Carrots and Sticks

24 01 2010

Our future human resources

I got up early yesterday to drive these two daredevils to their ski-race camp. And, it got me thinking about how we, both as parents and as a society, choose incentives and disincentives to manage our human resources, ie. carrots and sticks. In this case their parents, who are friends of mine, have found Franny (left) and Kristina are willing to lift weights, dry-land train, get up early in the morning and hurtle their growing bodies down icy slopes, in exchange for the rewards associated with competitive ski-racing. They do it, because they love it. That seems like a progressive way of steering kids into healthy pursuits.

In contrast, it occurred to me that we as a society are regressing.  A new Angus Reid public opinion survey found 62 per cent of respondents favour capital punishment for murderers. This is a significant increase since 2004, when 48 per cent favoured capital punishment. The survey, conducted last fall in Canada, the United Kingdom and the United States, reveals the shared belief by many that even though mandatory minimum sentences can be unfair, they are an indispensable tool, a good stick, that helps deter criminals from committing crimes.

Unfortunately despite the average Canadian’s experience with punishment as a way of deterring behaviour, experts in criminology have shown that neither mandatory sentences nor capital punishment have ever been shown to deter crime.

As a recent letter to the editor of the Globe and Mail by Jim Hackler, author, Canadian Criminology: Strategies and Perspectives, Victoria documented: both California and Texas offer case studies of how politicians used “get tough” policies to deceive voters who respond to simple-minded slogans about crime. For several decades, these states built prisons to accommodate an ever-increasing number of convictions. Funds for education and child care, which provide a positive return for society, were cut. Funds for prisons, which provide a negative return, were increased. Why not spend taxpayer money on things that actually reduce crime?

Negative consequences do deter crime, unfortunately not in most criminals. There are some good neurobiological reasons for this. Let’s take a moment to review the neurobiology of reward and punishment.

Humans have a reward circuit. It’s a dopamine circuit and it runs from the brainstem to a place called the nucleus accumbens, aka, the reward centre. But dopamine does not only communicate reward, it also is the neuro-chemical for at least four other circuits. The five main dopamine circuits are:

Reward Dysfunction here is manifested as being easily bored, feeling diminished pleasure, reward or satisfaction from normal stimuli.

Attention Dysfunction here is manifested as poor attention to detail, careless mistakes, difficulty listening, losing things.

Executive function Dysfunction here is manifested as difficulty with commitment, difficulty sticking to task, difficulty self monitoring, poor planning/ organization, poor problem solving.

Motor control Dysfunction here would manifest as fidgeting, inner restlessness, difficulty sitting through meals, meetings, movies.

Impulse control Dysfunction here would cause distractibility, impulsivity,  excessive talking, blurting things out, being impatient and interrupting others. One of the most obvious deficits associated with poor impulse control is the difficulty making choices between competing priorities.

You can see in the italicized text, that many common criminal traits are associated with dopamine circuit dysfunction. It’s no surprise then that the likelihood of finding ADHD and addiction, two disorders associated with dopamine dysfunction, is very high in criminals.

This is not my opinion or some excuse that bad people use to avoid responsibility for their bad behaviour. This can be shown on SPECT scans of criminals, gamblers, adulterers, liars, thieves, rapists, murderers, you name it. When they are in the heat of the moment, the part of the brain that usually lights up in normal people when they are weighing the consequences of a potential action, DOES NOT LIGHT UP. Simply put, in most cases they WERE NOT thinking through the consequences of their actions. Now before you jump down my throat and label me soft on crime, hear me out.

  • I am not saying criminals do not know wrong from right. They do.
  • I am not saying that criminals have not pre-meditated their crimes. Ususally they have.
  • I am not saying that criminals should not be responsible for the consequences of their actions. They should.

What I am saying, is that most criminals have poor impulse control and don’t show much foresight. They know the consequences, they just don’t weight them properly. They know logically that their actions will have negative consequences, they just don’t value those consequences at the point of performance. Like a kid who launches his skateboard down a steep hill without a helmet. He “knows” the danger. He just values the reward, higher than the risk.

And who do you think becomes a criminal in our society? People who are willing, on multiple occasions, to choose actions with huge potential negative consequences, because they undervalue the risk. Criminals are essentially compulsive gamblers. And all the research we have ever done on pathological gamblers show that they do not have a normal risk evaluation system. That is their illness. That is why mandatory sentences including capital punishment are excellent deterrents for normal people, they just don’t work on criminals, because there is such a thing as a criminal mind.

I could go on, but I think you get my point.

So why are we building bigger jails and spending more money on lawyers, judges and crown prosecutors? Every bit of data ever collected says this is not only the wrong approach, it is THE MOST EXPENSIVE APPROACH. On the contrary, the data shows that we save $7-10 dollars in the social costs of mental health, addiction and crime for every dollar we spend on youth centres, mental health services, child care, parenting programs, etc.

It is my considered opinion that if we paid more attention to parents and children, we would have to spend much less on crime and punishment. If we improved the use of carrots, we would need to spend less on sticks.

Which brings me back to Franny and Kristina. I’m not saying that were it not for ski-camp, these two would be headed for a life of crime. Ski-camp may not be for everyone. But organized, group-based, outdoor physical activity, whether it is soccer or sailing, provides kids with bevy of physical, emotional, cognitive and spiritual benefits that should be considered highly prized social outcomes. These kids will be fitter, their brains will be more flexible, they will learn to cope with failure and loss, they will learn social skills, they will be more accountable for their actions, they will learn to soothe their fears, they will be more confident and will probably spend less time obsessing about their clothes or possessions, THEY WILL SPEND MORE TIME IN NATURE and LESS TIME AT THE MALL. There is a good chance they will be better stewards of the environment. In short, while there is no guarantee they will fly straight, the chances are in their favour.

It would be simplistic to think that we don’t also need to have negative consequences when people break rules. We do. We need both carrots and sticks. And, we need to be progressive with both. While money invested in youth  does not guarantee good social outcomes, playing to our kid’s strengths and spending at least as much money on parents and kids as we do on jails is in my opinion a preferred human resources management.

Cheers, A

Dr. Anthony Ocana – MSc, MD, CCFP, ABAM – special interest in mental health and addiction – co-founder NorthShore ADHD Clinic

http://www.northshoreadhd.com





Are we having fun yet?

11 01 2010

Happy Hank

I’m not the most dedicated hockey fan, but recently I have been following the Vancouver Canucks as they move up the NorthWest Division. In the process, we have seen two hat-tricks by Alex Burrows, two fights by Rick Rypien, a slew of goals by Samuelsson and the Sedins and a pair of shoot-outs. I thought it might be interesting to explore “winning” through the lens of neurobiology.

When I was in high school. I was cajoled into being the stats guy for the senior basketball team and then the trainer for the senior football team. In the process, I spent a lot of time on the side-lines and I can tell you, it’s uncanny how closely the ‘fun quotient’ parallels performance on the field.

Well, of course, you say. Winning is fun. No. I’m saying, I could predict when we would start scoring, before the fact, based on how much the guys were smiling! And, I think you could see the same thing with the Vancouver Canucks and their opponents this past few weeks. Let me give you a few examples…

If you watched the players warm up, skate or talk on the bench, you can tell when they are having fun. Regardless of the intensity of the game, when the mood was up, the players seemed looser.You could see this even if they were getting outshot, even if they were getting penalties, even if they made dumb turnovers and even when pucks were bouncing off goalposts and crossbars left and right,  When they relaxed they, stick-handled more adeptly, were quicker on their feet, made sharper passes, checked harder and always seemed to have their sticks in the right place at the right time. There is a reason for that.

In the low stress state, the body is in what we call parasympathetic mode. That is the nervous system’s nurturing mode. That suggests looser muscles, slower heart rate more blood to the brain allowing increased rational and more flexible thinking and … a sense of humour.

Having fun releases endorphins which increases pain tolerance, dopamine which improves focus, and satisfaction, adrenaline which increases motivation and energy and serotonin which improves mood and confidence. All in all, an almost unbeatable cocktail of feel good chemicals.

The high stress state is also known as the  sympathetic mode. That is the nervous system’s fight or flight state. That is accompanied by tighter muscles, faster heart rate and less blood to the brain, facilitating rapid reflexes, but not much nuance. Sympathetic mode may increase performance if you are a sprinter or a weight-lifter, which require lightning fast, but very predictable effort. Sympathetic mode may not be so helpful if you have to think on your feet.

If you want to wheel and deal, it’s better to be strong, but flexible, able to adjust your attack based on a number of scenarios, rather than just an on-or off switch. It’s better to be having fun. Take the Burrows and the Sedins. When they are having fun, it’s like watching the ballet: Burrows looks up ice, finds Henrik who carries across the line, streaks right, drops left to Daniel who slams it home, GOAL! Wow. That was fun.

On the other hand, if you’re angry at the ref, or trying to get revenge for a late hit or scared you might lose in a shoot-out…there’s too much negative vibe and that spells trouble. Take Rypien for example. In the first fight on Saturday night he threw a few jack-hammers and had a slight upper hand.  Then Prust landed that uppercut and Ripien kind of faded, but later in the penalty box, you could see he was upset, which he then carried with him through the rest of the game, drawing Prust into another fight, but also sucking a certain amount of energy out of the team as they watched his already bruised and bloody face take a few more gut wrenching hits.

Seeing a team-mate get hurt triggers the release of a massive amount of the neurotransmitter GABA. It has an inhibitory effect on motor function and drops blood pressure. That tiny bit of reservation, that tiny bit of hesitation, that tiny decrease in motivation… is the difference between a successful poke check and watching your man skate around you. Hockey is a game of micro-seconds. Whoever wants it more, wins.

Finally, in overtime, watching Iginla laughing on the bench, joshing with the ref, I thought…OhOh. When the opposing team is laughing in over-time, that’s a bad sign (for us). And sure enough they were the more relaxed team, especially in the shootout when they scored 3/3. Did you see that little move that Lundmark pulled at the last second. He weaves right on the forehand, kicks his foot out to the left to distract Luongo, then flips the puck to his backhand and taps it in the corner. The guy looks like he’s back in the school-yard, dipsy-doodling. You can’t do that when you’re stressed.

Flames move to the top of the division. Ouch. Are we having fun yet?

Dr. Anthony Ocana MSc, MD, CCFP, ABAM –  Special interest in Mental Health and Addiction –  North Shore ADHD Clinic –  www.northshoreADHD.com





What is evil?

29 12 2009

Umar Farouk Abdulmutallab

Looking through the paper today, I could not miss the article about the Nigerian guy who tried to blow up the Northwest flight from Amsterdam to Detroit on Christmas morning.

According to an article in the Globe and Mail, December 28, 2009. This baby-faced 23 year old was the quiet and studious son of a wealthy Nigerian banker, who resembles, at first glance any other young man from the northern Nigerian city of Kaduna. He wore designer clothes, sunglasses and fashionable suits. However, there was something  different about him.  His neighbour noticed that he stayed at the mosque far longer than anyone else after prayers. He rarely talked, and when he did it was mainly about Islam. According to the neighbour, “There is a serious and growing problem of Islamic fundamentalism in this part of Nigeria. He is a product of this type of hatred and intolerance.”

His father, a prominent banker, was so worried by the radicalization he saw in his son that he contacted the U.S. embassy in Nigeria to report his concerns.

According to the current world-view, this young man is the epitome of evil. But what is evil?

If we look at Mr. Abdulmutallab through the lens of mental health, there are a couple of things that we can say: He is angry, intolerant, obsessed. He lacks empathy for others, remorse for his actions. He may have even been psychotic at the time. What we can say for sure is that he meets the criteria for what we call anti-social personality disorder. This does not mean that he did not like to socialize, although that may be true. It means he is capable to committing acts that are against the most basic social norms.

Again, the Western media is happy to moralize these traits as “bad”. But it might be more appropriate to view these traits under the umbrella of “sick”. In fact whenever the veneer is stripped back on people who commit these types of acts, they often come across more as “troubled” rather than evil. In many other aspects of their lives they seem either very normal, or often, subject to real or perceived trauma.

Take the young men at the centre of the Columbine massacre. They were the victims of relentless bullying….

We don’t know why Mr. Abdulmutallab saw fit to try to blow up an airplane full of people, but it seems to me this is more the domain of forensic psychiatry than morality.

This is neither to condone, nor to justify, terrorism. The taking of innocent lives for any reason is always a tragedy. It is an act for which we must hold people accountable. However, if we can understand why people commit acts of terrorism, maybe we might be more successful at fighting it. On the face of it, we have spent billions of dollars and sacrificed thousand of lives and we seem no further ahead in the fight against terrorism. A terrorist can be anybody. A suicide bomber will be effective in any small crowd. It seems to me, this is not the sort of thing you can fight using conventional warfare.

The person who commits terrorism, especially through suicide, obviously feels deeply wronged on some level. Real or perceived, that sense of injustice is so great, that the person feels it is worth dying for. We ignore these underlying causes at our peril.

That’s what bullies do. They are neither attentive to, nor do they take responsibility for the wrongs that they perpetrate on their weak or innocent victims; Then they are surprised that their victims lash out using what seem like cowardly methods; Finally, they retaliate with the fury of righteousness on their feeble attackers.

Again, this is not to blame the US, nor any other country or target of terrorism, it is merely an attempt to make sense of this seemingly senseless act and perhaps to cast it in less moralistic terms in the hopes that we might avert some of the negative consequences.

A healthy person who is wronged and then invalidated might feel helpless. An angry, intolerant, anti-social person is more likely, in a final act of defiance, to lash out in the most extreme way possible, by sacrificing his/her life to harm his tormentor .

In the mental health business, we have a name for the disorder that allows someone to harm others with no remorse. We call it “attachment disorder”.

It is often the case that bullies have at one time been traumatized themselves. As mentioned earlier, this may may be real or perceived. It doesn’t really matter. People who suffer from attachment disorder, feel no attachment to others and are therefore insensitive to the hurt that they may cause. As opposed to a psychopath who chops off someone’s head in a mad impulse, the person with attachment disorder has pre-meditated the consequences of his/her actions in gruesome detail, but without a whiff of remorse.

The theory goes like this: The person with attachment disorder was never properly nurtured by his/her primary caregiver. On the contrary, he/she was likely verbally, emotionally, physically and/or sexually abused, neglected, shamed and/ or abandoned. Often this type of abuse is repeated, ritualized and/ or relentless. For the record, this is not rare.

There are millions of people in our society who have endured tis kind of trauma, somewhere in their lives. According to the theory, if the people who are supposed to care for you, don’t, then why would/should you care about anybody else. And when you don’t care about anybody and you are or feel wronged and invalidated you become the kind of person that can blow up an airplane full of innocent people Christmas Day.

Now, I don’t know Mr. Abdulmutallab, nor is there any suggestion that he had this kind of background, so for the moment this is purely speculation, but anyone who is capable of such an act, despite their outward appearance, is usually someone who is acting from a place of extreme hurt. So, if this is the case, what is evil and how should we best deal with it?

Dr. Anthony Ocana
MSc, MD, CCFP, ABAM

Addiction Specialist
Co-founder NorthShore ADHD Clinic
http://www.northshoreadhd.com





Homelessness can be beaten

22 12 2009

In a few weeks, hordes of world’s media will descend on Vancouver, British Columbia for the 2010 Winter Olympic Games. The most intrepid journalists will grab a camera man and head down to Vancouver’s Downtown Eastside (DTES) to get their money-shot: a homeless person sleeping on a heating vent, or a drug user shooting-up in Blood-Alley. Then they will roll out the sad-but-true statistics to contrast the majesty of the snow-capped North Shore mountains with the human misery of Canada’s worst slum. This will be broadcast around the globe for billions to see. There will be gnashing of teeth and wringing of hands, as Canadians are forced to explain the horrors lurking on their doorstep.

However, in the wake of this social catastrophe, there are rays of hope. The local, federal and provincial governments have poured hundreds of millions of dollars into the area over the past decade in an effort to keep this from being cast as a totally bad-news story.

Duncan Sallie, cleaning up

This weekend’s Globe and Mail ran a two page story on Duncan Sallie, an ex-squeegee kid, and his quest for employment on the DTES. Mr. Sallie is a 26 year old homeless man with a checkered past, few marketable skills, years lost to drug-addiction and a history of mental illness. Yet, he showed up to his first job interview wearing a clean shirt and big smile.

One of the stories within the story is the success of BOB (Building Opportunities with Business) a government funded agency which provides unconventional services to the city’s neediest and hardest to employ, resulting in real jobs for 137 inner-city residents, like Duncan Sallie, since October 2008.

Mr. Sallie is an ex-crack addict with a rebellious and violent past. As a child, before taking drugs, he was diagnosed with Attention Deficit Hyperactivity Disorder. Although the story does not specify the details, it is a story that I hear in my office, every day.

Young men like Mr. Sallie have a frighteningly common trajectory. The movie goes something like this…

As a child, he was a charming and energetic boy, who did not like to read and had difficulty sitting still. He was a daredevil, risk taker, good at sports, but bored in school. He may have been raised in a loving home, and may even have done well in school, initially. But his quirks get him rejected by the popular students and invariably he falls in with the wrong crowd. He starts smoking and drinking early. He quickly graduates from smoking to “blazing”, but he does not graduate from high school. Smoking pot starts off as a way to ease the boredom or to be cool, but eventually becomes a daily ritual. If smoking pot is as far as this young man’s drug taking ever goes, the story may be a downer, but it’s not a tragedy.

In order to have a truly tragic ending, he needs to move on to more adventurous experimentation with mushrooms, acid, speed, ecstacy and/or cocaine…. And, he does. Again, while snorting cocaine may leave you in debt, it does not usually leave you homeless. In order to win that distinction, you usually have to tangle with one of the three home-wreckers: crack, alcohol or heroin.

If you want to see homelessness, live and in colour, go down to the DTES. Stand on the corner of Main and Hastings and the sights will break your heart. Homelessness is not caused by lack of money. Every day more money changes hands in the DTES than on the Vancouver Stock Exchange. Homelessness is not caused by mental illness per se. It is caused by the executive dysfunction and impulsivity that is associated with certain types of mental illness including substance abuse and addiction. Can’t get a job; can’t hold a job; can’t pay the rent; go on disability, get housing assistance, but get kicked out for doing drugs or beaking off to the landlord.

Mr. Sallie is trying to change his lot in life. Currently, he is on methadone, prescribed by an addiction specialist in Vancouver. It keeps him away from the needle and allows him to focus on getting a job. But even though 10 doctors will have seen ADHD on his chart at various hospital or clinic admissions, no one will have taken it upon themselves to treat it.

There are some good and practical reasons to be wary of treating ADHD in a person with an active addiction, but the experts agree, it’s not a deal breaker. All the research shows that the risk of treating ADHD, even in the actively addicted, can be managed. The problem is, as in the case of Duncan Sallie, the diagnosis is made and an initial treatment is prescribed, but there are not enough skilled clinicians to provide patient education, follow-up or ongoing treatment for those who go on to manifest ADHD as adults.

There were 1000 adults on the waiting list at the only adult ADHD facility in British Columbia. The BC government wanted to shorten the waiting list, so they closed the program. They pay for the risky, short acting, addictive stimulants, but they do not cover the cost of the safer, non-addictive, slow release stimulants. Go figure. They think they are saving money.

The hallmarks of ADHD are executive dysfunction and impulsivity. A number of recent studies have documented how frequent ADHD is in homeless men. A few years ago, the Mayor of Vancouver, Sam Sullivan tried to start a program of treating cocaine and methamphetamine addiction with “replacement therapy”. It was not a bad idea. If stimulant abusers were addicted to fast-acting stimulants, maybe we could wean them off their drug of choice by using slow-acting stimulants. The same principle is used in replacing heroin addict’s fast-acting opioids with slow-acting opioids (methadone). Sullivan’s wish to get replacement treatment on the street before the Olympics was innovative and plausible with some adjustments, but it met with significant resistance from various stakeholders and the plan died on the vine.

A more rationale idea would have been to screen homeless stimulant abusers for ADHD and, within the risk management guidelines alluded to above, treat their impulsivity and executive dysfunction. Duncan Sallie would likely, in my opinion, have benefitted.

Mr. Sallie showed up to his job interview on time, but at the last minute, he realizes that he has forgotten to put together a resume. He sits down to write one, but he is so nervous and so fidgety, that he spills coffee on his new pants. We don’t know for sure why he does not get the job, but we’re not given any reason to be particularly optimistic.

Last May, I presented a paper at the 2nd International Congress on ADHD in Vienna, Austria. “Management of ADHD in patients with co-morbid cocaine addiction”. To make a long story short, the study which included 53 patients, showed that those cocaine users whose impulsivity was pre-treated with a mood-stabilizer (which inhibits glutamate, increases GABA. or both) before their executive function was treated with ADHD medications, had significantly better outcomes than those who received ADHD treatment without a mood stabilizer. It’s a preliminary study,not yet replicated, and as yet unpublished, but there is a signal there. It is an outcome that I see every day in my practice…

Treat the impulsivity first (by modulating Glutamate and GABA), then treat the executive dysfunction (by boosting Dopamine) and the patient’s function will improve. Here are a few quotes from one the patients in the study….

“I still have ups and downs, but I feel more on an even keel. I can deal with things better. I can listen. I can go to a meeting and actually follow. I can take care of children and really be attentive. It’s amazing”.

“I don’t feel as aggressive. I don’t want to throw stuff, kill people, or kill myself. I’m not as violent. I don’t fly into rages anymore. I don’t seem to have nearly as many cravings. I can concentrate better. I can actually read three chapters. That’s a big improvement.”

I don’t know whether this kind of intervention could have helped Mr. Sallie’s chances of  making a comeback. What is important is that his story has been told and that the people following the Olympics realize that with with the right resources and a little political will, homelessness can be be beaten.


Dr. Anthony Ocana  MSc, MD, CCFP, ABAM             Family Physician/ Addiction Medicine Specialist                 drocana@telus.net





Sex, text and Tiger’s fall from grace.

15 12 2009

Tiger and Elin in happier days KAREN BLEIER / AFP/Getty Images

Much has been written recently about Tiger and his ‘transgressions’. The revelation of the escapades of this once untouchable hero provide a timely opportunity to discuss the science of sex addiction.

It’s not really acceptable in medical circles to diagnose someone you have never met, so let’s stick with the undisputed facts.

Tiger Woods is a distinguished athlete and a very wealthy man, who can afford to buy just about anything he wants. He is married with children. By his own admission, he has had affairs with multiple partners in the recent past. He has lied about these. And, only by the dogged perseverance of the press and the release of those sordid texts, has he come clean.

In my business, there is really no room for judgement. Good people do bad things. Tiger was not the first, nor will he be the last to cheat on his wife and children. It is easy to frame his behaviour in moral terms, but that is a bit tired and does not give us any new insights.

If we could have a better understanding of why people cheat, maybe we might have a better chance of doing something useful about it. Regardless of why, it is clear that Tiger’s transgressions caused a lot of negative consequences for a lot of people.

Let’s start with Tiger’s embattled wife Ellie. Despite what financial benefits she may gain from this fiasco, it can’t be pleasant having your husband’s dalliances smeared all over the front pages, ditto for the kids. Ellie’s mom has already been to the hospital with what is likely stress induced gastritis. Tiger’s friends and associates are likely suffering too and as for Tiger…yikes, put yourself in his shoes. It’s a lose/ lose for everybody.

Imagine what the rest of his life will be like, no matter how much he apologizes, no matter what he does to make up for this, at any time, some wise-guy can bring it up again. Ha-ha, just kidding. Except it’s not so funny. As I stood at the check-out counter today, I saw Tiger’s anguished face on the cover of one of those gossip magazines. “Tiger suicidal”, read the headline. Can you blame him? He is now, and forever will be the laughing-stock of 2009.  No matter what short-term benefits he got from being sexual with his bevy of busty blondes, the long term harm is immeasurable. Never mind the billions of dollars in potential income lost, that’s the least of his worries.

Some in the psychiatric field have thrown around the term, “sexual addiction” which by definition is compulsive sexual activity despite evidence of harm. Well you might say, there was not, until recently, any evidence of harm. I can’t say for sure, but that’s unlikely. More likely is that there was a progressive loss of intimacy between Tiger and Elin that lead to the loss of attachment that preceded his transgressions. Maybe his kids felt the distance when he slipped out to be with his mistress, rather than spend time with them. The early harm associated with his affairs may not have been as evident, or as catastrophic, but the warning signs probably were. Intuitive women can tell when their man has other things on his mind.

So, does Tiger’s fall from grace follow from his sexual addiction. That has a certain amount of validity, but to understand what that really means, let’s break addiction it into three parts.

Addiction starts with dysphoria. Dysphoria is the opposite of euphoria. Basically you feel uneasy in some way. Dysphoria can be secondary to all kinds of emotional triggers: sadness, loneliness, worry, distress, boredom, pain, fatigue, confusion, irritability, agitation, anger, racing thoughts; you name it.

It would of course be optimal if we could manage these emotions on our own. That is the goal of cognitive therapy. Learn to recognize your emotions; Learn to “be” with your emotions; or because most emotions are secondary to thoughts, learn to modulate your thoughts as a way of managing your emotions. That sounds easy enough, but it’s not. Many people are neither capable of recognizing, reading or managing their emotions. When emotions become unmanageable they experience dysphoria.

The next step in the addiction cycle is… using a substance or behaviour as a coping mechanism for dysphoria.

“Using” as a way of coping starts off innocuously enough. Some might say that addiction is a kind of resourcefulness on the part of the addict. “I feel usually bad… but when I do this, I feel good”. Research suggests that addiction is a pediatric disorder. The large majority of addiction starts in adolescence.  For the truly vulnerable, it starts in childhood. As we progress though our youth, we are exposed to various behaviours and substances, experimentation naturally follows. In time, by an unconscious process of trial and error, we stumble upon what makes us feel good. We find out what calms us; interests, energizes and/or rewards us. We experience our environment and find out what is important. The neurobiologists call it salience attribution. Our brain has a way of recognizing what’s important and what’s necessary for survival because these stimuli light up the brain’s dopamine circuits. It just so happens that all addictive substances and all addictive behaviours stimulate also dopamine neurotransmission. So, on some level, addiction is really a big fake-out.

Addictive substances and behaviours stimulate dopamine, and as such, trick the brain into thinking that they are necessary for survival. That’s quite the story, but it’s not the whole story.

The third step in the addiction cycle is the loss of control.

While dopamine and the associated “feel good” that it provides, triggers the “go” switch that drives us to preferentially choose these substances and behaviours over others, we also have brain circuits give us control over the dopamine circuit.

Glutamate stimulates/ GABA inhibits

The dopamine “go” circuit can either be potentiated (by Glutamate) or inhibited (by GABA).

Glutamate says, “Just do it”. GABA says, “Hmmm, maybe that’s not such a good idea.”

Glutamate pushes us down a corridor that quickly turns into a tunnel, leading to loss of control. GABA buys us time. Time to weigh the pros and cons of using. Time to think through the consequences of our actions. Time to envision the look on a loved-one’s face. Time to insert a more rational thought.

Finally, when poor choices lead to negative consequences, we return full circle to dysphoria…and so it goes around and around and where it stops, nobody knows. Where it stops is usually a cold hard place.

Tiger’s transgressions, then, can be seen as behaviour that he initially chose as a coping mechanism for some type of dysphoria, but over which he progressively lost control, despite evidence of negative consequences, eventually resulting in unimaginably more dysphoria.

That does not excuse the behaviour, nor does it absolve him of the responsibility for the harm that his actions caused. It just takes this out of the realm of morality and puts it under a less judgemental light.

I think I’ll stop there.

Stay tuned for more QuestForFire next week.

Dr. Anthony Ocana  MSc, MD, CCFP, ABAM             Family Physician/ Addiction Medicine Specialist                 drocana@telus.net





The little voice in your head

8 12 2009

Last week, I finally listened to the little voice in my head. At the time, I was contemplating, “Should ride back down on the road, or should I ride down the trail.”

The trail would have been much more fun. There are roots, rocks, some really steep pitches, lots of fast curves, tricky corners and a series of hairpin turns right before the big drop that delivers you back to the road just above the highway. Usually, by that time my heart is pounding, my legs shaking and my arteries flush from the injection of adrenaline. Then it’s back to the office.

But just then I passed the sign on the road that says, “Are you prepared? If you get lost, does anyone know where you are going? This is not for nothing. Every year, in every season, people die on the North Shore mountains, because they get lost, it get’s dark and they fall of a cliff or succumb to hypothermia. So, just before I pointed the front tire of my new Trek Fuel mountain-bike down that gnarly path, I heard the little voice in my head.

The voice said, ” You know, that might not be such a good idea. It’s Friday at noon on December 4th; there is no one on the trail, nor will there be anytime soon; the trails are super-slick because it has been raining like crazy for the last month; no one knows where you are; you don’t have a cell phone;  and if you fall and need help, it will be dark and cold soon and basically, you’re toast!”

Usually, I would have argued with the voice. I would have said, “Oh, what do you know. It’s a beautiful day; you haven’t ridden this trail in months and you’ve got lots of time. Don’t be a wimp.”

But then I remembered all the near death experiences I have ever had. Three of them, three and a half if you include the time Simon Parker and I got lost in the dark on the back side of Bowen Island. Right before each of them, I had a similar exchange with the voice in my head. And… I remembered that after each of them I promised that I would be more diligent, more careful and I would not ignore the voice of caution.

So this time I listened.

I listened to that voice… no questions asked. I listened because I finally realized that if you get that little voice in your head telling you, “maybe this is not such a  good idea”, that you should bloody well listen, because it is not telling you, it’s not such a good idea, for nothing. It’s telling you, it’s not a good idea, because it is desperately trying to save your bacon. So, listen.

Most anthropologists are pretty clear in saying that humans are not completely rational beings. They point out that humans often act in ways that are contrary to their best interests, when we make emotional rather than rational decisions. Recent research suggests that, it’s not that we are not rational, but rather that we often act before any rational thought has had a chance to influence our behaviour. We are often flying down that proverbial trail and before we know it, we are ass-over-tea-kettle, looking right at the worst possible consequence that we could ever have anticipated, if only we had…anticipated. But we didn’t anticipate. We didn’t think it through. We acted without thinking, again.

Does this sound familiar?

To most of my patients with ADHD and addiction, this is the story of their life. Shoot first, ask questions later. Neuro-biologically, this can be explained as follows…

Normal people have about 4 milliseconds between impulse and action, giving them a brief but adequate window, during which the little voice in their head has just enough time to say, “Hmm, maybe that’s not such a good idea.” This is when normal people put on the brakes, look over the edge of cliff and say, “Phew, that was close.”

On the other hand, impulsive people have about 1 millisecond between impulse and action, which means, by the time their little voice has spoken, they are already at the bottom of the cliff, wheels up, engine billowing smoke, wondering, “What the heck just happened. Maybe I should have hit the brakes.”

For the record, Buddhist monks have about 8 milliseconds between impulse and action, during which they have enough time to have a national debate on whether or not to hit the brakes.

So, as you can see, being impulsive is quite the handicap. Take for example, the patient I saw the other day. Tough kid…  smoked dope at 11; doing lines of coke at 13, dropped out of school at 14; smoking crack and shooting heroin before his sixteenth birthday. So you might think he was stupid, or came from a bad family. That’s the current thinking. But he was an intelligent kid, raised by loving and intelligent parents. Unfortunately, he was also impulsive, a risk taker, a stimulus seeker who found school to be too boring. He was a skilled mountain-biker, dirt-biker, 4×4 truck driver, but what really turned him on was seeing the duffle bag full of $20 bills when he cashed in his first grow. 4000 marijuana plants make a lot of pot and at $2000 a pound, that’s a lot of green. Pretty soon he’s running two grow-ops and starting a third. Money is as addictive as the finest drug.

Long story short, our friend, we’ll call him Jake, is now up for 5 counts of possession with the intent to traffic. So he comes in today to have a little chat. He was diagnosed with ADHD as a child because he was hyperactive and could not focus in school. He was tried on medication, but it made him an introvert and he did not like it and so he stopped.

I explain to him that is a very common outcome, because the medicines in those days were too short-acting; few people knew how to use them and that his experience is caused not by the medicine, but by the medicine wearing off. He and his father both nod as if they understand, but I can see that they both wish there would be could be a way to make it all better.

I explain that right now there won’t be any medication; that we first need to finish our assessment and I remind his father of what he already knows. There will be no more bail-outs. It’s not that we don’t feel any empathy for Jake’s plight. It’s just that protecting Jake from the consequences of his actions is not doing him any favours. So he is  looking at 6 months in jail. He’s made his bed, now he has to sleep in it.

I tell Jake that I am happy to help him, but the first thing he needs to do is to make a commitment to stop using cocaine, because I can’t safely treat his ADHD until he is cocaine free for 4 months. There are a few things we can do in the meantime, so I am not blowing him off, but he has at least to give me his best effort. I say good bye and wish them both luck.

A few hours later, Jake’s dad calls back in a bit of a panic.

As we discussed, Jake’s dad made it clear that there would be no more hand-outs, bail-outs or redemptions. That Jake would have to stay in a shelter and get some kind of temporary job so that he could get back on top again. It so happens that Jake is a highly skilled carpenter who could easily earn $50,000 a year, legally, by applying the skills of his trade. Unfortunately, he sold all of his tools to buy drugs.

Jake, being the master manipulator that all drug addicts are, will have none of it. He wants Dad to take him back. If he doesn’t, Jake says he will commit a few B/Es to get the cash that he needs.

Jake’s dad wants to know what to do. I tell him my thoughts and he thanks me. He just needed to hear it from someone else.

So, do you think Jake will take the time to think through the consequences of his threatened actions? Do you think he will listen to the voice in his head? Do you think he can even hear the voice in his head?

Stay tuned...

Dr. Anthony Ocana

MSc, MD, CCFP, ABAM

Family Physician

Addiction Specialist

drocana@telus.net







What’s your default mode?

29 11 2009

K2 The Savage Mountain

Last week, an old climbing buddy, Eileen Bistrisky, invited me to a presentation by Canadian climber, Don Bowie. K2 – The Ascent of the Savage MountainI was both inspired and horrified as he described his successful ascent of K2 without the use of supplemental oxygen.. At 28,253ft above sea level, K2, located in Northern Pakistan is the world’s second highest peak. It is widely considered to be the hardest and most dangerous mountain on earth to climb. On July 4th, 2007, Don became the 4th Canadian to summit.

Those are the raw stats. But they don’t begin to describe the strength of character of this young man. Not only did Don and his two team mates make it to the top, shortly after watching a fellow climber slide by and disappear over the edge of a cliff forever. But on the way down, in the falling dark, he stopped to help a fellow climber who had collapsed and was lying motionless in the snow. He could have kept walking. In fact, one got the feeling from hearing the story that the large majority of climbers on that mountain, would have done just that.

While helping that guy down to camp four, Don lost his footing and shot down the icy slope. Maybe it was karma, but it seems it was not his time to die, as he slid feet first into a snow-bank and stopped. 10 feet either was and he would have been toast.

The good news was that he was still alive. The bad news was that his toes on one foot were facing the wrong way; down instead of up – He had badly fractured his ankle. However, when you only have one good leg and you are 24,000 feet up a mountain, you might as well  be dead.

Unbelievably, other than his team-mates, no one else offered him any assistance. Don was stunned. Finally, just before the treacherous ice falls, getting impatient with the lack of empathy, he lashed out in frustration. This seemed to have guilted a few of the otherwise oblivious climbers into action and with that, they carried him through the last stretch. As it turns out. Don, did make it to base camp in one piece and with the help a US Army helicopter, he made it the rest of the way home.

In the ensuing Q and A, someone asked why he was willing to help a fallen comrade when he was surely close to total exhaustion himself. (remember, he has been climbing without oxygen) This is where Don really blew me away…

He said, “I train so that when I’m down to my last 5%, and I’m at the end of my rope, that my default mode is kindness”.

Kindness, now that’s an interesting concept. How many of us are even aware that when push comes to shove, when our brain is being hijacked by pain and fatigue that we even have a default mode? And how many of us have been conscious enough, in that storm of emotions, to be able to step back and pay attention to how we feel, how we are behaving and how we are being perceived? Now, take it one step further…How many of us train to control our behaviour in default mode?

I’m going to suggest that that level of self awareness is pretty rare.

Neurobiologically, we are driven into fight or flight mode when our amygdala, the part of the brain that perceives danger, flips the switch triggering the sympathetic nervous system which responding to the amygdala’s wailing siren, prepares us to either put up our dukes, or get the hell out of Dodge.

On the other hand, when we are down to our last 5%, lactic acid coming from our fatiguing muscles sends an inhibitory signal to our sensory cortex that says, “Batten the hatches, we’re going down”. At that point, parasympathetic functions like consciousness, digestion, cognition and the like start shutting down to conserve energy.

That is why you have to train your default mode.

Because, whatever happens at that point had better be automatic or else it’s not going to happen. So, in fact, not only do you have to have an idea of what you want your default mode to be, but you have to practice putting yourself in that situation over and over in order to train yourself to behave the way you want to in default mode.

In my daily work as an addictionologist, I work with people who are precisely those who in their QuestForFire become completely unconscious of the consequence of their actions Their default mode is to use drugs and alcohol as a way of coping with their dysphoria. I’m not saying that in a pejorative way. It’s just the way it is. That’s the definition of addiction. Continued use of drugs or alcohol as a way of managing distress despite evidence of continuing negative consequences.

So that is why I was so impressed with Don Bowie. In his QuestForFire, his mindset is exactly the polar opposite of impulsivity. In fact, it is the essence of impulse control.

And, when you look at the massive social, economic and interpersonal harm that results when we are unable to adequately control our impulses, you can see the amazing value of Don’s ability to ride the horse, instead of letting the horse ride him.

I for one struggle with my impulse control. It may be in my genes as I come from a long line of short-tempered Spaniards who are known to succumb to temptation. I’m not trying to make excuses. It’s just that I often find myself doing and saying things in default mode that make me shake my head.

“What were you thinking”? I wonder to myself. That’s just it. I wasn’t thinking. I was in default mode. So now the challenge is to imagine a more sensible default mode and to see if I can behave differently enough times to crack the mould and hopefully sculpt something I can be proud of.

Next week we’ll talk more about impulse control, what’s behind it neurobiologically and how we can harness it.

Cheers, A

Dr. Anthony Ocana   MD, MSc, CCFP, ABAM                                                               Family Physician, Addiction Specialist                                                     drocana@telus.net






Everybody makes mistakes.

23 11 2009

Sam Brown

Last week I watched a documentary, on CBC’s The Fifth Estate, on one Sam Brown, a thrill seeking, award-winning, mountain-biker from Nelson BC, who found the greatest thrill was hauling hockey bags full of pot across the border to the US. (http://www.cbc.ca/fifth/2009-2010/over_the_edge/)

Sam didn’t fancy himself a drug dealer and would be offended at the suggestion. In his mind, he was just having fun. The more dangerous the mission the better. He revelled in pushing the limits and fancied himself as quite the tactician. And as time went on, the rewards got bigger.

Sam surrounded himself with fancy bikes, fancy sleds and fancy girls.

But the risks got bigger too. Soon enough, Sam was not only dropping off pot, but hauling back coke on the return trip, hundreds of kilos worth.

Even his Dad figured something was up when Sam came home one night with a helicopter for his Dad to fix. You’d think Dad would say something like, ‘What the hell are you doing with a helicopter. Are you out of your frickin’ mind. Do you know what the American’s will with you if they catch you? But instead his attitude was, ‘Don’t ask, don’t tell’. “I’d rather aid and abet my son’s illegal activity, than watch him crash because of faulty equipment”.

As it happens, one of Sam’s associates found herself with faulty equipment caught in the wrong place at the wrong time by the Feds and doing time, awaiting trial in the US. With the heat on, Sam starts wondering whether maybe he should quit while he’s ahead. Plan B was to cash out and maybe find something a little more mainstream. But, of course, there would have to be one last run to raise money for his associates’ legal fees.

As it happens, the DEA was on his tail too… and on that fateful night, with darkness falling and wind and snow closing in on him, he flew right into the web that his captors had set for him. Long story short, when they stuck this young man in the local jail, his characteristic bravado nowhere to be found, he hung himself with a bed-sheet.

Lyndon Mackintyre who I have always found to be an excellent journalist ends the piece with a sob-story about how this is his handler’s fault, the American’s fault, the drug culture’s fault, his parent’s fault. Everyone is to blame, except Sam. I nearly threw up.

But then I though, maybe I’m being a little too judgmental. So, I’m exploring the topic today in QuestForFire because it brings up a number of issues that I think are at the heart of our societies current ambivalence towards addicts and addiction.

My sense is that people are drawn towards one side or the other based on their inherent empathy quotient.

On the one side, those who do not fell for Sam, see him as the master of his own fate and as awful as it may seem, shed no tears for the daredevil drug dealer. This is the side to which, I must say, I gravitate to, at least initially. It’s not so much that I have no empathy for him, but rather that I have more empathy for the drug users who end up homeless, psychotic or in a ditch somewhere, as a result of the crack, that Sam was able to supply them with. As an addiction specialist, I am only too familiar with the shattered lives that drugs (and alcohol) leave in their wake.

On the other side, are people with a high empathy quotient who feel sorry for Sam and his family. They see Sam the victim, the young man with poor judgement. “Everybody makes mistakes”, they say.

Sure, everybody makes mistakes. But this was not an act of impulse. This was a repeated and persistent pattern of willful anti-social behaviour.  Sam was happy to enjoy the fruits of his labour and even took umbrage at being labelled a trafficker. But that’s what he did without any thought of the consequences to himself or to others.

Some have said, he was just looking out for number one. And if he didn’t deliver those drugs, well someone else would. And that’s true. But it doesn’t change the fact that it was wrong, and he knew it.

But there is another way of looking at it… that was not raised in that very long list of viewer feedback on the CBC website. Sam Brown was a daredevil, a thrill seeker, an adrenaline junkie. He had to to push the limits, because doing what everyone else does, the way everyone else does it, is just too boring. I know the type. I work with them every day. As an addictionologist, understanding this, is my stock in trade. Maybe Sam Brown was just a different kind of addict.

There is quite a bit of science that says that Sam Brown was likely suffering from Attention Deficit Hyperactivity Disorder. He has all the hallmarks: He was smart, but did not do well in school. He was hyperactive, never could sit still. And he was impulsive, to the nth degree. About 50% of ADDers suffer from one or more addictions (if you include nicotine) and probably higher if you include behavioural addictions such as compulsive shopping, gambling, gaming, sex and eating.

Addiction and ADHD have a lot in common. They are both associated with dysfunctional dopamine circuits. (read more about it on my web-site, northshoreadhd.com. I won’t go into anymore detail on that, but suffice it to say, both addicts and ADDers have chemical imbalances that lead them to be easily bored, to be unlikely to learn from their mistakes, and to have difficulty saying, “no” to temptation. And that leads them to make exceptionally bad choices, and to have the kind of poor judgement that can kill you.

So, I guess, if I think about it, maybe I can find some empathy in my heart for Sam Brown. I certainly feel for those who lost a friend or a family-member.

As a physician, hearing a story like this I find myself wondering, “what if”. What if someone had seen the ADHD pattern and directed him to some treatment. Or what if he had been able to stick to a less dysfunctional addiction such as extreme mountainbiking.It would have been nice to have been able to help this young man before he felt so desperate that he ended up taking his own life. I now if he were my patient, I might be able to look past his poor judgement. As long as he/she were willing to take some ownership of their actions. Those with a higher empathy quotient might say, “Let he/she who has not made mistakes, cast the first stone”.

Cheers, A

Dr. Anthony Ocana   MD, MSc, CCFP, ABAM                                                   Family Physician, Addiction Specialist                                         drocana@telus.net





QuestForFire

17 11 2009

QuestForFire is my new blog. I am an addiction specialist and would like to share some thoughts with you…LIfe through the lens of neurobiology. My teachers are my patients. They are like snowflakes, no two are completely alike. I feel honoured to work with them and not a single day goes by that I don’t learn something new. I’m sure I learn more from them than they learn from me.

Addiction refers to those experiences that are so engaging that once we taste them, we become so enthralled that we quickly find ourselves planning our next visit to this wonderful place. If we are not careful and if we are vulnerable to addiction we soon find ourselves seeking to recreate that initial high, not withstanding the harm that this might cause us, or those around us.

Addicts continue to use their “drug of choice”, despite negative consequences.

Before there were drugs, there were likely other pinnacle experiences that our ancestors had, and sought to repeat. I imagine that one of these occured the first time they tasted glucose from a sweet overripe fruit, first time they mated, or the first time they were able to harness fire.

I imagine that after any of these experiences, they were probably so excited that nothing else mattered. In fact, they may very well have forgotten to eat or sleep for days when they were right down to it. That sort of engagement, while not dysfunctional per se, is the kind of intense focus that accompanies the first hit of any highly pleasurable substance/ behaviour. So that’s why I’m calling this blog about addiction, “QuestForFire“.

Cheers, A

Dr. Anthony Ocana   MD, MSc, CCFP, ABAM                                                   Family Physician, Addiction Specialist                                         drocana@telus.net





Personality Disorder

28 03 2011

Al Pacino - Scarface

I’ve seen a lot of drug dealers lately. I’ve never met one in my personal life, but I have met plenty as a doctor. I must be on some list somewhere, because in the last week, I’ve seen three of them. In the process of doing my assessments I have seen an interesting trend.

3 out of three were diagnosed with anti-social personality disorder with narcissistic traits.

I’ve always been a bit of a skeptic when it comes to personality disorders. It always seems to me like a bit of a diagnostic cop-out.

It just so happens that in psychiatric circles, it’s pretty much a known fact that there is no treatment for personality disorders. That’s very handy.  If we don’t like you, and there is no treatment, then we have no duty to care for you. It’s the perfect ‘out’. So, if we don’t know what is wrong with you and we don’t like you, and we’d just as soon wash our hands of you, guess what… You have a personality disorder.

That’s why it struck me as odd that three of the last three patients I saw last week who had been diagnosed with personality disorders had recently had a psychiatric assessment on their way out of jail.

I know, you’re probably thinking… ‘They are the scum of the earth, let’s be done with them’! OK, I get that. It’s hard to have empathy for someone who has no empathy.

But what struck me was that each of these fellows was actually relatively likeable. I don’t mean ‘take them home for dinner’, likeable, but not as bad as you would think. They have a number of things in common that might explain why they are often tagged with the diagnosis, “personality disorder”

  1. They all grew up with mother’s who were either not around, or were pre-occupied, or just didn’t ‘get’ them. They did not have strong attachment to their primary caregiver. In fact, many were bullied, neglected or abused as children, so they often have little attachment to anyone.
  2. They are reward deficient. Meaning they have a tendency to be easily bored, are risk takers, defiant, irritable and sensitive to criticism.
    The first trait, ‘attachment disorder’ means they do not feel the misfortune of others. This allows them to lie, cheat, steal, manipulate, defraud, assault or even kill people, without losing sleep. If no one ever cared about you, why should you care about anyone else.
The second trait, ‘reward deficiency’ means that earning a living the legal way is too boring. It means you don’t sweat it too much when you are on a ‘most wanted’ list, because risk is part of the allure. It means you are oppositional; you don’t bow down to authority (because that’s no fun). It also means that you are quick to anger and you’d just as soon kill someone who disrespects you, than look at them. Remember Pacino in Scarface or Brando in The Godfather?
    Reward deficiency also ties into narcissism. Narcissism is a moral not a biological construct. In the animal kingdom you don’t call the alpha male a narcissist. He’s just looking out for number one, that’s how he got to be the alpha male. In our society we consider that being selfish. When I get to know these guys, I don’t see selfish. I see self preservation. I see a person who feels so bad, that he can’t tolerate things getting any worse. That manifests as not liking: being told what to do; being criticized; or not having things your way.
    In other words, he’s reward deficient. That pretty much explains it. If your like that, and you have attachment disorder, people consider you a narcissistic asshole. But is it really their fault? It’s not their fault that they inherited genes that disrupted their dopaminergic reward circuit. And, it’s not their fault that their mother and other’s did not teach them the language of empathy. That’s why when you talk to them, even though they just got out of jail for some pretty nasty business, they seem a lot less horrible than you would think, relatively likeable actually.
    However, I’m not saying it’s OK to be a drug dealer. But if you hear the whole story, like I do, you are less likely to ascribe blame. As one of my psyche teachers said. It’s maybe not their fault, but it is there responsibility and as such, even though I get where they are coming from, I still think they should pay for their crimes. However, while they are in jail, paying for their crimes, maybe they can get some therapy to help them understand themselves, or maybe they might get some medication to increased the voltage in their dopamine circuits. Maybe that might help them turn around more than just being in jail and then being diagnosed with an untreatable personality disorder.
Anthony Ocana MD




BC Bike Race: The Day(s) After

5 07 2010

The Thrill of Victory

Mother Hubbard went to the Cupboard: Sunday morning: It was great to finish the BC Bike Race yesterday, and the banquet afterwards was a blast. But somewhere that evening, my body checked out. You’re on your own now, I’m done.” And so began a slow spiral of deteriorating health.

Sunday afternoon: Basically, I feel like crap. I haven’t felt this bad since, well, I can’t remember. I think this is what they call ‘viremia’: I have a headache, a backache… I have no energy; I am dizzy. I could fall asleep at any moment. I have no appetite and frankly, I don’t give a damn. I have done everything I can think of. I’m hydrating, taking vitamins, took a hot-tub, had a massage, went to bed early….I guess mother Hubbard went to the cupboard and the cupboard was bare. I’m going to take it easy for the rest of the week, and hope for the best.

Goodbye to good friends: Sunday evening, Lobby of the Chateau Whistler: Seven days and at least seven good friends. I’ve got phone numbers, business cards, emails, home addresses too. We have a lot in common. It will be sad to part ways with these troopers. And, I’m actually going to follow up this time. Who knows? I might even make a road-trip to Dawson Creek

Back to the real world (really?) Monday morning: Feeling slightly better, had good sweat last night, napped in the car on the way down from Whistler. Actually made it to work today and I’m on task.

Tuesday afternoon: I’m so tired that I had to take time off work today. It’s a rare occurrence for me, but, I still feel like I have been hit by a truck…  I have to get back in the game.

Tuesday evening: I still have a headache but I must be getting better now because I did watch a bit of the soccer and I did check to see if that beer in the corner of the fridge was still cold…So, I must be starting to turn the corner.

Wednesday: I seemto have a bit more spring in my step. I got the kids off to school without a hitch. I even remembered their hats and sunscreen. That’s progress. Today, as I walked down I took the first deep breath in a long time…. (just after crossing the finish line, I started hacking up a lung) … and that was 4 days ago.

Why do we do it? Today after a healthy lunch of grilled mackerel and spinach, I wondered…”Why do we do these things? Why do we use up our precious vacation time only to return to the office, scraped, bruised, twisted and visibly ill? To whom would this seem normal?

After a little while, looking across Ambleside and out over the Lion’s Gate Bridge to Stanley Park, it came to me…

We do this to bolster what psychologists call ‘self-efficacy’. (our confidence in our ability to get things done)

We do this to support our ‘world view’ that we are strong, capable and competent.

We do it because it strengthens our belief that…”I can do it!”

And we do it so that…

at some other time, in some other place…

when the sky is dark and the wind is biting,

we will have the confidence

to follow the star of our desire

across that barren plain,

however far and however wide

to hold the one hand that belongs in ours….

and know that

WE WILL SUCCEED!

That’s why we do it.

Anthony M. Ocana MD





BC Bike Race-Day 6: Squamish

3 07 2010

In the Groove on Half Nelson

Laughter in Tent City: I woke up this morning to the sound of laughter with a European accent. I’m not sure it’s something about Belgians or Belgian cyclists or maybe it’s the same ethos that makes them the worlds greatest brew-masters. In any case, the mood was contagious and I found myself looking for the lighter side of things and not dwelling on the negative.

Home court advantage: How nice it was cycling in my own backyard, knowing, not just submitting to the lanndscape. It allows you to give’r on some sections because you know it’s going to be easier up ahead.

Big deep belly breaths: It started after second aid station in Sechelt. I remembered to breathe, right down into my diaphragm. It’s not an accident that it helps you relax. A deep belly breath expands your lungs, pushing out your belly, stretching your diaphragm and stimulating the 10th cranial nerve,  which is the key to the parasympathetic nervous system (PNS). The PNS is essential to keep engaged in long physical efforts. It stimulates the smooth muscle in the stomach to relax, allowing the gut to empty, which allows your body to access the food, water and electrolytes that you have been diligently taking in, which fuels your cooling system, which allows you to perform what you are actually capable of. That’s the key: breathe and think nice thoughts.

Beware the Bonk: You know the PNS is not engaged when you can hear the sloshing in your stomach long after you last took in any liquid. So, in the absence of  a relaxed stomach, things rapidly deteriorate into a vicious negative spiral known as the Bonk. Similarly, any factor that impedes the chain of performance, such as not sleeping well, not eating enough, not hydrating, getting too hot, or over exerting yourself because of excess enthusiasm hastens the bonk. There are so many moving parts, so many ways to screw up. This is what makes having a good day, especially later in the race, such a triumph. It’s also very unlike me, so it’s especially sweet. Now you’ll have to excuse me. I have to relax.

The play by play
I made a real conscious effort to apportion my enthusiasm on the uphill section leading into the trails and to relax on the scary downhill bits. I started pretty far back on the line, but that was just as well. After the nasty single track climb and flowly downhill bit under the powerline, I caught a ride behind a guy on the road out. This probably frustrated him to no end, since I drafted him on all the flat sections, but it really helped me. Drafting makes sense any time you are going at least 12km/h. It decreases the effort to maintain speed by 35%. That’s not chump change, just ask any roadie.

The Comforts of Home

I’m also starting to optimize my position on the bike. I noticed that when I pull back slightly on the bars using core vs arm muscles, and slightly extend my back, it put weight on the seat and optimizes power transfer to the back wheel. If I then concentrate on making big full circles with my pedals, I can save energy for the short bursts needed to get up and over rocks or nasty steep bits.

Using my new technique I made it comfortably up to the new, hyper groomed, $60000 trail known as to Half Nelson, while lots of other riders had to get off their bikes and walk. I love watching them get off their bikes, pretending they have to fix something or take a pee, when really, we all know what’s going on.

I rode Half Nelson competently if a little cautiously and Tsuga, Tsuga the same. I made down all the big drops and over the bridge ok. I did dismount at the real steep loosey goosey part, but so did everyone else. Then I manhandled the last choppy rooty section and dumped down onto the road no worse for wear and still maintaining position. I took my time and ate well that aid #1, but did not dilly-dally and I climbed comfortably and descended competently down the plunge, my erstwhile nemesis, but now an old pal. I took pains again at aid #2 to fill the tank because I knew the killer Crumpet Woods lay ahead and I was not going to be a victim. Sure enough, I held my own through the woods and down the other side and I fairly hammered it home to a big hug and a 4:35 finish. Not too bad for Day 6.

The Comforts of Home: Tonight I did take a hot shower, have an hour long massage, eat real food, sleep in a real bed, wake up rested. Who could ask for anything more? See you tomorrow in Whistler.





BC Bike Race-Day 7: Whistler

3 07 2010

Day 7: Crank Me Up

It’s ALMOST Over: We’re on the bus on the way from Squamish to Whistler. We spent two nights in Squamish, so there was some repreive of the usual ‘hurry up and wait’, but now, it down to the crunch… One more ride and it’s over. You can almost feel the relief in the air.  This has been a gureulling week. We have put every ounce of blood, sweat and tears into this race… and now we can smell… the end is near.

Laughing Before Crying: There are a few nasty climbs and a few wicked pieces of BC single-track to be had, and then… we will be saying good bye. So, there are mixed emotions in my heart. I feel like I am laughing before crying, because in a way, I never want this experience to end.

Blue Collar Cyclist – There are nearly 500 of us. We’re off the line in groups of 50…I was in the 300 group which means I was not first, not last, but where I expected I would be… with the working class. I call it that because we have to work harder to get to the line every day. There are no mid afternoon naps for us because by the time we gety in from the days racing we only have  few hours to do all of our chores.

The Play by Play: Off the line and up the hill, then down…. then a long grinding up to the first chairlift. Then down Crank me up which is a bike park trail with huge berms and table tops and kickers, the kind of things that scare the hell out of me, because i have no idea how to position myself or my bike in order to make it safe or fun. So I tried to stay in the groove, roll with the berms and keep the rubber down. We did one more climb and then down A line which was much of the same but more chattery. Down through the crowd of adoring fans, I caught my loved one out of the corner of my eye. ‘Giddy-up little cowboy’ was the look in her eye… so I straightened up, pulled in the reins and locked in for the torrent of stoney single track that is the Lost Lake Loop. It looks easy enough on the map. No great elevation changes, no nasty descents, but those trails are nerve wracking. Just when you get a head of steam up, there is a nasty uphill curve, or a narrow off-camber bridge or a rocky bench to step up to, or a boulder patch that seems to have no clear line through it. You can’t cherry pick your way, you just have to plow your way through it. Big gear, Big power. And man, on day 7 it can be completely exhausting. Luckily, I ate well and slept well.

Los Conquistadores

Tolerance of Ambiguity – One of the things that occurred to me sitting at the post-race BCBR banquet on Saturday night was that no-one came into this race having it all figured out. Every one at our table told a story of setting out on a journey, assessing the challenges, struggling and finally getting to a point where they felt, “hey, I can do this.” In my business, that is what we call tolerance of ambiguity. It’s the opposite of need for certainty. Have you ever been on a ride and the rider next to you says, “How much further do we need to go?” What they are looking for is information, certainty, safety. That is pretty normal. But it takes a special person to put themselves in a position of uncertainty and not to panic.

That’s What it Takes That’s what you see at BC BIKE RACE, 500 people who can handle the heat and are not looking for the door to the kitchen. They are calm, cool and collected even under extreme conditions. They have the drive, the energy, the skill and the emotional stability to keep the wheels turning and the sticky side down. That’s what it takes to conquer 7 super-sized days of ass-kicking single-track. Yah Baby. AND, WE HAVE WHAT IT TAKES!





BC Bike Race – Day 5: Sechelt to Langdale

2 07 2010

Girl Power: You can’t help but notice that amongst the massive, ripped, pit-bull like warriors are some pretty fresh-faced, lithe, bike chix. This should not surprise anyone, but it is worth noting, that despite their smaller frames and muscles, they are just as strong, just as fast, and just as courageous as any of the men. And frankly, if you got in their way, they would not hesitate to eat you for breakfast. You go, Girls!

Duelling Doctors: Is it a co-incidence or is there a reason that I have now met about 15 other doctors on this trail? Type A, check. Over-acheiver, check. Reward Seeking Personality, check. Get distracted by shiny things, check. No, it’s no co-0incidence. This race was made for us.

The play-by play – The day started relatively well, breakfast was a bit late, so felt a little bloated to start. I had good legs up the first climb as usual, but started to weaken as the insulin surge of breakfast hit me early into the first single track.

I did not panic, took my time, ate and drank diligently and did the water-down-the pants-thing at the first aid station. The cold water lowered my core body temperature quickly and my energy returned. I headed back into the woods with conviction, but got stuck in traffic with some less experienced riders and could not get any momentum. Every time I had the juice to get ahead,  I had to brake to avoid a collision at the next climb or obstacle. The I had to use precious resources to wind it up again. With all the stops and starts, my legs eventually turned to mush and by the second aid station, I was circling the drain, again.

Auto-rescuscitation: By the time I reached the second aid station, things were looking pretty grim. As I got off my bike, I could barely see straight. My knees were weak and my gait was wobbly. I reached out to grab the handle on the back of the Aid Station truck like an air sick passenger reaches for the bathroom door. Then, I lost control of my bladder. I’m a bit embarrassed about it, but physiology can often trump even the best manners, so I let it go, much to the horror of the aid-crew who were watching me like hawks, but in a good way. Again, I did not panic, because I had read about this in a cycling magazine recently and I knew what I needed to do. So, I calmly took one bottle after another and slowly poured them over my head, down my neck, down my pants and I was quite amazed by how quickly I felt better.

Rain Forest Romp

Then I slowly drank and ate my way back into fighting shape in what seemed like a half hour but was probably only 29 minutes… and set off for the last 400 m climb through the forest, before the sweet descent to the Ferry terminal in Langdale. This all went relatively well, although I did have to walk a significant amount, but I had the nerve and the guts to ride most of the slippery bridges and ladders that surely would have been my nemesis had I not taken the time to refocus and refuel.

Finding the Groove Again: The final descent was a spectacular series of buffed berms and bends and I felt that I rode it competently. As the trail snaked down the hillside, and the Red Bull shot seared through my circuits I found the groove again. Like driving a car, I sent the front wheel wide, visualized the apex, and squared my shoulders to the exit and down the next straightaway. Someday, I will do this automatically and effortlessly, but right now it’s still a series of mechanical tasks that need to be strung together consciously. I avoided any major heroics as I was not feeling like falling 10 feet into a creek. Moreover, I was getting bounced around quite a bit towards the bottom as my two year old shocks were starting to fail. Never the less, I arrived safely at the bottom in 5:35.






BC Bike Race – Day 4: Earls Cove to Sechelt

30 06 2010

Technical Challenges on Day 4

Trauma on the Trail: Touch wood. I have not had any major crashes. OK, my body is covered with scrapes and bruises of every size and colour of the rainbow. I have crushed both pinky fingers on passing tree trunks; I have had a handful of endos (short, for end over handle bars). And, I had a couple of good high-speed tumbles… but so far, all my injuries are “dermatological”. Crashes in cycling fall into four categories: dermatological vascular, orthopedic or neurosurgical. As I walk around our campsite every night, I see more and more people who had serious crashes, so I consider myself lucky. To be fair though, I’m also careful. I don’t go charging down the trail. I leave that to the thrill-seekers: I have kids and a mortgage. It never ceases to amaze me how fast some of these guys (and gals) go… it’s frightening, really. Having said that, these are not the guys who crash. It’s the tentative ones. In mountain-biking commitment is everything.  I’m not quite there yet, but I certainly had a lot of practice on Day 4. Off camber obstacles have often been the bane of my day. Today, I learned to power up and float, using my body positioning and leaning the bike into the turn to optimize traction… most importantly, I learned to keep my hands off the brakes, take on speed as necessary and look down the trail, sometimes looking around the corner, for a flatter, grippier section, where braking would not send me into a skid.

The Tyranny of Tenting: During the past 4 days we have been living in tents. In the evening, base camp becomes a veritable tent city with portable bathrooms and showers, etc. At night, we retitre to our small nylon homes which we share with a tent-mate. This is not necessarily bad. You get to meet an interesting person from another part of the world with whom you have a great deal in common, mostly biking, but often other interests and traits as well. It’s actually one of the best parts of this whole adventure. So far I have had two roomies, Frank from Sydney, Australia and Dirk, a South African psychiatrist who now lives in Dawson Creek, BC. The downside is that now that you have someone to talk to, you do, often late into the night. This cuts down on precious sleep time. You also sleep on the floor, which does not lend itslf well to recovery. It’s damp and depending on body chemistry and the digestive patterns of your roomie, it can also be a bit smelly.

The Play by Play – I pushed up into the ranks of the elites today on a long hilly stage. That worked for quite a while, but energy is not endless and enthusiasm has its perils. My mantra all day was, maintain position, maintain position. That worked for a while too, but all those burly descenders were soon upon me and the descents were tricky if not ominous, so I had to concede positions to my chagrin. At the second aid station my back was hurting… when I went to visit the bushes I saw my urine was dark yellow… I remebered what we were told in orientation, “every good mountaineer pees clear… so I drank about 2 l and poured another 2 L over my head and down my pants, even though we’re not supposed to do that. I figured it was better to pour that water on my head than to need it intravenously later. It sure helped. It gave me the energy to push up that nasty little climb and as I crested the next hill the cool breeze felt fantastic as it billowed through my soaking jersey. And then I felt my energy coming back. As the food and water from the last aid station started to enter by blood-stream, I felt my energy and confidence return.

The kindness of strangers:Minutes later, just after the aforementioned cool breeze, as I careened down the double track, the guy ahead of me hit the breaks and a cloud of dust obscured the apex of the turn. Suddenly a rock the size of a baby’s head appeared directly in front of me. With a flick of the wrist and a spring of the legs, I took to the air and over I went… however, this baby had a rather pointy head so as my back tire slammed into it, it caused my tire to ‘burp’. This, I am told is what happens when you hit a tubeless tire with great impact, breaking the seal of the tire with the rim, and letting out the aforementioned low pitched ‘burp’ sound. Luckily, I came to a safe stop and lost not too much time as another rider who could see I was a newbie, (I didn’t know how to put the tube into a tubeless tire, I didn’t even have a tube because I was assured I could not get a flat, and my Co2 inflator did not work) This fellow, from Endless Biking kindly stopped to lend a hand..and got me on my way. Thank God for the Good Samaritan..

Finding Flow on the Sunshine Coast

In Flow: We’re  going down. While it is certainly not my strength my descending skills have been improving all week. In the past, having always ridden a hard tail my tendency has been to find the path between big rocks and around the edges of deep grooves. That works sometimes. But sometimes the best line is the one over the rocks and into the groove. That’s where weight distribution and good shocks make the work into a game.  That is of course easier said than done. When you are scared, you lean forward, your back tire loses grip and the whole thing goes to hell in a hand-basket pretty quickly. It’s hard to believe that those rocky, dusty, steep and twisty bits are actually rideable. But they are… and it feels so amazing when you finally get it right.

This is what Mihalyi i (CHICK-zent-mi-high) calls flow. In his book Flow: The Psychology of Optimal Experience (1990) he described the flow state as one in which an athlete performs seemingly without effort, but with total concentration, feeling totally in control without thinking about it. Self-consciousness recedes into the background as total focus is upon present activity, such that someone might call you to dinner and you would not hear a thing.

To paraphrase Czikszentmihaly’s work, you get into flow when you find the sweet spot between challenge and reward. That means that the activity has to be difficult enough to engage all of one’s senses, yet easy enough that one can succeed and experience the reward of mastery.

I finished the rest of that day, thanks to the Good Samaritan, competently and in flow and arrived safely at base camp in Sechelt in 5:32.





BC Bike Race – Day 3: Powell River

29 06 2010

Finesse in the Forest

Day 3 – Fun in the Forest: OK I am caught up now and feel much better both physically and mentally… could it be a good night’s sleep?… All the great people, anti-inflammatories, Red Bull energy shot, a doule bowl of oatmeal… All of the above?

Race Relations… I’m not fond of people who bend the rules, in my business we call them boundary crossers…but… I guess I often find myself in that position where I would like someone to bend the rules for me. Anyway, here at BC bike Race, Michelle from Race Relations has made my day. We are only allowed one bag, our skookum new Dakine bag to be exact. I don’t really want to cram my new 17″ MacBook Pro into my race bag, so Michelle has been kind enough to carry my laptop with her, so I can blog while on the ferry. This precious time, usually in the morning, is the only time have energy and cognitive function to write anything, so I am very thankful.

Tent Mafia: It takes a special kind of person to yell at someone, first thing in the morning. I am not saying they are bad people… But only a special person can yell at the top of their lungs a t 6 am, “Anyone who is not out of their tent in 20 minutes does not get any coffee.” I don’t even drink coffee, but they sure had my attention. I suppose the ability to yell at people must have some surviuval value, because you find these special people everywhere: police officers, airport security people, nurses. I guess they are put on earth to help all us ADD survivors to get our shit together and stop procrastinating. Maybe their parents yelled at them. My parents never really did that, so I always find it somewhat abrasive (maybe I was just grumpy after having two shitty days). But, I guess that’s why it works.

Different Strokes: This is a long race.. 7 days and, to the trail designers credit, they have thrown in a wide variety of  geographical and technical elements to test both our fitness and bike handling skills. The first day was 67km and arduous. The second day was shorter but more brutish with a 10 km climb in the middle of the day and another nasty climb towards the end of the day. Today will shorter, only 53k, but it looks very choppy.

The Play by Play: We start the day with a long outbound double-track and I’m feeling strong…the local school kids have lined the trail and are cheering madly making me feel, for a minute, like I am Fabian Cancellara in the Tour de France. I am passing on the flat with confidence. I feel steady in the single track today… maintaining position behind my new friends, also riding under the Different Bikes banner, the husband and wife team of Marty and Frannie. It’s endearing listening to them chatter back and forth, supporting each other, making sure they are in sync. Now that’s attachment.

Physics Power: Meanwhile, I am adapting to the geometry of my new bike. It’s actually an old bike, but since I had my bike re-fit by my cycling coach, the indomitable, Larry Zimich, things are a bit different and I’m still getting used to it. Larry measured and tweaked my position in climbing, time trial and sprinting positions. He shortened my stem, trimmed my handle-bars, lowered my seat and moved it forward a smidge. The goal here is to be able to get as aerodynamic as possible, maintain power and optimize traction. The principle is that as you lower your torso, you decrease angle between you chest and your quad. That decreases wind resistance, which is 95% of what you are pushing against, but it also decreases power. So, by moving the seat a bit forward you open the angle and restore the power. Now, it’s time to use all this science to optimize energy transfer from mitochondria to pedal to where the rubber hits the loam. Sit back, pull back and scrape mud.

I also dropped the psi in my back tire to 30 from 45 and switched from Schwalbe Racing Rons to Nobby Nicks, which increases traction and allows me to roll over wet roots rather than spinning out or getting bounced around.

Colin Kerr of Bowen Island

There were Lots of stops and starts today, so I was trying to focus on consistency… Winding up my wheels, rather than pounding away at them. There’s more to this than meets the eye. After wind resistance and rolling resistance, there is rotational resistance. That is the force required to push the rotating parts through one revolution. As it turns out, the force is proportional to the weight of the rotating parts. So that is why weight weenies first obsession is the heft of their hoops. The lighter the wheels, tires, pedals and cranks, the less force required to push them around. The next factor is the friction at the level of the hub. The smoother the bearings, the less force it takes to push them around. So, as the sweetness of light wheels meets the blessing of smooth bearings you have a dream which gets better with each  revolution. Now, if you can increase the force on the cranks slow and smoothly, rather than fast and furiously, you expend less energy; And, if you can optimize your pedal stroke to deliver power evenly over the entire 360 revolution, you’re even more efficient. And, if you can maximize the transfer of power from your body to the bike by stabilizing your bum on the seat; And, if you can distribute the power output to a broader selection of fast twitch muscles by pulling back on the handle bars while pulling forward with your core; And you can optimize the oxygen transfer to your muscles by taking slow deep breaths; And you can make sure there is enough glucose going to your muscles to fuel aerobic metabolism… then you can really fly.

Very few open climbs today so just trying to maintain my position in the forest and pass on the double track. The open descent with wide turns and long straightaways played to my strength. So whenever I could, I tucked into TT position and cheated the wind… I had my best day yet. I took another 15 spots: 4:05 today, WOW… Now I’m 51st, vs.84th yesterday in Solo Masters Men . Beware the tortoise!