The Origins of Addiction

The Origins of Addiction


  §§  >>HELLO.
I’M STAN RHOADS. THANKS FOR
JOINING US. WELL, TODAY WE’RE
GOING TO LOOK AT THE ORIGINS
OF ADDICTION TO HELP US BETTER
UNDERSTAND THE DISEASE, THE SCIENCE BEHIND IT, AND WHERE IT COMES FROM. ACCORDING TO A DEFINITION
FROM THE AMERICAN SOCIETY
OF ADDICTION MEDICINE, ADDICTION IS A PRIMARY
CHRONIC DISEASE OF BRAIN
REWARD, MOTIVATION, MEMORY, AND RELATED CIRCUITRY. THE DEFINITION
CONTINUES ON TO SAY: THIS IS REFLECTED IN AN INDIVIDUAL PATHOLOGICALLY
PURSUING REWARD AND/OR RELIEF BY
SUBSTANCE USE AND OTHER BEHAVIORS. WELL, TO HELP US ALL
UNDERSTAND THE COMPLEXITY SURROUNDING THE
ORIGINS OF ADDICTION, TWO SCIENTISTS FROM
THE NATIONAL INSTITUTE
ON DRUG ABUSE, KNOWN AS NIDA, ARE WITH ME TODAY
ON THE PROGRAM. DR. RUBEN BALER
IS PART OF NIDA’S
SCIENCE POLICY BRANCH. HE IS AN EXPERT ON
NEUROBIOLOGY OF DRUG
ABUSE AND ADDICTION. DR. STEVEN GRANT IS THE
CHIEF OF THE CLINICAL
NEUROSCIENCE BRANCH AT NIDA. HIS EXPERTISE INVOLVES
HUMAN BRAIN IMAGING, COGNITIVE NEUROSCIENCE, AND BRAIN PHARMACOLOGY. RUBEN AND STEVEN,
WELCOME TO THE PROGRAM. GLAD YOU ARE HERE. HELP US UNDERSTAND BETTER
HOW ADDICTION WORKS AND HOW IT RELATES
TO BRAIN ACTIVITY. RUBEN, EXPLAIN TO ME — YOU CALL IT THE EVOLUTION
OF THE BRAIN — HOW IT
HAS CHANGED.>>WELL, IT ACTUALLY
TURNS OUT — AND WE HAVEN’T REALLY
BEEN PAYING TOO MUCH
ATTENTION TO THIS — THAT EVOLUTION,
UNDERSTANDING THE
HISTORY OF OUR BRAINS, HAS A VERY IMPORTANT
ROLE TO PLAY IN OUR UNDERSTANDING
OF ADDICTION. THE FACT IS THAT OUR
BRAINS HAVE EVOLVED TO PERFORM VERY
SPECIFIC FUNCTIONS AND UNDER CERTAIN VERY
SPECIFIC CIRCUMSTANCES. SO WHENEVER WE MOVE THE
BRAIN AND WE ASK FROM
THE BRAIN TO DO THINGS THAT HAVE NOT BEEN PREDICTED
OR SEEN DURING ITS EVOLUTION, THE BRAIN MAY RUN
INTO TROUBLE.>>STEVEN, I THINK
OF THE THREE Rs. I THINK OF READING,
WRITING, AND ARITHMETIC. BUT IN YOUR LINE OF
WORK, THE THREE Rs ARE
A LITTLE DIFFERENT.>>YES. IN TERMS OF BRAIN
ORGANIZATION, THE IMPORTANT
PRINCIPLES IS, FIRST, THAT THE BRAIN IS
REGULATORY, THAT THE BRAIN REGULATES
BOTH THE INTERNAL
ENVIRONMENT OF THE ORGANISM AS WELL AS MOVING
THE ORGANISM THROUGH THE EXTERNAL ENVIRONMENT. SECOND, THE BRAIN IS
REDUNDANT, THAT IS, IT HAS
MANY, MANY LAYERS THAT PERFORM THE
SAME FUNCTION. AND SO THERE IS OFTEN
COMPETITION BETWEEN
DIFFERENT PARTS OF THE BRAIN TO DO THE SAME THING. AND THE THIRD PART IS
THAT IT’S RECURRENT, WHICH MEANS THAT IT
FEEDS BACK ON ITSELF, WHICH GENERALLY IS
NOT SOMETHING THAT IN
ENGINEERING, LET’S SAY, OR ELECTRONICS, IS CONSIDERED
TO BE A GOOD THING, THAT THE OUTPUT GOES
BACK INTO THE INPUT. IF YOU HAVE A
THERMOSTAT, FOR EXAMPLE, THAT’S HOW A THERMOSTAT
WORKS AND KEEPS THE
TEMPERATURE CONSTANT. THAT’S FINE. HOWEVER, YOU CAN ALSO
FEED BACK INFORMATION
THAT IS MORE OF THE SAME, AND YOU CAN ACTUALLY GET
A POSITIVE FEEDBACK, WHICH IS EXPLOSIVE, BUT THAT’S VERY GOOD IN PRODUCING CHANGE.>>IS THERE AN ORDER
TO THE THREE Rs?>>NO.>>OKAY. HOW DOES THE BRAIN
PROTECT ITSELF?>>WELL, ONE OF THE MAIN
WAYS THAT THE BRAIN
PROTECTS ITSELF IS USING THE EVOLUTIONARY CONCEPT
OF FLEXIBILITY
VERSUS ADAPTABILITY. DURING EVOLUTION, THE BRAIN
HAS EVOLVED THIS CAPACITY TO BE BOTH FLEXIBLE
AND VERY ADAPTABLE. SO IT TRIES TO ADAPT ITSELF
TO THE THINGS AND THE
CHANGES IN THE ENVIRONMENT, BOTH EXTERNAL
AND INTERNAL, THAT ARE
CHANGING ALL THE TIME. THINK ABOUT DAY AND
NIGHT, FOR EXAMPLE. THESE ARE CHANGES THAT CAN
BE PREDICTED AND THAT THE
BRAIN CAN ADAPT ITSELF TO. SO THE BRAIN HAS EVOLVED THESE
MECHANISMS TO BE VERY ROBUST TO THINGS IT HAS
SEEN IN ITS PAST, AND IT HAS THESE
MECHANISMS, MOLECULAR
AND GENETICALLY DRIVEN, TO ADAPT TO CHANGES
IN ITS ENVIRONMENT.>>DOES THE BRAIN
HAVE CONSTRAINTS? DOES IT KNOW WHAT IT
CAN, WHAT IT CAN’T DO,
WHAT IT SHOULDN’T DO?>>WELL, THERE ARE PHYSICAL
AND GENETIC AND MOLECULAR
CONSTRAINTS THAT ARE LIMITS, LIKE ANY MACHINE, THAT CAN
WORK WITHIN THOSE OPTIMAL
MINIMA AND MAXIMA, AS WE SAY. AND WHENEVER WE DEMAND
FROM THESE MACHINES THAT
WE CARRY IN OUR SKULLS TO GO BEYOND THOSE LIMITS,
THERE ARE CONSTRAINTS
THAT ARE EXPRESSED, MANIFESTED IN THINGS LIKE
ADDICTION, FOR EXAMPLE.>>DOES THAT VARY FROM
PERSON TO PERSON?>>ABSOLUTELY. THERE ARE MANY VARIABLES. AT THE GENETIC
LEVEL, FOR EXAMPLE, WE DETERMINED A HUGE
RANGE OF VARIABILITY BETWEEN
DIFFERENT INDIVIDUALS.>>DOES OUR BRAIN FILL
IN INFORMATION, MUCH
LIKE A COMPUTER DOES? DOES IT FILL IT IN? LIKE PERHAPS YOU
LEAVE A WORD OUT, DOES
IT FILL THINGS IN?>>WELL, THIS IS
PART OF WHAT THE BRAIN
HAS EVOLVED TO DO IS TO BE VERY EFFICIENT
AT CONSTRUCTING NARRATIVES BASED ON
PARTIAL INFORMATION. THIS IS WHAT THE BRAIN
DOES VERY, VERY WELL. SO IT PICKS UP PARTIAL
INFORMATION FROM THE ENVIRONMENT AND TRIES TO CREATE
A NARRATIVE THAT MAKES SENSE, THAT ALLOWS THE BRAIN TO
PREDICT AND SIMULATE REALITIES TO CHART THE COURSE
OF ACTION THAT HOPEFULLY
WILL BE APPROPRIATE FOR THE PRESENT
CIRCUMSTANCES.>>DOES THIS ACTIVITY
HAPPEN IN ALL PARTS OF THE
BRAIN, JUST CERTAIN PARTS?>>THE BRAIN ACTIVITY REALLY
IS DISTRIBUTED FOR MANY,
MANY DIFFERENT FUNCTIONS. IT’S TRUE THAT
THERE ARE MANY AREAS OF
THE BRAIN THAT ARE ACTIVE AT A PARTICULAR
POINT OF TIME, BUT THERE ARE NODES
IN THE BRAIN THAT PERFORM
PREDOMINANTLY ONE FUNCTION VERSUS ANOTHER.>>WHEN WE GET THROWN OFF
WITH SOMETHING — WE’RE DRIVING DOWN THE
ROAD AND A CAT OR A DOG OR SOMETHING COMES ACROSS
AND IT THROWS US OFF — DOES THE BRAIN TRY TO BALANCE
US TO GET US BACK ON COURSE? WHAT DOES IT DO?>>WELL, YEAH, THE
BRAIN IS EXACTLY THAT. IT’S TRYING TO ADAPT TO
SURPRISING EVENTS, ALWAYS
WITHIN CERTAIN LIMITS, AND IT’S EXTREMELY
CAPABLE OF DOING THAT. THIS IS WHY WE
ARE WIRED FOR DISTRACTION, BECAUSE THINGS THAT ARE OUT OF THE ORDINARY AND UNEXPECTED ARE VERY SALIENT,
VERY IMPORTANT, VERY SIGNIFICANT
FOR THE BRAIN. THE BRAIN TENDS TO
PAY HEIGHTENED ATTENTION
TO THE THINGS THAT HAPPEN OUT OF
THE ORDINARY.>>YOU MENTIONED
IT’S FRAGILE, BUT YET
IT’S, WHAT, ROBUST?>>ROBUST. THIS COMES OUT OF THE
EVOLUTIONARY DRIVEN BALANCE OF TRYING TO COMBINE
FLEXIBILITY AND ADAPTABILITY. YOU NEED TO BE ADAPTABLE TO
CHANGES IN THE ENVIRONMENT. YOU NEED
TO BE FLEXIBLE, BECAUSE CHANGES MAY BE
SOMETIMES OUT OF THE ORDINARY.>>HOW DOES THE BRAIN
REACT TO SOMETHING
IT’S NEVER SEEN BEFORE?>>PATHOLOGICALLY,
I WOULD SAY. AN ADDICTION IS A
PERFECT EXAMPLE. IF EVOLUTION HAS
NOT SHOWN — DURING EVOLUTION, THE BRAIN
HAS NOT SEEN SOMETHING, CHANCES ARE THAT THE
ADAPTATION TO THAT SOMETHING WILL BE MALADAPTIVE. AN ADDICTION IS A
PERFECT EXAMPLE OF THAT.>>WHAT ABOUT DEALING
WITH SOMETHING IN EXCESS
OR MAYBE DEFICIENCY? HOW DOES THE BRAIN
DEAL WITH THAT? STEVE, I’LL THROW
THAT QUESTION TO YOU.>>WELL, THE BRAIN, AS
I SAID, IS REGULATORY. SO IT –>>IT’S BACK TO
THE THREE Rs.>>THAT’S RIGHT. UNFORTUNATELY, THE BRAIN IS
NOT PERFECTLY REGULATORY. THE BRAIN HAS EVOLVED TO
DEAL WITH SOME TYPES OF
DEFICIENCIES, FOR EXAMPLE, VERY WELL, LIKE THE LOSS
OF BLOOD, WHICH WOULD
INDICATE AN INJURY. HOWEVER, THE BRAIN IS
NOT WELL ADAPTED TO DEAL
WITH AN EXCESS OF BLOOD, HIGH BLOOD PRESSURE. THAT’S WHY HIGH BLOOD
PRESSURE IS CALLED
THE SILENT KILLER. THERE’S NO WAY THAT THE
BRAIN HAS EVOLVED TO DETECT
HIGH BLOOD PRESSURE BECAUSE IT’S
NOT SOMETHING THAT IT WAS
EVOLUTIONARILY EXPOSED TO. SAME THING WITH THE
EXCESS OF HIGH FAT OR HIGH
CALORIC SWEET FOOD ITEMS. THEY WERE GENERALLY SCARCE
IN THE ENVIRONMENT. SO IT WAS ADAPTIVE TO GATHER
AND HAVE AS MUCH OF THAT AS
YOU COULD WHILE YOU COULD BECAUSE THERE WAS NO
GUARANTEE YOU WOULD HAVE
THAT IN THE FUTURE. ON THE OTHER HAND,
NOW THAT WE HAVE THIS
IN GREAT ABUNDANCE, THE BRAIN IS NOT WELL ADAPTED
TO DEAL WITH THE EXCESS.>>SO IT DOESN’T
TELL US TO STOP. IT DOESN’T PUT
THOSE STOP SIGNS UP
AND TELL US TO QUIT.>>NOT AS WELL
AS IT WOULD FOR OTHER
TYPES OF THINGS, YES.>>YOU’RE TALKING
ABOUT EXCESS. HOW DOES IT DEAL WITH
ALCOHOL OR WITH DRUGS? DOES IT NOT HAVE THE STOPGAP
THERE, THE STOP SIGN?>>WELL, REMEMBER THAT
DRUGS ACT ON THE BRAIN. AND THE WAY THAT DRUGS ACT
ON THE BRAIN CAN OFTEN
IMPAIR THOSE VERY MECHANISMS THAT EITHER TELL YOU
TO GO OR TO STOP. AND, THEREFORE, DRUGS CAN
IMPAIR, ESPECIALLY THOSE
THAT LEAD TO ADDICTION, THE VERY BRAIN MECHANISMS
THAT ARE INVOLVED
IN CHOICE, IN INHIBITION, OR SEEKING ITEMS IN
THE ENVIRONMENT, GOAL SEEKING.>>LET’S TAKE A DEEPER
LOOK INTO OUR TOPIC. RESEARCHERS ARE ALWAYS
TRYING TO LEARN MORE ABOUT
WHAT MAKES THE BRAIN WORK. NIDA HAS A TEAM OF
SCIENTISTS WORKING AT THEIR
INTRAMURAL RESEARCH LABS, OR IRP,
IN BALTIMORE, MARYLAND. THE FINDINGS COULD
LEAD TO NEW PREVENTION
AND TREATMENT METHODS. LET’S LOOK AT SOME OF THE
SCIENCE BEHIND THE SCIENCE TO BETTER UNDERSTAND THE
ORIGINS OF ADDICTION.  >>MY NAME IS
BRANDON HARVEY. I AM THE DIRECTOR OF THE OPTOGENETICS AND TRANSGENIC TECHNOLOGY CORE HERE AT THE NIDA INTRAMURAL
RESEARCH PROGRAM. ONE OF THE PRIMARY
OBJECTIVES OF THIS LAB IS TO BUILD
MOLECULAR TOOLS FOR DISSECTING OUT THE GENETIC
COMPONENTS OF ADDICTION. IN TERMS OF THE ADVANCES THAT
ARE OCCURRING IN ADDICTION NOW, MUCH OF IT RELIES
ON MOLECULAR BIOLOGY TOOLS AND BEING ABLE TO MANIPULATE NEURONS AT A GENETIC LEVEL. THIS ALL STARTS WITH DNA. SO WHAT WE’RE TRYING TO
CREATE ARE VIRAL VECTORS THAT WE USE
AS DELIVERY VEHICLES. SO THESE ARE VIRUSES THAT
HAVE BEEN GENETICALLY MODIFIED SO THEY NO LONGER
HAVE THE VIRUS PROPERTIES OTHER THAN THE ABILITY TO
DELIVER DNA INTO A CELL. AFTER WE HAVE THE DNA MADE THAT
CAN BE USED TO MAKE A VIRUS, WE NEED TO PUT
IT INTO MAMMALIAN CELLS. IN THIS CASE, WE’RE USING
THE MAMMALIAN CELLS AS A
FACTORY TO PRODUCE VIRUS. WE GET THAT CONCENTRATED
VIRUS IN A SMALL TUBE. FROM THERE, THE VIRUS
GOES INTO A RODENT BRAIN
INTO SPECIFIC REGIONS. SO IT’S DIRECTLY
INJECTED INTO THE BRAIN. ONCE WE DO THAT, WE NEED TO VERIFY THAT WE ACTUALLY GOT THE GENE DELIVERED TO THE CELLS THAT WE
WERE INTERESTED IN, THE REGION OF THE RAT BRAIN
THAT WE’RE INTERESTED IN. SO TO DO THAT, WHAT WE
DO IS WE FREEZE THE BRAINS AND WE SECTION
THEM VERY THINLY AND LOOK AT THEM ON
SLIDES USING A MICROSCOPE.  >>INTERESTING STUFF
GOING ON IN THOSE LABS. WE’LL SEE MORE OF THE
SCIENCE BEHIND THE SCIENCE
THROUGHOUT THIS PROGRAM. WELL, DID YOU HAVE ANY
RESPONSE TO THIS AT ALL
BEFORE WE MOVE ON, THAT YOU WANTED
TO MAYBE ADD?>>WELL, THESE ARE REAL
EXCITING TECHNIQUES. FOR CLINICAL, WE ARE FAR
AWAY FROM USING SOME OF
THESE TECHNIQUES, OF INJECTING VIRUS,
FOR EXAMPLE, INTO
THE BRAIN OF A HUMAN. BUT SOME CLINICAL
WORK SHOWS, FROM SEVERAL
YEARS AGO, ACTUALLY, THAT YOU CAN INDEED
REDUCE ALCOHOL
CONSUMPTION, FOR EXAMPLE, BY INJECTING SPECIFIC GENES
USING THESE TYPES OF VEHICLES IN THE BRAINS OF
LITTLE RODENTS. THIS HAS A LOT OF
IMPLICATIONS FOR RESEARCH FOR UNDERSTANDING THE
GENETICS BEHIND ADDICTION BUT ALSO EVENTUALLY FOR TRANSLATING THOSE INTO A CLINIC.>>LET’S CONTINUE
TALKING MORE ABOUT THE
BRAIN DURING ADDICTION. IS THERE SOMETHING
THAT TRIGGERS ADDICTION
WITHIN THE BRAIN?>>WELL, WHAT TRIGGERS
ADDICTION, THE FIRST
STEP, IS THE DRUG. THE DRUG ENTERS
THE BRAIN –>>THAT DRUG COULD BE
ALCOHOL OR AN ILLICIT DRUG.>>ILLICIT DRUG. IT COULD BE A DRUG THAT’S
USED FOR MEDICAL PURPOSES, LIKE ADDERALL OR
OPIATES FOR PAIN. CIGARETTES, ANY
KIND OF DRUG.>>SO IT TRIGGERS.>>IT GOES INTO THE BRAIN, AND THERE ARE TWO THINGS
THAT WE HAVE FOUND OUT THAT ARE CRITICAL
FOR ADDICTION. ONE IS THAT THE DRUG HAS
SOME INFLUENCE ON A SYSTEM
OF THE BRAIN KNOWN AS THE DOPAMINE SYSTEM THAT USES
A CHEMICAL, GROUP OF NEURONS, A SMALL GROUP OF NEURONS THAT
USE THE CHEMICAL DOPAMINE TO COMMUNICATE
WITH OTHER CELLS. THE SECOND THING WE FOUND
OUT IS THAT THE
CONSEQUENCES OF THAT DRUG REACH DEEP INTO THE
FUNCTIONING OF THE CELL. IT ACTUALLY WILL REACH
ALL THE WAY INTO THE
LEVEL OF GENE EXPRESSION. IT WILL CHANGE
THE TARGET CELL. IT WILL MAKE IT
GROW OR SHRINK, WHICH WILL IN TURN CHANGE OTHER CELLS THAT IT’S CONNECTED TO. SO THE EFFECTS OF THE DRUG
PROPAGATE THROUGHOUT THE
ENTIRE NERVOUS SYSTEM. AND WITH CHRONIC USE, PARTS OF THE BRAIN THAT
ARE FAR REMOVED FROM THE INITIAL SITE OF
DRUG ACTION CAN BE ALTERED.>>STEP BACK JUST
A MOMENT. EXPLAIN TO ME,
WHAT IS DOPAMINE? WHAT IS ITS PURPOSE?>>TO UNDERSTAND DOPAMINE,
WE AGAIN NEED TO LOOK AT
THE EVOLUTION OF THE BRAIN. DOPAMINE IS A SIGNAL
MOLECULE THAT HAS MANY,
MANY DIFFERENT ROLES. BUT ITS MAIN PURPOSE,
IN THE CONTEXT OF DRUG
ABUSE AND ADDICTION, IS REALLY A
TEACHING TOOL. IT’S AN INSTRUMENT, A
CHEMICAL THAT THE BRAIN,
THROUGH EVOLUTION, USES TO RECOGNIZE A SALIENT
FEATURE OF THE ENVIRONMENT, SOMETHING THAT
IS IMPORTANT, THAT HAS SURVIVAL VALUE,
HEIGHTENED FITNESS
VALUE FOR SURVIVAL, AND THAT THE ANIMAL
HOPEFULLY WILL REPEAT. IT’S DESIGNED TO SHOW THE
ANIMAL WHERE FOOD WAS, WHERE MATES WITH
WHOM HE CAN ENGAGE IN
MATING BEHAVIOR ARE FOUND OR BEHAVIORS THAT
INDUCE FEMALES TO COME OR MATES TO COME TO
THE INDIVIDUAL. SO THESE ARE
SURVIVAL VALUES. AND DOPAMINE ALLOWS THE
INDIVIDUAL, THE ORGANISM TO
RECOGNIZE THOSE ELEMENTS, WHERE FOOD IS AND
WHERE MATES ARE. SO THIS IS WHAT
EVOLUTION INTENDED. IT’S A SYSTEM OF REWARD THAT
THINGS LIKE DRUGS CAN HIJACK AND TAKE
IN DIFFERENT DIRECTIONS,
PATHOLOGICAL DIRECTIONS.>>SO DOPAMINE WE HAVE FOUND
RECENTLY DOES NOT SIMPLY SAY SOMETHING GOOD IN THE ENVIRONMENT HAS HAPPENED. BUT IT SAYS THAT YOU CAN
EXPECT THAT SOMETHING GOOD
IS GOING TO HAPPEN, AND NOT ONLY THAT, BUT
SOMETHING BETTER THAN YOU
EXPECTED IS GOING TO HAPPEN. SO WHATEVER YOU’VE DONE,
YOU SHOULD DO IT AGAIN AND YOU SHOULD KEEP DOING THAT IN ORDER TO GET TO THAT RESULT THAT IS BETTER
THAN EXPECTED. IN THIS WAY, HABITS CAN BE
FORMED WITHIN THE BRAIN WHERE THE ANIMAL CAN EFFICIENTLY TRACK THROUGH THE ENVIRONMENT TO GET TO
NECESSARY GOALS.>>SO HUMANS AREN’T THE ONLY
ONES WHO HAVE DOPAMINE.>>OH, NO, BY NO MEANS.>>SO IT IS SHARED. WHAT IS THE DIFFERENCE
BETWEEN THE FIRST USE OF
A DRUG FOR SOMEONE AND A CHRONIC USE IN
REGARD TO DOPAMINE?>>THE DRUG ADAPTS — I’M
SORRY, THE BRAIN ADAPTS, AND PARTICULARLY WE KNOW FROM PRINCIPLES OF PHARMACOLOGY THAT CHRONIC DRUG ADMINISTRATION
CAUSES ADAPTATIONS THAT GENERALLY REDUCE
THE EFFECT OF THE DRUG. THE BRAIN ACTS IN A
HOMEOSTATIC MANNER. THAT IS WHAT I
MEANT BY REGULATORY. SO IF YOU DISTURB THE BRAIN
IN SOME WAY, PERTURB THE
BRAIN IN SOME WAY, IT WILL ADJUST TO MINIMIZE
THAT PERTURBATION. IN THE CASE OF DOPAMINE
AND DRUGS THAT ACT ON THE
DOPAMINE SYSTEM — FOR EXAMPLE, COCAINE,
WHICH INCREASES
THE LEVEL OF DOPAMINE, OVER TIME THE
TARGETS OF DOPAMINE, THE RECEPTORS THAT RECOGNIZE
THE PRESENCE OF DOPAMINE DIMINISH BECAUSE THERE
IS AN EXCESS OF DOPAMINE. SO IT COMPENSATES
BY DIMINISHING THE
NUMBER OF RECEPTORS.>>SO DOES DOPAMINE PUSH
THINGS TO BE AUTOMATIC?>>THAT IS ONE OF THE MAJOR
THINGS THAT DOPAMINE DOES IS IT STARTS OFF
A CYCLE IN WHICH BEHAVIORS
THAT LEAD TO A GOAL THAT IS BETTER THAN EXPECTED
GET REPEATED, GET REINFORCED, AND OVER TIME,
THOSE BEHAVIORS CAN
BECOME MORE EFFICIENT, THE NEURAL ACTIVITY
BECOMES MORE EFFICIENT. SO THE ENVIRONMENT, THE CUES IN THE ENVIRONMENT
THAT TELL YOU THAT
YOUR GOAL IS COMING UP, YOU CAN GET
TO IT VERY WELL. YOU CAN USE LESS BRAIN
RESOURCES TO DO IT, AND IN THE
CASE OF HUMANS, IT BECOMES WHAT WE
CALL AUTOMATIC. YOU DON’T HAVE TO
THINK ABOUT IT.>>GIVE ME AN EXAMPLE.>>WELL, A GOOD EXAMPLE
IS MILITARY TRAINING. YOU LEARN HOW TO REACT
TO A DANGEROUS AND
STRESSFUL SITUATION THROUGH A SERIES
OF MOVEMENTS, THROUGH A SERIES
OF ACTIONS THAT YOU DON’T
HAVE TO THINK ABOUT, THAT YOU CAN DO
VERY QUICKLY. FOR EXAMPLE,
DISASSEMBLE, REASSEMBLE
YOUR GUN IF IT’S JAMMED, EVEN IF IT’S IN THE DARK,
EVEN IF YOU CAN’T SEE IT.>>WHAT ABOUT A GOLF SWING? TRYING TO CONNECT –>>GOLF SWINGS ARE AN
EXCELLENT EXAMPLE, AND THEY ARE VERY GOOD AS AN
EXAMPLE OF WHAT IS A PROBLEM IN TREATING ADDICTION. PEOPLE DEVELOP
GOLF SWINGS.>>NOT THAT EVERYONE WHO
PLAYS GOLF IS ON DRUGS.>>NO.>>RIGHT.>>YOU WOULD HOPE
THAT THEY WERE NOT.>>RIGHT.>>THAT THEY
BECOME PRACTICED. THEY SWING THE GOLF CLUB
IN A PARTICULAR WAY. MY MOTHER AND FATHER
PLAYED GOLF EXTENSIVELY. THEY PAID A LOT OF MONEY TO
GOLF PROS TO TEACH THEM TO
KEEP THEIR ELBOW DOWN, TO KEEP THEIR HIPS STRAIGHT,
TO SWING THROUGH THE BALL. HOWEVER, IF YOU
HAVE THESE ACTIONS THAT
ARE WELL PRACTICED, THEY BECOME VERY
HARD TO CHANGE. YOU’RE NOT EVEN
NECESSARILY AWARE THAT
YOU’RE MOVING YOUR HIPS, THAT YOUR
ELBOW IS HELD UP. AND SO EVEN THOUGH YOU GO
THROUGH A SESSION WITH A COACH TO PRACTICE THESE NEW TYPES OF
WAYS OF SWINGING THE GOLF CLUB, YOU MAY REVERT BACK
TO THOSE OLD WAYS.>>LET’S BRING THIS
BACK NOW WITH SOMEBODY WHO IS REALLY DEEP
INTO THE THROES OF A DRUG. WHAT IS
IT DOING TO THEM?>>IT’S VERY
IMPORTANT TO UNDERSTAND THIS IS ONE CRITICAL COMPONENT OF THE PROBLEM OF ADDICTION IS THIS AUTOMATIZATION
OF RESPONSES, OF BEHAVIORS, AND THE AUTOMATIC GOING
FOR A DRUG AND THE
DRUG-SEEKING BEHAVIOR. THERE IS ANOTHER COMPONENT
TO DRUG ADDICTION THAT STEVE
ALLUDED TO BEFORE THAT’S VERY IMPORTANT
TO POINT OUT AND HIGHLIGHT. ADDICTION IS AN EVER-EXPANDING
WAVE OF DYSFUNCTION THAT IS INITIATED IN
THESE AREAS OF THE BRAIN THAT
WORK MAINLY WITH DOPAMINE, THE REWARDERS OF THE BRAIN. BUT EVENTUALLY, CHRONIC USE
LEADS TO MORE AND MORE
DYSFUNCTIONING HIGHER LEVELS OF THE BRAIN, HIGHER
COGNITIVE AREAS, WHICH ARE ESSENTIALLY THE AREAS THAT KEEP TABS ON OUR IMPULSES, OUR ABILITY
TO INHIBIT IMPULSES, TO REACH FOR THE SECOND, THIRD,
OR FOURTH COOKIE ON THE PLATE. SO THOSE AREAS
OF THE BRAIN, AT THE TIME THAT THE DRIVE TO SEEK A DRUG ARE STRENGTHENED, THE AREAS THAT ARE
IN CHARGE OF INHIBITORY
CONTROL ARE WEAKENED. SO IT’S THIS IMBALANCE BETWEEN
DRIVE FOR THE FOURTH COOKIE OR FOR THE PUFF OF CIGARETTE
OR FOR COCAINE IS INCREASED, THE INHIBITORY CONTROL
IS SIGNIFICANTLY WEAKENED.>>HOW DIFFICULT IS IT TO
CHANGE FOR THAT PERSON?>>WELL, IF YOU LOOK
AT THE PROTOCOLS FOR
TREATMENT OF ADDICTION, YOU CAN SEE THAT THERE
ARE MANY PRINCIPLES THAT DISTILL THE WISDOM OF ADDICTION RESEARCH FOR THE LAST COUPLE OF
DECADES, THREE DECADES, SOMETHING LIKE THAT.>>BECAUSE THE
THINKING IS, JUST QUIT. JUST STOP. JUST GET
AWAY FROM IT.>>EXACTLY. DETOXIFICATION OF GETTING
AWAY FROM THE DRUG IS
PROBABLY THE FIRST STEP. WE KNOW THAT YOU NEED
TO BE CLEAN TO INITIATE
THE PROCESS OF THERAPY. BUT THERE ARE DEEPLY ENTRENCHED
CIRCUITRIES IN THE BRAIN, MALADAPTIVE BEHAVIORS. THE BRAIN HAS LEARNED TO
REALLY DEPEND ON THIS DRUG
FOR NORMAL FUNCTIONING. SO THE RETRAINING OF THOSE
CIRCUITS IS AS HARD AS
UNLEARNING YOUR GOLF SWING OR YOUR ASSEMBLING AND
DISASSEMBLING YOUR WEAPON.>>DO WE KNOW HOW TO
START TRAINING SOMEONE
TO MAKE THAT CHANGE?>>NOT AS WELL
AS WE NEED TO. WE HAVE MANY DIFFERENT TYPES
OF TREATMENT PROTOCOLS, BUT IT IS DIFFICULT TO HAVE THE PERSON RECOGNIZE ALL OF THE
TRIGGERS IN THE ENVIRONMENT THAT MAY START THESE
HABITUAL BEHAVIORS. AND THAT WHEN SOMEONE GOES
INTO A TREATMENT CENTER AND
LEARNS THESE NEW SKILLS, IT IS OFTEN DIFFICULT TO
TRANSFER THOSE OUT INTO
THEIR REGULAR ENVIRONMENT. WE HAVE A NUMBER OF
DIFFERENT PROCEDURES THAT HAVE BEEN DEVELOPED AND HAVE BEEN TESTED BY NIDA AND HAVE SHOWN
TO BE EFFICACIOUS. HOWEVER, WE HAVE ALSO
STARTED TO FIND OUT THAT
DIFFERENCES IN THE BRAIN MAY LEAD SOME PEOPLE
TO BE MORE RESPONSIVE
TO THESE TREATMENTS THAN OTHER PEOPLE.>>DO WE KNOW A PERCENTAGE
OF WHAT THAT MIGHT BE OF THE POPULATION
OF THOSE WHO ARE INVOLVED
WITH DRUGS AND SO FORTH?>>IT TURNS OUT, IF YOU LOOK
AT THE EPIDEMIOLOGY DATA, THAT A LARGE PORTION
OF PEOPLE WHO HAVE A
LIFETIME EXPOSURE TO DRUGS DO NOT CONTINUE, DO NOT PROGRESS TO
THE STAGE OF ADDICTION. IT IS SOMEWHERE BETWEEN 8
AND 20 PERCENT OF PEOPLE WHO
ARE EVER EXPOSED TO DRUGS GO ON TO DEVELOP A FULL-BLOWN
PROBLEM WITH ADDICTION.>>JUST BETWEEN 8
AND 20 PERCENT OF
THOSE WHO — OKAY. IS THERE A DIFFERENCE
BETWEEN DEPENDENCE ON A
SUBSTANCE AND ADDICTION?>>WELL, OF COURSE. DEPENDENCE IS A
PHARMACOLOGICAL TERM. IT MEANS THAT THE BRAIN HAS
ADAPTED TO SOMETHING NEW. IT COULD BE A PRESCRIPTION
DRUG, FOR EXAMPLE, AN OPIATE THAT YOU
TAKE FOR CHRONIC PAIN, AND THE BRAIN
HAS ADAPTED, AND YOU NEED TO INCREASE THE DOSE TO ACHIEVE THE SAME EFFECTS AS THE FIRST DOSES. THAT’S A
DEPENDENCE ON A DRUG. IT COULD BE
A PSYCHOACTIVE DRUG, A PSYCHOACTIVE DRUG THAT CAUSES THIS DEPENDENCE OF THE BRAIN. THE BRAIN IS ADAPTING, BUT THIS IS DIFFERENT FROM
WHAT WE DEFINE ADDICTION AS THE COMPULSIVE NEED
AND URGE TO SEEK A DRUG, DESPITE ALL
THE CONSEQUENCES.>>WELL, WE’RE GOING
TO CONTINUE OUR LOOK INTO
THE ORIGINS OF ADDICTION. AND TO GET A BETTER
UNDERSTANDING OF HOW
EVERYTHING FITS TOGETHER, RESEARCHERS
AT NIDA’S IRP LABS ARE LOOKING AT INDIVIDUAL COMPONENTS OF BRAIN CELLS. IT’S MORE OF THE SCIENCE
BEHIND THE SCIENCE TO BETTER UNDERSTAND THE
ORIGINS OF ADDICTION.  >>MY NAME IS CARL LUPICA. I AM A SENIOR INVESTIGATOR. I AM CHIEF OF THE ELECTROPHYSIOLOGY
RESEARCH SECTION AT NIDA. THE LAB PRIMARILY
WORKS WITH BRAIN SLICES OBTAINED FROM ANIMALS THAT HAVE EITHER ACUTELY OR CHRONICALLY BEEN EXPOSED TO
ABUSED DRUGS. AND THE NEURONS
ARE STILL FIRING, SYNAPSES ARE STILL
COMMUNICATING WITH ONE ANOTHER. MITOCHONDRIA ARE STILL
WORKING SUPPLYING
ENERGY TO THE CELLS. ALL OF THE NORMAL RESPIRATORY
PROCESSES THAT CELLS GO THROUGH ARE STILL OCCURRING
IN THESE NEURONS FOR MANY HOURS AFTER
WE’VE MADE THESE BRAIN SLICES. SO THE NEXT STEP OF THE
ANALYSIS IS ACTUALLY TO ATTEMPT TO IDENTIFY THESE LIVING
NEURONS IN BRAIN SLICES, AND THAT INVOLVES
PASSING INFRARED LIGHT
THROUGH THE MICROSCOPE AND THEN UTILIZING
SOME OPTICAL TRICKS TO LOOK FOR NEURONS
IN THESE LIVING BRAIN SLICES. ESSENTIALLY,
WE’RE USING AMPLIFIERS
TO TAKE THE SMALL SIGNALS THAT ALL
NEURONS GENERATE, AND WE’RE MAKING
THOSE SIGNALS BIGGER SO THAT WE CAN
THEN MONITOR THEM AND RECORD THEM
ONTO A COMPUTER. AND THE IDEA IS THAT THESE
NEURONS THAT SHUT OFF
DOPAMINE NEURONS MAY BE INVOLVED IN SOME
OF THE AVERSIVE CONSEQUENCES THAT OCCUR FOLLOWING
THE USE OF ABUSED DRUGS.>>THIS IS ABSOLUTELY
FASCINATING. STEVE, YOU HAD A
COMMENT TO FOLLOW UP ON.>>YES, WHAT
DR. LUPICA IS WORKING ON IS ONE OF THE MOST EXCITING
NEW FINDINGS THAT WE HAVE, WHICH IS THERE
IS A SYSTEM IN THE BRAIN THAT ACTUALLY NOT ONLY
TURNS ON DOPAMINE NEURONS, WHICH IS WHAT WE FOCUSED ON
MAINLY IN DRUG ADDICTION, BUT ALSO TURNS
OFF DOPAMINE NEURONS. AND THESE ARE UNDER
CONDITIONS WHERE THE OUTCOME
IS WORSE THAN EXPECTED. OVER TIME WITH CHRONIC DRUG
USE, THERE SEEMS TO BE — ONE OF THE ADAPTATIONS IS
WHEN THE DRUG IS NOT PRESENT, THE DOPAMINE NEURONS ARE NOT AS ACTIVE AS THEY ARE BEFORE. IT MAY BE DUE TO THE
INCREASE IN ACTIVITY IN THE
NEURONS THAT HE IS STUDYING. THAT WILL LEAD TO FEELINGS OF
DYSPHORIA TO UNEASE, ANXIETY,
MAYBE SOMETHING THAT — THE LACK OF ENERGY,
DEPRESSION — THAT THE PERSON NOW IDENTIFIES
THAT THE SOLUTION TO IS TO TAKE MORE DRUG. SO THE DRUG INITIALLY GIVES
YOU A HIGH, AND THEN –>>PUSHES YOU TO WANT MORE.>>– PUSHES YOU
BELOW NORMAL. AND OVER TIME,
YOU STAY BELOW NORMAL AND YOU HAVE TO TAKE THE DRUG AGAIN TO GET NORMAL AGAIN.>>YOU HAVE TO TAKE MORE?>>YOU MAY HAVE
TO TAKE MORE.>>IS EVERYONE
VULNERABLE TO ADDICTION?>>WELL, THIS IS ONE OF THE
KEY QUESTIONS, OF COURSE, THAT WE WOULD LOVE
TO KNOW THE ANSWER TO.>>BE ABLE TO
IDENTIFY WHO IS –>>OBVIOUSLY, WE KNOW THAT
DRUG USE IS VERY DIFFERENT
FROM DRUG ADDICTION. WE KNOW A LOT OF PEOPLE THAT
USE DRUGS AND HAVE USED
DRUGS IN THEIR LIVES, BUT NOT EVERYBODY REALLY
BECOMES ADDICTED. WE KNOW THAT IT’S
ONLY A FRACTION OF THOSE
THAT ARE EXPOSED TO DRUGS THAT EVER
BECOME ADDICTED. AND WE WOULD
LIKE TO KNOW WHY. THE BEST ANALOGY THAT I FOUND
TO EXPLAIN THE DIFFERENCE, THE INDIVIDUAL DIFFERENCES
OF WHY SOME BECOME
ADDICTED AND SOME NOT, IS TO THINK OF A HUMAN BEING AS
A STACK OF SWISS CHEESE SLICES. IMAGINE EACH SLICE
OF OUR CIRCUMSTANCES, OUR LIVES BEING SEPARATED BETWEEN GENETICS, EARLY ENVIRONMENT,
CHILDHOOD, PARENTAL STYLE, OUR SCHOOL ENVIRONMENT,
SOCIETY, AND SO ON.>>ARE THERE OTHER
SLICES BESIDES THIS?>>THERE ARE AN INFINITE
NUMBER OF SLICES. ALL THOSE THAT MAKE REALLY OUR
LIVES OR OUR CIRCUMSTANCES, FROM THE MOLECULAR TO THE
POLITICAL AND SOCIAL CONTEXTS. SO YOU CAN IMAGINE
THAT EACH OF THOSE SLICES HAS SPECIFIC RISK
AND PROTECTION FACTORS. WE MAY HAVE GOOD
GENES AND BAD GENES THAT PUTS US AT HIGHER
OR LOWER RISK FOR ADDICTION. WE MAY BE IN A GOOD
PARENTAL ENVIRONMENT OR A
BAD PARENTAL ENVIRONMENT. GOOD NEIGHBORHOOD
OR BAD NEIGHBORHOOD. SO YOU CAN THINK
OF THE ADDICTION AS THE ABILITY OF THE
FIRST EXPOSURE TO A DRUG, THE ABILITY OF THAT
ARROW OF HAZARD, TO GO THROUGH
ALL THE SLICES. AND THAT’S
A RARE EVENT. IT WILL BE MORE OFTEN THE
CASE THAT ONE SLICE OR ANOTHER WILL BE ABLE TO PREVENT
THE GOING THROUGH OF THAT INITIAL
ARROW OF USE. AND THAT’S
WHY, IN MY MIND, A GOOD WAY TO THINK ABOUT WHY NOT EVERYBODY GETS ADDICTED.>>IS THERE AN
ADDICTION GENE?>>IT’S NOT ONE
ADDICTION GENE. IT’S LIKE ANY
COMPLEX BEHAVIOR. THERE ARE MANY GENES
THAT AFFECT ALL
SORTS OF PARAMETERS. FOR EXAMPLE, THE
ATTITUDE THAT ONE HAS
VIS-A-VIS RISK FACTORS, RISK-TAKING BEHAVIORS. IT’S NOT ONE GENE. IT’S MANY GENES THAT
MAKE UP THAT PARTICULAR
TYPE OF BEHAVIORAL STYLE. AND RISK-TAKING BEHAVIORS,
THE TENDENCY OF A PERSON TO
ENGAGE IN RISKY BEHAVIORS, IS ONE EXAMPLE
OF A MAJOR COMPONENT,
PSYCHOLOGICAL COMPONENT, THAT MAY DRIVE ONE
PERSON TO SEEK DRUGS OR TO FALL UNDER PEER
PRESSURE, FOR EXAMPLE.>>ARE THERE DIFFERENCES
BETWEEN A NORMAL BRAIN AND ONE THAT HAS BEEN
SUBJECT TO DIFFERENT DRUGS? MAYBE IT IS AN
ADDICTED BRAIN. ARE THERE
DIFFERENCES?>>YES. USING THE TECHNIQUES
OF BRAIN IMAGING, AS THEY’VE BECOME MORE
AND MORE SOPHISTICATED
OVER THE LAST 20 YEARS, WE HAVE BEEN ABLE TO
DOCUMENT NUMEROUS CHANGES OR DIFFERENCES BETWEEN THE
BRAINS OF PEOPLE WHO MEET
THE CRITERIA FOR ADDICTION AND THOSE WHO ARE NORMAL. AND PART OF
THE RESEARCH PROGRAM THAT WE’RE CARRYING OUT IS TRYING TO FIGURE OUT WHICH OF THOSE
DIFFERENCES MAY BE DUE TO PREEXISTING RISK FACTORS, WHICH OF THESE ARE DUE
TO ADAPTATIONS TO THE DRUG, WHICH ONES MAY
BE CRITICAL TO REVERSE TO GET
A THERAPEUTIC EFFECT.>>ARE THERE COMMON
FACTORS FOR PEOPLE WHO
HAVE BECOME ADDICTED?>>SOME OF THE COMMON
FACTORS INVOLVE CIRCUITS IN THE BRAIN
INVOLVING THE DOPAMINE SYSTEM, WHICH LIE
UNDERNEATH THE CORTEX, A PART OF THE BRAIN
CALLED THE BASAL GANGLIA, WHERE HABITS
ARE GENERATED. ANOTHER PART OF THE BRAIN
INVOLVES A PART OF THE BRAIN CALLED THE ANTERIOR
CINGULATE AND THE INSULA, WHICH IS VERY IMPORTANT
IN RECOGNIZING WHEN THINGS DISTURBING TO THE
HOMEOSTATIC INTERNAL
ENVIRONMENT HAS OCCURRED.>>DO WE KNOW HOW DRUGS
AFFECT HOW THE BRAIN
RESPONDS TO TEMPTATIONS?>>HOW THE BRAIN
RESPONDS TO TEMPTATIONS?>>UM-HUM. TEMPTATIONS AND THE
ABILITY TO MAKE DECISIONS.>>WELL, AGAIN, STEVE IS
PROBABLY MUCH BETTER PREPARED TO ANSWER TEMPTATIONS.>>THIS IS A VERY — THIS IS A VERY NEW
AREA OF RESEARCH THAT HAS TAKEN THE COMBINATION
OF RESEARCH IN ECONOMICS AND RESEARCH IN
BRAIN FUNCTION AND PUT THEM TOGETHER TO SEE HOW
DOES THE BRAIN MAKE DECISIONS, HOW DOES THE BRAIN ASSIGN
VALUE TO VARIOUS THINGS IN
THE ENVIRONMENT? HOW DOES THE BRAIN CHOOSE
BETWEEN APPLES AND ORANGES? IT TURNS OUT THAT THE CIRCUITS
THAT WE’RE TALKING ABOUT — THE DOPAMINE CIRCUIT, THE
PARTS OF THE FRONTAL CORTEX — ARE VERY INVOLVED IN THESE
TYPES OF FUNCTIONS NORMALLY, AND THESE CIRCUITS ARE
THE ONES THAT ARE CHANGED
IN DRUG ADDICTION.>>DID YOU HAVE A
FOLLOW-UP COMMENT?>>NO, NOT REALLY.>>OKAY. DO DRUGS PRODUCE
ARTIFICIAL CONSISTENCIES?>>MEANING?>>WELL, WHEN WE’RE TALKING
ABOUT THE SPECIFIC CIRCUITS
THAT BECOME IMPAIRED, DO THEY MAKE US GO DOWN A
PARTICULAR PATH THAT WE
WOULDN’T NORMALLY GO?>>WELL, YEAH, OF COURSE. IN THIS CONTEXT, WE ALSO
NEED TO THINK ABOUT THE SPECIFIC EFFECTS OF DIFFERENT DRUGS. WE’VE BEEN TALKING
ABOUT, IN GENERAL, DRUGS
THAT AFFECT THINGS — DIFFERENT DRUGS
CONVERGE. FOR EXAMPLE, DOPAMINE
SYSTEM IS ONE BIG FUNNEL WHERE MANY DRUGS
HAVE SIMILAR EFFECTS. BUT WE ALSO HAVE TO THINK
ABOUT ALL THE SPECIFIC
EFFECTS OF DIFFERENT DRUGS. I’M GOING BACK TO
THE GENETICS OF DRUG
ABUSE, FOR EXAMPLE. NICOTINE IS ONE
OF THE BEST EXAMPLES WHERE WE KNOW THE GENES
THAT HAVE SPECIFIC EFFECTS, SPECIFIC
VULNERABILITY RISK.>>DO WE HAVE MORE
STUDIES, MORE INFORMATION
IN REGARD TO NICOTINE?>>NICOTINE IS PROBABLY
ONE OF THE BEST EXAMPLES
IN GENETIC STUDIES THAT HAVE SHOWN SPECIFIC
VULNERABILITIES THAT HAVE TO
DO WITH NICOTINE RECEPTORS, THAT YOU WOULDN’T EXPECT
THEM TO HAVE A DIRECT EFFECT, IMPACT ON VULNERABILITY
TO OTHER DRUGS. THEY HAVE SHOWN A VERY
SIGNIFICANT IMPACT OF
GENETIC DIVERSITY IN NICOTINE RECEPTORS,
FOR EXAMPLE.>>WE’RE GOING TO TAKE
A VERY SHORT BREAK. WHEN WE COME BACK, WE’LL TALK ABOUT WHAT WE CAN DO WITH ALL OF THIS INFORMATION.   §§  >>IT WOULD BE BETTER
IF I HAD CANCER. THEN YOU WOULDN’T TELL
ME WHAT I’M GOING THROUGH IS JUST A PHASE. YOU WOULDN’T
SEE MY CONDITION AS A LACK OF WILLPOWER BUT THE DISEASE
THAT IT TRULY IS. THERE WOULD
BE WALKS, TELETHONS, CAMPAIGNS TO RAISE
FUNDS TO END IT. IF I HAD CANCER, YOU’D UNDERSTAND
I NEED TREATMENT, NOT A LECTURE.>>DRUG ADDICTION
IS A DISEASE. LEARN HOW YOU CAN HELP
SOMEONE YOU CARE ABOUT.  >>I’D RATHER HAVE
HEART DISEASE. THAT WAY YOU WOULDN’T
LOOK AT ME WITH SHAME. YOU AND I COULD TALK
OPENLY ABOUT MY PROBLEM. THERE WOULD BE NO STIGMA. YOU COULD ASK
YOUR FRIENDS HOW THEIR FAMILY
MEMBERS GOT HELP. IF I HAD HEART DISEASE, YOU WOULD UNDERSTAND
THAT I NEED TREATMENT, NOT HATE.>>DRUG ADDICTION
IS A DISEASE. WHEN YOU TREAT
IT THAT WAY, PEOPLE CAN
GET BETTER. LEARN HOW YOU CAN HELP
SOMEONE YOU CARE ABOUT.   §§>>AND WELCOME BACK
TO OUR PROGRAM ON “THE ORIGINS OF ADDICTION.” WE’VE LEARNED A LOT
ABOUT THE BRAIN AND THE ORIGINS
OF ADDICTION. NOW, IN
OUR FINAL SEGMENT, LET’S TALK ABOUT WHAT
WE CAN DO WITH THIS INFORMATION. AGAIN, JOINING ME
ONCE AGAIN ON THE PROGRAM, DR. RUBEN BALER
AND DR. STEVEN GRANT. LET’S GO BACK TO THE
PSAs WE JUST SAW. “IF I HAD CANCER,
YOU WOULD TREAT ME.” “IF I HAD A HEART CONDITION,
YOU WOULD TREAT ME.” BUT DRUG ADDICTION? ANY COMMENTS TO THAT?>>DRUG ADDICTION
IS PERHAPS ONE OF THE
MOST STIGMATIZED CONDITIONS THAT EXISTS
IN OUR SOCIETY TODAY. AND IT IS STIGMATIZED
BECAUSE IT IS VERY DIFFICULT FOR PEOPLE TO PARSE
OUT THE MORAL COMPONENTS FROM IT BEING A DISEASE. FOR SO LONG, WE THOUGHT
OF DRUG ADDICTION AS BEING INDICATIVE
OF BEING A BAD PERSON. DRUG ADDICTION IS NOT
BEING A BAD PERSON. DRUG ADDICTION
IS A DISEASE, LIKE ANY OTHER
TYPE OF DISEASE, BUT IT AFFECTS THOSE
PARTS OF THE BRAIN THAT ARE INTEGRAL
TO BEING A PERSON, THAT ARE INTEGRAL TO ACTING
AND INTERACTING IN SOCIETY.>>SO WHAT CAN
WE DO ABOUT IT? LET ME ASK THIS QUESTION. DO MEMORIES, EXPERIENCES
THAT ONE PERSON HAS HAD, DOES IT CHANGE
THE BRAIN?>>OF COURSE. EVERYTHING THAT HAPPENS TO
THE BRAIN CAN CHANGE IT. THIS IS WHY WHEN WE APPROACH
THE PROBLEM OF ADDICTION, WE NEED TO THINK
IN AN INTEGRAL WAY. IT’S NOT JUST GENES
AND THE EARLY ENVIRONMENT, BUT ALSO THE
GENERAL ENVIRONMENT. IT’S THE SCHOOL,
IT’S THE FAMILY, IT’S THE EARLY STRESS,
IT’S THE CHRONIC STRESS, IT’S THE EMPLOYMENT
ENVIRONMENT, IT’S THE RELATIONSHIP WITH OUR EMPLOYEES AND OUR EMPLOYERS, EVERYTHING AFFECTS, AND OUR
MEMORIES, OF COURSE, SET UP THE SUBSTRATE ONTO WHICH
ALL THESE LATER EXPERIENCES CAN EITHER INCREASE OR
DECREASE THE RISK FOR ABUSE AND THEN ADDICTION.>>DOES IT BECOME ONE OF
THE LAYERS OR SOME OF THE
LAYERS OF THE SWISS CHEESE?>>IT’S ONE
OF THE SLICES, AND THAT’S WHY WE TALK
ABOUT AN ADDICTION CAREER OR AN ADDICTION
TRAJECTORY. IT’S MADE OUT OF MANY
DIFFERENT MOMENTS THAT EITHER ADAPT
TO INCREASE RISK OR TO A
RESILIENT INDIVIDUAL.>>ARE THE CHANGES IN A
PERSON, THOSE MEMORIES, THOSE THINGS THAT TAKE PLACE, THOSE EXPERIENCES, ARE THEY PERMANENT?>>WE HOPE THAT THEY
ARE NOT PERMANENT. WE WOULD LIKE TO FIND WAYS
TO REVERSE THE CHANGES THAT ARE ASSOCIATED
WITH ADDICTION.>>SO IS RESEARCH BEING
CONDUCTED TO LOOK INTO THAT?>>ABSOLUTELY. THAT’S ONE OF OUR MAJOR
FOCUSES AT THIS TIME IS TO UNDERSTAND WHAT
CHANGES IN THE BRAIN AND THEN HOW DO THOSE
CHANGES GET RESTORED BACK
TO A NORMATIVE LEVEL. ONE ISSUE THAT WE HAVE
TO CONFRONT IS KIND OF
A CHICKEN-AND-EGG ISSUE. THAT IS, THERE
MAY BE CONDITIONS IN
THE BRAIN THAT PRE-EXIST BEFORE THE PERSON
EVER TAKES THE DRUG THAT MAKES THEM VULNERABLE
TO PROGRESS TO ADDICTION, THAT THERE ARE HOLES IN
THE SWISS CHEESE BEFORE
THE DRUG EVER — THE PERSON IS EVER
EXPOSED TO THE DRUG THAT MAKES THEM MORE
LIABLE TO PROGRESS.>>SO SIMPLY SAYING TO THEM
“JUST STOP” DOESN’T DO IT.>>NO MORE THAN IT WOULD
HAVING A TENNIS PRO TELL YOU
TO KEEP YOUR ELBOWS — JUST KEEP YOUR ELBOWS
STRAIGHT AND THEN WALK AWAY.>>YOU MENTIONED EARLIER,
JUST A SHORT WHILE AGO, ABOUT IT NOT BEING A
MORAL FAILURE?>>SO MUCH OF WHAT WE
THOUGHT ABOUT IN ADDICTION IS THAT THESE ARE
BAD PEOPLE. THEY HAVE BAD
MORALS –>>BAD FAMILY, BAD ENVIRONMENT,
BAD EVERYTHING.>>THAT’S RIGHT. BUT ALSO BECAUSE THE TYPES
OF BEHAVIORS THAT PEOPLE
ENGAGE IN IN ADDICTION, BECAUSE THEY ARE ENGAGING
IN ILLICIT ACTIVITIES, MANY TIMES LEADS THEM TO
ENGAGE IN CRIMINAL ACTIVITIES. THEY MAY ROB. THEY MAY STEAL. THEY MAY DO THIS TO
THEIR OWN FAMILY. THEY ARE DOING THINGS
THAT ARE NOT ACCEPTABLE
IN OUR SOCIETY. WHAT IS DIFFICULT TO
UNDERSTAND IS THAT THE
PROCESS OF DRUG ADDICTION ACTUALLY CHANGES THOSE PARTS
OF THE BRAIN THAT ALLOWS A
PERSON TO EVALUATE WHETHER THEY ARE ACTING
IN A MORAL WAY OR IN A WAY
THAT’S GOING TO HURT THEM.>>WELL, IN HOPES OF
FINDING WAYS TO ACCELERATE
TREATMENT AND RECOVERY, NIDA RESEARCHERS
ARE USING BRAIN SCANS TO TRY AND FIGURE OUT
EXACTLY WHAT PARTS OF THE BRAIN
WE USE FOR SPECIFIC TASKS. THEY ARE USING THE
SCIENCE BEHIND THE SCIENCE TO BETTER UNDERSTAND
THE ORIGINS OF ADDICTION.  >>I’M THOMAS ROSS. I AM A STAFF SCIENTIST IN THE
NEUROIMAGING RESEARCH BRANCH AT THE NATIONAL
INSTITUTE ON DRUG ABUSE. SO OUR BRANCH USES
BRAIN-IMAGING TECHNIQUES TO INVESTIGATE
ISSUES IN DRUG ABUSE. PRINCIPALLY, WE USE A
TECHNIQUE CALLED FUNCTIONAL MAGNETIC
RESONANCE IMAGING. WE DO IT IN A WAY
THAT’S SENSITIVE TO CHANGES
IN BLOOD FLOW. SO YOU CAN IMAGINE
THAT IF PART OF YOUR
BRAIN IS WORKING HARDER, THEN IT WILL
NEED MORE OXYGEN, SO THERE WILL BE A LOCAL INCREASE IN BLOOD FLOW. AND WE CAN SET UP OUR MRI
MACHINE SO IT’S SENSITIVE
TO THOSE LOCAL CHANGES IN BLOOD FLOW. IT SHOWS US WHAT PARTS
OF THE BRAIN ARE NEEDED
TO DO CERTAIN THINGS. MAYBE IF I ASKED YOU
TO MAKE A RISKY DECISION, I MIGHT WANT TO KNOW
WHAT PART OF YOUR BRAIN CHANGES
DURING THAT RISKY DECISION AND MAYBE THAT DIFFERS BETWEEN
A DRUG USER AND A NONDRUG USER. AND WE WILL CREATE AN
IMAGE WHERE THE COLOR
OF THE IMAGE IS RELATED TO HELPING THE
BLOOD FLOW CHANGES. AS WE TAKE THESE
IMAGES ACROSS TIME, THESE HUNDREDS AND HUNDREDS
AND HUNDREDS OF IMAGES, AND COMBINE THEM TO
MAKE A SINGLE IMAGE THAT REPRESENTS CHANGES RELATED
TO WHATEVER WE’RE LOOKING AT. SO WHEN YOU SEE THESE
IMAGES OF COLORFUL, WE CALL THEM
CLUSTERS OR BLOBS, REGION OF ACTIVATION
OVERLAID ON TOP OF A BRAIN, THOSE COLORS REPRESENT HOW BIG THE SIGNAL CHANGE WAS. WE HOPE TO BETTER INFORM
THE SCIENTIFIC COMMUNITY WHAT PARTS
OF THE BRAIN ARE IMPORTANT
AND CRITICAL IN DRUG ABUSE SO THAT THEY
CAN BE TARGETS FOR EITHER SOME SORT OF BEHAVIORAL THERAPY OR SOME SORT OF PHARMACOTHERAPY TO HELP END DRUG ABUSE.  >>FASCINATING RESEARCH. SCIENCE BEHIND THE SCIENCE. STEVEN, YOU HAD A COMMENT.>>YES, THE ABILITY TO
LOOK AT ACTIVITY DIRECTLY
WITHIN THE HUMAN BRAIN HAS BEEN ONE OF THE
MAJOR ADVANCES WE’VE HAD IN OUR FIGHT
AGAINST ADDICTION. AND DR. ROSS MENTIONED TWO
THINGS THAT I THINK BEAR
UPON THE QUESTION THAT YOU ASKED BEFORE
WE SAW THAT SEGMENT. HE TALKS ABOUT RISKY
DECISION MAKING. ONE OF THE THINGS THAT IS
ASSOCIATED WITH DRUG ADDICTION ARE CHANGES TO THOSE
PARTS OF THE BRAIN THAT ARE ENGAGED
IN EVALUATING RISKS AND HOW THAT WOULD INFLUENCE
YOUR DECISION MAKING. THE SECOND THING IS THE
LAST PICTURE THAT YOU SAW THAT LOOKED LIKE
A BIG TANGLE OF WIRES.>>A 3D IMAGE.>>3D IMAGE. IT’S THE LATEST ADVANCE
IN BRAIN IMAGING, WHICH IS LOOKING AT CONNECTIONS
BETWEEN DIFFERENT BRAIN AREAS. AND WE’RE FINDING OUT THAT
IT’S NOT ONLY CHANGES IN
PARTICULAR BRAIN AREAS, BUT THE CONNECTION
BETWEEN THOSE BRAIN AREAS, THE ABILITY OF ONE BRAIN
AREA TO COMMUNICATE WITH ANOTHER THAT IS ALTERED
NOT ONLY IN ADDICTION BUT IN MANY OTHER
PSYCHIATRIC DISEASES.>>THAT’S PART OF WHAT
THE NEURON RESEARCH WAS
ABOUT IN OUR OTHER PIECE.>>THAT’S RIGHT. AND THERE IS A MASSIVE
PROJECT NOW GOING ON CALLED “THE HUMAN
CONNECTOME PROJECT” THAT IS INTENDING
TO MAP OUT THE CONNECTIONS
IN THE HUMAN BRAIN.>>HOW IS THE ADOLESCENT BRAIN
DIFFERENT FROM AN ADULT BRAIN?>>WELL, THIS IS A
FASCINATING QUESTION. WE TALKED BEFORE
ABOUT THE IMBALANCES BETWEEN THE CENTERS THAT
DRIVE IMPULSES AND BEHAVIOR AND THAT HIGHER
COGNITIVE PART OF THE BRAIN THAT ALLOWS US
TO INHIBIT THOSE AREAS AND TO SEEK A PROPER
BALANCE BETWEEN DRIVE
AND INHIBITORY CONTROL. THE ADOLESCENT BRAIN IS
NOT FULLY DEVELOPED YET. THIS IS A FINDING
FROM THE LAST 10 OR 15
YEARS FROM AN INVESTIGATOR AT THE NATIONAL INSTITUTE
OF MENTAL HEALTH, JAY GIEDD, THAT FOUND LOOKING
AT PROSPECTIVE STUDIES, CROSS-SECTIONAL
STUDIES OF INDIVIDUALS FROM 5 YEARS
OLD ALL THE WAY TO
20, 25 YEARS OLD. AND IT’S OBVIOUS THAT THE
LAST PART OF THE BRAIN TO
REALLY FULLY MATURE IS THE
PREFRONTAL CORTEX, WHICH IS IN CHARGE OF THE INHIBITORY CONTROL. ALL THE TIME,
THIS AMYGDALA PART, THE LIMBIC STRUCTURES
THAT ARE IN CHARGE
OF DRIVING THE IMPULSES, ARE FULLY DEVELOPED. SO IN A WAY, THIS ADOLESCENCE,
THROUGHOUT ADOLESCENCE, YOU HAVE AN IMBALANCE
THAT CREATES A GAP, CREATES A RISK FOR RISKY DECISION MAKING.>>SO THE MATURITY OF THE
BRAIN ISN’T THERE UNTIL,
WHAT, AGE, 24, 25?>>IT’S NOT
THERE UNTIL 22 OR 25, WHICH IS SOMETHING THE CAR RENTAL INSURANCE KNEW ALL ALONG. IF THEY JUST LOOK AT
THE TABLES OF WHEN DO
THE ACCIDENTS HAPPEN, THEY WILL CHARGE YOU MORE
UNTIL YOU GET TO THAT AGE.>>SO THIS KIND OF TELLS US
THAT TEENS, THEN, HAVE PERHAPS A PROBLEM
OF MAKING DECISIONS.>>WELL, WE KEEP CALLING
YOUNG PEOPLE TROUBLEMAKERS
OR TROUBLE KIDS. IN FACT, THE
TROUBLE IS WITH SOCIETIES, WITH ENVIRONMENTS THAT DOESN’T REALLY GIVE HEALTHY OUTLETS TO THE NATURALLY,
EVOLUTIONARILY DRIVEN RISK-TAKING BEHAVIORS. WE NEED SOMETHING THAT IS
GOOD THROUGH OUR EVOLUTION.>>AS RUBEN
ALLUDED TO EARLIER, THIS IS A PART OF
THE EVOLUTION OF THE BRAIN, THAT DURING
EARLY CHILDHOOD, THERE IS AN INCREASE IN PLASTICITY OF THE BRAIN. THE BRAIN IS
RAPIDLY GROWING. IT PLATEAUS FOR A WHILE,
AND THEN IN ADOLESCENCE, IT STARTS BECOMING
PLASTIC AND MALLEABLE AGAIN. IT BECOMES OPEN TO
CHANGING WITH EXPERIENCE BECAUSE THE SOCIAL CONTEXT THAT THE INDIVIDUAL IS GOING THROUGH, THE TRANSITION FROM
CHILDHOOD TO ADULTHOOD, IS CHANGING, AND THE BRAIN
NEEDS TO ADAPT TO THAT. THAT MEANS THAT THE BRAIN
NEEDS TO EXPERIENCE A WIDER VARIETY OF TYPES OF BEHAVIORS AND CONDITIONS. AND THIS MAY LEAD TO
DIFFICULTIES AND BAD DECISIONS, BUT WE WOULD WANT IT TO
LEAD TO LEARNING THOSE THINGS THAT LEAD THE PERSON TO BE A GOOD PERSON IN SOCIETY.>>RUBEN, WHAT IS THE
THING, EPIGENETIC? WHAT IS THAT?>>EPIGENETICS IS
A TERM THAT REFERS TO
CHANGES IN THE GENOME, IN GENE EXPRESSION THAT HAVE
NOTHING TO DO WITH MUTATIONS, WITH GENETIC CHANGES. WE KNEW FOR A LONG TIME THAT
BIOLOGY AFFECTS BEHAVIOR. WE ALSO KNEW THAT
ENVIRONMENT CAN
CHANGE BEHAVIOR. WHAT WE WERE NOT PARTICULARLY
PAYING TOO MUCH ATTENTION TO IS THE FACT THAT THE
ENVIRONMENT CAN ITSELF
AFFECT GENE EXPRESSION, AFFECT THE GENOME WITHOUT
CAUSING MUTATIONS. ONE ANALOGY THAT I USE TO
EXPLAIN WHAT EPIGENETIC, THIS VERY
FASHIONABLE TERM IS, IS THINK ABOUT
A COUPLE OF CARS THAT CAME OUT OF THE
FACTORY IN DIFFERENT COUNTRIES, DIFFERENT DATES,
AT DIFFERENT TIMES. THESE TWO VERY DIFFERENT
CARS HAVE OBVIOUSLY
DIFFERENT BLUEPRINTS, DIFFERENT GENES. THEY WILL HAVE VERY
DIFFERENT TIME COURSES. NOW, YOU MENTION
TWO CARS THAT CAME OUT
OF THE ASSEMBLY LINE AT THE SAME TIME,
ONE AFTER ANOTHER, THEY ARE TWIN CARS
FROM THE SAME FACTORY, AND THEY HAVE OBVIOUSLY THE SAME
BLUEPRINTS, THE SAME GENES. BUT IF YOU LOOK
AT THESE TWO CARS, LET’S
SAY, 10, 20 YEARS LATER, YOU WILL SEE THAT THEY HAVE VERY
DIFFERENT PERFORMANCE. EVEN THOUGH THEY STILL
HAVE THE SAME BLUEPRINT,
THE SAME GENOME, THEIR PERFORMANCE,
THE WAY THESE ENGINES
ARE EXPRESSED OR PERFORMED IS VERY DIFFERENT. AND THIS IS NOT BECAUSE OF
CHANGES IN THE BLUEPRINT, BUT THIS IS BECAUSE
OF CHANGES THAT THE ENVIRONMENT HAS IMPACTED UPON
THIS BLUEPRINT. THESE ARE EPIGENETIC
GENES THAT HAVE TO
DO WITH LIFE EXPERIENCE, WHO THE OWNER WAS,
HOW WELL WERE THESE CARS
TAKEN CARE OF, AND SO ON. SO THESE ARE ENVIRONMENTAL
IMPACTS ON THE BLUEPRINT THAT WE CALL
EPIGENETIC EFFECTS, AND THE DRUGS
ARE NOTORIOUS DRIVERS
OF EPIGENETIC CHANGES.>>SOMETHING WE
HAVEN’T TALKED ABOUT
IS SELF-CONTROL. HOW DO THESE DRUGS
AFFECT SELF-CONTROL?>>WELL, THE MOST
OBVIOUS ANSWER IS THAT
IT ERODES SELF-CONTROL, THE ABILITY OF THE PERSON
TO STOP TAKING THE DRUG. THIS IS THE HALLMARK
OF DRUG ADDICTION.>>NOW, YOU SAY “ERODE.” DOES IT TOTALLY
REMOVE IT? IS IT PUT OFF IN
THE BACKGROUND?>>NO. ACTUALLY, IT IS
BETTER THOUGHT OF IS IT
REFOCUSES SELF-CONTROL. IT REFOCUSES SELF-CONTROL
ON THE ACQUISITION
AND USE OF THE DRUG TO THE EXCLUSION OF
OTHER TYPES OF BEHAVIOR.>>WOW. SO IT JUST RECHANNELS
YOU BACK TO THAT POINT.>>YES.>>HMM. YOU HAD MENTIONED THAT DRUG
ABUSE, ALCOHOL, SO FORTH, ARE OPERATIONAL FAILURE
AND NOT MORAL ONES. WOULD YOU
COMMENT TO THAT?>>WELL, YEAH, AS I
MENTIONED BEFORE, ADDICTION IS REALLY
A WAVE OF DYSFUNCTION THAT STARTS WITH
A REWARD SYSTEM, BUT IT ENDS UP IMPACTING
OTHER CIRCUITRY IN THE BRAIN. AS STEVEN JUST SAID, THE SELF-CONTROL PARTS
OF THE BRAIN ARE KEY THERE. SO WHEN WE READ LETTERS
FROM CUSTOMERS, CLIENTS, OR PATIENTS,
AS WE CAN SAY, THEIR SON IS STEALING
THEIR MONEY FROM THEIR
DRAWERS, FOR EXAMPLE, WE SEE THESE BEHAVIORS,
AND WE IMMEDIATELY
SEEK AN EXPLANATION IN THE REALM OF THE MORAL
FAILURE, OF A CHARACTER FLAW. BUT WHEN WE KNOW
THROUGH THE fMRI IMAGES, THROUGH THE
STUDIES IN ANIMALS, THROUGH MOLECULAR
AND GENETIC STUDIES, WHAT HAPPENS IN
THE BRAIN OF INDIVIDUALS THAT HAVE BEEN EXPOSED
FOR SO MANY YEARS TO THE DEVASTATING
POWER OF THESE DRUGS, WE CAN ACTUALLY SEE
THAT THE BRAIN, THE IMBALANCES
IN THE BRAIN, IS WHAT PROMPTED US TO CALL
THIS AN OPERATIONAL FAILURE OF THE BRAIN’S
DIFFERENT CIRCUITRY THAT IS COMPOUNDED BY THE STIGMA THAT SOCIETY IMPARTS UPON IT.>>JUST LIKE THERE ARE
PARTS OF THE BRAIN THAT ARE RESPONSIBLE FOR US BEING ABLE TO HEAR OR SEE, THERE ARE PARTS OF THE
BRAIN THAT ARE RESPONSIBLE FOR US TO MAKE DECISIONS. THERE ARE PARTS OF THE BRAIN
THAT ARE ENGAGED WHEN YOU
HAVE TO MAKE A MORAL, WHAT WE WOULD CALL
MORAL DECISION, AND THOSE PARTS OF
THE BRAIN ARE IMPACTED DURING THE PROCESS OF THE
DEVELOPMENT OF DRUG ADDICTION.>>IS A LACK OF SELF-CONTROL
A WARNING SIGN?>>ABSOLUTELY. ACTUALLY, THERE ARE
EXPERIMENTS THAT SHOW THAT
THE FIRST SIGNS OF A WEAK, OR LESS-THAN-OPTIMAL
SELF-CONTROL, CAN REALLY POP UP WHEN
AN INDIVIDUAL IS THREE OR
FOUR OR FIVE YEARS OLD — IN TODDLERS. WE CAN MEASURE WITH SIMPLE
COGNITIVE EXPERIMENTS,
PSYCHOLOGICAL TESTS, BATTERIES, THAT YOU
CAN TEST THE STRENGTH
OF SELF-CONTROL. IF THE MOTHER LEAVES THE
ROOM, FOR EXAMPLE, YOU CAN SEE HOW
THE BABY REACTS. SOME OF THEM WILL BE
RESTRAINED, WILL WAIT, OR KIND OF KNOW THAT THE MOTHER WILL EVENTUALLY COME BACK. SOME BABIES WILL COMPLETELY
THROW A TANTRUM RIGHT AWAY AND START CRYING UNTIL THE MOTHER COMES BACK. SO THESE ARE THE FIRST SIGNS
THAT SELF-CONTROL CIRCUITRY, LIKE MANY OTHER
FUNCTIONS IN THE BRAIN, HAVE A VERY BROAD, VERY BROAD RANGE OF INDIVIDUAL VARIABILITY. THIS IS,
AS WE’RE FINDING OUT, ONE OF THE MOST IMPORTANT
PROXIES OR MARKERS
FOR RISK LATER ON IN LIFE.>>ARE WE BORN WITH A CERTAIN
AMOUNT OF SELF-CONTROL AND THEN RELY ON OTHERS TO
TEACH US OR IMPRESS UPON US?>>THE GOOD NEWS
IS THAT SELF-CONTROL, LIKE MANY OTHER
PARTS OF THE BRAIN, CAN CHANGE. THE BRAIN CAN LEARN TO BE
ABLE TO EXERT MORE, OR IN THE
CASE OF ADDICTION, LESS SELF-CONTROL. THERE ARE PEOPLE WHO HAVE
MADE A ROUGH ANALOGY BETWEEN
SELF-CONTROL AND MUSCLES, THAT EXERTING
TOO MUCH SELF-CONTROL
MAY LEAD TO A FATIGUE AND A FAILURE OF SELF-CONTROL
IN THE SHORT RUN, BUT YOU CAN ALSO
EXERCISE SELF-CONTROL, AND YOU CAN LEARN TO EXERT MORE
SELF-CONTROL OVER TIME.>>WHY IS TREATMENT SO OFTEN
DIFFICULT FOR SOME PEOPLE
AND SOMETIMES THEY RELAPSE?>>AGAIN, THE CIRCUITS IN
THE BRAIN ARE VERY ROBUST. ONCE YOU ESTABLISH THE
MAPS OF BEHAVIORS, THESE AUTOMATIC BEHAVIORS, AS WE ALL KNOW IN MANY
OTHER REALMS OF LIFE, THEY ARE VERY DIFFICULT
TO GET RID OF. THEY ARE INSTANTIATED
IN MOLECULAR PROCESSES THAT ARE VERY, VERY
STRONG AND VERY HARD TO ERASE, LIKE MEMORIES, FOR EXAMPLE,
LIKE TRAUMATIC MEMORIES. THE SAME REASON WHY PTSD
IS SO DIFFICULT TO TREAT.>>DO PEOPLE NEED TO HIT
ABSOLUTE ROCK BOTTOM BEFORE
THEY CAN BE TREATED? IS THERE ANOTHER –>>I’D LIKE TO SAY
THAT EVERYBODY HITS
ROCK BOTTOM. EVERYBODY HITS BOTTOM. THROUGHOUT THEIR
LIFE, HITTING BOTTOM
IS AN INTRINSIC WAY THAT THE BRAIN KNOWS THAT
WHATEVER ADAPTATIONS OR BEHAVIOR THAT IS BEING USED TO COPE
WITH A CERTAIN SITUATION
IS NOT WORKING. THE BRAIN HAS CIRCUITS AND
SYSTEMS THAT TELL YOU WHEN
THERE HAS BEEN A FAILURE. AND WHEN THERE’S
BEEN A FAILURE, YOU NEED TO
CHANGE YOUR BEHAVIOR. SO EVERYBODY, IN A SENSE,
HITS BOTTOM ALL THE TIME. THE QUESTION IS, HOW DEEP DO YOU HAVE TO GO BEFORE YOU HIT THAT POINT WHERE THOSE CIRCUITS
ARE ENGAGED? ONE THING WE’RE FINDING
OUT IS EITHER THAT
DRUGS AND ADDICTION ARE ASSOCIATED
WITH IMPAIRMENTS OF THOSE
SYSTEMS AND CIRCUITS THAT TELL YOU WHEN
YOU NEED TO CHANGE.>>HOW CAN WE REMOVE SOME
OF THAT STIGMA ATTACHED
TO SUBSTANCE ABUSE?>>WELL, IF YOU HAVE THE
KEY TO REMOVING STIGMA,
IT’S UNDERSTANDING. IT’S EXACTLY WHAT WE’RE
DOING HERE TODAY, TRYING TO DISSEMINATE WHAT REALLY HAPPENS IN THE BRAIN OF THESE INDIVIDUALS THAT
HAVE BEEN UNLUCKY ENOUGH THAT ALL THOSE HOLES IN THE
SWISS CHEESE STACK OF THE SLICES WERE ALIGNED IN A WAY THAT ALLOWED THAT INITIAL USE TO GO THROUGH AND CAUSE
A FULL-BLOWN ADDICTION. THIS IS JUST
A LACK OF LUCK. NOT A LACK OF MORAL
FIBER OR CHARACTER.>>IS IT IMPORTANT FOR
US TO REALLY UNDERSTAND
THAT THIS IS A DISEASE?>>IT IS ESSENTIAL FOR US
TO UNDERSTAND THAT DRUG
ADDICTION IS A CONDITION, WHETHER YOU CALL IT A
DISEASE OR WHETHER YOU HAVE
ANOTHER TERM FOR IT, THAT PEOPLE CAN OVERCOME,
THAT THERE ARE TREATMENTS. THEY MAY BE DIFFICULT. THEY MAY TAKE ENORMOUS
AMOUNTS OF TIME AND EFFORT, BUT THERE ARE TREATMENTS, AND PEOPLE CAN OVERCOME ADDICTION TO DRUGS.>>IS THAT SOME OF THE
STIGMA WITH IT, BECAUSE IT WILL
TAKE SO MUCH TIME, SO MUCH
ENERGY, SO MUCH EFFORT?>>YES, NOT ONLY BY THE
PERSON THEMSELVES, BUT BY
THEIR FAMILIES AND MAYBE BY THE
LARGER SOCIAL COMMUNITY.>>SO WHAT’S NEXT IN
RESEARCH REGARDING THIS?>>THERE ARE
MANY FACETS THAT WE’RE
ACTIVELY INVESTIGATING. ONE OF THE FACETS THAT WE
HAVEN’T TALKED TOO MUCH
ABOUT IS COMORBID CONDITION, FOR EXAMPLE, AND
THAT ALSO FEEDS INTO
THE AREA OF STIGMA. WE KNOW THAT A MAJORITY, PRETTY MUCH A MAJORITY OF PEOPLE THAT ARE AFFECTED BY ADDICTION ALSO MAY HAVE
EITHER OVERT OR UNDERLYING
OTHER MENTAL ILLNESSES, LIKE DEPRESSION OR SCHIZOPHRENIA. ONE OF THE LEADING
THEORIES IS THAT MANY
OF THE CASES OF ADDICTION REALLY ARE CASES OF PEOPLE
TRYING TO SELF-MEDICATE. AND THEY ARE APPROACHING
THIS SCENARIO BECAUSE
THE SYSTEM HAS FAILED TO DIAGNOSE OR IDENTIFY THOSE
THAT ARE MORE VULNERABLE. SO I THINK THAT ONE OF THE
MESSAGES IS THAT IT’S
SOCIETY’S ROLE, REALLY, TO IDENTIFY AS EARLY AS
POSSIBLE THOSE KIDS IN SCHOOL THAT MAY PRESENT
WITH PROBLEMS OR WITH
UNDERLYING VULNERABILITIES THAT SHOW ABNORMAL BEHAVIORS
OR ABHORRENT BEHAVIORS THAT MAY SIGNAL
THAT THEY MIGHT FALL PREY TO THIS PROBLEM OF
ADDICTION LATER IN LIFE.>>DR. BALER, I’LL LET THAT
SERVE AS YOUR FINAL THOUGHT. STEVEN, WILL YOU PLEASE
GIVE US YOUR FINAL THOUGHT REGARDING OUR
DISCUSSION TODAY?>>WELL, I’LL EXPAND A LITTLE
BIT ON WHAT RUBEN SAID, AND THAT PEOPLE USE DRUGS
FOR A NUMBER OF REASONS. THEY USE DRUGS NOT
ONLY TO GET HIGH AND FOR
RECREATIONAL PURPOSES, BUT THEY USE
IT FOR RELIEF. AND THAT RELIEF MAY BE AS
MUCH OF A PROBLEM, OR CAUSE AS
MUCH OF A PROBLEM, AS THE RECREATIONAL USE,
THE EUPHORIA.>>QUICKLY, WE HAVE A
LITTLE BIT MORE TIME. WHAT CAN WE CHANGE?>>WELL, I THINK THAT
SOCIETY HAS A VERY HUGE
RESPONSIBILITY HERE. WE SAY THAT ADDICTION IS
NOT THE MORAL FAILURE. I CALL IT A SYSTEM FAILURE. WE HAVE TO LOOK AT ALL THOSE
SLICES AND RECOGNIZE THAT WE
HAVE A RESPONSIBILITY TO PROTECT OUR KIDS,
PARTICULARLY THE
ADOLESCENTS. WE KNOW THAT EARLY
INITIATION HAS A
DRAMATICALLY HIGHER RISK OF BECOMING
AN ADDICTION. SO WE HAVE TO DO A BETTER
JOB OF EDUCATING AND
PROTECTING OUR YOUNG PEOPLE.>>ANY FOLLOW-UP
WITH THAT, STEVEN?>>AND THAT WE PROVIDE THE
WAYS AND MEANS FOR PEOPLE TO
CHANNEL THE TYPES OF THINGS THAT THEY DO GET FROM DRUGS
INTO OTHER TYPES OF ACTIVITIES, WHETHER THOSE
ACTIVITIES MAY INVOLVE PROVIDING THE
RELIEF FOR CONDITIONS
THAT THEY ARE SEEKING OR TO PROVIDE THE RECREATIONAL
TYPES OF ACTIVITIES THAT WILL BE BENEFICIAL
IN THE LONG RUN.>>WELL, VERY
GOOD, GENTLEMEN. I DO APPRECIATE IT. THAT IS ALL THE TIME
THAT WE HAVE FOR TODAY. FOR DOCTORS
RUBEN BALER
AND STEVEN GRANT, I’M STAN RHOADS. THANKS FOR WATCHING
“THE ORIGINS OF ADDICTION.”  

6 comments

  1. I wouldn't say it all starts in the brain. I'd say the problem starts in the spirit and people use drugs and alcohol to fill the void! This includes smoking cigarettes too!

  2. Revelation 3:20 – "Behold, I stand at the door, and knock: if any man hear my voice, and open the door, I will come in to him, and will sup with him, and he with me."

    John 10:3 – "The gatekeeper opens the gate for him, and the sheep recognize his voice and come to him. He calls his own sheep by name and leads them out."

    John 10:9 – "Truly, truly, I tell you, whoever does not enter the sheepfold by the gate, but climbs in some other way, is a thief and a robber."

  3. Concerning the question about temptation, it seems a good corollary would be to study sexual behaviour. ("Sexual addiction" seems to be recognised at this time.) Sexual desire is one of the basic things regulated by dopamine and sex also covers basic points of addiction such as anticipation, reward, expectations, etc. Yet within societies there have usually been sexual norms established, many times very strict requirements, designed for the protection of families and children. For example in western societies monogamy has been established as the best way. (There are other systems in other societies but in most all there are also taboos and restrictions and breaking these rules many times has harsh consequences.)~~~~~Whatever the social norms, a high percentage of people are able to meet the goal. With sexuality, temptations are all around all the time yet people are able to maintain whatever level of faithfulness society establishes. How does the brain function when there is severe temptation yet a person consciously rejects the temptation and remains faithful to a mate, family, etc.?~~~~~In a similar vein there are taboos, things that are rejected outright with implication that dread things will happen if the taboo is broken. Most people, worldwide, would be disgusted with the idea of sex with children. Or incest. What happens in the brain when a person rejects the idea of breaking a taboo?~~~~Finally, in our western society, even though some folks are proud rebels, most of us cringe at the idea of going naked in public. Talk about a habit that is ingrained! How did we get and how do we maintain such control over covering at least certain parts of our bodies? Could understanding the physiology of such control teach us anything about the loss of control in drug addiction and addictive behaviour in general?

  4. 21:20 we do not need to "train" people away from addiction, but "untrain" them from the horrifying parenting/education/religious indoctrination that lies at the roots of societal ills and dysfunction. for that matter, the focus should be much less on genetics and much more on refraining from sexual repression, child abuse, religious indoctrination, and "schooling" children with boring, useless, unproductive models. give a child protection/safety, appropriate affection, healthy food, intelligent "play", and exciting, relevant hands on education and we will see addictions virtually disappear. in my own life, I had suffered all of these institutions and only when I began to eat healthy, create art/music/writing, reoriented my learning in my "own way and for my own purposes"–and rejected religion–did I conquer all the nasty addictions of my youth (mostly junk food).

  5. There's no such thing as addiction, there's only things you prefer doing more than other things. It's much easier to fool people than it is to convince them they have been fooled though. Oh well-ism, c'est la vie.

  6. Maybe it's because Marijuana still illegal?? Nowadays people talk about Marijuana as an 'exit drug'. Many articles on the internet says that Marijuana can lower the tolerance of opioid medication like oxycodone. So people who addicted to Oxycodone can taper off safely with the help from Marijuana. Besides, the chance to get addicted to Marijuana is very small. Even if you are addicted to it, I think it will not make so much problems like when you get addicted to opioid medications.

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