Travel & the Brain

What its like to Live in Medellin, Colombia’s Former Cocaine Capital & the Neuroscience of Addiction

It is with a heavy heart that we bid farewell to Medellin. Its charm and idiosyncrasies were not lost on us.  While the cocaine cartels no longer overshadow life in the city, the white powder trail around the Gringo beat is ever present. Here I’ll explore the effects of drugs on the brain and the neuroscience of addiction. But first, what is life all about in Medellin?

If not for the premier Netflix series, Narocs, detailing the life and times of drug lord, Pablo Esobar, you might not have heard of Medellin (pronounced Me-de-jinn). This would be a pity because Colombia’s second largest metropolis is a wonderful city and although the violent history of the cocaine war is deeply etched into the minds of the generation who were victim to the atrocities, Medellin nowadays is the kind of place you’ll want to make your home for a while. And that is what we did, for two months at least.

The original plan was to settle in Bogota, but the sprawling capital city, lying at 2.64 kilometers above sea-level was cold and grey and this did not align with our concept of the Colombian lifestyle. Instead of taking the 11 hour bus that winds its way down and around the lush coffee plantations between the two districts, we opted for the flight. Just 40 minutes after takeoff, we found ourselves in the “city of eternal spring”.

 Ubiquitously Medellin:

The locals, or “paisas” as they affectionately call themselves, are people of generous spirit and cherished custom. In their city that is defined in equal measure by tropical causality but also award winning innovation, you can’t exist long without bumping up against the institutions of life in this society.

Unlike the city’s international reputation, Pablo Escobar no longer dominates the scene (and its best not to talk about him too much around Paisas). Though to be honest, I’d be presenting a false impression of Medellin if drugs did not make it onto this list. So to get on with it, in no particular order other than the one that came to mind, if you get acquainted with the following, you’ll know a thing or two about life in Medellin:

The Spring-like weather.

There are few occasions for winter-wear in Medellin. There’ll be regular down pours but with balmy temperatures and zero breeze factor, the rain is not such a bother.

The Bandeja Paisa.

The “country platter”, originally prepared for hard-working country folk (paisais) at the end of a grueling day. It consists of over thirteen ingredients, including a serving of steak, powdery ground beef, pork sausage, runny beans, chicharrón (deep fried pork loin), eggs, rice, plaintains (fried savory banana), French fries, avocado and salad.

Fernando Botero.

Botero’s art is what you’d imagine to turn into after too many bandeja paisas. His work is ever-present in downtown Medellin and features comically voluptuous figures that offer a commentary on the social and cultural embodiment of Medellin and its people.

Salsa.

If Medellin is the body, salsa music and dance are the blood. Life affirming in so many ways, everybody can dance and they dance a lot in sweaty, intimate live music bars all over the city. Paisas make it look easy, but as we discovered, it takes more than a free lesson on Tuesday nights at Eslabon Prendido to get your feet and hips moving like a local.

Arepas (burnt).

Arepas are corn patties, usually stuffed with cheese. No meal is complete without one. One of the distinctive aromas of apartment dwelling in Medellin is the suspiciously frequent wafts of burning arepas permeating the building. We discovered for ourselves, you don’t cook an arepa, you burn one.

The Hot dog vendor.

Another source of questionable aroma. The hotdog vendor is on every street corner from early evening to midnight, cooking up a roaring trade of sizzling pork sausage ‘dogs’ with heaps of pork-fleshy, almost human-smelling bacon. We didn’t try one but grabbing a dog on the run is a Medellin way of life. Try one at Rapidog or Dogger, just for the names.

Yellow taxis.

In Bogota, hopping in a taxi opens you up to all variety of criminal activity, but in Medellin, riding in one of the countless yellow Hyundais is a cheap and cheerful experience. Don’t expect the driver to know where he’s going. You’ll probably need to show him a map and put your Spanish skills to practice as you explain to him the best route.

Aguardiente.

Translates literally into “fire water”. Aguardiente is the liquor of choice around these parts. It tastes like Zambuca (aniseed) and its common to buy a whole bottle of it when out and drink it by the shot. We preferred the rum, drunk the same way.

Butt implants

At first we thought it was just the Colombian genetics, like dark hair and almond shaped eyes, but then we learned that cosmetic surgery to enhance the size and contour of the behind is big business in Medellin. For those afraid of the knife, they have the underpants version of the Wonderbra.

Cable cars:

The cable-cars or “metrocables” are special in Medellin because they cost the same as public transport and they exemplify the city’s progressive innovation. They were originally built to service the more struggling hill-side communities and they still function to connect up commuters with the city’s central transport grid but the metrocable is also one of the biggest and most affordable tourist attractions. Follow it to the final destination and you’ll arrive at Parque Arvi, a wildlife reserve at the top of the hill.

Chiclets chewing gum.

We began to wonder if Chiclets gum was really gum or just small packages disguising something unlawful. Because Chiclets gum is everywhere, offered to you in hand while you’re sitting at a bar. We later read that people peddling the sweets are in deed undercover drug dealers, but the only people we saw selling them surreptitiously were elderly women, who seemed likely to be fast-tracked to a heart-attack if you asked the wrong questions.

Mondongo soup.

Mondongo is a famous soup of the region, made with animal innards that have been slow cooked with other more friendly ingredients like garlic, bell peppers and cabbage. It is the perfect hangover antidote though the floating pieces of lung can be a bit off-putting.

Heavenly hills.

Medellin is situated in a narrow valley and as the day draws to an end, the rays of sunlight filtering through the haze against the lush, undulating hills creates a biblical scene. The effect is magnified by what seems to be agricultural burning on the upper hillsides, but I couldn’t find any information to confirm the source of the smoking hills of Medellin.

Cerveza Michelada.

This is an icy beer served with a shot of lime, bits of fruit and salt around the rim of the glass. Sort of like a beer margarita. Waiters’ eyes light up when they ask if you want your beer served “michelada”. No thank you.

Innovative park life.

Dotted all over the city, and concentrated in the city’s many leafy parks, are strange and unusual sculptures and installations. Public green spaces are well maintained in Medellin and part of the ongoing upgrades the city has been undergoing since the turn of the century. Saturdays are good for hanging out with the market people in the park at Ciudad del Rio, outside the Museum of Modern Art. For some grunge and beer drinking, head to Parque del Periodista in the evenings. Though not the most sensational, my favourite features of Medellin park life are the antiquated wooden benches of Poblado which look like they belong in a 1940’s classroom.

Highways & Traffic.

Medellin has some mean motor ways. We’re well aware of this because we spent one month in an apartment that overlooked several major intersections. Pollution from car exhausts can be such a problem that the city has implemented a rule which dictates when you can drive depending on the numbers on your license plate – licenses ending in odd or even numbers are only permitted to be on the road on alternating days.

 Red-brick high rise buildings.

Towering red-brick apartment blocks are an iconic piece of the Medellin skyline – though the same can be said for Bogota. From what I’ve been able to uncover, red clay bricks are cheap and very durable but it was the much loved architect, Rogelio Salmona, who really set the trend.

 Staghorn ferns.

Every second apartment has a giant conglomerate of Staghorn ferns hanging in the balcony, looking like a spectacular botanical chandelier. They caught my attention quickly because they are not easy to grow in Cape Town but here they thrive. To me, Staghorns are special, animal spirit-like specimens, not just because they clearly have major hipster appeal…

Cocaine.

Especially around the city’s most fashionable hub of nightlife – Parque Lleras – you’ll quickly pick up on the white powder trail. Take a stroll through the area on a Saturday morning and you’ll sport the tiny white-incrusted zip-lock bags littering the floor. Some consider this a sign of “cocaine tourism”, a new spin on Medellin’s reputation as the “cocaine capital” of the world. The product sells at roughly 5% of the going rate in the US, but whether this alone is attracting tourists or whether its recreational use is considered a legitimate form of cultural immersion, is not yet clear.

As I will detail in the following section on the neuroscience of addiction, experimentation with drugs is not inherently addictive. Many people can use drugs recreationally without too much collateral damage. However, the world over, criminal organizations who peddle drugs are responsible for unthinkable acts of violence, making cocaine tourism in Medellin something to actively question.

The Neuroscience of Addiction

Clinically speaking, drug addiction is a chronic condition in which compulsive drug-taking behaviours persist despite the blatant negative consequences it produces. In its manifestation, it is characterised by three core features: 1) recurrent intense, compulsive urges to procure and take a drug; 2) loss of control in inhibiting usage; and 3) the emergence of negative emotions when the effect of a drug has expired and access to more is unavailable.

Addiction is considered by many to be a “brain disease”, and indeed it is associated with several disturbances in brain function such as inhibitory control and motivation. But addiction is nevertheless a highly complex phenomenon in which personality, socio-cultural and political factors play a key role in its development.

What is the Appeal of Drugs?

Addictive drugs exert their effects by acting on the brain’s dopamine systems, commonly referred to as the ‘reward’ pathway. Dopamine makes you feel really great by creating the sense of pleasant expectation, and a feeling that something ‘good’ will follow. The famous affective neuroscientist Jaak Panksepp donned this pathway the SEEKING system.

There are two major neural projections of this central reward system; the nigrostriatal system, which extends from the substantia nigra to the dorsal striatum; and the mesocorticolimbic dopamine system, which runs from your subcortical emotional (limbic) centres through and up the midline of the brain.

The brain evolved to ensure that things that are important for survival and reproduction are able to activate systems in the brain that make you feel good (rewarded) so that you will repeat the experience again. This is the basis of emotional learning. The desire to follow reward is an instinctual response that we share with all mammals. You can’t decide, for example, that energy-rich sugar tastes bad.

The medial forebrain bundle forms the hub of the mesocorticolimbic dopamine system, the brain's central reward pathway (AKA the SEEKING system).
The medial forebrain bundle forms the hub of the mesocorticolimbic dopamine system, the brain’s central reward pathway (AKA the SEEKING system).

Different drugs activate the reward system in different ways.

Substances like cocaine, ecstasy and amphetamines increase dopamine levels by preventing it from being washed away after its initial activation. These drugs interfere with a thing called a transporter, which, like its name suggests, is responsible for transporting the molecule away from the neuron. This is the equivalent of one of those automatic dog bowl feeders and the trap-door or lever, closing off the supply from the top, would be the transporter.

Other drugs like heroin, alcohol and marijuana operate indirectly by stimulating a different neurochemical called glutamate, which then increases the firing of dopamine-releasing cells. This is like you (dopamine neuron) holding on to the hosepipe and having the fireman (glutamatergic neuron) come and ramp up the flow of water.

The initial reinforcing effects of drugs is therefore quite straight forward, relying heavily on the rapid artificial surge in levels of dopamine.

The drugs that are really seriously habit forming, like heroin, are especially potent because they not only elicit the good-expectation vibes of dopamine, but they also act directly on other pleasure centres of the brain that are modulated by endorphins and other opioids. This group of chemicals is associated more with a kind of dreamy serenity. They are extremely effective at rapidly dissolving any feeling of anxiety or discomfort and that’s part of why they can be so alluring.

Is Addiction Just About Reward?

No. The rewarding, feel-good effects of psychoactive substances are strongly implicated in initial drug-using habits; however, reward per se does not explain the transition from controlled use to the full-blown disorder of addiction.

For many drug users, the drugs stop being rewarding after a period of chronic use. It becomes more about warding off negative or dull feelings than creating a high.

The natural function of dopamine is to communicate to you that whatever you just did was biologically good for you. But, drugs work by direct pharmacological action, without signalling any biological value and as such they short-circuit the adaptive function of the reward system.

This begins to change how the reward system operates. It puts a “spanner in the works”.

The release of drug-induced dopamine far surpasses the level achieved by natural rewards – like kidding around with your friends, engaging in a creative task or a sport – and they therefore always signal a ‘better than expected’ message to other parts of the brain. What soon happens is that the natural, more simple pleasures in life lose their capacity to signal reward to the brain. They become uninteresting.

Instead, drug-related events are encoded in your memory as super salient. What results is an increasing network of cues that are able to elicit powerful cravings. Your hippocampus, which is responsible for conscious, contextual memories, gets really good at picking up on clues that signal an opportunity for the drug. If you’ve been doing a lot of cocaine while you’re out drinking at a club, the feeling of being intoxicated, even the loud, thumping music, will start to set off a craving.

Cocaine induced cravings in turn increase dopamine in a brain structure called the dorsal striatum, which is responsible for the automatic initiation and selection of behavioural responses. What this means is that when a craving sets in, it begins to hijack your free-will. The conscious, intentional control of your actions, which would allow you to think more logically about your choices (referred to as “top-down”), becomes disrupted. These cue-induced cravings may persist for years because the synaptic structure and weight that underlies reward memory is amongst the most resilient in biological alterations.

As difficult as it can be to overcome cravings, this alone also does not account for the compulsive cycle of addiction. Most critical are the profound neural adaptions that result as a consequence of chronic chemical imbalances in the brain’s reward pathways.

Long-term Changes in how the Brain responds to Reward

Chronic drug use begins to corrode the central dopamine system. After time, levels of the brain’s natural dopamine plummet and the neurons responsible for its release start to fire in sluggish ways.

These changes affect the functioning of the orbitol frontal cortex, the prefrontal cortex and the anterior cingulate cortex, all regions that allow you to think logically and maintain inhibitory control of your actions and your feelings – to “hold back” from your impulses and regulate your emotions.

 

Because behaviour in human beings is ultimately regulated by these “executive functions” and not merely by simple stimulus-response mechanisms like Pavlov’s dog, the real crux of drug addiction falls to this long-term impoverishment of brain structures that enable rational decision-making. Its not to say that addicts don’t have the capacity for rational thought, its just that in the moment, when the powerful drug cravings compete for attention, the executive pathways fall short.

Its like when you’re in the kitchen on a “healthy day” and like a bolt of lightening, you manage to convince yourself that the chocolate cake is fine, only to wonder a moment later, how you could have forgotten about your diet? That’s the executive system usurped.

Individual Differences in Vulnerability

 The idea that experimentation with addictive drugs will certainly and ultimately lead to addiction is actually a myth. Rather, there appears to be a number of individual genetic and environmental factors that determine the relationship between controlled and recreational drug usage.

For one, differences in the neurochemical mechanisms that control stress can make someone especially vulnerable to addiction. Studies have shown that repeated stress exposure produces a similar effect to that of continual amphetamine usage, because stress activates dopamine neurons in the dorsal striatum. Recall that the dorsal striatum is linked to encouraging automatic behaviours, which would be important in times of great stress where there’s no time to think.

As such, it has been proposed that the experience of extreme, chronic stress at some critical developmental period in life might predispose an individual to full-blown addiction.

Even one’s social status can affect brain pathways that eventually protect or predispose toward the development of later addiction. The strains and stresses of being low-ranking in the social hierarchy can produce profound alterations in the levels of dopamine receptors (the ‘keyholes’ that unlock the potential of dopamine in a target brain cell). Studies in monkeys show that cocaine use only becomes compulsive and pathological in subordinate monkeys, but not in dominant ones. These findings may help to explain why addict populations are most often composed of oppressed socioeconomic groups.

To end, its clear that addiction is no simple phenomenon. What we define as an addiction or simply a revered cultural practice is another whole debate. What’s clear though is that drug use can and very often does cause insurmountable suffering to many human beings and their families and so when the issue arises, whether it’s about cocaine tourism in Medellin or dependence on pharmaceutical grade pain-killers, its certainly something to think about.

If you would like some references for further reading, or if you have any questions or comments, please leave a message below.

 

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3 thoughts on “What its like to Live in Medellin, Colombia’s Former Cocaine Capital & the Neuroscience of Addiction

  1. Thanks for this great summary of Medellin life and the interesting (and well explained to the lay person) explanation of addiction and the brain. Love reading what you’ve written so far!

    1. Thanks Meg! I’m glad you enjoyed it. We’re hanging around until its time to head to the airport. We’ll miss Medellin a lot but Central America awaits us =) I can’t wait to hear all about Kenya! xxx

  2. Love your blog and interesting times you and Mish are having. It is a lifetime experience that very few get to have.

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