Q&A - The Neuroscience of Addiction - with Marc Lewis

[Music] hi thank you very much for your talk was amazing Chuck this might be a bit of a controversial question in the world of psychiatry especially now but are you familiar with the use of ancient kind of psychotropic substances such as iboga and ayahuasca what you think about those and if they're possible for treating addiction yeah I I am somewhat familiar with that and there's been a new wave of research into using psychedelics for treatment of anxiety depression PTSD and addiction and I think it's great I mean in a nutshell I think that psychedelics are in a very different category than drugs like heroin and methamphetamine for most people for most people they can be very helpful for all kinds of issues of self actualization getting a better sense of yourself in the world of course for some people are not nice and some people have to just avoid them but in general I think you know they have this tremendous capacity for changing one's perspective in a pretty radical way which might take a long time through psychotherapy so I think it's very promising there's two up the back there and one man down yes Everett yes doesn't start at that yeah thinking about all the different things that one become can become addicted to is it the case that those differences between them in terms of the level of addictiveness and if that is the case do we know why a level of addictiveness or addictiveness addictiveness the difficulty to kick yeah well I mean those the statistics about the timeframe from starting to ending is helpful in that respect so presumably it's a lot easier to kick cocaine that it is to kick nicotine because the median you know duration is four years rather than twenty five years so that tells us a lot but I would say that those medians are those out there's like means or averages but it's a median slightly different mathematically are they're a little bit misleading because that implies that there's some bell-shaped curve and it's not like that there could be a very you know very messy curve it could be bimodal so some people might quit much sooner and some people might take longer and I think that then leads us to think really in terms of individual differences and how important it is to think about the synchronization between the person and the substance so you know some people don't like heroin at all and for some people that's fantastic you know it's the same with best I'm fed Amina coke some people really like it some people hate it and these individual considerations these individual attractions are really interesting to me because they they come from the personality they come from our game what do you feel you're missing are you missing you know the sense of connectedness and love or you feel like you're missing a sense of power and awakeness and you know dynamism that will determine what you're attracted to and the degrees will determine how much you're attracted to those things that there's another question up there yeah yes I have a friend who months and months and months can go by and then suddenly starts again and what it makes me think is that craving or is that the results of the stress that long-term how if it involved in high-level jobs and what have you especially and they can't stand it anymore and this is a way out of the stress yeah there's a both there's this phenomenon called incubation of craving which means that Kragen can increase during say the first six months or so of abstinence so might be easier to avoid going back to it in the first two or three weeks when it's still very fresh how nasty it was and now it's [ __ ] up your life my that's haha but but and then you know three or four or five months later when those negative memories are more dim you might be more tempted to say well you know maybe on weekends it's okay and then you fall back into it but that certainly interacts with with stresses and the any any kind of perturbing negative experience which induces anxiety or depression losing a job losing a marriage losing whatever getting a parking ticket god and the netherlands parking tickets are you can like 200 euros sometimes it's all you know send me back into being an addict so I think I think that both are really important and it does manifest as craving because the stress start makes you start thinking about you know it really likes if just calm down just like - let's deal with this and I know that if I had a drink I'd really feel better and it's like so then the craving starts up so that's that's the way in which they're interconnected I think that you definitely you know yes this one next at the TMS - you talked about before but that was actually for depression so just interested in your comments about the comparison addiction and depression in that regard you talk about TMS treatment for depression yeah I've heard about that they are starting to use it clinically for depression and also for OCD so do you mean CMS or do you mean deep brain stimulation new TMS okay I don't really know much about it say the truth I mean I don't know how well it's been studied and how well it's been validated and what sort of success rates they have but I guess the good thing to to remember is that TMS can turn regions off but it can also turn regions on it can stimulate activation in cortical regions or it can yeah disrupt activational cortical regions depending on the frequency of the pulse and stuff like that and I really don't know much about it was it lady here and then there's a lady at the back somewhere yes down here thank you very much for laying out dominance in addictions why also an accent to call it a disease except the psychosocial reasons that it makes the person feel disempowered I mean that you describe the brain mechanisms behind it and it has its the case isn't it that not everybody the possibility of becoming addicted becomes addicted and I know what what comes addicted not every person's addicted yes and I was thinking of earlier work it's still thought of this palette with primates where they were drink I think opium latent and some drank and became addicted and others didn't and wouldn't solicit and didn't become addicted and they were forced to drink and I'm following up the drive here it's some after and some of them stopped drinking for months and then as it appeared fell by the wayside again so I'm just trying to think that must be perhaps brain mechanisms and individual differences which yeah there sure there are individual differences it and why wouldn't that allow unsupported because biological differences in the brain don't make something a disease brain differences can predict school performance can predict the likelihood of a successful marriage can predict you know the likelihood of making a certain amount of money brain differences the intelligence cognitive style I mean all of these have to do with brain differences but you you touched on two important points one is the genetic factor and the other is the environmental factor and the genetics of addiction yes there are genetic predictors but you get sold a real bill of goods when people say that addiction is 50% genetic because that implies that there is an addictive personality and there isn't if you look at the behavioral genetics you look at the data some people who have impulsive personality styles who are risk takers more or less kind of like me when I was a kid I apparently climbed up on you know climbed things whenever I could and so that increases the propensity the likelihood of addiction because you're more likely to try stuff you're also more likely to try bungee jumping and skydiving and unsafe sex so you get some of the variance from that other people who are anxious or depressive that may have to do with rejection sensitivity which can be biological it can be partly partly inborn partly genetically linked they also are more more prone to addiction so you've got two opposite personality styles both of which increase the odds of becoming addicted so instead of any personality just addiction personality you've got all these little variables and that's how behavioral genetics works they just pull all this stuff together you're probably also more likely to become addicted if you're really ugly or or something you know or if your feet smell like because these things matter everything is biological and and and this is the way that your body is shaped by your inherit by inherited characteristics is important what's also important is the way you interact with your social environment so when you talk about that primate research there's also research with primates showing that the monkeys who are put in a lower position on the dominance hierarchy this is fairly recent stuff I don't remember the exact details but if they're in the presence of a more dominant male they are more likely to drink and the dominant male is less likely to drink why because the dominant male is having a good time and the sub dominant male is it so these are strong social environmental factors that also affect the propensity towards addiction so the genetics the environment the you know the social context and also there's all these societal variables including poverty the you know that some of the racism the particular problems that people have to resolve because of their class or their color or their parentage these are all problems that will predict the likelihood of addiction well I'll go sick can we get there were some people over here who wanted to ask questions could we go there first right okay sorry I'm sorry it wasn't it was thanks very much you mentioned the key role of dopamine in the brain this is a slightly specialist question would you be able to say anything about drugs the block dopamine and how that might affect the the picture in terms of learning in terms of goal seeking behavior in terms of just generally functioning they this is John Mason who's a colleague of mine he's a psychiatrist and maybe but it's a shared it we have a shared concern about the effects of antipsychotic drugs which block and reduce rate I mean right functionally so it'd be interesting well your article that I read this morning so yeah so most the dopamine blocking drugs are antipsychotics and there are as you know they have all kinds of nasty side effects like a flight flat effect changes in body size overeating they dull motivation and and so on and so forth and they can you know the list way better than I do I don't think they've been able to find drugs that can specifically block the dopamine receptors that are specialized for the d1 and d2 receptors we've seen and d3 in the striatum which are most involved in the mesolimbic dopamine system right the dopamine system that's involved with motivation rather than the motor dopamine system and and because you can't find a specialized dopamine blocker you have these these things that block dopamine at a global level which just you know flat and motivation and emotion and a much too general away that's my sense of it give you some questions up there yes of two men night I think you think if you talk I just wanted a question about unintended consequences so you're talking very much about the brain individual brains and and the sub brain level about how all the stuff works if you were to go up to the societal level um I'm thinking of an example like in Australia where they're effectively banning cigarette smoking through lawful means is there anything that can be learned from that do you think there might be bigger consequences that do you might be suppressing addictive outcomes on a on a very large scale are those sort of lawful interventions and maybe that's outside your feel but like those who have what was the last bet um the lawful interventions which are trying to stop this addictive behavior it's not addressing any of the stuff you talked about right I said intended consequences you know I mean I kind of follow Johann Hari British journalist who wrote a book called the chasing of The Scream the first and last days of the war on drugs the war on drugs has been this massive program and policy that has been disseminated by Western governments particularly by the u.s. to suppress and block the availability of drugs that we don't want people to take and it was originally you know kind of like well particularly targeted toward cocaine and heroin it had strong racist characteristics because we didn't like the way black people took cocaine and heroin and even now in the u.s. blacks are much more likely to land in prison for cocaine related offenses including just using cocaine than our white people but the overall the overall outcome of the war on drugs has been disastrous you try to suppress drugs you try to suppress drug availability and what happens is you're handing it over to criminal elements so you get these massive empires and these drug cartels that have really overtaken both Mexico for sure and a lot of the rest of Central and South America they're incredibly powerful because if people want a particular commodity and it gets blocked at one point it gets Perdue it gets made available by another point supply and demand well we tried it with alcohol right with prohibition that didn't work very well so if there is a way that one could actually close down access to really dangerous drugs like methamphetamine or heroin maybe that would be a good thing but I just don't think we're capable of it maybe you could do that with cigarettes but again well in Canada for example you get your cigarettes from the native reservations because you know Canadian law doesn't extend to those reservations so and they're cheaper and they're not taxed and so forth it's just all these different channels for people getting what they want so better to deal with the 10% who really have problems with substances then try to ban these substances entirely and end up with hundreds of thousands of people in jail there was a man behind you that's right he's had his hand up for a while and we if we're going to finish on time it might have to be the last contribution I'm sorry and yes I will come to the balcony next we've got time sorry a few minutes Thanks thank you so much for the talk okay I thought was really interesting towards the end when you mentioned motivation where are you I can't find you thank you sir hi yeah particularly the the internal aspect of motivation and it's something that I've struggled with especially with about motivation about personal motivation connecting Alex with with the world and with their sort of their life narrative is very important part of where you see the answer being yeah it's something actually struggle with with people people that I would look at and see it's lacking motivation who have no sir addictive problem but I would say is not really making the best of themselves and of their lives because they don't have that internal engine and always very frustrating because it seems to be the one thing that you can't give to someone but yeah it is so so intrinsic to them as a person so yeah I don't know whether it's one of the specific psychological processes you listed on the scales at the end but if there is something that you but what are your thoughts on on helping people to achieve that yeah well there's something called motivational interviewing which is a approach to psychotherapy talk psychotherapy that helps people really look for what it is that they're attracted to and helps them kind of clear the air and put things in perspective in terms of what their goals are so maybe that's part of the answer I think there are societal blocks and constraints on what people are capable of achieving as I said before when you have like oppressed sectors of the population and so forth they maybe have good reason to be lacking motivation because they're not gonna get a good job and they're not going to you know whatever they're not going to be able to accumulate wealth or property whatever it is they're after so sometimes there's a reason for people to be lacking motivation but when those factors are not import or not are not dominant then yeah you know it's a hard problem I mean I agree it's a hard problem how do you help somebody find something which is intrinsically only available for them to find the balcony person sorry yes you want to go thank you very much mark I'm a member of a loved one who's an addict how would you say from the unique perspective of someone he's an addict how best to support them without enabling their activities and do you see any hereditary aspects to addiction they're rather Tara Terry Parks I think I already spoke about that there are different personality counts to it where are you by the way I couldn't find you oh you're way up there no one can find you ah so they're different personality characteristics that predisposed to word addiction to some degree 5 10 15 percent each whatever it is but it doesn't matter how you get there if you get if you become if you have a serious addiction problem yes of course it's very difficult what addicts need is inclusion connection love acceptance and and so forth but it's really hard sometimes to love an addict it's hard to know how to give them support and acceptance when in fact they're not only wrecking their own life but wrecking yours as well perhaps the lives of their children and you know it's there they can be pretty unpleasant people so I think people have to find a balance between firmness and making defining their own limits and clarifying what those limits are and being able to accept the other person without rejecting them entirely so you can say look I don't want to see you when you're smashed I don't want to be around you in your drunk but tomorrow when you're drunk anymore come on over for lunch or whatever it is or we could have a talk or if you don't want to get drunk tonight you know you could come for a visit we could watch a movie together or we can go out so there's ways at which you can sort of I guess you know disseminate your regard for that person in your capacity to approve of them and connect with them without having to be in their presence when they are actually harming you causing you distress I I shouldn't I should mention the the rat Park studies the very very briefly we're talking about other animals and so forth and what what a number of researchers found and very very counter well perhaps counterintuitive results in the eighties and nineties so they found that they gave rats morphine a choice between morphine and water regular water and rats that were in the normal steel cage is one rat to a cage would prefer the morphing to the water like your monkeys and rat Park was they took these animals out of their isolated cages put them in a large wooden enclosure where they could interact with other rats and socialize and have fun together and they had toys to play with rat toys and guess what they stopped preferring morphine they started preferring water and even those who are physically addicted to the morphine would spontaneously stop taking it even though they'd have to suffer withdrawal symptoms because they preferred the socialization to the to the morphine and I think that's one way of trying to highlight the fact that addicts really do need to be connected with other people we don't want to isolate them we conclude because that just makes it worse we take one more contribution I saw you let this man down here yeah okay um sorry this is too sociological maybe philosophical guys wanting to get your thoughts on just what is the distinction between behavior which is addictive and other very similar learning behavior and I'm thinking of a kind of you know toy example where you have two people both the watch let's say a lot of pornography one of which feels really bad about it and stuff is a great deal and feels are addicted the other one who's not bothered who watches the same amount and enjoys it and feels like that's just part of living in the modern world now who is one of them addicted in the other not well I don't know I mean if you feel bad enough about it you probably stop doing it and so it's usually the ones who are feeling I don't think either of those things is essentially part of the addictive pattern you can feel very bad about something you do a lot of or you can feel very good about something you do a lot of them conversely you know so alright try to take it easy though okay so that that's what I think I think those are mainly interacting emotional dynamics thank you okay okay so um so thank you very much Denmark

Channel: The Royal Institution

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Keywords: Ri, Royal Institution, neuroscience, science, Q&A, dopamine, addiction, drugs, alcohol, lecture

Id: pEjMi1OPnYY

Length: 23min 58sec (1438 seconds)

Published: Sat Dec 10 2016