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Time for Reflection

The Way to Wellville, the 10-year nonprofit project I started in 2013, has been going for more than four years now. I embarked on it in part because I knew I would learn something… and of course, what I learned was well beyond what I expected. It wasn’t just about health or metabolism or racism, but neuroscience and dopamine cycles and time. Here’s a mid-term report:

Addiction is short-term desire.

Purpose is long-term desire.

If you spend much time working with and learning about people and their health and their capacity to cope not just with “everyday stress” but with challenging circumstances, it becomes clear that some of them are just better at it than others. But if you read about pre-/post-natal care, early childhood development, the effects of nutrition and parenting on body and mind, it becomes clear that a lot of this resilience is learned, not innate. In particular, children who learn early that it’s safe to think long-term, to wait for rewards, to trust, aren’t constantly tensed to deal with disappointment, punishment or scarcity.

In essence, vulnerability to addiction reflects learned attitudes towards time and predictability. In the well-known marshmallow test, children are shown a marshmallow, and told they can eat it right now, or wait for a while for a researcher to come back with a second marshmallow – two for the price of one, plus a little wait. Years later, the research showed, the wait-ers were doing better in school, in behavior, in all sorts of measures of achievement/success.

But why did some kids wait and others grab in the first place? If your home life is uncertain, if your dad is sometimes home or sometimes not, if your mother is sometimes loving and sometimes abusive, you’ve learned to take what you can get without waiting for a better deal. Your behavior is not stupid, but appropriate for the circumstances you face. You have learned to take what pleasure you can because good behavior isn’t necessarily rewarded.

This notion now pervades my thinking: Short-term thinking – and by extension addiction – is a learned response to disorder, as well as a learning disorder that processes new experiences wrongly. (For two excellent books that clarify this perspective, you can read Unbroken Brain by Maia Szalavitz and The Biology of Desire by Marc Lewis MD.)

In addictive behavior, people become focused on some short-term source of pleasure or at least gratification. It may be drugs, but it can also be sex, cat videos, Facebook likes, food, self-cutting, alcohol. Some of these may not be inherently damaging, but the focus on them – to the exclusion of regular life – disrupts regular life and interferes with people’s longer-term progress. Yet as described by Marc Lewis, an addict’s focus distorts – or perhaps more accurately, reduces – their sense of time. The past is irrelevant; the future is unperceivable. There’s only the present; the immediate desire. There’s no notion of agency or change; of behavior that can lead to a different future beyond that addictive, persistent present.

Short-term thinking is not limited to abused children. Ecomomists would call it a high discount factor; in other words, an immediate reward beats a larger, long-term reward. It’s why interest rates go up in times of uncertainty; people require higher returns to take the risk of investing. (And they also go down when there’s nothing worth investing in; the long-term rewards are too low to be worth the risk. But that’s another topic.)

More broadly, though, we have become an immediate-return culture, in business as well as personal lives. You can see that not just in people with “traditional” addictions, but also in Wall Street traders who can never get enough, in governments who make empty promises and those who believe them. Businesses want to find qualified people rather than train people to become qualified. In health care, some voters and politicians now resist fixing (or at least resist paying for fixing) people who are sick – but even more, we do not want to invest in their health. In particular, health insurers are not incentivized to invest in health promotion or prevention that won’t pay off for many years, likely after an enrollee has moved to another plan.

You can also see this in many community health initiatives: pilots and programs that promise change but deliver only short-term results that vanish once the funding runs out. The comfortable (indeed, rewarded!) default focuses on running programs and getting funding, rather than on long-term, sustainable change.

Unfortunately, you can’t have long-term purpose without the same brain functions that foster short-term desire; the difference is just how that desire (call it dopamine function to simplify) is trained and manifested. The same dopamine urges that keep us alive – for food, sex, water, love – are the ones that give us long-term purpose. Without desire, we would do nothing, short-term or long-term.

The problem is the context – and time scale – in which desire occurs. The solution lies in changing that context – and more practically, how we raise our children, how we train and support parents, how we provide a food supply (especially in schools), how we provide meaningful jobs and pay for long-term value, how we educate children and train employees, for the long term. Helping five US communities learn how to do that for themselves, sustainably, is my – and Wellville’s – purpose, at least through the remaining seven years of this 10-year challenge.

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