The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think

January 22, 2015

My friend Chaney sent this to me. Low and behold, this is what we teach in Restarting, that addiction is an attachment where we attach to drugs, food, shopping, whatever! instead of attaching to people and God. Kinda sad. But I am happy this article by Johann Hari from Tuesday’s Huffington Post is on the right track. Enjoy!
It is now one hundred years since drugs were first banned — and all through this long century of waging war on drugs, we have been told a story about addiction by our teachers and by our governments. This story is so deeply ingrained in our minds that we take it for granted. It seems obvious. It seems manifestly true. Until I set off three and a half years ago on a 30,000-mile journey for my new book, Chasing The Scream: The First And Last Days of the War on Drugs, to figure out what is really driving the drug war, I believed it too. But what I learned on the road is that almost everything we have been told about addiction is wrong — and there is a very different story waiting for us, if only we are ready to hear it.

If we truly absorb this new story, we will have to change a lot more than the drug war. We will have to change ourselves.

I learned it from an extraordinary mixture of people I met on my travels. From the surviving friends of Billie Holiday, who helped me to learn how the founder of the war on drugs stalked and helped to kill her. From a Jewish doctor who was smuggled out of the Budapest ghetto as a baby, only to unlock the secrets of addiction as a grown man. From a transsexual crack dealer in Brooklyn who was conceived when his mother, a crack-addict, was raped by his father, an NYPD officer. From a man who was kept at the bottom of a well for two years by a torturing dictatorship, only to emerge to be elected President of Uruguay and to begin the last days of the war on drugs.

I had a quite personal reason to set out for these answers. One of my earliest memories as a kid is trying to wake up one of my relatives, and not being able to. Ever since then, I have been turning over the essential mystery of addiction in my mind — what causes some people to become fixated on a drug or a behavior until they can’t stop? How do we help those people to come back to us? As I got older, another of my close relatives developed a cocaine addiction, and I fell into a relationship with a heroin addict. I guess addiction felt like home to me.

If you had asked me what causes drug addiction at the start, I would have looked at you as if you were an idiot, and said: “Drugs. Duh.” It’s not difficult to grasp. I thought I had seen it in my own life. We can all explain it. Imagine if you and I and the next twenty people to pass us on the street take a really potent drug for twenty days. There are strong chemical hooks in these drugs, so if we stopped on day twenty-one, our bodies would need the chemical. We would have a ferocious craving. We would be addicted. That’s what addiction means.

One of the ways this theory was first established is through rat experiments — ones that were injected into the American psyche in the 1980s, in a famous advert by the Partnership for a Drug-Free America. You may remember it. The experiment is simple. Put a rat in a cage, alone, with two water bottles. One is just water. The other is water laced with heroin or cocaine. Almost every time you run this experiment, the rat will become obsessed with the drugged water, and keep coming back for more and more, until it kills itself.

The advert explains: “Only one drug is so addictive, nine out of ten laboratory rats will use it. And use it. And use it. Until dead. It’s called cocaine. And it can do the same thing to you.”

But in the 1970s, a professor of Psychology in Vancouver called Bruce Alexander noticed something odd about this experiment. The rat is put in the cage all alone. It has nothing to do but take the drugs. What would happen, he wondered, if we tried this differently? So Professor Alexander built Rat Park. It is a lush cage where the rats would have colored balls and the best rat-food and tunnels to scamper down and plenty of friends: everything a rat about town could want. What, Alexander wanted to know, will happen then?

In Rat Park, all the rats obviously tried both water bottles, because they didn’t know what was in them. But what happened next was startling.

The rats with good lives didn’t like the drugged water. They mostly shunned it, consuming less than a quarter of the drugs the isolated rats used. None of them died. While all the rats who were alone and unhappy became heavy users, none of the rats who had a happy environment did.

At first, I thought this was merely a quirk of rats, until I discovered that there was — at the same time as the Rat Park experiment — a helpful human equivalent taking place. It was called the Vietnam War. Time magazine reported using heroin was “as common as chewing gum” among U.S. soldiers, and there is solid evidence to back this up: some 20 percent of U.S. soldiers had become addicted to heroin there, according to a study published in the Archives of General Psychiatry. Many people were understandably terrified; they believed a huge number of addicts were about the head home when the war ended.

But in fact some 95 percent of the addicted soldiers — according to the same study — simply stopped. Very few had rehab. They shifted from a terrifying cage back to a pleasant one, so didn’t want the drug any more.

Professor Alexander argues this discovery is a profound challenge both to the right-wing view that addiction is a moral failing caused by too much hedonistic partying, and the liberal view that addiction is a disease taking place in a chemically hijacked brain. In fact, he argues, addiction is an adaptation. It’s not you. It’s your cage.

After the first phase of Rat Park, Professor Alexander then took this test further. He reran the early experiments, where the rats were left alone, and became compulsive users of the drug. He let them use for fifty-seven days — if anything can hook you, it’s that. Then he took them out of isolation, and placed them in Rat Park. He wanted to know, if you fall into that state of addiction, is your brain hijacked, so you can’t recover? Do the drugs take you over? What happened is — again — striking. The rats seemed to have a few twitches of withdrawal, but they soon stopped their heavy use, and went back to having a normal life. The good cage saved them. (The full references to all the studies I am discussing are in the book.)

When I first learned about this, I was puzzled. How can this be? This new theory is such a radical assault on what we have been told that it felt like it could not be true. But the more scientists I interviewed, and the more I looked at their studies, the more I discovered things that don’t seem to make sense — unless you take account of this new approach.

Here’s one example of an experiment that is happening all around you, and may well happen to you one day. If you get run over today and you break your hip, you will probably be given diamorphine, the medical name for heroin. In the hospital around you, there will be plenty of people also given heroin for long periods, for pain relief. The heroin you will get from the doctor will have a much higher purity and potency than the heroin being used by street-addicts, who have to buy from criminals who adulterate it. So if the old theory of addiction is right — it’s the drugs that cause it; they make your body need them — then it’s obvious what should happen. Loads of people should leave the hospital and try to score smack on the streets to meet their habit.

But here’s the strange thing: It virtually never happens. As the Canadian doctor Gabor Mate was the first to explain to me, medical users just stop, despite months of use. The same drug, used for the same length of time, turns street-users into desperate addicts and leaves medical patients unaffected.

If you still believe — as I used to — that addiction is caused by chemical hooks, this makes no sense. But if you believe Bruce Alexander’s theory, the picture falls into place. The street-addict is like the rats in the first cage, isolated, alone, with only one source of solace to turn to. The medical patient is like the rats in the second cage. She is going home to a life where she is surrounded by the people she loves. The drug is the same, but the environment is different.

This gives us an insight that goes much deeper than the need to understand addicts. Professor Peter Cohen argues that human beings have a deep need to bond and form connections. It’s how we get our satisfaction. If we can’t connect with each other, we will connect with anything we can find — the whirr of a roulette wheel or the prick of a syringe. He says we should stop talking about ‘addiction’ altogether, and instead call it ‘bonding.’ A heroin addict has bonded with heroin because she couldn’t bond as fully with anything else.

So the opposite of addiction is not sobriety. It is human connection.

When I learned all this, I found it slowly persuading me, but I still couldn’t shake off a nagging doubt. Are these scientists saying chemical hooks make no difference? It was explained to me — you can become addicted to gambling, and nobody thinks you inject a pack of cards into your veins. You can have all the addiction, and none of the chemical hooks. I went to a Gamblers’ Anonymous meeting in Las Vegas (with the permission of everyone present, who knew I was there to observe) and they were as plainly addicted as the cocaine and heroin addicts I have known in my life. Yet there are no chemical hooks on a craps table.

But still, surely, I asked, there is some role for the chemicals? It turns out there is an experiment which gives us the answer to this in quite precise terms, which I learned about in Richard DeGrandpre’s book The Cult of Pharmacology.

Everyone agrees cigarette smoking is one of the most addictive processes around. The chemical hooks in tobacco come from a drug inside it called nicotine. So when nicotine patches were developed in the early 1990s, there was a huge surge of optimism — cigarette smokers could get all of their chemical hooks, without the other filthy (and deadly) effects of cigarette smoking. They would be freed.

But the Office of the Surgeon General has found that just 17.7 percent of cigarette smokers are able to stop using nicotine patches. That’s not nothing. If the chemicals drive 17.7 percent of addiction, as this shows, that’s still millions of lives ruined globally. But what it reveals again is that the story we have been taught about The Cause of Addiction lying with chemical hooks is, in fact, real, but only a minor part of a much bigger picture.

This has huge implications for the one-hundred-year-old war on drugs. This massive war — which, as I saw, kills people from the malls of Mexico to the streets of Liverpool — is based on the claim that we need to physically eradicate a whole array of chemicals because they hijack people’s brains and cause addiction. But if drugs aren’t the driver of addiction — if, in fact, it is disconnection that drives addiction — then this makes no sense.

Ironically, the war on drugs actually increases all those larger drivers of addiction. For example, I went to a prison in Arizona — ‘Tent City’ — where inmates are detained in tiny stone isolation cages (‘The Hole’) for weeks and weeks on end to punish them for drug use. It is as close to a human recreation of the cages that guaranteed deadly addiction in rats as I can imagine. And when those prisoners get out, they will be unemployable because of their criminal record — guaranteeing they with be cut off ever more. I watched this playing out in the human stories I met across the world.

There is an alternative. You can build a system that is designed to help drug addicts to reconnect with the world — and so leave behind their addictions.

This isn’t theoretical. It is happening. I have seen it. Nearly fifteen years ago, Portugal had one of the worst drug problems in Europe, with 1 percent of the population addicted to heroin. They had tried a drug war, and the problem just kept getting worse. So they decided to do something radically different. They resolved to decriminalize all drugs, and transfer all the money they used to spend on arresting and jailing drug addicts, and spend it instead on reconnecting them — to their own feelings, and to the wider society. The most crucial step is to get them secure housing, and subsidized jobs so they have a purpose in life, and something to get out of bed for. I watched as they are helped, in warm and welcoming clinics, to learn how to reconnect with their feelings, after years of trauma and stunning them into silence with drugs.

One example I learned about was a group of addicts who were given a loan to set up a removals firm. Suddenly, they were a group, all bonded to each other, and to the society, and responsible for each other’s care.

The results of all this are now in. An independent study by the British Journal of Criminology found that since total decriminalization, addiction has fallen, and injecting drug use is down by 50 percent. I’ll repeat that: injecting drug use is down by 50 percent. Decriminalization has been such a manifest success that very few people in Portugal want to go back to the old system. The main campaigner against the decriminalization back in 2000 was Joao Figueira, the country’s top drug cop. He offered all the dire warnings that we would expect from the Daily Mail or Fox News. But when we sat together in Lisbon, he told me that everything he predicted had not come to pass — and he now hopes the whole world will follow Portugal’s example.

This isn’t only relevant to the addicts I love. It is relevant to all of us, because it forces us to think differently about ourselves. Human beings are bonding animals. We need to connect and love. The wisest sentence of the twentieth century was E.M. Forster’s — “only connect.” But we have created an environment and a culture that cut us off from connection, or offer only the parody of it offered by the Internet. The rise of addiction is a symptom of a deeper sickness in the way we live — constantly directing our gaze towards the next shiny object we should buy, rather than the human beings all around us.

The writer George Monbiot has called this “the age of loneliness.” We have created human societies where it is easier for people to become cut off from all human connections than ever before. Bruce Alexander — the creator of Rat Park — told me that for too long, we have talked exclusively about individual recovery from addiction. We need now to talk about social recovery — how we all recover, together, from the sickness of isolation that is sinking on us like a thick fog.

But this new evidence isn’t just a challenge to us politically. It doesn’t just force us to change our minds. It forces us to change our hearts.

Loving an addict is really hard. When I looked at the addicts I love, it was always tempting to follow the tough love advice doled out by reality shows like Intervention — tell the addict to shape up, or cut them off. Their message is that an addict who won’t stop should be shunned. It’s the logic of the drug war, imported into our private lives. But in fact, I learned, that will only deepen their addiction — and you may lose them altogether. I came home determined to tie the addicts in my life closer to me than ever — to let them know I love them unconditionally, whether they stop, or whether they can’t.

When I returned from my long journey, I looked at my ex-boyfriend, in withdrawal, trembling on my spare bed, and I thought about him differently. For a century now, we have been singing war songs about addicts. It occurred to me as I wiped his brow, we should have been singing love songs to them all along.

The full story of Johann Hari’s journey — told through the stories of the people he met — can be read in Chasing The Scream: The First and Last Days of the War on Drugs, published by Bloomsbury. The book has been praised by everyone from Elton John to Glenn Greenwald to Naomi Klein. You can buy it at all good bookstores and read more at http://www.chasingthescream.com.

Johann Hari will be talking about his book at 7pm at Politics and Prose in Washington DC on the 29th of January, at lunchtime at the 92nd Street Y in New York City on the 30th January, and in the evening at Red Emma’s in Baltimore on the 4th February.

The full references and sources for all the information cited in this article can be found in the book’s extensive end-notes.


What make the Life Model (and Restarting) unique

August 5, 2011

Churches are typically made up of two groups of people: Those who say they are “just fine” and those who feel that they need help. Those who need help often feel that they don’t belong, that everyone else’s needs are being met—but not theirs–and that no one really cares about them. Often the people who are “just fine” are coaxed or goaded or guilted into helping the needy ones, which would be okay if it really helped, but it usually does not. Those one-sided relationships often become burdensome because the needy people feel that they never get enough and those who are “just fine” feel resentful and wonder why the needy ones can’t get it together.

The Life Model has answers for this age-old dilemma because it combines character development and healing.

About three years ago I had a intern who introduced me to the Life Model.  The life model came out of a ministry to street kids in Van Nuys California called Shepherds House. As the ministry grew the leaders began to  see Christian leaders who were struggling. They began to question why some people came to Christ and began to grow while others seem stuck and kept relapsing.  At one point they were seeing about a thousand people a month. They began to examine people on a case-by-case basis so as to identify what people need to thrive.  What they learned integrated well with groundbreaking work on the brain as well as infant and child development. They were informed by their Biblical worldview and their experience with healing prayer and over time came up with programs that helps our left brains understand while our right brains receives the non-verbal training it needs.

We are huge fans of Theophostic at Church of the Apostles, but what we have found is that Theophostic alone is not enough. It is healing, and comforting and you would think this would be enough, to connect with God and have him dispell the lies. But we find some people settle into their dysfunction. They are comforted into complacency.  Ed Smith the founder of TPM freely acknowledges that TPM exposes lies and renews the mind, marvelously– but it does not give us all that we need.  We also need community; we need to know what is our job, where we have deficits and what we need to recover.  If you never learned to tame your cravings as a child, TPM will help uncover the lies you believe that make taming those cravings so pernicious, but in the end you will have to abstain. You will need to follow the ancient spiritual practices of fasting if you want to tame them. If you never learned to do hard things (another childhood task) you have to start doing them.  If, like me, you fail to explain yourself to those who misunderstand you, you have to start doing it. Getting TPM helps me be at peace when I approach those who have misunderstood me but I still needed to force myself to go back to the person and explain, “I don’t think you understood my heart here.”  It is easy to think it is their job, after all we’re they the ones who impuned my motives? But the Life Model makes it clear that helping people understand me it is a childhood task, one someone in their fifties should not find so difficult. Sigh. TPM helps in so many ways: it is transforming to know you are loved and have value but it does not fix the whole problem.

The Life Model is not just for the people who we typically think of as being wounded. Everyone is missing something they should have gotten as children. Often we don’t know what we are missing.  What we experienced as children feels normal because that was our model, all we had.

When I first encountered the Life Model, I thought that I was doing rather well and I was compared to where I used to be. I had been running the Healing Center at Church of the Apostles for four years and I had processed much of my pain.  I no longer had frequent meltdowns. But I had never held my life up to any kind of ideal measuring stick. It is a little akin to growing up in Japan and thinking you are tall until you visit Sweden.  Or Sudan.

The Life Model provides just such a measuring stick.  It has evolved into a think tank where pastors, psychiatrists, social workers and teachers have come together to define where we should be–had life been perfect–and how we can get there, even though it wasn’t. Not that we will ever reach perfection but there is so much more maturing that we can do!  It is joyful, fulfilling to find our true hearts and begin to live out of that solid center.

Much of the early work was done by Jane Willard the wife of the late Dallas Willard, but there are other familiar names that are involved like Daniel Amen, famous for scanning tens of thousands of brains, and other not so well known names like Jim Wilder who mentors many of the Life Model players. Karl Lehman, Chris and Jen Coursey, and Ed and Maritza Khouri.

The life Model breaks life into stages: Infant, child, adult, parent and elder.  An infant should have his needs met without having to ask; a child learns to take care of himself. An adult learns to satisfy two people, at first a friend and later a mate.  A parent takes the whole family’s needs into account and an elder sees those who are at risk in the community and reaches out to them.  There are needs and tasks for each level. One of the biggest mistakes we make is when we try to become elders too soon. Parents need to raise their little ones; there will be plenty of time to save the world when their children are adults.

One of the hallmarks of the Life Model is the belief that we were created by God to live in joy, that joy should be our natural state. When I first heard this I gulped. I am pretty serious and I would not have characterized my normal state as one of joy.

Life is meant to be characterized by rhythms of joy and quiet. Knowing how to quiet yourself should have been learned in the arms of your mother but you can only download from her what she had to give. Do not worry, if you don’t have that skill! One of the first Life Model exercises is learning how to quiet yourself.

The Life Model also teaches that we are created as relational being, meant to attach to God and to a spiritual family. To thrive we need to live as if relationships are more important than anything else.

They also believe that we need more than teaching to heal. If understand principles were sufficient, the church in the west would be vibrant and whole. The western church has largely focused on the left brain, the part that is rational and logic, but apparent that is not enough. We need to train both the right and left hemispheres our brains so we can have healthy relationships much in the same way we train to learn to play a violin or speak Spanish. Reading about playing the violin is not going to make you even a mediocre performer.

On the Life Model website they write: “Contemporary Christianity has failure to achieve moral and character change. Beliefs do not change your character.”

Another belief is that someone can be gifted, even anointed and still not be mature.  It is like building a tall building. If the foundation is missing a few bricks it won’t matter at first, but as the building goes up (more responsibility), those missing bricks destabilize the entire structure.

Most people don’t recognize what they are missing.

Addictions come from a catastrophic failure to reach adult mature and mimic the ideal rhythms of joy and quiet.  Some drugs mimic quiet; other mimic joy but they are all counterfeits, taking the place of the joy and quiet that should come from within as we connect deeply to God and safe people. So the addict who uses something to calm himself is looking for quiet while the addict who uses to get high is looking for joy.

Another eye opening concept for me was the realization that we can miss out on infant maturity primarily because the adults who took care of us did not know what we needed, and yet we can still appear fairly mature.  The Life Model calls this pseudo-maturity and likens it to flying upside down:  The plane that is your life appears to be at the right elevation but if you look closely it is upside down. Ouch! We know how to do hard things, but don’t know how to receive or rest or be still before God.  Skills we should have mastered in infancy. In our culture, the pseudo-mature often rise to the top where they burn out or become addicted to something to get them through. Sadly you are only as mature as the lowest hole in your wall. So pseudo mature people are . . . infants.

The average American man is halfway through childhood maturity; the average woman is half way through adult maturity. No wonder our nation is in trouble!

Life Model program are solution based. That means you don’t just learn about principles, you also exercise your brain (play the violin) so your brain and body learn the skills it needs to connect to God and people.  You can grow and mature.

When I first heard about brain skills I thought, what?  I pictured people sitting in yoga position humming. But the exercises are as simple as inviting God to speak and listening to him. Being quiet with a group of people.  Practicing telling short stories about your life to other people, walking in sync with two other people, learning to recognize when someone is overwhelmed so you can give them room, evaluating your maturity using an easy checklist, recognizing your own attachment style and attachment pain. So much of what is learn is what healthy, socially-skilled adults learned in childhood, but we all have deficits so if I can’t return to joy from anger but someone else in my group can, I can connect with them and over time download what they have.

Because there are so many players involved in developing the Life Model there are many ways to experience it—lots of books, DVDs, online essays, conferences and at least three websites.  The original way people learned was by attending a one week conference in July. They have four levels and participants go every year for four years.  People rave about these conferences but they are expensive—nearly 1000 bucks for the conference registration with hotel bills and transportation on top of that and they are only held in two locations—Edmonton, Alberta, Canada and Peoria, Illinois.  I am not making this up!  And you had to go with a bonded pair—two sisters, a husband and wife, mother and son—someone with whom you have a permanent bond.

In 2007 one of the Life Model developers, Ed Khouri, decided to develop a program that could be done in groups so churches and recovery groups would have another way to learn the material and practice the brain skills as well as develop community.  He knew that most addicts have burned their bridges and did not have a family member who would be willing to spend a week–and a lot of money to bond more deeply with them. No, I don’t think so! Restarting was the first module in Ed Khouri’s program. In October, 2013 a prequel book, Joy Starts Here, was released. The program is comprised of five modules Restarting, Forming, Belonging, Healing and Loving; each runs 12 weeks. The first three modules are currently available the other two are still in development.

What kinds of things do you do in Restarting?

Every week you watch a DVD—between 25 and 45 minutes long, and then you have exercises you do in groups of three that are the equivalent of brain training. I have to admit that I was skeptical because so many groups talk about transforming lives so in 2009 I ran two test groups and saw the change before my eyes.  I don’t know that I understand it entirely but somehow you are giving each other what you should have gotten as children and infants which causes transformation.

Some of the topics you learn about in Restarting include:

Painful emotions

Healthy relationships

Toxic relationships

Trauma, hope and recovery

Leaving co-dependency behind

Attachment

Identity

Maturity

You learn to tell great stories from your life in two to three minutes, you learn to express appreciation, you learn to connect with God experientially, you learn to recognize when you are in attachment pain, you learn to build joy, so you increase capacity and at the end of the class you evaluate your maturity.

You DON”T spend a lot of time talking about your problems.  You DON’T spend time problem solving or trying to fix each other. You DON’T share painful details of your story (we teach you how to take the thorns out of your story).

You DO connect with God interactively and listen to him.  You DO learn how to better regulate your emotional pain and pleasure so your attachment to BEEPS does not run your life.

This one of my favorite Life Model stories from Jim Wilder’s book: A Complete Guide to Living with Men. This story shows what can happen, over time, when a group comes together and does the work.

Page. 284

Here is an example of a spiritual family and how it might work. A small church, comprised largely of cowboys and rodeo riders, asked me to do a men’s weekend. During that weekend we talked about the levels of maturity enough that all the men identified their own level. There were two elders, about three fathers, five adults and 20 boys and infants. By the end of the weekend the elders, fathers and adults decided (on their own) to help the boys and infants mature. Remember that when I say infants we are talking about men in their 20s, 30s, and even 60s.  Each of the children/infants checked off a list of the needs and task they had yet to complete to become adults. The group, under the direction of the elders, assigned men who were strong in those areas to guide the immature men through to adult maturity. One of the least mature men was Bob, the town drunk. The elders assigned three men to him. When I returned to that town a number of years later Bob was a sober father of two with a happy wife. There were three men glowing with pride in how Bob had grown. The entire group of men was heavily involved in summer and after-school programs for the community children—a sign of life to give.

Life Model websites

http://www.lifemodel.org/

http://www.joystartshere.com/

http://thrivingrecovery.org/    Ed Khouri

http://www.equippinghearts.com/  Ed and Maritza Khouri

http://www.thrivetoday.org/  Chris and Jen Coursey

http://www.kclehman.com/  Karl and Charlotte Lehman

Endorsements

The Life Model is the best model I have seen for bringing Christ to the center of counseling and restoring the disintegrating community fabric within Christian churches.

Dr. Dallas Willard
Speaker, Author, Professor of Philosophy USC
www.dwillard.org

 

The answer given in the Life Model is very real—a combination of healthy spirituality, intellectual insight, a need for community and friendship—all put together to help us become transformed.

Dr. Francis MacNutt
Founding Director, Christian Healing Ministries
www.christianhealingmin.org

My counseling practice has been revolutionized by what I have learned from Dr. Wilder and the Shepherd’s House team.  Utilizing the principles from your books and the Thriving: Recover Your Life materials, I have been able to give the parents of the children I work with simple, do-able activities to build bonds with their kids and make a difference.  I can also explain to the parents why they work, which gets them more on-board with doing them. 

The Life Model is more practical and applicable than any of the theories I learned in my master’s program or since.  It makes sense and it works.  I can apply the theory to what’s going on in my clients’ lives (not to mention my own) and provide simple, practical ways for them to make the changes that they need to make.  Thanks for making that possible!

 Dawn C. Bartels, M.A., L.M.H.C.
(Licensed Mental Health Counselor) Orlando, FL

To read more endorsements see: http://www.lifemodel.org/info.php?page=endorseLM