brand-name analgesics over unlabeled sources of
the same drug (Moerman, 2000). Micro context effects are reflected in
“set” and “setting” influences. These involve the expectations of the recipi-
ent, including attitudes, knowledge, and cognitive preferences of the per-
son (the “set” as in mindset) and the social and physical context (“setting”)
of the drug consumption or medication. These psychodynamic effects are
investigated as part of placebo effects, where nonpharmacological factors
include arbitrary drug attributes such as color and shape, the physical set-
ting in which the drug is administered, and the prescriber’s characteristics
such as status and personality. The finding that drug effects, addiction,
and dependence are situationally, socially, and culturally determined
questions the disease view of addiction (Peele, 1985, p. 128). Nonbiolog-
ical factors, such as personality, cognitive and developmental factors, cul-
tural, social, situational, and ritualistic aspects, influence the reaction to
drugs (Bla
¨tter, 2007). Situational factors reflect a reality of desire, that
drug effects cannot be separated from the situation in which the drug is
taken. The rituals that accompany use and addiction are important ele-
ments in continued use and show the important ritualistic aspect of use
and dependence.
The Paradox of the Biomedical Concept of Addiction
There is a paradox in the medical approach to addiction in that practice
does not follow ideology. Although addiction is seen in the medical frame-
work as a physical and biological condition, the dominant treatment models
172 Altering Consciousness

of American biomedicine have come to follow the Alcoholics Anonymous
(1976, 1987) approaches that do not share the medical concept of addic-
tion. The underlying ideology of Alcoholics Anonymous (AA), reputed to
be the most widespread and effective treatment system in the United States,
advocates the perspective that addiction is a spiritual disease and that conse-
quently the addict is powerless in the face of the addiction and can only
escape through a surrender to a higher spiritual power, however one con-
ceptualizes that power. The AA approach explicitly conceptualizes addic-
tion in terms of altered consciousness, with its 12-step program including
changes in consciousness and a spiritual awakening as fundamental to over-
coming addiction. The AA recovery process emphasizes the importance of
an alteration of consciousness, calling for “a new state of consciousness
and being” (Alcoholics Anonymous, 1987, p. 106) designed to replace the
self-destructive pursuit of alcohol-induced altered states with a positive,
life-enhancing approach.
The engagement of biomedicine with this alternate framework is so
complete that the American Medical Association will only accept as
adequate programs for physician rehabilitation that are so extensive in
terms of frequency of meetings and other features (availability of follow-
up, support systems) that the only program that may fulfill all of the
requirements is AA/NAC (Alcoholics Anonymous/Native American
Church) (Houck, 1998). How can we reconcile a biomedical model with
a treatment program that calls for a spiritual awakening and modification
of consciousness as fundamental to resolution of addiction?
Dependence as an Acquired State of Consciousness
Metzner described the relationship of addiction and dependence to the
dynamics of consciousness in general and the alteration of consciousness
in particular. He proposed a model of consciousness as a “spherical field
of awareness, that surrounds us and moves with us wherever we go”
(Metzner, 1994, p. 5). Awareness and attention can be thought of as a
kind of beam that can focus on a very narrow point or can take in a much
wider range and area of the total circle of potential consciousness. In terms
of this 360°circle of potential awareness and attention, a usual baseline
state of consciousness might engage 30°to 60°, with a constant narrowing
and widening of focus (Metzner, 1994, p. 6). For instance, expansion of
consciousness unfolds every morning, when we wake up. Metzner refers
to mother–infant bonding and especially breastfeeding as natural human
experiences in which extreme selective narrowing of consciousness occurs
(Metzner, 1994, p. 7).
Addiction and the Dynamics of Altered States of Consciousness 173

Dependence is a contracted state of consciousness that appears as a
compulsive behavior that is fixed and repetitive. The addictive lifestyle
becomes more and more ritualistic and restricted, and attention and
behavior become isolated from interpersonal and occupational relations.
Some ASC such as transcendence and ecstasy involve an expanded aware-
ness of consciousness that seems to exceed the normal baseline condition
of awareness, exemplified in mystical experiences of connection with the
entireuniverse[seeBeauregard,Volume 2]. In this model, addiction is
represented by an extremely narrow, focused scope or even point of con-
sciousness. In contrast, ASC are time-limited states in which the patterns
of thought, feeling, and mood of perception and sensation are altered from
the ordinary baseline conditions.
From a neurophysiological perspective (Tassi & Muzet, 2001), both
dependent and transcendent ASC may be produced by a variety of induc-
tion methods, not only drugs but also behaviors such as sleep or sensory
deprivation, meditation, and so forth. Additionally, Tassi and Muzet
(2001, p. 185) noted a wide range of physiological states of consciousness,
reflecting spontaneously changing levels of vigilance, arousal, and biologi-
cal rhythms. Human states of consciousness are constantly changing,
undergoing periodic fluctuations during the 24-hour circadian cycle and
the regular modulation of physiological processes shifts in states of con-
sciousness between waking, sleeping, and dreaming. A similar periodicity
of ASC is seen in a second endogenous cycle, the 90-minute ultradian
cycle of doing and resting, a shift from left-brain to right-brain predomi-
nance reflecting differential sympathetic and parasympathetic activation
(Rossi, 1991; see Kokoszka & Wallace, this volume). These fluctuations
of consciousness are natural and inevitable, with health, well-being, and
creativity linked to the ability to tune into and utilize naturally occurring
and artificially induced modulations of consciousness (Metzner, 1994,
p. 4). Modulating consciousness with external stimuli is a pervasive and
natural human drive. Humans have developed a variety of catalysts and
triggers of ASC, including foods, sounds, rhythms, visual stimuli, move-
ments, breathing exercises, hypnosis, meditation, shamanistic practices,
religious rituals, and mainly drugs that can capture our capacities for
addiction. Our addictive tendencies must be understood in relationship
to our similarly pervasive tendency to deliberately seek ASC.
When an external stimulus, like a drug or a certain behavior, has the
ability to produce an immediate, effective, and pleasant modification of
mood and sensation, there is a high likelihood for repetition and a poten-
tial for the development of attachment and dependence (Metzner, 1994,
p. 4). When a behavior becomes so habitual as to dominate the individual
174 Altering Consciousness

life to the disadvantage of interpersonal and occupational functioning, the
diagnosis of addiction or dependence is given. Dependence, compulsions,
and attachments are an extreme of normal experience but an inevitable
part of human experience, beginning with mother–infant bonding.
Dependence, compulsions, and attachments,whetherornotthey
involve drugs, involve a fixation of attention and a narrowing of percep-
tional focus. This disposition to fixate and focus attention is extremely
useful and beneficial where there is a need to reduce pain, fear, or anxiety.
Addictive drugs are potent modifiers of mood and sensation because they
involve a very rapid need satisfaction and anxiety reduction. Psychoactive
drugs can shift the focus of attention from anxiety to relaxation, and
because they bring these changes effectively and rapidly, consumers
quickly learn how to use them to escape painful conditions. Fixation and
dependence can then easily develop. Awareness is disengaged from other
aspects of our experience of reality, particularly unpleasant aspects. Means
that can immediately and effectively satisfy needs may lead to attachment
or addiction processes. In focusing attention on the means, the experience
of craving or wanting begins.
The power to instantly alter consciousness, especially to move it from
painful to pleasurable, can be generalized from the physiological drug
effect to the drug induction behavior. In the subsequent repetition of the
relieving acts over time, a kind of ritual behavior develops. The ritual
aspect of addiction and compulsion is significant; ingestion of drugs that
produce dependence is generally associated with ritualistic behavior.
Development of fixed rituals is essential for the formation of addictive
behavior (Metzner, 1994). Compulsive repetition is described for alcohol,
opiate, and cocaine consumers, and ritualistic ingestion is quite obvious in
the well-known cases of socially sanctioned and commercially promoted
addictive substances, such as alcohol, tobacco, and coffee. Ingestion rit-
uals are also evident in food addictions and in the case of activity addic-
tions such as compulsive sexual activity, gambling, shopping, or
working. These patterns reflect an ability of ritual to reduce anxiety and
change consciousness through absorption in routine tasks (Metzner,
1994, p. 8). Indeed, ritual is a cross-cultural pattern used to alter con-
sciousness with deep biogenetic roots in primate rituals that function to
reduce aggression and enhance relaxation (Winkelman, 2010). Moreover,
rituals are important, too, when it comes to learning controlled, nonaddic-
tive consumption patterns for highly addictive substances. Studies of con-
trolled use of heroin (Zinberg, 1984) and cocaine (DeCorte, 2000) have
illustrated the possibilities of using these substances regularly without
developing tolerance, withdrawal, and dependence by following strict
Addiction and the Dynamics of Altered States of Consciousness 175

rules of rare collective ingestion. These findings emphasize the importance
of factors beyond the physiological effects in explaining addictions and the
alterations of consciousness sought.
Although the search for transcendence and expanded or heightened
states of consciousness may involve drugs, it is not usually characterized
by dependence. Generally, the consciousness-expanding psychedelics do
not lead to addiction (McKim, 1991; Nichols, 2004). Their effects are
too unpredictable, varied, subtle, and delayed to allow the immediate pain
or tension relief the addict seeks (Metzner, 1994). Furthermore, in con-
trast to the narrowing focus of addiction, psychedelics tend to produce
experiences that widen the focus of attention beyond the boundaries of
the ordinary or baseline state. They represent the opposite of the addictive
contractions of consciousness. However, transcendent experiences them-
selves, whether induced by drugs or other means, can also become the
object of addiction with a similar state regularly involved and to the exclu-
sion of other interests (Metzner, 1994, p. 9). This seems to be a rare excep-
tion. In contrast is the widely noted ability of psychedelics to counter
addictions (see Winkelman, 2009b).
Calabrese (2007) maintains that many addiction professionals con-
sider the Native American Church (NAC) to be the only effective treatment
of alcoholism among Native Americans. NAC members consume peyote in
an all-night meeting during which all the community may participate in
singing, prayers, chanting, and drumming. Peyote contains mescaline,
with stimulant properties similar to ephedrine and amphetamines, and
has additional effects mediated through the serotonergic system (McKim,
1991). Peyote produces a physical and psychological afterglow (see
Halpern, 1996, for review) that has been noted to be conducive to thera-
peutic interventions by increased openness to communication regarding
one’s problems.
Pharmacological effects are not the only treatment mechanism. The
effectiveness of the NAC as addiction treatment includes a variety of
supportive psychotherapeutic modalities: a master guide, marathon group
sessions, ego-reduction techniques, social networks, and self-actualization
(Calabrese, 1997, 2007; Wiedman, 1990). The NAC also addresses addic-
tion through social psychological mechanisms, forming a sense of commu-
nity that promotes a new identity and a social support group that does not
use nor tolerate alcohol use. The NAC brings hope to Native American
communities, instilling a moral code of devotion to family and obligation
to the community and producing feelings of spirituality and unity (Aberle,
1966). Peyotism provides Native Americans with religious healing, tran-
scendence, release from guilt, guidance, and a sense of purpose.
176 Altering Consciousness

Heggenhougen (1997) suggests that therapeutic effects involve managing
cultural alienation experienced by young Native Americans, providing a
context for a ritual death and rebirth, and construction of a positive iden-
tity with one’s culture. Jilek (1994) conveys the peyotists’ perspective that
the peyote ritual combats alcoholism through reducing physical and
mental stress and enhancing mental and physical strength through contact
with the supernatural. Calabrese (1997, 2007) describes the Peyote Way as
a cultural psychiatry that increases suggestibility and leaves adults more
open to education and mental health interventions. In this sense, peyote
rituals heal by shaping consciousness in ways that facilitate symbolic heal-
ing processes. Calabrese (2007) also notes that unlike many traditional eti-
ologies that attribute personal misfortune to supernatural causes (e.g.,
witches, taboo violations), the Peyote Way instead places the causal factors
in a lack of personal responsibility for one’s own behavior.
Psychedelics can help patients open their consciousness and widen their
awareness (see coverage of addiction treatment programs with ibogaine,
LSD, and ayahuasca; Winkelman, 2009a, 2009b; Winkelmann & Roberts
2007b). Under the influence of these substances, which Winkelman
(2007) calls psychointegrators, people can acquire spiritual insight, learn
to recognize and identify their own restricted and destructive patterns of
addictive behavior, and switch to new, healthier perspectives and behav-
iors. These effects are dependent on set and setting but have cross-cultural
manifestations that reflect physiological mechanisms.
The interrelationship of drug addiction, ASC, and spirituality is
a theme repeated across cultures (Heggenhougen, 1997; Jilek, 1994;
Winkelman, 2001, 2009a, 2009b). The universality of spiritual practices
associated with ASC suggests a need for experiencing alterations of con-
sciousness that are intrinsically linked to concepts of spirituality. The
association of drug addiction with our drive for seeking alterations of con-
sciousness involves a common biological basis in the brain for rewarding
and addicting experiences, particularly in relation to others. The concept
of meaningful social connections links spiritual states and our addictions
in our deep-seated need and desire for social bonding, a function of our
paleomammalian brain where the predominance of opioids are found
(cf. MacLean, 1990).
The Reward System and ASC
Recent findings in the neurobiology of addiction research using brain-
imaging techniques provide insights into the development of addiction
involving anatomic and functional connections between hippocampal
Addiction and the Dynamics of Altered States of Consciousness 177

and amygdala structures that modulate emotions and regulate affects. A
common quality of all psychoactive drugs is that they alter the evaluation
of sensory input and its conceptual comparison and assessment with
known information (Emrich & Schneider, 2006). This happens through
drug-specific individual activation and inhibition of the interaction among
the midbrain, cerebrum, and cerebellum. One of the basic functions of the
hippocampal structures seems to be the generation of reasonable internal
world-models and the comparison of expected and incoming data. Metzner
(1994) discussed the effect of drugs on contracted and expanded con-
sciousness using a circle model of “potential awareness” (p. 5ff). Aware-
ness is narrowed under the influence of addictive drugs or expanded
under the influence of psychedelic drugs. The model is based on the
potential sum of sensory information reaching the brain structures, throt-
tled by regulatory mechanisms in the neuronal pathways.
The mesolimbic system of the midbrain changes the evaluation param-
eters through emotional coloring of sensory data. This “paleomammalian
brain” process provides the emotional dynamics of life, memory, and the
basic sense of social self. This area of the brain managing our emotional
and social life is also the primary anatomical location for the receptors
involved in drug responses: our endogenous reward system.
At the center of neurobiological theories of addiction is the concept of
the endogenous reward system. Anatomically, it includes connections of
neurons that lead from the tegmentum (area ventralis tegmentalis, origin
of dopaminergic mesolimbic neurons) and project into the nucleus
accumbens, prefrontal cortex, and other areas of the brain (Emrich &
Schneider, 2006). The nucleus accumbens is the center of the reward sys-
tem, with numerous opiate receptors as well as dopaminergic neurocytes.
Those are modulated by endorphins, the endogenous opiate of the brain
(Emrich & Schneider, 2006). The human brain contains various kinds of
opiate receptors, (e.g., -, -, ´-, and -receptors enkephalines and dynor-
phin) with different functions. Activating ´-receptors, for example, leads
to a euphoric feeling, while activating -receptors triggers fear and dys-
phoria. Endorphins are neuropeptides able to dock at the various kinds
of opiate receptors in the brain. Precursory proteins, from where the
endorphins emerge, are found in notably high density in all areas of the
brain where emotions and motivation are modulated (Emrich &
Schneider, 2006).
Another neuropharmacological system involves an endogenous canna-
binoid receptor system that is evolutionarily highly conservative and has a
high density of receptors in diverse parts of the human and animal brain
(Iversen, 2008). These anandamides appear to increase release of dopamine
178 Altering Consciousness

in the reward system, as does cannabis use (Mechoulam, Hanus, & Martin,
1994). Other substances like cocaine, amphetamines, and MDMA also
lead primarily to increased release of dopamine in the reward system.
Following dopaminergic release, endorphins are also released in the reward
system.
Psychoactive substances, as well as physical stimuli or behavioral pat-
terns perceived as pleasurable, have reinforcing properties that can be
ascribed to the neuronal reward system. The complex systems of neuro-
transmitters interacting with the nervous system to arouse euphoria are
not yet satisfactorily understood. The reward system theory postulates that
reaching pleasurable or euphoric states is the major goal of drug users and
addicts; further, that emotional assessment of occurrences leads to the
preference for states that are perceived as pleasant by the nervous system.
Psychoactive drugs as well as specific behavioral patterns can activate the
rewarding system and are therefore used to close the cycle of motivation-
search-fulfillment (Emrich & Schneider, 2006). Eating chocolate or a
refreshing drink with some sugar, as well as various other activities, can
also activate the reward system (Small, Zatorre, Dagher, Evans, & Jones-
Gotman, 2001).
Dopamine: Pleasure, Lust, and Desire
Pleasure, lust, and desire are essential evolutionary programs that guar-
antee reproduction and satiation and are mediated by the feeling that
something we like has happened (Esch & Stefano, 2004). Intense emo-
tions connected to pleasure, lust, and desire connotate the valence and
meaning of an experience and inform about the salience of an event being
different from normal. Depending on the stimulus, we may develop an
increasing desire to experience this intensity again. However, pleasure
and desire are regulated in different ways. Pleasure is the state in which
we feel satiated, happy, and fine, and which we seek. Desire, or lust, is
the drive that brings us to this state but has a mechanism of its own.
In pleasure, desire, and lust, the dopamine system is active in a tonic
and a phasic way. First, the tonic component of dopamine release in the
prefrontal cortex of the brain regulates the readiness to react to stimuli.
Second, there is an increase in dopamine release (phasic) when meaning-
ful objects are in the focus of attention; the more dopamine is released, the
higher is the personal meaning and valence of the object in focus. All
drugs of abuse increase dopamine release and therefore affect these two
ways of dopaminergic functioning (Yacubian & Bu
¨chel, 2009). As a result
of unconscious sensory input changes under the influence of the drugs
Addiction and the Dynamics of Altered States of Consciousness 179

taken, a variety of possible neurotransmitter interactions will start to
modulate the experience of pleasure.
Although pleasure is mainly mediated by the dopamine system, a long-
ing for satisfying experiences like the taste of chocolate remains even when
dopamine release is inhibited. Pleasure involves a variety of neurotrans-
mitters and endocrinological communicators (Berridge & Kringelbach,
2008). Although the opioid system is mainly responsible for pain reduc-
tion, the endocannabinoid system seems to enhance sensory experience
and therefore enhance the longing for pleasure (Esch & Stefano, 2004;
Mahler, Smith, & Berridge, 2007).
Opiate and Dopamine Interaction
In the case of opiates, external neurotransmitters seem to stimulate the
mesolimbic dopaminergic system more than endogenous neurotansmit-
ters (endorphins) do. Repeated application of opiates leads to tolerance
with the decrease of several pharmacological effects like analgesia, respira-
tory depression, and emetic effects. Tolerance is reversible and declines
after a few days. Tolerance and withdrawal symptoms are explained by
accelerated metabolism, restriction, and decoupling of receptor systems
and neurobiological adjustment on diverse levels, for instance raised sym-
pathetic tonus and alteration of calcium channels on cellular level. The opi-
ates change intracellular transduction of signals and lead to a change in
transcription rates and changed activity of the relating neuronal circuits
(Kamphausen, 2009). Although tolerance and withdrawal disappear
rather quickly, behavioral changes can be very robust. Even after a longer
period of abstinence, the risk of relapse persists. This may be explained by
persistent neuroplastic changes (see below) including CREB and Delta-
FoS–B-mediated triggering of the craving processes (Ammon-Treiber,
Mayer, & Ho
¨llt, 2006). One possibility for the development of addiction
then is that repeated stimulation leads to a change in motivation and
amplifying mechanisms, mediated via neurobiological adaptation of drugs
with a solid internal assessment: that is, drug effects are determined from
the drug action itself. Moreover, it has been shown that release of dopa-
mine in the nucleus accumbens seems to correlate more with the anticipa-
tion of reward than with reward in itself. The repeated application of
opiates leads to a raised longing rather than to a heightened award
(Ammon-Treiber et al., 2006, p. 53).
Neuroanatomically, some pathway seems to lead from the prefrontal
cortex directly to the temporal lobes and hippocampus, where compara-
tive functions of sensory stimulus (bottom-up) and internal representation
180 Altering Consciousness

(top-down) data take place (Emrich & Schneider, 2006). Within this con-
text, there are two possibilities to develop addiction:
a. Drugs with a relative solid internal assessment (like opiates) are to a large
extent independent of situational cues. They have a hermetic or closed,
context-independent, and immediate effect on pain and tension while act-
ing on the primary mesolimbic centers of assessment and induce pleasur-
able states with the accordant reinforcement properties, independent of
contextual or situational cues.
b. Drugs with a contextual bonding and assessment (like cannabis and
hallucinogens) are more situational in their effect. Emotions and percep-
tions mediated by the hippocampal comparator systems modulate the
drug effect much more than drugs with a solid internal assessment
(Emrich & Schneider, 2006, p. 16).
There are differences in the degree and frequency of striving and fulfill-
ing rewarding bodily activations. If the frequency of events becomes very
high, as observed in lab rats that could not resist acting to receive the next
electrical activation of their reward centers, then the body is in danger,
whether it is from an overdose of sugar and cacao, 3 liters of whisky, or
a big dopamine release in getting the next big share from a complex finan-
cial deal. The financial crisis in 2008 suggests that those who were making
big money exhibited the same pattern of loss of control and irresponsibil-
ity as addicted drug users. Neuro-economical research has shown that
expecting to make monetary profit and being able to possess expensive
cultural objects such as expensive sports cars induces a strong activation
in the reward system, namely in the ventral striatum, nucleus accumbens,
and orbitofrontal cortex (Elliott, Newman, Longe, & Deakin, 2003; Erk,
Spitzer, Wunderlich, Galley, & Walter, 2002; Knutson, Westdorp, Kaiser,
& Hommer, 2000), areas that influence decision-making processes by
valencing expected rewards and their intensity. This illustrates a funda-
mental feature of addiction, its relationship to some extrinsic system of
reward and evaluation.
Drug Sensitization and Neuroplasticity
When it comes to drugs, the separation of pleasure and desire is the
most tricky trap for the consumers on their way from drug use to abuse.
Addiction research has identified the two “culprits” for this process of
drug sensitization. While dopamine levels rise after drug ingestion, a pro-
tein that serves as a nuclear transcription factor abbreviated as CREB
(stands for cAMP [cyclic adenosine monophosphate] response element-
Addiction and the Dynamics of Altered States of Consciousness 181

binding) is released, and this leads to a reduced sensitivity of the reward
system to the drug. Another transcription factor called DeltaFos-B then
comes into action and acts like a drug memory concerning the amount
of reward the drug has offered (McClung et al., 2004). This memory trace
increases its somatic impact with the amount of drug use. As the CREB
release is terminated after drug action, the DeltaFos-B activity and its cor-
responding information stays stable, inducing a memory trace that makes
the consumer long again for that experience (Esch & Stefano, 2004).
However, this process of sensitization also happens with other reward-
ing pleasure experiences like sex or satiation after food. The context of
drug use and the experiences of the rewards—the social setting and
psychological state—contribute associations to the experience of both
pleasure and dependence. The brains of cocaine addicts activate the same
way when watching someone else use coke as when they themselves use it;
even just seeing the paraphernalia may stimulate the brain’s reward cen-
ters. Drugs act directly on the neurotransmitter systems of the brain; there-
fore, the remaining drug memory trace is very strong. Opioid and
dopamine signal pathways bypass orbitofrontal control functions, and
the memory traces induced by DeltaFos-B alert the pleasure-seeking sys-
tem when cues associated with the drug experience are present (Esch &
Stefano, 2004). If this cue has become certain music or an associated life-
style and arouses the person within a state-dependent recall (Fachner,
2006, 2010), the desire or craving (the narrowed scope of searching for
immediate satisfaction) starts again.
Conclusions: Addiction as Culturally Shaped Consciousness
The contemporary problems of addiction are socially fashioned phe-
nomena, emerging with modernity. The social-constructivist approaches
illustrate that the effects of drugs and the experiences of dependence and
addiction are not merely physiological processes but rather social prod-
ucts. Addiction is a multifaceted phenomenon that takes place along a
continuum and is not limited to single substances or objects but is a com-
pulsive behavior, and consequently it involves a narrowed scope of aware-
ness. Generally, socio-cultural learning is crucial to use patterns, making
the concepts of set and setting central to explanations for vulnerability to
addictive behavior and cultural differences in addiction potential to sub-
stances.
Neurobiology gives insight into the basic physiological mechanisms
that promote pleasure-seeking behavior. The similarity between
182 Altering Consciousness

endogenous and external neurotransmitters suggests a biological function
for the human striving to enhance and constrict consciousness and reach
especially pleasurable states. Transcendent or ecstatic experiences and
psychedelic drugs represent the opposite of the addictive contractions
and involve a widening of the focus of attention beyond the boundaries
of the ordinary or baseline state. As their effects are too unpredictable, var-
ied, subtle, and delayed, they do not foster dependence and this may be
because they are serotonin rather than dopamine based.
With regard to ASC, the view of addiction as the tunnel perspective of
a heavily constricted state of consciousness is central for understanding
and treatment. The disposition to fixate and focus consciousness on pleas-
urable states can be useful and beneficial where there is a need to reduce
pain, fear, or anxiety, but it bears the danger of habituation and depen-
dence. Searching for transcendence and expanded states of consciousness
is a pervasive and natural human activity. In psychedelics therapies,
patients widen their awareness with the help of drug effects. They may
get acquainted with spiritual insight and learn to overcome addictive pat-
terns of behavior. In successful cases, they may adopt new, healthier per-
spectives, while their addictive tendencies mature out. Thus, spiritual
perspectives become crucial tools in a maturation process that links iso-
lated and addiction-prone individuals into broader social and symbolic
networks. These provide meaningful connections that assure well-being
and self-comfort in ways that precludes a need to rely upon external sour-
ces of chemical reward.
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