Speaker 1: Hi everyone. Quick announcement from me. This is a reissue
Speaker 1: of a wonderful episode we did about addiction, and I
Speaker 1: am rereleasing in honor of a friend of mine who
Speaker 1: is dealing with their own addictions at the moment, and
Speaker 1: I thought this would be a perfect time to rerelease it,
Speaker 1: and it's been on my mind and it was a
Speaker 1: wonderful talk. So I hope you enjoy and we'll be
Speaker 1: back with a new episode next week. You can't get
Speaker 1: addicted if you don't learn that the drug helps you
Speaker 1: do something. Welcome to the one you feed Throughout time,
Speaker 1: great tinkers have recognized the importance of the thoughts we have.
Speaker 1: Quotes like garbage in, garbage out, or you are what
Speaker 1: you think ring true. And yet for many of us,
Speaker 1: our thoughts don't strengthen or empower us. We tend toward negativity,
Speaker 1: self pity, jealousy, or fear. We see what we don't
Speaker 1: have instead of what we do. We think things that
Speaker 1: hold us back and dampen our spirit. But it's not
Speaker 1: just about thinking. Our actions matter. It takes conscious, consistent
Speaker 1: and creative effort to make a life worth living. This
Speaker 1: podcast is about how other people keep themselves moving in
Speaker 1: the right direction. How they feed their good wolf. Thanks
Speaker 1: for joining us. Our guest on this episode is Maya
Speaker 1: Salivits a neuroscience journalist and author who specializes in mental
Speaker 1: health coverage, with a particular focus on addiction, drug policy, neuroscience,
Speaker 1: and media criticism of reporting on these issues. Her new
Speaker 1: book is Unbroken Brain, Why Addiction is a learning disorder
Speaker 1: and why it matters. And here's the interview with Maya Salivates. Hi, Maya,
Speaker 1: welcome to the show. I'm excited to get you on.
Speaker 1: Your book is called Unbroken Brain, a revolutionary new way
Speaker 1: of understanding addiction, and listeners will know that addiction comes
Speaker 1: up from time to time on the show. I myself,
Speaker 1: I'm a former addict, so we will get into a
Speaker 1: lot of detail on that. But let's start like we
Speaker 1: always do with the parable. There's a grandfather who's talking
Speaker 1: with his grandson and he says, in life, there are
Speaker 1: two wolves inside of us that are always at battle.
Speaker 1: One is a good wolf, which represents things like kindness
Speaker 1: and bravery and love, and the other is a bad wolf,
Speaker 1: which represents things like greed and hatred and fear. And
Speaker 1: the grandson stops and he thinks about it for a second.
Speaker 1: He looks up at his grandfather and he said, well, grandfather,
Speaker 1: which one wins? And the grandfather says, the one you feed.
Speaker 1: So I'd like to start off by asking you what
Speaker 1: that parable means to you in your life and in
Speaker 1: the work that you do. I really like this parable
Speaker 1: because I feel that it is incredibly relevant for addiction.
Speaker 1: Addiction is a lot of repetitive behavior, and the more
Speaker 1: you repeat the behavior, the more likely you become to
Speaker 1: repeat the behavior because of the way human learning works.
Speaker 1: So that is a very true statement about the nature
Speaker 1: of what will happen if you continue to repeat the behavior. Yeah.
Speaker 1: I first heard it in some twelve step meeting somewhere,
Speaker 1: and it kind of knocked me on the head at
Speaker 1: that point because it was so clear to me that
Speaker 1: I don't even know that I had been feeding the
Speaker 1: bad wolf so much as the bad wolf had been
Speaker 1: eating me recently. But it just is a very straightforward
Speaker 1: to me, like, oh, if I take these sort of actions,
Speaker 1: then I'm going to have good things happen, and if
Speaker 1: I don't, then I'm going to continue to get more
Speaker 1: of what I've been getting. Yeah, I mean, obviously, like
Speaker 1: all of these things. It's it's oversimplified, but I think
Speaker 1: it's it's really important to realize that. Yeah, your brain
Speaker 1: becomes what it does, and the more you, you know, um,
Speaker 1: repeat an activity, the easier gets to do that activity,
Speaker 1: and then the more likely you become to repeat it. Now,
Speaker 1: this is great if that activity is exercise or being
Speaker 1: kind or you know that kind of thing, but it
Speaker 1: is not so great if it is harmful drug. You right, absolutely,
Speaker 1: So let's start with the core premise of the book.
Speaker 1: And I'm just going to quote you here. You say,
Speaker 1: addiction is a developmental disorder, a problem involving timing and learning,
Speaker 1: more similar to autism, a d h D, and dyslexia
Speaker 1: than it is to mumps or cancer. So talk to
Speaker 1: me about what you mean by that or developmental disorder. Sure. So,
Speaker 1: I mean, if you think about developmental disorders, they tend
Speaker 1: to have several things in common. Um. The first one
Speaker 1: is that they tend to affect like specific kinds of learning.
Speaker 1: So with autism, you have a problem with social learning,
Speaker 1: but you don't have a necessarily have a problem with
Speaker 1: other types of learning. With dyslexia, you may have a
Speaker 1: problem with reading, but not with other things, So it's
Speaker 1: about a specific thing. Um. It's also the case that
Speaker 1: if you have one of these conditions, they tend to
Speaker 1: start at a particular phase in life. So there are
Speaker 1: three important phases of brain development in human life, and
Speaker 1: the first one is prenatal, the second is zero to five,
Speaker 1: and then the third is like adolescence and young adulthood.
Speaker 1: All of these disabilities tend to start at specific time.
Speaker 1: So autism and a d h D start in early childhood,
Speaker 1: whereas you wouldn't see schizophrenia out or addiction generally until
Speaker 1: adolescents or early adulthood. So that gives us a clue
Speaker 1: as to kind of what's going on in the brain
Speaker 1: in relation to these things. And the other thing I
Speaker 1: mean when I talk about addiction as a developmental disorder
Speaker 1: is that learning is critical to addiction. You can't get
Speaker 1: addicted if you don't learn that the drug helps you
Speaker 1: do something, because, for one, you wouldn't know what to crave,
Speaker 1: so it would be kind of hard to buy it,
Speaker 1: right um and um. Secondly, if it doesn't give you
Speaker 1: comfort or pleasure or some sort of relief, you're unlikely
Speaker 1: to be repeating it exactly. And so you talk about
Speaker 1: this being a learning disorder, and the way that we
Speaker 1: tend to think of addiction is it's either thought of
Speaker 1: as a disease, which is a it's probably the more
Speaker 1: common paradigm this day, an age or a moral failing,
Speaker 1: and both those things are confusing. And I agree with
Speaker 1: a lot of what you say about that, and we'll
Speaker 1: get into that in a minute, But talk about the
Speaker 1: implications if addiction is a learning disorder and not either
Speaker 1: a disease or a moral failing. Well, let me speak
Speaker 1: to the disease thing first. In the United States and worldwide,
Speaker 1: because of our influence, Um, this disease idea has really
Speaker 1: taken off. I don't mind if you call a learning
Speaker 1: disorder a disease, but the way we've seen addiction as
Speaker 1: a disease has been deeply problematic because basically, we argue
Speaker 1: in public that addiction is a disease. Meanwhile we criminalize
Speaker 1: people with it. We also argue in public that addiction
Speaker 1: is a disease and the treatment is meeting confession and prayer,
Speaker 1: which isn't how we treat any disease or learning disorder. So, UM,
Speaker 1: what has happened is that the dominance of the twelve
Speaker 1: step paradigm for addiction has meant that we end up
Speaker 1: trying to argue that addiction is a disease while treating
Speaker 1: it as a moral failing. And this mixed up mush
Speaker 1: of things UM really kind of makes the disease idea
Speaker 1: problematic when it wouldn't have otherwise been. So there's that now.
Speaker 1: The moral failing business is just you know, I mean,
Speaker 1: when you see people with addiction desperately trying to stop
Speaker 1: and then relapsing over and over, it's kind of hard
Speaker 1: to think that they're choosing to lose everything and to
Speaker 1: you know, be in these dire straight because they're having
Speaker 1: so much fun. Anybody who sees addiction knows that this
Speaker 1: is not driven by everything so fun. So I'm going
Speaker 1: to give up all the rest of the good things
Speaker 1: in my life, Like that's just isn't what happens, So,
Speaker 1: you know, So that point of view UM is outdated
Speaker 1: and not especially useful. So I see the learning disorder
Speaker 1: idea as kind of a way to really get at
Speaker 1: the complexity of addiction, which is that, like, it's not
Speaker 1: about you being a total zombie and having no control
Speaker 1: over your behavior the way some of the extreme disease
Speaker 1: models present it, but it's also not about you know,
Speaker 1: freely choosing um with ultimate freedom the way some of
Speaker 1: the moral models pres in it. What happens when you
Speaker 1: learn a habit is that it changes the way you
Speaker 1: react to things. And when you learn in the way
Speaker 1: that addiction is learned, what it basically does is reset
Speaker 1: your priorities, just the way when you learn to fall
Speaker 1: in love, which is another learning process. Interestingly, when you
Speaker 1: learn that, it shifts your priorities, and that means that
Speaker 1: you will make very different decisions, like if I get
Speaker 1: a new boyfriend or something, I might get interested in
Speaker 1: something I'm completely uninterested in normally, right. I think that
Speaker 1: when we bring learning into it, we understand the way
Speaker 1: addiction really is and the way it really appears, as
Speaker 1: opposed to the sort of idealized pictures of sin or disease.
Speaker 1: And I'm saying disease as in the disease models that
Speaker 1: we are stuck with, not the idealistic medical disease models
Speaker 1: that you might have in the absence of the history
Speaker 1: of the twelve seven thing. Yea, let's explore that a
Speaker 1: little bit further, because the learning piece makes sense to me.
Speaker 1: I think we're gonna need to go into a little
Speaker 1: bit more what you mean by that, but let's start
Speaker 1: with the statement you just made about you learn to
Speaker 1: fall in love or you learn to be addicted, which
Speaker 1: the second one I understand. And at the same time,
Speaker 1: my reaction to alcohol and drugs was very prominent from
Speaker 1: the get go, right the minute I tried it. There
Speaker 1: was a very strong reaction there. And so help me
Speaker 1: the first site, Yeah exactly, Yeah, So I mean, so
Speaker 1: it's it's the thing is that, like, um, there are
Speaker 1: a lot of people who take let's say, an opiate
Speaker 1: and it's like, oh my god, this is the best
Speaker 1: thing ever, this is totally amazing. Oh I love this.
Speaker 1: You know what, I don't want to ruin my life.
Speaker 1: I am never going to do this again. That is
Speaker 1: actually the most common reaction to taking a substance that
Speaker 1: is ultimately blissful. That's a healthy reaction to it. So
Speaker 1: the thing with people with addiction is that you're not
Speaker 1: addicted at the moment that you have that you sort respond.
Speaker 1: You only become addicted after you continue to repeat it
Speaker 1: despite negative consequences. So while you can sort of put
Speaker 1: the start of your addiction at that kind of love
Speaker 1: it first site moment, the actual process needs to have
Speaker 1: up and before you are actually addicted. Does that make
Speaker 1: any sense? I agree? I think what I was driving
Speaker 1: at was something that you explore in the book. Also,
Speaker 1: which is that these substances are often used as a
Speaker 1: coping mechanism, and so the addiction may begin, the process
Speaker 1: of becoming addicted to that substance may begin when you
Speaker 1: try that substance, but for lack of a better word,
Speaker 1: the seeds of that addiction have very likely or very
Speaker 1: possibly been planted before that. Oh absolutely, And and you know,
Speaker 1: I mean, given that the vast majority of people who
Speaker 1: take even the most addictive drugs do not become addicted,
Speaker 1: we have to look at what's going on with that
Speaker 1: person beforehand. You know, if your life's already messed up
Speaker 1: and you get this blissful experience, you are far more
Speaker 1: likely to say, yeah, I want to give up what
Speaker 1: I have because what I have is horrible for you know,
Speaker 1: and this is, you know, this is something that seems better. Also, like,
Speaker 1: especially if you have any kind of you know, social anxiety,
Speaker 1: drugs seem to solve them a variety of ways. One
Speaker 1: is that they are tend to be taken in social settings,
Speaker 1: and other drug users tend to welcome you as long
Speaker 1: as you use drugs, which is unlike most social settings, right,
Speaker 1: And so there's that bit that makes it easier. There's
Speaker 1: also just the pharmacology, so that if you're a person
Speaker 1: who is very anxious, like alcohol or opioids might take
Speaker 1: the edge off. And if you're a person who's kind
Speaker 1: of understimulated or depressed, like a stimulant might you know,
Speaker 1: really make you engaged in things. And so when you
Speaker 1: see that you can use these substances to control the
Speaker 1: way you respond to the world. If you're just regulated,
Speaker 1: they're going to be way more attractive. Is that the
Speaker 1: developmental part of this? Yeah, you know, we all start
Speaker 1: out with some kind of initial temperament. You know, we
Speaker 1: might be shy or bold or um, you know, over
Speaker 1: sensitive to stimuli or under sensitive to stimuli. All of
Speaker 1: this stuff genetics is going to give us. And then
Speaker 1: we have the environment where you know, you may get
Speaker 1: tons of love and support, um, you might not. You
Speaker 1: might have some predispositions that are really extreme um that
Speaker 1: you know, may lead to mental illness and in certain situations,
Speaker 1: and those things are all kind of percolating during your development,
Speaker 1: and you know, if you let's say, like you know,
Speaker 1: in my case, I felt really different from other kids
Speaker 1: from very early on because I was extremely oversensitive and
Speaker 1: also like I was reading very early and got like
Speaker 1: labeled gifted, and so I just my interests were completely
Speaker 1: different to the interests of other kids. Basically, so I
Speaker 1: just sort of got absorbed in ideas. And that would
Speaker 1: have been fine if I hadn't been decided that I
Speaker 1: was a bad person because I couldn't really connect with people.
Speaker 1: So that sort of internal decision of seeing myself as
Speaker 1: bad led to a cascade of things that ultimately sort
Speaker 1: of led to depression and probably then led to addiction.
Speaker 1: And so the developmental pieces is sort of how all
Speaker 1: of these things interact over time in this kind kind
Speaker 1: of viraling fashion um that creates the complexity of the
Speaker 1: conditions we end up seeing in people. Yeah, you say
Speaker 1: that the role of learning and development addiction means that cultural, social,
Speaker 1: and psychological factors are inextricably woven into its biological fabric.
Speaker 1: And I really like that because I've always thought that
Speaker 1: the disease model of alcoholism or addiction was particularly when
Speaker 1: you treat it as you mentioned, via moral mechanisms, it
Speaker 1: didn't make any sense, and that this felt like the
Speaker 1: word I would have used as a syndrome than a
Speaker 1: disease or a thing. It's this complex bringing together of
Speaker 1: all these different factors that happened to equal addiction. Yeah,
Speaker 1: and I mean I think you know, the same is
Speaker 1: true of really all developmental disorders and all um psychiatric problems,
Speaker 1: because all psychiatric problems are nor nor developmental disorders. Like
Speaker 1: you don't suddenly appear fully fledged um person with schie
Speaker 1: mania without the developmental history that gets you there. Like
Speaker 1: it's not like even though the symptoms might suddenly appear
Speaker 1: in your twenties, it's not like your brain hasn't been
Speaker 1: going down that path for a long way. And so
Speaker 1: people have historically left development out because it is so
Speaker 1: complex and individual. Um. But you know, reductionism can sort
Speaker 1: of only get us so far. It's great to you know,
Speaker 1: like say, okay, look, we can get this threat to
Speaker 1: press the lever and it will take a ton of coke. Well, yeah,
Speaker 1: you would press the lever to take a ton of
Speaker 1: cooke if you had nothing else to do. Um. Also,
Speaker 1: so you know, so it's it's like we have to
Speaker 1: bring in you know, we've got to start with the
Speaker 1: reduction of stuff, but then we've got to bring in
Speaker 1: all these other pieces like genes, like culture, like timing,
Speaker 1: and then see, you know how this changes things. And
Speaker 1: you know a lot of neuroscience and and you know
Speaker 1: psychiatry is now heading in this direction and trying to
Speaker 1: you know, now that there is big data and you
Speaker 1: can calculate these things with so many variables, we're being
Speaker 1: able to bring this stuff in and look at it
Speaker 1: more scientifically than you know we could in the past.
Speaker 1: One of the implications of this, and I don't want
Speaker 1: to spend a lot of time on it because we
Speaker 1: already covered it in an episode with Johan Harry's his
Speaker 1: book Chasing the Scream, but one of the big implications
Speaker 1: of this is drug exposure alone doesn't cause addictions. So
Speaker 1: the drug itself is not the problem here, and our
Speaker 1: efforts to get rid of all the drugs is really
Speaker 1: a misguided and feudal attempt. And we may talk a
Speaker 1: little bit about why punishing addicts doesn't work later, but
Speaker 1: I did want to just reference that for listeners if
Speaker 1: you're interested in that sort of thing. Maya's book definitely
Speaker 1: talks about it in our interview with Johan Harry does
Speaker 1: also I'm gonna stay a little bit away from the
Speaker 1: policy implications of that and focus more on the personal implications,
Speaker 1: but I did want to make sure we got that
Speaker 1: in there, because that's a big part of what you
Speaker 1: talk about. Yeah, I think you know, on basically, if
Speaker 1: addiction is compulsive behaviors that occurs despite negative consequences, and
Speaker 1: we've spent the last hundred years of policy trying to
Speaker 1: fix it with negative consequences. It's pretty ridiculous. And you know,
Speaker 1: in the book, I talk about how, um, you know,
Speaker 1: the kind of like trying to stomp out O c
Speaker 1: D handwashing by like banning soap. Now, you can have
Speaker 1: a harm reduction effect sometimes if you like ban a
Speaker 1: particularly harsh soap, right, but you're not dealing with the
Speaker 1: underlying problem. Um. But our supply side efforts have basically
Speaker 1: done the opposite. So we push people from you know,
Speaker 1: pharmaceutical drugs which are certainly dangerous but at least you
Speaker 1: know the purity and the dose to sentinel where you know,
Speaker 1: we're just getting so many depths. Yep. We could probably
Speaker 1: spend two episodes on the failure of American drug policy
Speaker 1: and all the ways that it's misguided. But again we'll
Speaker 1: save that for different telling. But I do want to
Speaker 1: talk about that idea though, that this is a learning
Speaker 1: disorder that is characterized by a resistance to pun smith.
Speaker 1: Let's talk about that, because this idea of having to
Speaker 1: hit bottom is very prevalent, and I'll have to say,
Speaker 1: like I still there's a part of me that feels, well,
Speaker 1: I have an interesting experience with this, So let's let
Speaker 1: me have you talk about that first. Sure, the problem
Speaker 1: with the idea of bottom is that it can only
Speaker 1: be defined retrospectively. So let's say I'm a person in
Speaker 1: recovery and I'm happily in recovery for several years. I
Speaker 1: believe that the thing that preceded my recovery was my bottom.
Speaker 1: Now I relapse, Suddenly I have a new bottom. Now
Speaker 1: I relapse again, suddenly have a new bottom. I don't
Speaker 1: know what my bottom is till I'm dead, really right, Um,
Speaker 1: So it's a useless concept scientifically. It's also a really
Speaker 1: moralistic concept because it it kind of means that you
Speaker 1: have to hit this point of extreme degradation before you
Speaker 1: can stop, and that is just not with the research.
Speaker 1: So if you just ask yourself this question, who's more
Speaker 1: likely to recover a doctor with a thriving practice who
Speaker 1: has just gotten into trouble or a homeless stuff and
Speaker 1: quite obviously the doctor, right, yes, yes it is. We
Speaker 1: know this instinctively that like, if you have more resources,
Speaker 1: you are going to be more likely to recover, just
Speaker 1: for obvious reasons. But the whole idea of hitting bottom
Speaker 1: tells us to take resources away from people and to
Speaker 1: try to continue to inflict negative consequences until there comes
Speaker 1: some point when this thing that is defined by not
Speaker 1: responding to punishment suddenly decides to respond to countliments. The
Speaker 1: first time I got sober, it came as a result
Speaker 1: of some pretty serious negative consequences pending, as did your
Speaker 1: Sobriety also at least seem to be motivated initially I
Speaker 1: some negative consequence. So I while I recognize the idea
Speaker 1: that having to hit a bottom is a fallacious concept,
Speaker 1: because I actually got sober again many years later after
Speaker 1: I had a relapse, and I didn't hit any sort
Speaker 1: of bottom and got sober, So I don't totally believe
Speaker 1: in the concept, but I'm curious about what, then, do
Speaker 1: you believe is the motivation that turns people towards recovery
Speaker 1: if it's not avoidance of negative consequences. I think this,
Speaker 1: you know, like if people continue using despite losing your families,
Speaker 1: losing their homes, losing their jobs, losing their loved one,
Speaker 1: you know, practically losing their lives many times, you know,
Speaker 1: this is a very inefficient way of spurring recovery, right,
Speaker 1: and it is quite likely to end up spurring death
Speaker 1: instead of recovery. So you're saying it can work in
Speaker 1: some cases, but it's a pretty bad way to make
Speaker 1: it happen. Well, yeah, And I mean, what do you
Speaker 1: mean by work? Like? I mean, for me, I got arrested,
Speaker 1: and it's leasing a horrendous sentence because, um, it was
Speaker 1: New York in the eighties, and I had a lot
Speaker 1: of cocaine and we had the Rockefeller a lot. I
Speaker 1: kept using for another two years after that, so, you know,
Speaker 1: and my life was constantly getting worse during that time.
Speaker 1: I was using during the peak of the AID depidemic
Speaker 1: in New York City, when fifty percent of people were
Speaker 1: infected IVY drug users, Like what I think happened? Um,
Speaker 1: you know, certainly I was, you know, cognitively terrified and
Speaker 1: aware of the potential consequences, but I kept using because
Speaker 1: I felt like I just couldn't survive any other way.
Speaker 1: I just couldn't see that I had other options. And
Speaker 1: I think recovery comes when you begin to be able
Speaker 1: to see the options. And and I'd like to use
Speaker 1: this analogy of like, let's imagine your prisoner in a
Speaker 1: cell and there's a rug on the floor, and you
Speaker 1: have no idea that like under that rug is like
Speaker 1: a trapdoor that you could just walk out. Right. If
Speaker 1: you don't know that that's there, you can't escape, But
Speaker 1: once you know that it's there, you can. And you
Speaker 1: can't make somebody sort of suddenly see the lot through
Speaker 1: negative consequences, like sometimes they do and sometimes they don't,
Speaker 1: And you can't make them suddenly see the light by
Speaker 1: like being loving and kind, because sometimes that helps and
Speaker 1: sometimes it doesn't. It is a very complicated process that's
Speaker 1: highly individual. I tend to prefer the loving, supportive, hopeful
Speaker 1: approach because a it does less harm and be it
Speaker 1: is more likely to work on something that doesn't respond
Speaker 1: to punishment generally. But you know, there is a mystery
Speaker 1: as to how human behavior change occurs, and it's not
Speaker 1: a simple thing, but I do think, you know, insight
Speaker 1: is sort of necessary but not sufficient. Yeah, it is
Speaker 1: a fascinating subject of why some people get sober and
Speaker 1: others don't. It has mystified me the whole time that
Speaker 1: I've been in recovery. I think it ultimately was at
Speaker 1: the bottom of the complete undoing of my belief in
Speaker 1: the spiritual type of God that often talked about, because
Speaker 1: I was like, well, that doesn't make any sense. It's
Speaker 1: it's just a mystery. And what you said there is
Speaker 1: interesting because I was pushed to go into treatment because
Speaker 1: of some seriously negative consequences. But you're right, it was
Speaker 1: the sudden appearance of hope that probably kept me going
Speaker 1: or got me interested in trying. So that is a
Speaker 1: different way to look at that situation. Yeah, I mean,
Speaker 1: you know, like I was writing something today about learned helplessness,
Speaker 1: which is basically this you know, part of of these
Speaker 1: for studying depression um. And you can create this basically
Speaker 1: in animals by doing horrible things to them like unpredictable,
Speaker 1: uncontrollable stress um. And basically when you do this, after
Speaker 1: a while, the animals have stopped struggling and says, the
Speaker 1: hell with it. And at that point, when you want
Speaker 1: to test an antidepressant, you basically see if it keeps
Speaker 1: the animal trying longer, right, and drugs that are effective
Speaker 1: at being antidepressants keeps the animal from giving up. Right.
Speaker 1: But once you get to that point of like learned helplessness,
Speaker 1: that's where a lot of people with addiction are kind
Speaker 1: of living. And without giving them hope, without giving them
Speaker 1: insight and a sense that they're worth it, it's very
Speaker 1: hard to get them to change. And it's going to
Speaker 1: be you know, I mean, I think we need to
Speaker 1: recognize the role of trauma here. Um, if you've been
Speaker 1: severely traumatized and drugs are the only thing that allows
Speaker 1: you some moment of peace, you are not going to
Speaker 1: give that up until you find some other way of managing.
Speaker 1: And so like a lot of how harm reduction works
Speaker 1: is by helping people learn other ways of managing before
Speaker 1: they give up the drugs when they're not yet ready
Speaker 1: to do so, so that when they do, they have
Speaker 1: a way of soothing themselves. Basically, and we recently had
Speaker 1: an episode where we talked about trauma and the role
Speaker 1: of trauma or you know, what's known as adverse childhood
Speaker 1: experiences on later life behavior, addiction being one, and we
Speaker 1: had we had gab or mate on who talks a
Speaker 1: lot about this. But I think what you just said
Speaker 1: there is really important, which is that a lot of
Speaker 1: people are using addiction, as we said earlier, as a
Speaker 1: coping mechanism. It's not seen as the problem by us
Speaker 1: in the beginning because it's actually a wonderful solution to
Speaker 1: an existing problem, at least for a period of time.
Speaker 1: And so I really think that's an important piece of this,
Speaker 1: which is how do you cope with life in the
Speaker 1: absence of a substance. A matter of fact, I think
Speaker 1: that's probably of what recovery seems to me to be about,
Speaker 1: is those coping mechanisms. Yeah, and I mean, you know,
Speaker 1: in the past, sort of under the disease models, the
Speaker 1: idea that people who are still actively learning or people
Speaker 1: who are still actively using could learn was like, oh, no,
Speaker 1: they're still actives. They don't learn anything, And that's just
Speaker 1: not the case. Um harm reduction programs has shown this
Speaker 1: over and over and over again. Like people do use
Speaker 1: see needles, people do use safe injection facilities, people do
Speaker 1: begin to learn ways of coping before and they quit.
Speaker 1: So it is simply not the case that active users
Speaker 1: can't learn and can't change and can't make improvements to
Speaker 1: their life. So, you know, it's it's kind of weird
Speaker 1: that we have this idea that, like we should just
Speaker 1: take everything away before we help people get stuff that's
Speaker 1: going to allow them to stay over. Yeah, harm reduction
Speaker 1: has just always seemed to me to be just an
Speaker 1: imminently common sense way to look at the problem. Like
Speaker 1: even you know, regardless of whether it's going to stop
Speaker 1: somebody or whether it's going to help somebody towards recovery,
Speaker 1: it just seems like, you know, harm reduction is just
Speaker 1: a good idea, but given our misguided policies, often we
Speaker 1: don't do that, although we see to be doing more
Speaker 1: of it these days. Well, and I think, like, you know,
Speaker 1: here again comes a problem that is unfortunately part of
Speaker 1: the UM twelve up ideology, which is this notion of enabling.
Speaker 1: And you know, it's the idea that like, unless you
Speaker 1: remove all the support from somebody with addiction, they won't change.
Speaker 1: And again we've see that that's not the case. But
Speaker 1: the biggest opposition to harm reduction has come from people
Speaker 1: who believe that you are enabling the person to inject
Speaker 1: or to do whatever it is that you don't want
Speaker 1: them to do by actually helping them stay alive. And
Speaker 1: I just find the moralism in those arguments to be
Speaker 1: really appalling because it's basically like, we think you're better
Speaker 1: off dead than addicted. Yeah, it is. It is pretty
Speaker 1: bad logic into somebody who thankfully escaped HIV and AIDS
Speaker 1: but did end up with hepatitis C. I am aware
Speaker 1: of that issue pretty intimately. No, And I mean it's
Speaker 1: it's like you know, and and hepsey, it's just much
Speaker 1: harder to prevent being able to change than HIV because
Speaker 1: it's just a much hardier virus unfortunately. Right. Another area
Speaker 1: that was very interesting to me that I'd like to
Speaker 1: talk about is this idea of there being two types
Speaker 1: of this. Probably in the right term, I just gonna
Speaker 1: use it mechanisms that different types of mechanisms that are
Speaker 1: happening in addiction. And you refer to it, or researcher
Speaker 1: referred to it as the pleasures of the hunt versus
Speaker 1: the pleasures of the feast, and then you also refer
Speaker 1: to it as liking versus wanting. Can you walk us
Speaker 1: through that, because I just thought that was fascinating. Sure, now,
Speaker 1: I mean I find this really interesting too, and I think, um,
Speaker 1: it can kind of teach us a lot about how
Speaker 1: we behave because so if you think about it, um,
Speaker 1: you know, pleasure isn't singular, um, Like, you have pleasures
Speaker 1: that are about desire and about um, you know, I
Speaker 1: mean sex is really the obvious one here, being excited
Speaker 1: and um, having desire is pleasurable. It can also be
Speaker 1: pleasurable to be satisfied. And that's so like the hunt
Speaker 1: would be the desire part, and the feast is where
Speaker 1: you are satisfied and satiated and comfortable. So wanting is
Speaker 1: like that desiring bit, and liking is like the satisfaction
Speaker 1: of that um. And you know, sort of these very
Speaker 1: primitive models of addiction where it's all dopamine dopamine dopamine
Speaker 1: never made that distinction and it didn't make any sense
Speaker 1: because if you constantly escalate wanting, it becomes severely non fun.
Speaker 1: I mean, who wants to live in a permanent state
Speaker 1: of unsatisfied desire? That's like hell, right, Um, you know
Speaker 1: you could permanently you can escalate contentment and satisfactional you want.
Speaker 1: You may not be very motivated to do anything, but
Speaker 1: you will be happy. Um. But if you constantly escalate
Speaker 1: desire without satisfaction, you know, that's like the rolling stones.
Speaker 1: It's not going to be good. So, you know, we
Speaker 1: do need to distinguish these between these things because they
Speaker 1: refer to different motivational states and they are you know,
Speaker 1: I mean, cocaine is sort of a classic example of
Speaker 1: a drug that escalates wanting rather than liking, and you
Speaker 1: can just be doing coke and doing coke and wanting
Speaker 1: and wanting and wanting, and you're never satisfied and it
Speaker 1: ultimately becomes very unpleasant for that reason. Opioids, on the
Speaker 1: other hand, are sort of more statiating drug and although
Speaker 1: they can escalate wanting as well. Um, but you know,
Speaker 1: it's like this is why it it's a lot easier
Speaker 1: to do maintenance with opioids than it is a stimulants,
Speaker 1: because if you have something that you can get to
Speaker 1: the satisfactory level of, it's a lot easier than if
Speaker 1: you have something that's constantly escalating desire, right, and things
Speaker 1: like methodone as as an example, methodone no orphine um,
Speaker 1: heroin itself possibly, Um yeah, Um, so yes, that's that
Speaker 1: is what I mean. And I think, like you know,
Speaker 1: when we understand that addiction is defined as compulsive behavior
Speaker 1: despite negative consequences, we can see that maintenance can be
Speaker 1: recovery because you might still be physically dependent on a
Speaker 1: maintenance drug, but you aren't having compulsive behavior despite negative consequences,
Speaker 1: so you are not in active addiction. That makes total
Speaker 1: sense for cocaine for people who have been down that road.
Speaker 1: You know, it is, as you describe, an escalating cycle
Speaker 1: of never being satisfied and chasing that satisfaction for long
Speaker 1: and awful periods of time, Whereas, as you said, with
Speaker 1: with heroin or other drugs, there is a satiation point
Speaker 1: where you're like, all right, I don't want anymore until
Speaker 1: you're no longer at that satiated point, right exactly. And
Speaker 1: so what's the role of wanting then? Is it just
Speaker 1: that as you come down from that, now you want
Speaker 1: again because you're not there, Yeah, exactly, And I mean
Speaker 1: this is again my main names work because if you
Speaker 1: just stay at a steady state level of the drug
Speaker 1: in your system, you don't escalate either wanting or liking
Speaker 1: you're just you know normal. What about alcohol? Where does
Speaker 1: alcohol fit in that? Alcohol is complicated because it's such
Speaker 1: a dirty drug in it it does um and I
Speaker 1: mean dirty in the sense of that it it activates
Speaker 1: multiple complex things as opposed to being very simply targeted
Speaker 1: to something. UM. So you know, initially, alcohol acts like
Speaker 1: a stimulant. It has this bi phasic effect, so first
Speaker 1: you feel kind of excited and up, and then you
Speaker 1: feel kind of tired and sedated. And a lot of
Speaker 1: people sort of make a mistake with drinking where they
Speaker 1: think like, oh, if I drink more, I'm going to
Speaker 1: get more of that excitement, but you actually get more
Speaker 1: than the sedation. So one way to learn about moderation
Speaker 1: is to realize this and to not drink more when
Speaker 1: you think you should. Um. But um anyway, Like, yeah,
Speaker 1: so alcohol is kind of both and that UM. I
Speaker 1: think that's one of the reasons why, you know, a
Speaker 1: drug like n altrek zone, which blocks opioids, is probably
Speaker 1: more useful in alcohol than it is an opioid, because
Speaker 1: with people with opioid addiction, they tend to be chasing
Speaker 1: a really strong opioid effect and completely preventing that completely
Speaker 1: preventing even your natural opioids from working may not be
Speaker 1: so good for some people. But with alcohol, where you're
Speaker 1: not blocking the direct thing and there's other things going on, um,
Speaker 1: it may be more manageable. And it may also, um,
Speaker 1: you know, help with moderation. Yeah. I think that's an
Speaker 1: interesting idea. I explored this with someone not too long
Speaker 1: ago about was an l truck zone a good idea?
Speaker 1: And the concern was, Yeah, it's blocking opioid receptors and
Speaker 1: this person is wrestling with depression to start with, So
Speaker 1: is this really the best approach? No, and that's a
Speaker 1: really bad idea. No, I think, I mean, you know,
Speaker 1: it's it's interesting because um, I think, um mail truck
Speaker 1: zone and vitral, which is a little long acting version
Speaker 1: of it. Um, I think they're very similar to antidepressants
Speaker 1: in that some people are going to work great for
Speaker 1: and actually make their mood better, and then other people
Speaker 1: are going to be a disaster for and make them
Speaker 1: kind of suicidal. Um. And you really need to figure
Speaker 1: out which group you fall into before you take something.
Speaker 1: And it's gonna last a month, right, um. And you
Speaker 1: should not be coerced into you know, taking me anything
Speaker 1: like this. The other thing that we really really need
Speaker 1: to know about uh mail truck zone is whether vitral
Speaker 1: actually increases overdose death risk during the month or two
Speaker 1: after you stop it, because it could potentially sensitize the receptors,
Speaker 1: and we really don't know this yet. Meanwhile, we do
Speaker 1: know that the other two drugs nothing down to briven
Speaker 1: orphin cut mortality by or more. And so you know, um,
Speaker 1: if I'm making a choice and they also don't block
Speaker 1: indogenous opiates, I'm going to tend to think that they
Speaker 1: should be the first choice. So let's now wade into
Speaker 1: the territory where the knives are going to come out
Speaker 1: from someone somewhere listening or who knows. But we're gonna
Speaker 1: we're gonna wade into the sensitive territory of twelve step
Speaker 1: programs and are they effective, are they useful, etcetera, etcetera.
Speaker 1: And so I'm going to just state a little bit
Speaker 1: of what you say in the book, and then you
Speaker 1: can agree or disagree, and then we can kind of
Speaker 1: go into the discussion. And sure you talk about how
Speaker 1: a you recovered from a twelve step or via twelve
Speaker 1: step program. So there's there's that piece and the fact
Speaker 1: that twelve step programs have been inserted into our national
Speaker 1: drug policy in a way that is very injurious. And
Speaker 1: I think that's a point that hopefully a lot of us, anybody,
Speaker 1: can agree on, which is that, you know, making twelve
Speaker 1: step programs the place where you just push everybody who's
Speaker 1: got any kind of problem against their will is probably
Speaker 1: not a great idea. So, with with that in mind,
Speaker 1: tell me what else you know, kind of your where
Speaker 1: you are with with the idea of twelve step programs today, um,
Speaker 1: in your life and in general? Yeah, um, I think
Speaker 1: that twelve step programs are absolutely wonderful self help for
Speaker 1: people who find them helpful, and the only way to
Speaker 1: find that out is to try it for yourself. Basically,
Speaker 1: some people are going to go and they're going to
Speaker 1: find a warm, welcoming community and feel as though they
Speaker 1: are part or something and they get the social supports
Speaker 1: that they need and it helps them, you know, remain
Speaker 1: sober and avoid relapse and and all that good stuff.
Speaker 1: Other people are going to go and say, this is moralistic,
Speaker 1: this is religious, this is spiritual. I don't like this.
Speaker 1: I don't feel comfortable here. Um, And it's it's just
Speaker 1: not their thing. You know, with any other condition, we
Speaker 1: would not accept of treatment being a program that involves
Speaker 1: taking moral inventory and turning your life and will over
Speaker 1: to a higher power. Like we would consider that alternative
Speaker 1: treatment at best, and we would definitely not mandate it
Speaker 1: for anybody. And the fact that we do mandate it
Speaker 1: for people, and we do have a large percentage of
Speaker 1: our treatment programs saying that you know, this is the
Speaker 1: only way to recover. It's an outrage. That doesn't mean
Speaker 1: the twelfth Step group as self help are bad. It
Speaker 1: just means that it should never have been married with medicine.
Speaker 1: And you know, A itself says that in the eighth
Speaker 1: tradition that, um, you know, we shouldn't be paid for
Speaker 1: doing twelve stepwork and teaching other people about the twelve Steps.
Speaker 1: Well that's exactly what goes on in at least of
Speaker 1: American treatment centers every day. And so a lot of
Speaker 1: you know a A old timers and and uh, you
Speaker 1: know an A people are like, yeah, like we should
Speaker 1: never have accepted this kind of weird marriage because you know,
Speaker 1: I'd like to use the analogy is like cancer treatment,
Speaker 1: like it may be that your faith is the only
Speaker 1: thing that allows you to like show up for all
Speaker 1: that horrible chemo, right, but you don't ask your faith
Speaker 1: based support group leader for what dose of chemo should
Speaker 1: be the best? Right, You ask your oncologist, is right,
Speaker 1: and you work with your doctors on the medical aspect,
Speaker 1: and you keep the faith stuff you know UM as
Speaker 1: the support you know. And this doesn't mean you can't
Speaker 1: be as religious and as believing and as spiritual as
Speaker 1: you like. It just means that, you know, modern medicine
Speaker 1: is different. And while we can have these things support
Speaker 1: and complement each other, when we try to mix them,
Speaker 1: it does not work very well. And the other problem
Speaker 1: on that occurs with just the top step UM ideology
Speaker 1: is that a kind of has been used to encourage
Speaker 1: this very insulting and demeaning form of treatment where you know,
Speaker 1: you get counselor saying you know, when is an attic line,
Speaker 1: when their lips are moving, you know, and where you
Speaker 1: get like all this like stuff aimed at forcing you
Speaker 1: to hit bottom and you know, sort of forcing you
Speaker 1: to feel like you're immoral and bad. And you know,
Speaker 1: for women and minority that can be really harmful. I'm
Speaker 1: sure it's harmful for some men. Too, but it's like
Speaker 1: especially harmful for groups that have historically been powerless. We
Speaker 1: don't need to be told that any or thank you
Speaker 1: very much, we need to be empowered. Yeah, for sure,
Speaker 1: I agree with with a lot of that. Talk to
Speaker 1: me about medicine though, and the role of medicine in
Speaker 1: a learning or developmental disorder or in a where we
Speaker 1: said earlier that most of what constitutes recovery is a
Speaker 1: means of coping with things, which is not exactly a
Speaker 1: is that a medical thing? How to cope with something?
Speaker 1: I mean again, like you know, this gets to our
Speaker 1: weird disciplinary boundaries. Um, I think that you know, I mean,
Speaker 1: is cognitive behavioral therapy simply teaching is good teaching therapy?
Speaker 1: Like right? To me? Like that ends up like being semantic, right,
Speaker 1: But if you know, I think the reality is that
Speaker 1: if we see people with addiction as students who need
Speaker 1: to learn better coping skills rather than sinners who need
Speaker 1: to be forced to repent um, we will have a
Speaker 1: much better power dynamic in our true eatment centers, right,
Speaker 1: and people will feel a lot better about themselves. And
Speaker 1: and you know, so I think you know, yes, a
Speaker 1: lot of what is needed for recovery is stuff that
Speaker 1: is needed for mental health in general. And given that
Speaker 1: most people with addiction either have trauma or mental illness
Speaker 1: or both, you need to figure out what the person
Speaker 1: is trying to cope with and what skills they lack
Speaker 1: and then help them find them. And and that's going
Speaker 1: to be a really different process for different individuals. I mean,
Speaker 1: like giving you know, a CEO job training and a
Speaker 1: g E. D. Is not very sensible. Some of the
Speaker 1: ones I've met might I mean, it might help, is
Speaker 1: all I'm saying. Well, right, okay, let's not current company
Speaker 1: that I might know at this time in my life. Not.
Speaker 1: I don't mean you guys, whoever you are is listening.
Speaker 1: I'm cheusing too, but like them at the point just
Speaker 1: more being if you you know, again, if you have
Speaker 1: like no education and no work history and no home,
Speaker 1: you're gonna need very different things. Then if your primary
Speaker 1: problem is like depression, and um, you know you've got
Speaker 1: a home, and you've got a husband, and you've got
Speaker 1: kids and you know all these other things, Um, it's
Speaker 1: really gonna depend you know, like giving depression treatment as
Speaker 1: the primary approach for addiction to somebody who's homeless, well,
Speaker 1: that situation is pretty darned depressing, right, it's unlikely to
Speaker 1: so you know, so you need to be sort of
Speaker 1: sensible and and you know, like biopsychosocial thing often gets
Speaker 1: tossed around, but if you actually recognize that and actually
Speaker 1: really enact that, then you will provide the appropriate things
Speaker 1: for people, um, you know, as needed. And I mean,
Speaker 1: I think this is why we often get this ridiculous
Speaker 1: thing where you know, oh, if you're going to go
Speaker 1: on method home, you must have counseling. Well, um, the
Speaker 1: data doesn't support this, and it's expensive. Why don't we
Speaker 1: just give counseling to the people who want counseling? You know, Um,
Speaker 1: it's just like it it seems it seems you know again,
Speaker 1: it's it's sort of this moralistic, controlling thing going on.
Speaker 1: And and once we understand that people with addiction are
Speaker 1: people like any other people, and they have the range
Speaker 1: of goodness and badness that everybody else has, um, you know,
Speaker 1: we can start you know, recognizing humanity, treating people just
Speaker 1: like people and figuring out, like, why are they behaving
Speaker 1: this way? It's not because drugs do something bizarre to you.
Speaker 1: It's because people figure out ways to like deal with
Speaker 1: what they have going on inside them, and we need
Speaker 1: to like help them rather than you know, keep trying
Speaker 1: to harm them. Yeah, and I think that's a great
Speaker 1: place to kind of wrap the conversation up. I think
Speaker 1: what you said there's is so important and I think that, Yeah,
Speaker 1: I couldn't agree more that treatment for these things needs
Speaker 1: to be it's a it's a cliche word, but holistic,
Speaker 1: right that. I've always thought that about depression too. It's like,
Speaker 1: my depression responds to a lot of different things, and
Speaker 1: I would say my addiction does too. It's it's a
Speaker 1: variety of factors I have to deal with for that
Speaker 1: to be effective. So being kind to each other is
Speaker 1: always a good message. So thank you so much for
Speaker 1: taking the time to come on. The book again is
Speaker 1: called Unbroken Brain, a revolutionary new way of understanding addiction,
Speaker 1: and I'm sure this is going to get some people
Speaker 1: stirred up, which is always good. So thank you so
Speaker 1: much for coming on. Thanks for having me. Okay, thanks Bye.