Speaker 1: You can't get addicted if you don't learn that the
Speaker 1: drug helps you do something. Welcome to the one you
Speaker 1: feed Throughout time. Great thinkers have recognized the importance of
Speaker 1: the thoughts we have, quotes like garbage in, garbage out,
Speaker 1: or you are what you think ring true, and yet
Speaker 1: for many of us, our thoughts don't strengthen or empower us.
Speaker 1: We tend toward negativity, self pity, jealousy, or fear. We
Speaker 1: see what we don't have instead of what we do.
Speaker 1: We think things that hold us back and dampen our spirit.
Speaker 1: But it's not just about thinking. Our actions matter. It
Speaker 1: takes conscious, consistent, and creative effort to make a life
Speaker 1: worth living. This podcast is about how other people keep
Speaker 1: themselves moving in the right direction, how they feed their
Speaker 1: good wolf m Thanks for joining us. Our guest on
Speaker 1: this episode is Maya Salivits, a neuroscience journalist and author
Speaker 1: who specializes in mental health coverage, with a particular focus
Speaker 1: on addiction, drug policy, neuroscience, and media criticism of reporting
Speaker 1: on these issues. Her new book is Unbroken Brain, Why
Speaker 1: Addiction is a learning disorder and Why It Matters. This
Speaker 1: episode sponsor is Casper Mattress Get fifty dollars toward any
Speaker 1: mattress purchase by visiting Casper dot com slash one you
Speaker 1: feed and using the promo code one you Feed at checkout.
Speaker 1: Terms and conditions apply. And here's the interview with Maya Salivates. Hi, Maya,
Speaker 1: welcome to the show. Thanks so much for having me.
Speaker 1: I'm excited to get you on. Your book is called
Speaker 1: Unbroken Brain, a revolutionary new way of understanding the action
Speaker 1: and listeners will know that addiction comes up from time
Speaker 1: to time on the show. I myself, I'm a former addict,
Speaker 1: So we will get into a lot of detail on that.
Speaker 1: But let's start like we always do with the parable.
Speaker 1: There's a grandfather who's talking with his grandson and he says,
Speaker 1: in life, there are two wolves inside of us that
Speaker 1: are always at battle. One is a good wolf, which
Speaker 1: represents things like kindness and bravery and love, and the
Speaker 1: other is a bad wolf, which represents things like greed
Speaker 1: and hatred and fear. And the grandson stops and he
Speaker 1: thinks about it for a second. He looks up at
Speaker 1: his grandfather and he said, well, grandfather, which one wins?
Speaker 1: And the grandfather says, the one you feed, So I'd
Speaker 1: like to start off by asking you what that parable
Speaker 1: means to you in your life and in the work
Speaker 1: that you do. I really like this parable because I
Speaker 1: feel that it is incredibly relevant for addiction. Addiction is
Speaker 1: a lot of repetitive behavior, and the more you repeat
Speaker 1: the behavior, the more likely you become to repeat the
Speaker 1: behavior because of the way human learning works. So that
Speaker 1: is a very true statement about the nature of what
Speaker 1: will happen if you continue to repeat the behavior. Yeah.
Speaker 1: I first heard it in some twelve step meetings 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: hind 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 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 in 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, right,
Speaker 1: um and um. Secondly, if it doesn't give you comfort
Speaker 1: or pleasure or some sort of relief, you're likely to
Speaker 1: be repeating it exactly. And so you talk about this
Speaker 1: being a learning disorder. And the way that we tend
Speaker 1: to think of addiction is it's either thought of as
Speaker 1: a disease, which is a it's probably more common paradigm
Speaker 1: this day an age or a moral failing, and both
Speaker 1: those things are confusing, and I agree with a lot
Speaker 1: of what you say about that, and we'll get into
Speaker 1: that in a minute. But talk about the implications if
Speaker 1: addiction is a learning disorder and not either a disease
Speaker 1: or a moral failing. Well, let me speak to the
Speaker 1: disease thing first. In the United States and worldwide because
Speaker 1: of our influence, um, this disease idea has really taken off.
Speaker 1: I don't mind if you call a learning disorder a disease,
Speaker 1: but the way we've seen addiction as a disease has
Speaker 1: been deeply problematic because basically, we argue in public that
Speaker 1: addiction is a disease. Meanwhile we criminalize people with it.
Speaker 1: We also argue in public that addiction is a disease
Speaker 1: and the treatment is meeting, confession and prayer, which isn't
Speaker 1: how we treat any disease or learning disorder. So UM,
Speaker 1: what has happened is that the dominance of the twelfth
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 motion
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
Speaker 1: now 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 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 presan 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. Yep, 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 youth 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 happen
Speaker 1: before you are actually addicted. Does that make any sense?
Speaker 1: I agree. I think what I was driving at was
Speaker 1: something that you explore in the book also, which is
Speaker 1: that these substances are often used as a coping mechanism,
Speaker 1: and so the addiction may begin, the process of becoming
Speaker 1: addicted to that substance may begin when you try that substance,
Speaker 1: But for lack of a better word, the seeds of
Speaker 1: that addiction have very likely or very possibly been planted
Speaker 1: before that. Oh absolutely, and and you know, I mean,
Speaker 1: given that the vast majority of people who take even
Speaker 1: the most addictive drugs do not become addicted, we have
Speaker 1: to look at what's going on with that person beforehand.
Speaker 1: You know, if your life's already messed up and you
Speaker 1: get this blissful experience, you are far more likely to say, yeah,
Speaker 1: I want to give up what I have because what
Speaker 1: I have is horrible for you know, and this is,
Speaker 1: you know, this is something that seems better. Also, like,
Speaker 1: especially if you have any kind of you know, social anxieties,
Speaker 1: drugs seem to solve them in a variety of ways.
Speaker 1: One is that they are tend to be taken in
Speaker 1: social settings, and other drug users tend to welcome you
Speaker 1: as long as you use drugs, which is unlike most
Speaker 1: social settings. And so there's that bit that makes it easier.
Speaker 1: There's also just the pharmacology, so that if you're a
Speaker 1: person who is very anxious, like alcohol or opioids might
Speaker 1: take the edge off. And if you're a person who's
Speaker 1: kind 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 gold 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: labels 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 of
Speaker 1: spiraling fashion um that creates the complexity of the conditions
Speaker 1: we end up seeing in people. Yeah, you say that
Speaker 1: the role of learning and development and action 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 happen 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 del nor developmental disorders.
Speaker 1: Like you don't suddenly appear fully fledged um person with
Speaker 1: schizophrenia 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.
Speaker 1: Well yeah, you would press the lever to take a
Speaker 1: ton of folk 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 also,
Speaker 1: I'm gonna stay a little bit away from the policy
Speaker 1: 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, basically, if addiction
Speaker 1: is compulsive behaviors that occurs to spite 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
Speaker 1: know in the book I talk about how, um, you know,
Speaker 1: it's 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 in the dose to sentinel where you know,
Speaker 1: we're just getting so many deaths. 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 from different telling. But I do want
Speaker 1: to talk about that idea though, that this is a
Speaker 1: learning disorder that is characterized by a resistance to punishment.
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, like,
Speaker 1: I still there's a part of me that feel, 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 this 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 is
Speaker 1: more likely to recover a doctor with a thriving practice
Speaker 1: who has just gotten into trouble or a homeless thought,
Speaker 1: and it's quite obviously the doctor, right, Yes, yes it is.
Speaker 1: We 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 punishments. 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 by
Speaker 1: some negative consequence. So I while I recognize the idea
Speaker 1: that having to hit the 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: I know, it's facing a horrendous sentence because, Um, it
Speaker 1: was New York in the eighties, and I had a
Speaker 1: lot of cocaine and we had the Rockefeller a lot.
Speaker 1: I kept using for another two years after that, so,
Speaker 1: you know, and my life was constantly getting worse during
Speaker 1: that time. I was using during the peak of the
Speaker 1: AID epidemic in New York City, when fifty percent of
Speaker 1: people were 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 light 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 that has often talked about,
Speaker 1: because I was like, well, that doesn't make any sense.
Speaker 1: It's it's just a mystery. And what you said there
Speaker 1: is interesting because I was pushed to go into treatment
Speaker 1: because of some seriously negative consequences. But you're right, it
Speaker 1: was the sudden appearance of hope that probably kept me
Speaker 1: going or got me interested in trying. So that is
Speaker 1: a different way to look at that situation. Yeah, I mean,
Speaker 1: you know, like I was writing something today about UM
Speaker 1: learned helplessness, which is basically this, you know, part of
Speaker 1: the use for studying depression UM. And you can create
Speaker 1: this basically in animals by doing horrible things to them
Speaker 1: like unpredictable, uncontrollable stress UM. And basically when you do this,
Speaker 1: after a while, the animals have stopped struggling and says
Speaker 1: the hell with it. And at that point, when you
Speaker 1: want to test an antidepressant, you basically, see if it
Speaker 1: keeps the animal trying longer, right, and drugs that are
Speaker 1: effective at being antidepressant 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 yep. And we recently
Speaker 1: had an episode where we talked about trauma and the
Speaker 1: role of trauma or you know, what's known as adverse
Speaker 1: childhood experiences on later life behavior a sction being one,
Speaker 1: and we had we had gab or mate on who
Speaker 1: talks a lot about this. But I think what you
Speaker 1: just said there is really important, which is that a
Speaker 1: lot of people are using addiction, as we said earlier,
Speaker 1: as a coping mechanism. It's not seen as the problem
Speaker 1: by us in the beginning because it's actually a wonderful
Speaker 1: solution to an existing problem, at least for a period
Speaker 1: of time. And so I really think that's an important
Speaker 1: piece of this, which is how do you cope with
Speaker 1: life in the absence of a substance. A matter of fact,
Speaker 1: I think that's probably of what recovery seems to me
Speaker 1: to be about, is those coping mechanisms. Yeah, And I mean,
Speaker 1: you know, in the past, sort of under the disease models,
Speaker 1: the idea that people who are still actively learning or
Speaker 1: people who are still actively using could learn was like, oh, no,
Speaker 1: they're still active, 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 stays 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 seem 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 umwel to bideology, 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 seen 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'm aware of
Speaker 1: that issue pretty intimately. No, And I mean it's it's like,
Speaker 1: you know, and and hep C. It's just much harder
Speaker 1: to prevent being needle to change than HIV because it's
Speaker 1: just a much hardier virus unfortunately. Right, Another area that
Speaker 1: was very interesting to me that I'd like to talk
Speaker 1: about is this idea of there being two types of
Speaker 1: this probably in the right term. I was just 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 research
Speaker 1: or referred to it as the pleasures of the hunt
Speaker 1: versus the pleasures of the feast, and then you also
Speaker 1: refer to it as liking versus wanting. Can you walk
Speaker 1: us 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 and um, having desire is pleasurable. It can also
Speaker 1: be pleasurable to be satisfied in that, So like the
Speaker 1: hunt would be the desire part, and the feast is
Speaker 1: where you are satisfied and satiated and comfortable. So wanting
Speaker 1: is like that desiring bit, and liking is like the
Speaker 1: satisfaction of that. UM. And you know, sort of these
Speaker 1: very primitive models of addiction where it's all dopamine dopamine
Speaker 1: dopamine never made that distinction, and it didn't make any
Speaker 1: sense because if you constantly escalate wanting, it becomes severely
Speaker 1: non fun. I mean, who wants to live in a
Speaker 1: permanent state of unsatisfied desire? That's like hell, right, Um,
Speaker 1: you know, you could permanently you can escalate contentment and
Speaker 1: satisfactional you want. You may not be very motivated to
Speaker 1: do anything, but you will be happy. Um, but if
Speaker 1: you constantly escalate desire without satisfaction, you know, that's like
Speaker 1: the Rolling Stones, It's not gonna be good. So, you know,
Speaker 1: we do need to distinguish these between these things because
Speaker 1: they 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 want to rather than liking, and
Speaker 1: you could just be doing coke and doing coke and
Speaker 1: wanting and wanting and wanting, and you're never satisfied and
Speaker 1: it ultimately becomes very unpleasant for that reason. Opioids, on
Speaker 1: the other hand, are sort of more statiating drug and
Speaker 1: although they can escalate wanting as well. Um, but you know,
Speaker 1: it's like, this is why there's a lot easier to
Speaker 1: do maintenance with opioids than it is a stimulants, because
Speaker 1: if you have something that you can get to the
Speaker 1: satisfactory level of, it's a lot easier than if you
Speaker 1: have something that's constantly escalating desire, right, and things like
Speaker 1: methodone as as an example, methodone no orphine, um heroin
Speaker 1: itself possibly, Um yeah, um, so yes, that's that is
Speaker 1: what I mean. And I think, like you know, when
Speaker 1: we understand that addiction is defined as compulsive behavior despite
Speaker 1: negative consequences, we can see that maintenance can be recovery
Speaker 1: because you might so physically dependent on a maintenance drug,
Speaker 1: but you aren't having compulsive behavior bite negative consequences, so
Speaker 1: you are not in active addiction. That makes total sense
Speaker 1: 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 effects of 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 an altruck 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 altruck zone a good idea? And
Speaker 1: the concern was, Yeah, it's blocking opioid receptors and this
Speaker 1: person is wrestling with depression to start with. So is
Speaker 1: this really the best approach? No, and that's a really
Speaker 1: bad idea. No, I think, I mean, you know, it's
Speaker 1: it's interesting because um, I think um mail trek Zone
Speaker 1: and Vitral which is a little long acting version of it, UM,
Speaker 1: I think they're very similar to antidepressants in that some
Speaker 1: people are going to work great for and actually make
Speaker 1: their mood better, and then other people are going to
Speaker 1: be a disaster for and make them kind of suicidal. Um.
Speaker 1: And you really need to figure out which group you
Speaker 1: fall into before you take something. And it's gonna last
Speaker 1: a month, right, um, And you should not be coerced into,
Speaker 1: you know, taking anything like this. The other thing that
Speaker 1: we really really need to know about uh mail trek
Speaker 1: zone is whether vitral actually increases overdose death risks during
Speaker 1: the month or two after you stop it, because it
Speaker 1: could potentially sensitize. It's the receptors, and we really don't
Speaker 1: know this yet. Meanwhile, we do know that the other
Speaker 1: two drugs nothing down a bun orphin cut mortality by
Speaker 1: or more. And so you know, um, if I'm making
Speaker 1: a choice and they also don't block indogenous opiates, I'm
Speaker 1: going to tend to think that they should be the
Speaker 1: first choice. So let's now wade into the territory where
Speaker 1: the knives are going to come out from someone somewhere
Speaker 1: listening or who knows. But we're gonna we're gonna wade
Speaker 1: into the sensitive territory of twelve step programs and are
Speaker 1: they effective, are they useful? Etcetera, etcetera. And so I'm
Speaker 1: going to just state a little bit of what you
Speaker 1: say in the book, and then you can agree or disagree,
Speaker 1: and then we can kind of go into the discussion.
Speaker 1: And sure you talk about how a you recovered from
Speaker 1: a twelve step or via a twelve step program. So
Speaker 1: there is there's that piece, and the fact that twelve
Speaker 1: step programs have been inserted into our national drug policy
Speaker 1: in a way that is very injurious. And I think
Speaker 1: 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 of something and they get the social supports
Speaker 1: that they need and it helps them, you know, remains
Speaker 1: sober and of void 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 twelve 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: traditions that, um, you know, we shouldn't be paid for
Speaker 1: doing twelve step work and teaching other people about the
Speaker 1: twelve steps. Well, that's exactly what goes on in at
Speaker 1: least of American treatment centers every day. And so a
Speaker 1: lot of you know a A old timers and and uh,
Speaker 1: you know an A people are like, yeah, like, we
Speaker 1: should never have accepted this kind of weird marriage because
Speaker 1: you know, and I'd like to use the analogy is
Speaker 1: like cancer treatment. Like it may be that your faith
Speaker 1: is the only thing that allows you to like show
Speaker 1: up for all that horrible chemo, right, but you don't
Speaker 1: ask your faith based support group leader for what dose
Speaker 1: of chemo should be the best? Right, you ask your oncologists, 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 and this doesn't mean you
Speaker 1: can't be as religious and as believing and as spiritual
Speaker 1: as you like. It just means that, you know, modern
Speaker 1: medicine is different. And while we can have these things
Speaker 1: support 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 TOLP 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 addict
Speaker 1: lyne when their lips are moving, you know, and where
Speaker 1: you get like all this like stuff aimed at forcing
Speaker 1: you to hit bottom and you know, sort of forcing
Speaker 1: you 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 anymore, thank you very much.
Speaker 1: We need to be empowered. Yeah, for sure, I agree
Speaker 1: with with a lot of that. Talk to me about
Speaker 1: medicine though, and the role of medicine in a learning
Speaker 1: or developmental disorder or in a where we said earlier
Speaker 1: that most of what constitutes recovery is a means of
Speaker 1: coping with things, which is not exactly a is that
Speaker 1: a medical thing? How to cope with something? I mean again,
Speaker 1: like you know, this gets to our weird disciplinary boundaries. Um,
Speaker 1: I think that you know, I mean, is cognitive behavioral
Speaker 1: therapy simply teaching is good teaching therapy? Like? Right? To me?
Speaker 1: Like that ends up like being semantic, right, But if
Speaker 1: you know, I think the reality is that if we
Speaker 1: see people with addictions as students who need to learn
Speaker 1: better coping skills rather than sinners who need to be
Speaker 1: forced to repent um, we will have a much better
Speaker 1: power dynamic in our treatment centers, right, and people will
Speaker 1: feel a lot better about themselves. And and you know,
Speaker 1: so I think you know, yes, a lot of what
Speaker 1: is needed for recovery is stuff that is needed for
Speaker 1: mental health in general. And given that most people with
Speaker 1: addiction either have trauma or mental illness or both. You
Speaker 1: need to figure out what the person is trying to
Speaker 1: cope with and what skills they lack and then help
Speaker 1: them find them. And and that's going to be a
Speaker 1: really different process for different individuals. I mean, like giving
Speaker 1: you know, a CEO job training and a g E. D.
Speaker 1: Is not very sensible. Some of the ones I've met
Speaker 1: might I mean, it might help, is all I'm saying. Well, right, okay,
Speaker 1: let's know what the current company that I might know
Speaker 1: at this time in my life not. I don't mean
Speaker 1: you guys, whoever you are is listening. I'm choosing too,
Speaker 1: but like them at the point just more being if
Speaker 1: you you know, again, if you have like no education
Speaker 1: and no work history and no home, you're gonna need
Speaker 1: very different things. Then if your primary problem is like depression,
Speaker 1: and um, you know you've got a home, and you've
Speaker 1: got a husband, and you've got kids and you know
Speaker 1: all these other things, Um, it's really gonna depend you know,
Speaker 1: like giving depression treatment as the primary approach for addiction
Speaker 1: to somebody who's homeless, Well, that situation is pretty darned depressing, right,
Speaker 1: It's unlikely to so you know, so you need to
Speaker 1: be sort of sensible and and you know, like biopsychosocial
Speaker 1: thing often gets tossed around, But if you actually recognize
Speaker 1: that and actually really enact that, then you will provide
Speaker 1: the appropriate things for people, um, you know, as needed.
Speaker 1: And I mean, I think this is why we often
Speaker 1: get this ridiculous thing where you know, oh, if you're
Speaker 1: going to go on method home, you must have counseling. Well, um,
Speaker 1: the data doesn't support this, and it's expensive. Why don't
Speaker 1: we just give counseling to the people who want counseling?
Speaker 1: You know. Um, it's just like it seems, it seems
Speaker 1: you know again, it's it's sort of this moralistic, controlling
Speaker 1: thing going on. And and once we understand that people
Speaker 1: with addiction are people like any other people, and they
Speaker 1: have the range of goodness and badness that everybody else has. Um,
Speaker 1: you know, we can start you know, recognizing humanity, treating
Speaker 1: people just like people, and figuring out, like, why are
Speaker 1: they behaving this way. It's not because drugs do something
Speaker 1: bizarre to you. It's because people figure out ways to
Speaker 1: like deal with what they have going on inside them,
Speaker 1: and we need to like help them rather than you know,
Speaker 1: keep trying to harm them. Yeah, And I think that's
Speaker 1: a great place to kind of wrap the conversation up.
Speaker 1: I think what you said there's is so important and
Speaker 1: I think that I couldn't agree more that treatment for
Speaker 1: these things needs to be it's a it's a cliche,
Speaker 1: were but holistic right that. I've always thought that about
Speaker 1: depression too. It's like my depression responds to a lot
Speaker 1: of different things, and I would say my addiction does too.
Speaker 1: It's it's a variety of factors I have to deal
Speaker 1: with for that to be effective. So being kind to
Speaker 1: each other as always a good message. So thank you
Speaker 1: so much for taking the time to come on. The
Speaker 1: book again is called Unbroken Brain, a revolutionary new way
Speaker 1: of understanding addiction. And I'm sure this is going to
Speaker 1: get some people stirred up, which is always good. So
Speaker 1: thank you so much for coming on. Thanks for having me. Okay,
Speaker 1: thanks bye,