How isolation fuels opioid addiction | Rachel Wurzman

How isolation fuels opioid addiction | Rachel Wurzman


What does it mean to be normal? And what does it mean to be sick? I’ve asked myself this question
from the time I was about seven, when I was diagnosed
with Tourette syndrome. Tourette’s is a neurological disorder characterized by stereotyped movements
I perform against my will, called tics. Now, tics are technically involuntary, in the sense that they occur
without any conscious attention or intention on my part. But there’s a funny thing
about how I experience tics. They feel more unvoluntary
than involuntary, because I still feel like it’s me
moving my shoulder, not some external force. Also, I get this uncomfortable sensation,
called premonitory urge, right before tics happen, and particularly
when I’m trying to resist them. Now, I imagine most of you out there
understand what I’m saying, but unless you have Tourette’s,
you probably think you can’t relate. But I bet you can. So, let’s try a little experiment here
and see if I can give you a taste of what my experience feels like. Alright, ready? Don’t blink. No, really, don’t blink. And besides dry eyes, what do you feel? Phantom pressure? Eyelids tingling? A need? Are you holding your breath? (Laughter) Aha. (Laughter) That’s approximately
what my tics feels like. Now, tics and blinking,
neurologically speaking, are not the same, but my point is that you
don’t have to have Tourette’s to be able to relate to my experience
of my premonitory urges, because your brain can give you
similar experiences and feelings. So, let’s shift the conversation from
what it means to be normal versus sick to what it means that a majority of us
are both normal and sick. Because in the final analysis,
we’re all humans whose brains provide
for a spectrum of experiences. And everything on that spectrum
of human experiences is ultimately produced by brain systems that assume a spectrum
of different states. So again, what does it mean to be normal, and what does it mean to be sick, when sickness exists on the extreme end
of a spectrum of normal? As both a researcher who studies
differences in how individuals’ brains wire and rewire themselves, and as a Touretter
with other related diagnoses, I have long been fascinated
by failures of self-regulation on the impulsive and compulsive
behavioral spectrums. Because so much of my own
experience of my own body and my own behavior has existed all over that map. So with the spotlight
on the opioid crisis, I’ve really found myself
wondering lately: Where on the spectrum
of unvoluntary behavior do we put something like abusing
opioid painkillers or heroin? By now, we all know that the opioid crisis
and epidemic is out of control. Ninety-one people die every day
in this country from overdose. And between 2002 and 2015, the number of deaths from heroin
increased by a factor of six. And something about the way
that we treat addiction isn’t working, at least not for everyone. It is a fact that people
suffering from addiction have lost free will when it comes to their behavior
around drugs, alcohol, food or other reward-system
stimulating behaviors. That addiction is a brain-based
disease state is a medical, neurobiological reality. But how we relate to that disease — indeed, how we relate to the concept
of disease when it comes to addiction — makes an enormous difference
for how we treat people with addictions. So, we tend to think of pretty much
everything we do as entirely voluntary. But it turns out
that the brain’s default state is really more like a car
idling in drive than a car in park. Some of what we think we choose to do is actually things that we
have become programmed to do when the brakes are released. Have you ever joked that your brain
was running on autopilot? Guess what? It probably was. OK? And the brain’s autopilot
is in a structure called the striatum. So the striatum detects
emotional and sensory motor conditions and it knows to trigger
whatever behavior you have done most often in the past under those same conditions. Do you know why I became a neuroscientist? Because I wanted to learn
what made me tick. (Laughter) Thank you, thank you. (Laughter) I’ve been wanting to use that one
in front of an audience for years. (Applause) So in graduate school,
I studied genetic factors that orchestrate wiring
to the striatum during development. And yes, that is my former license plate. (Laughter) And for the record, I don’t recommend any PhD student get a license plate
with their thesis topic printed on it, unless they’re prepared
for their experiments not to work for the next two years. (Laughter) I eventually did figure it out. So, my experiments were exploring
how miswiring in the striatum relates to compulsive behaviors. Meaning, behaviors that are coerced by uncomfortable urges
you can’t consciously resist. So I was really excited
when my mice developed this compulsive behavior, where they were rubbing their faces
and they couldn’t seem to stop, even when they were wounding themselves. OK, excited is the wrong word, I actually felt terrible for them. I thought that they had tics,
evidence of striatal miswiring. And they were compulsive, but it turned out, on further testing, that these mice showed
an aversion to interacting and getting to know other unfamiliar mice. Which was unusual, it was unexpected. The results implied that the striatum, which, for sure, is involved
in compulsive-spectrum disorders, is also involved in human
social connection and our ability to — not human social connection,
but our ability to connect. So I delved deeper, into a field called social neuroscience. And that is a newer,
interdisciplinary field, and there I found reports
that linked the striatum not just to social anomalies in mice, but also in people. As it turns out, the social
neurochemistry in the striatum is linked to things
you’ve probably already heard of. Like oxytocin, which is that hormone that makes
cuddling feel all warm and fuzzy. But it also implicates
signaling at opioid receptors. There are naturally occurring
opioids in your brain that are deeply linked
to social processes. Experiments with naloxone,
which blocks opioid receptors, show us just how essential
this opioid-receptor signaling is to social interaction. When people are given naloxone —
it’s an ingredient in Narcan, that reverses opioid overdoses
to save lives. But when it’s given to healthy people, it actually interfered
with their ability to feel connected to people they already knew
and cared about. So, something about not having
opioid-receptor binding makes it difficult for us to feel
the rewards of social interaction. Now, for the interest of time, I’ve necessarily gotten rid
of some of the scientific details, but briefly, here’s where we’re at. The effects of social disconnection
through opioid receptors, the effects of addictive drugs and the effects of abnormal
neurotransmission on involuntary movements
and compulsive behaviors all converge in the striatum. And the striatum
and opioid signaling in it has been deeply linked with loneliness. When we don’t have enough signaling
at opioid receptors, we can feel alone in a room full of people
we care about and love, who love us. Social neuroscientists, like Dr. Cacioppo
at the University of Chicago, have discovered that loneliness
is very dangerous. And it predisposes people to entire spectrums
of physical and mental illnesses. Think of it like this:
when you’re at your hungriest, pretty much any food
tastes amazing, right? So similarly, loneliness
creates a hunger in the brain which neurochemically hypersensitizes
our reward system. And social isolation
acts through receptors for these naturally occurring opioids
and other social neurotransmitters to leave the striatum in a state where its response to things
that signal reward and pleasure is completely, completely over the top. And in this state of hypersensitivity, our brains signal deep dissatisfaction. We become restless,
irritable and impulsive. And that’s pretty much when I want you
to keep the bowl of Halloween chocolate entirely across the room for me,
because I will eat it all. I will. And that brings up another thing
that makes social disconnection so dangerous. If we don’t have the ability
to connect socially, we are so ravenous for our social
neurochemistry to be rebalanced, we’re likely to seek relief from anywhere. And if that anywhere
is opioid painkillers or heroin, it is going to be a heat-seeking missile
for our social reward system. Is it any wonder people in today’s world
are becoming addicted so easily? Social isolation — excuse me — contributes to relapse. Studies have shown that people
who tend to avoid relapse tend to be people who have broad,
reciprocal social relationships where they can be
of service to each other, where they can be helpful. Being of service lets people connect. So — if we don’t have the ability
to authentically connect, our society increasingly lacks
this ability to authentically connect and experience things that
are transcendent and beyond ourselves. We used to get this transcendence from a feeling of belonging
to our families and our communities. But everywhere, communities are changing. And social and economic disintegration
is making this harder and harder. I’m not the only person to point out that the areas in the country
most economically hard hit, where people feel most desolate
about their life’s meaning, are also the places where there have been communities
most ravaged by opioids. Social isolation acts
through the brain’s reward system to make this state of affairs
literally painful. So perhaps it’s this pain,
this loneliness, this despondence that’s driving so many of us
to connect with whatever we can. Like food. Like handheld electronics. And for too many people,
to drugs like heroin and fentanyl. I know someone who overdosed,
who was revived by Narcan, and she was mostly angry
that she wasn’t simply allowed to die. Imagine for a second how that feels,
that state of hopelessness, OK? But the striatum is also a source of hope. Because the striatum gives us a clue
of how to bring people back. So, remember that the striatum
is our autopilot, running our behaviors on habit, and it’s possible to rewire,
to reprogram that autopilot, but it involves neuroplasticity. So, neuroplasticity
is the ability of brains to reprogram themselves, and rewire themselves,
so we can learn new things. And maybe you’ve heard the classic
adage of plasticity: neurons that fire together, wire together. Right? So we need to practice social
connective behaviors instead of compulsive behaviors,
when we’re lonely, when we are cued to remember our drug. We need neuronally firing
repeated experiences in order for the striatum to undergo
that necessary neuroplasticity that allows it to take
that “go find heroin” autopilot offline. And what the convergence
of social neuroscience, addiction and compulsive-spectrum disorders
in the striatum suggests is that it’s not simply enough to teach the striatum healthier
responses to compulsive urges. We need social impulses
to replace drug-cued compulsive behaviors, because we need to rebalance,
neurochemically, our social reward system. And unless that happens, we’re going to be left
in a state of craving. No matter what besides our drug
we repeatedly practice doing. I believe that the solution
to the opioid crisis is to explore how social
and psychospiritual interventions can act as neurotechnologies in circuits that process social
and drug-induced rewards. One possibility is to create
and study scalable tools for people to connect with one another over a mutual interest in recovery through
psychospiritual practices. And as such, psychospiritual practice
could involve anything from people getting together
as megafans of touring jam bands, or parkour jams, featuring
shared experiences of vulnerability and personal growth, or more conventional things,
like recovery yoga meetups, or meetings centered
around more traditional conceptions of spiritual experiences. But whatever it is, it needs to activate all of the neurotransmitter
systems in the striatum that are involved
in processing social connection. Social media can’t go
deep enough for this. Social media doesn’t so much
encourage us to share, as it does to compare. It’s the difference between having
superficial small talk with someone and authentic, deeply connected
conversation with eye contact. And stigma also keeps us separate. There’s a lot of evidence
that it keeps us sick. And stigma often makes it safer
for addicts to connect with other addicts. But recovery groups centered around
reestablishing social connections could certainly be inclusive
of people who are seeking recovery for a range of mental health problems. My point is, when we connect
around what’s broken, we connect as human beings. We heal ourselves
from the compulsive self-destruction that was our response
to the pain of disconnection. When we think of neuropsychiatric
illnesses as a spectrum of phenomenon that are part of what make us human, then we remove the otherness of people
who struggle with self-destruction. We remove the stigma between doctors and patients
and caregivers. We put the question of what it means
to be normal versus sick back on the spectrum
of the human condition. And it is on that spectrum
where we can all connect and seek healing together,
for all of our struggles with humanness. Thank you for letting me share. (Applause)

27 comments

  1. Absolutely fascinating. Rachel Wurzmanns research & conclusions certainly echo what I, and the group of recovering alcoholics I know, have found to be true, isolation fuels addiction. Interestingly, we are all using Naltrexone to 'unlearn' our hard wired drinking habits. Naltrexone is the long term version of Naloxone, the opioid antagonist mentioned in this talk.

  2. Random Thought: I am sober, never addicted to booze, never dipped into the dark arts, a bit lonely. According to general fact I should be an opioid addict/ addict?

  3. Wow. This effects everything. This opens the Opiod Crisis up in a way that effects us all. Loneliness, social isolation… explains a lot of the connection some have to Trump. It's deeply physiological .

  4. This all sound good. I just want to know why I have met more than one person who has friends, a partner, perhaps even kids, but still have alcohol problems? Maybe, maybe there is more to the story?

  5. This is amazing. Opioid addiction is on the rise, yet alcohol is still surpassing that. Addressing the opioid crisis is vital but why is there not also an alcohol crisis?

  6. This was a great Ted talk. Very well done!
    Ultimately, if someone wants to get clean off drugs/alcohol… THEY have to get clean off drugs/alcohol.

    All the help in the world just won't stop some people from doing what they really want to do, and, unfortunately, that thing that some people really want to do…is drugs.

  7. I've suffered with a lot of those same ticks my whole life although I've been able to hide it better. Never considered myself lonely although I don't enjoy being around people that much.

  8. She is so right about social connection and opioid abuse, they both fire up same part of the brain, giving you that blisfull feeling. My constant relapses were due to a lack of meaningfull interaction, so now I'm on supstitute therapy. It's not gonna solve my problem, but I hope I'll meet someone real soon and ditch all this sh…

  9. Man, I wish there was a button to mute the TED intro to every single TED video on YouTube. It's unnecessary as I know I'm watching a TED video from the title. The drop and timpani sound effects are always louder than the speaker that follows. Why is it there? This isn't broadcast TV. That's not how this works. TED people, can you PLEASE go look at your calendars because I don't think you're aware that this is 2018 and you're posting videos to YouTube. YOU'RE DOING IT WRONG. Don't even get me started on the opioid "crisis." FEH!! Everybody thinks they know everything about it. Especially this uppity broad.

  10. There is no opioid crisis. Only a f ton of people with chronic pain who can no longer get the ONLY thing that helps from their doctors. Opioids are on the World Health Organizations as a REQUIRED medication for any nation. Withholding opioids, by the WHO, is a crime against humanity. But here in the US, 100 people must suffer for each person lying to their doctor to get high. And remember, most addicts have always gotten their drugs from across the border, not from doctors. So all that we are doing is making the smuggling of opioids that much more profitable for the criminals, and of course making people in pain suffer and consider suicide as a better option. And remember, pretty much any sob story you've heard about the "horrors of quitting opioids" is complete BS. It is easier to quit opioids than to quit smoking. Do you see people "bearing their souls" about quitting smoking? If you no longer need opioids, it's relatively easy to quit. Ramp down slowly over a couple of weeks, and you might feel crappy for a few days after that. Seriously, EASIER THAN QUITTING SMOKING.

  11. Please help. I have been addicted to opiods for 14 years. I had success on Methadone until my state (Tennessee) has extreme cut access to methadone causing me to go to heroin for the first time in after a decade of pain medicine abuse. I have been clean only using Suboxone for some time. Suboxone has NALOXONE in it and TN bans all but pregnant women from non naloxone beprenorphine. My depression has become dramatically severe. Its been a year now and for the first time since way before opiods I have serious suicidal concerns when I'm at my worse. I don't have insurance for co-occering disorder treatment so I have to choose which disease I need to treat the most. Should I stop suboxone? Every non maintenance form of treatment always led to relapse, including homelessness and incarceration. I am doing very well to others who see me, but on the inside is an emptiness and depression that I fear will never go away. What is your advice?

  12. State Specific Learning: Habit, Routine, Ritual: Grabbing the Baby

    Let people be, self medication is used when culture is destroyed and these medicines work well. That our children are losing lives to heroin has less to do with heroin and more to with community. Nutrition, rest, safe shelter, accountability of action, inclusion regardless of intoxication and love are the antidotes to a world that is spinning so quickly into dangerous territories.

    Until one can provide these aspects of human: nutrition, rest, safe shelter, and inclusion, regardless of state of being, then do not speak of the causes of “mental illness”. In a world where our leaders do not even know how to sing and dance; we dissent. Mental dysfunction is a result of communal dysfunction; stop targeting individuals and get on with the day.

  13. you do knowthateverthing in the universe is bipolar right? yep this include human!youwant to feel better with the situation you have? ok here is a potential fix ( it will take 9 month ) here goes! buy a compass! and set your bedso north and south are head feet direction! when you wake up at night ( if you do) change from head to feet and vice versa each time you awake ! i didnt come up with it ! thot mention it

  14. remember this: it took a male and a female to make you ! this is important! why? its the bipolarity i mentionned! when this bipolarity is gone? you die!as for what you have? i dont know! but i will tell you the me. i got the part i am aware of, and th part i aint aware of, and i ask the part i aint aware of to help me promote flow in my body! its kind of weird but did you know that the unconscious part doesnt know the conscious part and the conscious part doesnt know what the unconscious part etc
    ? and this is what keep you alive? YEP , YOU HAVE TO TRUST YOUR UNCOUSCIOUS PART AND YOUR UNCONSCIOUS PART AS TO TRUST THE CONSCIOUS PART OF YOU! sound weird? it is! and yet you cant let these two join together , if you do ? if i did? i would die! weird hey! simple and yet complex

  15. opoid crisis? i suspect dosage testing is happening , they ll figure it out and then people will stop dying. the issue is this stuf is so strong that nobody has been able to dose properly lol! its not funny. and yet we re lucky ,you should see Colombia? 16 years old escort spike the drink of customer and , that drug? its the yes drug! ( what the kenedykiller was likely on!what is the yes drug? basicly its this : if someone is a good salesmen or women ? that salewomen would be able to sell all the fridge in the world to one Alaska customer and no this isnt theoretical! this unnamable drug is so old even those from Colombia dont know how far back it goes! it was always existing! my money was stolen a bank customer say. bank look.and ser you went to the atm to get money . worst years later the black out still occur, he loose hours a day he doesnt know what happened ( oups heilzemer? very likely) i wont name that stuff but any spiking people with this? should be on death row automatically ! be it government or laymen! ya its that bad

  16. "it is a fact that people dont have free will around drugs"???I know for a fact (actual fact) thats not true!I wonder what else she says in untrue…

  17. I'm glad she presented this. Addiction is a disease. And even though people that have been addicted or are addicted, they are normal people like us, they just need help to come out of that addiction.

  18. I am so lonely and I worry constantly that by isolating myself I am wasting my life. But my social anxiety is just to BIG for me to "put myself out there" and try to meet people and forge meaningful relationships.

  19. She’s so right the stigma kept me an addict for a much longer time. So much of what she’s said I completely agree with. I’ve been clean from heroin for 5yrs 2 months.

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