- I'm really grateful for this opportunity. As I mentioned earlier this material really matters a lot to me. I was actually walking down the hallway up above before coming down and really asking for guidance and support in getting this material out. It's not just intellectual material for me and I hope that it will land in some place that's meaningful for you no matter where you are in your lives and that's my aim. So I'll do my best to convey this material in many ways from what I know by heart, but I'm hoping that you'll leave here with a bit more information and also more self-reflection. Owing to the medium we won't have question and answer and dialogue here and in another context we would and so we're together in spirit and even afterwards if you want to write notes and we want to talk about this afterwards I'd be game on for further dialogue. I do have a bibliography that I'll save to the end and if you have to leave early I'll find you. I will track you down and give you a bibliography, okay, 'cause there's a lotta resources I'd like to mention. I'm coming off of a little bit of a cold and so, a lot of a bit of a cold and so periodically I'll be drinking water to keep my throat vital and alive so excuse that please. So let me start with a story. I had a recent conversation that's in the last six months with a woman who was the wife of a minister. She was talking to a group of people, talking about how it was that, she was telling us how she had gotten herself into trouble with alcohol. It had started innocently enough. It oftentimes, I think most often does where she had had a hard time sleeping. She was stressed out and so it was her way of taking the edge off and then going into sleep. But in her case, what happened is that it grabbed a hold of her and she started needing to drink a little bit more and a little bit more to get the same effect. That's referred to as tolerance. And she developed a biological tolerance to the alcohol and soon enough she got herself kind of hooked into a cycle of ever escalating need for more and more alcohol to the point that she was quite addicted to it and we'll talk more about addiction today, but how I mean that right now is that she needed more and actually required it biologically in order to, it started off being able to sleep and pretty soon it began to be able to manage her emotions, to be able to relax and so she found herself drinking through the day. So the story that she shared was that she was talking to her husband, the pastor, and said to her husband, with heavy heart, honey, I am such a loser. And his response was meaning to be compassionate, he said, oh my darling, you're not a loser. You're an alcoholic. To which she responded, I would so much rather be a loser than an alcoholic. And our topic today is to address some of what is behind that response. We'll be talking about shame and stigma and I'm gonna just ask you to kind of hold that story in mind why someone would prefer to be referred to as a loser which is surely no compliment as compared with the alternative which would be to bear the shame and stigma and we'll be unpacking both those terms that are attached to being addicted to anything, including alcohol. So that sets the tone for our conversation today. Some of you are familiar with this material. I'm just gonna ask you to kinda ride along with it. There'll be new material along the way. I shared this picture recently in one of our conversations. What is this? - A rocking chair.
- [Voiceover] A rocking chair. - It's a rocking chair and it's actually as I mentioned before it's a child's rocking chair so you can't tell from this picture, but it's a small rocking chair and it belongs to my sister, Nancy. So I wanna tell you another story again to kinda ground our conversation into shame and stigma in and around addiction and recovery with a story that precedes any of that. When I was five years old, I lived in Fort Worth, Texas and my mom and dad came home with two gifts, one for me and one for my sister, Nancy. She's a year and a half younger than I so she was just a little bit over three. She got a rocking chair and I got a straight back chair that was also a child's straight back chair. I can still picture it. I loved this chair and that evening set about doing what I think all patriotic American boys do is I took it apart stick by stick and laid it all out very neatly in a pile. And proudly went out to get my mom and dad and summoned them in and said look at my chair and you can imagine their response which was somewhere between horror and embarrassment that I was their child, whatever it was. They had a very strong reaction to it and I still remember that, I still remember that and I can laugh about it now. I don't think I was laughing then. I was punished and was shamed. And we'll be talking more about shame in terms of a definition, but I think all of us have a sense of that experience. I'd ask you just to pause for just a moment and for those of you that are watching this you can actually pause the video to reflect for a moment on an experience that you had, let's say in your early childhood, that might've been like what I experienced. Little Bobby took that chair apart and I was all excited about it. My parents' response was anything but excited and I was left with this horrible feeling and didn't learn 'til probably many years later that that feeling was shame so you can think about that for a moment. And let that guide us, excuse me. Let that guide us also through our conversation. I think if we can ground our conversation in personal examples it can help humanize the whole material today. Just a little epilogue to that experience is that the same boy that took apart that chair still takes apart things. I take apart chairs less often now, though given the opportunity, but I love taking things apart and most of my adult life career wise has been taking apart ideas as a teacher, working with clients in therapy, in coaching contexts in which there's a way that we talk about analyzing what the client brings and that's a way of taking apart an experience and trying to find different ways of putting it back together. And I think that was prefigured by the little Bobby that took apart his chair. I haven't forgotten that and then the second thing that I've mentioned before is that I'm also reminded every time I go to visit my sister who lives down by San Diego. Nancy still has in her living room that. That is the chair she still has. So all these years later her chair is intact. (growls) (laughs) It's a little helpful reminder of shame, right? While we're kind of laughing about this a little bit, you can think about how this, in fact, I wanna ask you to imagine. If you can imagine sharing whatever story comes to your mind, sharing it with somebody that could actually have a sense of humor with you like we're doing right now and how that would feel. And if you can in your mind's eye, and for those that are watching, maybe to pause for a second and just imagine by contrast what it would be like to have somebody respond not in a warm, empathic, even joking kind of way, but somebody that would respond with stern criticism, would have a negative judgement about whatever it is you thought about. Many of us are parents and we know that my parents' response isn't an unusual response. I'm a father and I can understand that response. As a child I was crestfallen, but if you can imagine the difference between being able to laugh about it and a little pat on the bottom or something versus for a child that kind of parental reaction, disgust, blame, and so on is a lot to bear, is a lot to bear and so just to notice that difference. It's gonna pertain to where we go the rest of our conversation this afternoon. I suppose if one of our goals, maybe it's a primary goal today would be to aim for the former response, the positive, facilitative response whether it's as friends and family or for those that are clinicians or training to be clinicians, that that would be the aim. I intend today to provide some tools for managing shame and stigma in and around the topic of addiction and specifically recovery from addiction. One of the ways I intend to do that which I'm gonna flesh out in detail here shortly is looking at how it is that we can take contributions from science, in this case brain science. How it applies to addiction and how information can help those that struggle with shame and stigma move through their own blockage, their own resistance, their own embarrassment, their own shame and stigma that stand in the way of their recovery. Our goal is to link together science which is more of a left brain phenomenon with the experiences of shame and stigma which we're gonna define here shortly which are really more right brain, more emotional. Our wish is to combine left and right today. Why is any of this important or all of this important? I wanna just share with you a few statistics that you may be familiar with, but they'll help also I think to provide a framework for the rest of our conversation. And some of these, most of these I have discovered just in the last couple years of my pretty intensive study of this whole area and some of them were pretty striking to me and I suspect they may be to you too. First of all, this one, this statistic was published by the Substance Abuse and Mental Health Services Administration, SAMHSA, back in Washington and I was really, really pretty blown away by this. Is that the statistics indicate that up to 50%, up to 50% of clients that come into therapy are currently addicted and that statistic is tied to substance. We'll be talking about non-substance or behavioral addictions here later on as well. This is just tied to alcohol and other drugs. For me as a long-term clinician I was really shocked by that when I look at it on paper. I wasn't so shocked when I began to review my experience clinically 'cause most of my work has been with adults, working with couples over the years, adults coming in that have work-related difficulties, people that are struggling with forms of distress like anxiety or depression. But I was struck by, though I've not tabulated this, how many of them have not come in saying, hey, Dr. Bob, I'm addicted to this or that. They'd say I've got a problem with my marriage or I've got a problem with my work or I've got a problem with my children and parenting and so on, but what would so oftentimes come out is that there was a problem with addiction. That's shocking to me and I just wanna share that with you all. This is referred to as co-occurring disorders and to have it be as many as half of clients coming in have co-occurring disorders, that is that they have a psychiatric disorder like anxiety or depression coupled with some kind of substance use disorder gets my attention anyway so I wanna share that. Here's some other statistics. This is the grimmest part of the whole presentation, okay? That 80% of those that are imprisoned, drugs were involved in their offenses that led to prison. And that could be that they were selling drugs. It could be that they were high on drugs when they committed a crime. I read a statistic recently, I can't remember all these statistics, how many violent crimes, particularly murder, are committed under the influence and it was almost 100%. It was really striking to me. It was some really high percentage. It makes sense to me as a human being, but really again, really shocking. Offenses that occurred while somebody was under the influence of drugs or trying to procure drugs, getting busted while trying to buy drugs. 80% of those involved, this comes out of a study that was done by Columbia University. It's a very authoritative study. In fact, it was done by Joseph Califano out of Washington, D.C., went to Columbia and did this study. That has had a lot of impact in terms of public policy. I wanna mention just as an aside, I've mentioned it before, that my father worked in the state prison system here in California for most of his career. Dad was a psychiatrist and he worked in the various medical units of prisons here in California including Patton and Soledad and Vacaville. Dad just passed away a year ago, but I know that if Dad was here right now he would say this was low. I grew up with Dad talking about his experience in the prison system and for him it just felt like it was almost a one to one correlation between those that were in prison and those that had a problem with addiction coming in. And then the psychiatric problems that arise when you take somebody off of the drugs that they've been on. That was the population Dad dealt with so another piece of that. That drugs are just almost universal in terms of our prison population. This statistic is also an attention getter for me that there are three times more overdose deaths, specifically with prescription painkillers, in this last year as compared with just 20 years ago. Three times more deaths. Another piece that I just read in the last few weeks, Cal Southern is in Orange County and Orange County is the number two state in the country in terms of prescription painkiller overdose deaths so we're number two in the whole country which really puts it front and center, doesn't it? It's like it's right here at home. This statistic is from the Center for Disease Control out of Atlanta. When it's at this level they describe it as a national epidemic. It's really an epidemic like any communicable disease. A few more statistics. This one comes from the National Institute of Drug Abuse again out of Washington that one out of 10 adults is currently addicted and I included that parenthetical statement there in the middle just because it's painful to me is that in their statistics they include anybody age 12 or older. That gives you an indication of how rampant drug abuse is down into the early teens. Most of the counseling clients that I've worked with over the years as well as part of the literature started their exposure to alcohol and other drugs oftentimes at age 11, 12, 13. So this statistic matches that experience. It's just something about seeing it on paper, seeing it up there that really gets your attention, that one out of 10 adults in the US are currently addicted. Out of the same institution, the National Institute of Drug Abuse, this statistic, that only 10% of those that are addicted are currently receiving treatment. So you can do the math on this and realize that means that 90% of those who are addicted are currently untreated. There's some good news and some bad news. The good news is that treatment works. The National Institute of Drug Abuse is kind of the clearinghouse nationally for all the research that's being done in terms of all kinds of different approaches to treating substance abuse and recently published a meta analysis which is where you corral every study together and do a statistical analysis on what works. If people are willing and able to actually comply with treatment it is effective. There are various forms that that takes, but what's clear is that sustained treatment does impact drug abuse and that there is success with treating addiction. That's the good news, the bad news is that 90%, that statistic I just, 90% of those addicted are untreated and so it's kind of a moot issue for 90% of people. The 10% that are able to stick with treatment, we'll talk more about relapse in a few minutes. It really requires sticking with it because it's a chronic illness. If you stick with it, you can have success with it, but it requires sticking with it. 90% are untreated and all right now. This is where statistics like that piece about prescription painkillers comes home for me is that without treatment you either end up in prison, 80% of those in prison are there because of drugs, or you die. It's so oftentimes progressive and eventually fatal with alcohol and other drugs. For sure, just spoke recently to a psychiatrist locally that works with teens in Orange County and he told me that there are many more deaths in the adolescent range to prescription painkillers than are published. Families don't want this stuff published and I don't know how that all goes in terms of getting publicity. Who really wants to know this? But that it's under reported even in the press. Because of his involvement in a local hospital there are a handful of local kids that die every week owing to just prescription painkiller overdoses. We not only die, but we die way too young and that's all the more reason for this conversation which is to look at what gets in the way of this 90% getting treatment because if they don't get treatment we now know the grim probabilities. In psychology we refer to these impediments as barriers, barriers to treatment. And the two most significant barriers to treatment for addiction from a psychological perspective are shame and stigma which we're gonna be looking at today. I recently did a Google search for barriers to addiction treatment and I put in shame and stigma. That was my study and I had 2.5 million results. (laugh) So if you have any question about the literature out there to support the fact that this is a major problem, there's a lotta resources available and it's just to suggest, to back it up with a really cursory study that it makes good sense that we pay some attention to these barriers to treatment because Well, lemme bridge that 2.5 million to the fact that if an individual is struggling with addiction and they are sunk by feelings of shame and or stigma, they won't go into treatment or they won't sustain it so there's the problem is that the addict ultimately has to take responsibility for his or her behavior and it's when we're sunk, and we'll be talking about the biology of this in a few minutes. If we're sunk by those feelings, those are the very things that hijack the brain and paralyze our incentive or our motivation and so we don't stick in treatment or we don't engage in treatment. It's next to impossible to take responsibility when you're buried by shame. That's the bottom line. Gonna talk for a few minutes about what is shame. I'm gonna pause here momentarily and if you're watching this online I'd like you to pause for maybe a couple minutes and just write down how do you define shame in a sentence or two. What is shame? We won't be doing that live but I'd like you to do it if you're watching this 'cause we all have a sense of this. Like when I gave you the example of little Bobby with the chair it isn't like we go, mm, what's that all about? It's universal. I think it's common enough, but lemme just reinforce it. Shame, one way I think about it is it's self-condemnation. We'll talking about stigma in a few minutes and that's really societal condemnation. But shame is self-condemnation and it's not for what we do. That's oftentimes understood as guilt. If I do something bad and I have this feeling inside and it's about what I did, that's really guilt properly understood. Shame is something deeper, more profound, and has more negative impact. Shame has to do with not what I did, but who I am. It has something to do with who I fundamentally am. I'll give you some examples. Attitudes that are evoked by shame include I am bad. I'm somehow defective, I am weak. I know this growing up as a boy, being socialized as a boy. In our culture, there's certain feelings that it's okay for a boy to have and certain feelings not to have and to have those feelings, for example, sadness or fear is seen as weakness, and so there's shame that attends even having those feelings which are universal feelings. There are also some beliefs that go with shame and those include in any case, but we'll be talking about addiction is that I brought this on myself and I'm the one to blame, there's only me to blame. That would be an example of a shaming attitude is that I brought this on myself, there's only me to blame. And we'll talk more about this. It'll make a lot more sense why that's problematic when we get in to talking about addiction and what happens in the brain around addiction. I do wanna make a distinction between toxic shame, which is shame about who we are, and I believe, healthy guilt which is about our behavior, about what we've done. And so I wanna share a couple stories with you. I don't know if any of you have read The Little Prince. I read The Little Prince in my freshman year in collage some days ago. (laugh) This is the cover of that book. I won't go into detail about the book other than to recommend that you look it up on Wikipedia. I will say this, I didn't know this, it's the bestselling book of French literature in the 20th Century. It's worth checking out and plus it's really short so you can read it quickly. It's one of these children's books for adults (laugh) that's how I think about it. I want to just read you a brief segment out of The Little Prince. The little prince comes from another planet to the Earth. It's a story of his travels, his observations. He comes upon a certain man and this is, I'm just gonna read to you just a few sentences out of the book. He asks this man "why are you drinking? "In order to forget, replied the drunkard. "To forget what? inquired the little prince "who was already feeling sorry for him. "To forget that I am ashamed, "the drunkard confessed hanging his head. "Ashamed of what? "asked the little prince who wanted to help him. "Ashamed of drinking, concluded the drunkard "withdrawing into total silence. "And the little prince went away puzzled. "Grownups really are very, very odd, "he said to himself as he continued his journey." Just as in the story of The Little Prince, one of the components of shame is that it makes us withdraw into total silence. And so when we talk about shame and somebody getting help for shame, excuse me. Addiction and somebody getting help for addiction, shame goes in the opposite direction. It pulls me into silence. The last thing I wanna do is open myself up to you and so therein lies the rub around shame and recovery. There's a second kind of shame, but I'd rather actually refer to this as healthy guilt. I'm gonna read you a little segment out of a story by a Native American and he uses the term shame here and I think I'm just gonna ask for us to translate that as guilt because I think it really applies to our idea of healthy guilt. And it helps this distinction I think get clearer. So if the first example of shame, the gentleman is ashamed of drinking and he withdraws. He hangs his head and withdraws into silence. Then here's an example of healthy guilt. This is from this book by Scott Momaday who's a Native American and it's from his, he won the Pulitzer Prize for this, The Way to Rainy Mountain. And again it's very brief, just a brief paragraph. "Once there was a man who owned a fine hunting horse. "It was black and fast and afraid of nothing. "When it was turned upon an enemy it charged "in a straight line and struck at full speed." Can you picture that? (small explosion sound) "The man needn't have no hand upon the rein even. "But you know that man knew fear. "Once during a charge he turned that animal from its course. "That was a bad thing. "The hunting horse died of shame." The hunting horse died of shame. That's the story. And why bring it in here is that all of us can relate to this. You can relate to this in your own life. When we turn from the right course for ourselves, in this case it's symbolized by the horse, but when we turn from our own right course, healthy guilt comes in to scold us. In the story, it literally killed the horse and that's the symbolism. There's a way that our deepest self comes in to remind us when we're off course and I think of that as a very helpful, almost like a thermostat or something and we're gonna call that healthy guilt to make that distinction here. In treatment for addiction, one of the most commonly employed approaches is referred to as motivational interviewing and this next sentence is the only thing I'm gonna say about motivational interviewing today. It's a whole literature out there. Motivational interviewing actually began as an intervention for substance abuse. But the idea of motivational interviewing is to clarify this distinction that I just shared. The distinction between toxic shame which wants to shut down healing and healthy guilt which wants to open up healing. A skillful motivational interviewer which would be to say a skillful counselor or even a skillful friend is able to help facilitate the latter, healthy guilt, which motivates us to change. It scolds us and also doesn't add to the toxic shame which paralyzes us. So that's really one of the goals of any effective treatment. So if that's about shame, let's talk about stigma for just a few moments. Stigma, okay, it's the same question. I wanna ask you to think about what you associate to with stigma for just a moment. And those that are watching to have you pause for a moment and write down maybe your one or two sentence definition of stigma. We've all been exposed to that term. It's less commonly known than probably shame, but I think we all have associations to stigma. I talked earlier about self-condemnation and I kind of showed you my cards on this one, is that stigma is really societal condemnation. This is where the individual is condemned or discredited by society for what he or she has done, that's stigma. There's an interesting piece here, is that in the shame literature in psychology, more recently the term for shame has come to be self-stigmatization. It's a mouthful. I prefer to say shame because I can pronounce it. But you get the idea there is that self-stigmatization is the idea that I internalize what society says about what I did and I turn that towards myself and that'd be another way to understand the dynamic of shame. With stigma, the very foundation of who we are is, the rug is pulled on that and so we're thrown off balance. It's almost impossible to feel good about yourself if you question whether you have any right to feel that way and if society constantly mirrors back to you that you're defective or something's broken about you, something's wrong about you or that you did something blameworthy it's very hard to get a foundation for feeling positive about yourself. Attitudes, stigmatizing attitudes are like this. Those people are bad, those people are defective, Those people are weak. What we talked about earlier in terms of shame pointed towards myself, if I have a stigmatizing attitude then it's you, it's them that are bad, defective, or weak. And the idea here, the belief here is that they brought this on themselves, they should pay for it. This probably ties into our 80% statistic earlier, but I'm not gonna go on a political diatribe right now. But the idea that what we do in our country is that we penalize them, we incarcerate those that are addicted and it's understandable in some ways. I don't mean to throw that out, but as we begin to talk in the next few minutes about the science of addiction and understand what goes on in the brain, it's gonna raise some interesting questions about some of those knee-jerk reflexes that are really rampant in our society. I wish I could remember statistics better than I can. It's something like this, that our population in the world is we're five or 10% of the world population and we consume 60 or 70% of all substances. It's just crazy how we have a cultural problem around it. And if you can see for just a minute the duplicity or the hypocrisy of that is that we're the most judgmental on the planet as well. We have a higher rate of incarceration by far than any other society on the planet. Most of those that are incarcerated are addicted and we consume way more than our proportion. So interesting things to think about, okay? I think one of my key points today is that what do you do about shame and stigma. And I'm an educator and I wanna make a plea here for good information. I think that good, solid information may be our first inroad to overcome the shame and stigma that paralyzes treatment for addiction and keeps people from moving into recovery. So the information I'll be specifically focusing on is Addiction and the Brain. Again as I mentioned before where we bring in left brain information, I think you can help to apply to confusing behaviors and emotions and my wish is to combine. Some look at the left and the right brain. I wanna talk a little bit personally for just a moment about the last couple years for me particularly intensive study in addiction. I've worked in this area for about the last dozen years, but the last two years are the most concentrated study that I've done. Specifically into studying the neuroscience of addiction which is just a fancy way of saying what goes on in the brain, in the nervous system, in and around addiction, substance abuse, drugs, alcohol, and so on. When you look into the literature of addiction and the brain, there's no question that addiction is seen as a brain disease. And I think there's other ways that are useful to look at addiction. I don't wanna throw out the other ways. For example, the 12-step programs will focus on the spiritual dimensions of addiction. I think those are just as relevant. It's just that from a biological and a research perspective the work that's been done on addiction in the brain makes no bones about it, that it's a brain disease. I'll tell you this, the further I've gone in my studies, the more and more compassion and the less and less judgment I have felt for those that are in recovery. That kinda surprised me, I wasn't expecting that. How can you be studying science and find your emotional reaction to people changing almost by the day and literally it's that way? I have an even more private confession to make is that what it brought up for me 'cause I've done a fair bit of counseling over the years in and around addiction. It brought up for me my own subtle prejudices and biases that I was not aware of because they were subtle enough that I missed them, but the further I studied into addiction in the brain I began to realize that that's what was coming up for me, is that deep down inside Bob Weathers were some judgmental attitudes toward addiction that needed rooting out and again ironically and surprisingly, I wasn't banking on it, it was studying science that helped do that. That's really the motivation behind today's conversation is to look at how it is that this information, if we can understand it in a basic, really accessible way, does it have the possibility of changing our own attitudes? Does it have the possibility of changing those self-shaming attitudes of those that are in need of recovery and for their families and friends that can either serve to support them or impede their progress? I have to tell you it's my own kind of personal journey with this experience that's brought me to bringing this material together. I hope it's implied, but my wish is to provide for a safe space here even though we're not in dialogue owing to the context today, a safe space for you to think about your own attitudes, your own biases towards yourself, towards others that you know. I won't be talking about this in detail today, but I have to call it up for just a second. There was a recent study that looked at the prevalence of addiction and how it affects families. I'm gonna quote this and you guys go easy on the actual number, but it's something like this. It's 70% of us have addiction in our immediate families. 70% of us have addiction in our immediate families. If I'm off by that, it's 10% one way or the other, okay? (chuckle) The 10% room for error there. So that's the first statistic is to say that we all have this close enough to us. And if you've been spared to have this in yourself or in your immediate family then you don't have to go very far in terms of friends that have been impacted by this. I just finished teaching a course on substance abuse treatment at a sister university here locally. Every student in class, in this class these are marriage and family therapy students, every student had been touched directly by addiction, most of them by parents, brothers, sisters, and so on. Really tragically, really tragically. It's to universalize that. There's another piece in this same study. This was a Harris pole. If you go back and look at that same population is that 70% of us in the United States, 70% of us recognize that there's such severe stigma around addiction that we don't talk to anybody about it. So if 70% of us walk around with addiction in our families and if you go to that same population, 70% of us don't dare talk about it because that's how pronounced, that's how negative the stigma is, that's also another piece. I haven't included that in this study. That's hot off the press, but that's like how can we make a difference? I think this is a presentation to therapists in training as one of the populations, but there'll be others that watch this. Every one of us has family members. Every one of us has friends. We have it in ourselves and how can we find some way to find a different relationship to addiction that extends more compassion and more hope and helps to de-stigmatize it and to weaken the shame that, as John Bradshaw says, binds us to the spiral, the downward spiral. A safe place here. One last comment before we dive into talking about the brain and that is a real bonus for me in my experience is I also do recovery coaching where I'm working with families, most often with families that have addiction in the family. I have to tell you guys in the last two years of sharing this information with individuals and families I've been working with, I've yet to have anybody respond other than favorably. It's really striking to me. And so the task for me today, but for all of us, especially if we're working, it's really for all of us. It doesn't matter if you're clinician or if you're just a normal human being. The task is how do you take this information and translate it where it's not so dadgum technical where it actually has use and what's remarkable about it is that people respond to it favorably really along the dimensions that we're talking about. It's not a formal research study, but it's been my absolute 100% observation is that I can think of families, I can think of individuals, the light goes on. It's like the attitudes that a husband has towards the wife and vice versa around addiction. Think of that first example that I talked about If you can take that kind of negative foundation out of the conversation then there's really hope for getting help and that's been my experience. That's a real bonus, I think, of working this material is that I feel like it's really effective. Shall we dive into the brain? I wanna come back to that. I have to say this is that this is a very brief overview of addiction in the brain. I just taught a seven-week class where this was part of what we did and that was a brief introduction. You can obviously have a full-on semester of this and just scratch the surface. I have a bibliography. I wanna mention this for those that are watching this is that if you write to me here at Cal Southern, I'll send you a bibliography that is I'll just pull it up here. It's three pages of really tiny print, the bibliography, and that just scratches the surface. But while I'm thinking of it, I'll say this. What I've done is I've put in bold the dozen references, most of them are books, that are the most accessible so that anybody can read them and including a lay person, a client, any client can read them and have been the most helpful I think in addressing this. I'm really standing on the shoulders of this reading and so I'm very happy to give this resource to you all. In that spirit, with that caveat, which this is a very brief overview, let's dive in. First comment here, that all addictions involve the same brain circuits and the same brain chemicals. This is from the American Society of Addiction Medicine. Lemme just say a word about this. You recall how we talked earlier about how one out of 10 adults is currently addicted to substances. Well, here's another statistic and it's gonna tie into what I just, this comment here. All addictions, this isn't just drug addictions. This would be all addictions including behavioral addictions which I'll be specifying in two minutes. They all involve the same brain circuits. So if one out of 10 adults are addicted to substance, 90% of us have non-drug behavioral addictions across our lifetime. So lemme talk about what non-drug behavioral addictions might include. In addition to alcohol and other drugs, nicotine and caffeine, those are all chemicals, if we take all those off off the table for right now, the list is endless in terms of behavioral addictions. These are by the way, sometimes referred to as process addictions. I'll be speaking in the fall at a conference in Las Vegas that's all about process addictions, but remember whether you're talking about addiction to a substance or to a behavior it's the same brain circuitry and as we talk about this in a few moments about some of the systems involved you'll see that. So what are some examples of behavioral addictions? We can be addicted to food, especially carbohydrates, gets a lot of attention. We can be addicted to compulsive sex. These are the most common behavioral addictions I'm mentioning. We can be addicted to gambling and its compulsive draw. We can be addicted to spending, shopping, compulsive spending. And most recently what's getting the most press is as our IT Department walks by Robert, what's getting the most press is Internet addiction, Internet addiction. It's absolutely epidemic. So what makes for any of these things being addicted? This is the Bob Weathers definition of addiction in a minute. I came up with this recently and I came up with these six components. Except for the bottom one which has to do with death, the five above this apply across all addictions and I'll talk about number six in a moment. So if we just look at this for a moment. This is just common sense, common language, and I'd like to have a simple way to take about this. An addiction means there's a behavior that I can't stop. And if I can stop it because there's some behaviors that we can actually overcome at least for a period of time and stop them, The one thing I can't stop is I can't stop the craving. Most often you can't stop the behavior. So if it's alcohol you can't stop drinking. If it's a drug you can't stop using. But even if you can white-knuckle it and stop for a period of time what you can't stop is the craving. In fact, the white knuckling is what is a function of the craving. (growling voice) Okay, I'm not using, I'm not using, but I'm dying inside 'cause there's such a strong craving. By consequences I mean it's when we can't stop doing something that has negative consequences and I'm gonna follow Freud on this when he talked about: zu lieben und zu arbeiten. It affects our ability to love and our ability to work and so negative consequences on our love, our work, our ambitions, our learning, our education, et cetera. So we continue, we can't stop. Two others aspects of addiction is that it's prone to relapse is that relapse is you find yourself going back to the behavior even if you've had a spell of time. Some people can be free of an addiction for years and move back into it and be caught in it immediately again. Relapse is part of it. This is important because insurance companies don't want to include that piece in addiction. This is to say it's a chronic illness and relapse is part of the condition. If I'm diabetic I'm prone to relapse around that in terms of my insulin levels and so on and I have to work on it. It's a lifetime proposition. The very same thing with addiction. When you look at it from a brain disease perspective, relapse is part of the chronicity of addiction. It's progressive and by progressive that just means it gets worse, it gets worse. Most people that are addicted, that 10% that are addicted it doesn't stay stable. It gets worse and worse without treatment. And when we're talking about alcohol and drugs, it's that they're deadly. I thought about this earlier today is that alcohol, drugs, nicotine, all of those can kill us. So can compulsive eating, so can our addiction to food. So that it's considered oftentimes a behavioral addiction. Nevertheless, it's quite deadly. You could probably find examples with the other addictions that are deadly, but certainly in terms of substance which is really where we're gonna go next talking about the brain and addiction that it's course is final, it will kill us. In a future presentation I wanna share some statistics I've just come across last week. By the way, the statistics I read are typically in the newspaper. I'm on list serves and this and that for this information, but a lot of this information just came out last week, was a statistic that I'm not gonna dare to quote. The number of deaths to binge drinking just in the last year. You know how they have these statistics like every five minutes somebody dies, it's like that. It was like unbelievable how often people die. And interestingly my recollection of the article is that much of the reading I've done is on college-age students and so on. It wasn't that, these were older adults that die of binge drinking is defined as five or more drinks in a short period of time and I can't remember if it's a couple hours, whatever it is. But that it actually is an older population than I would have anticipated that are dying in droves to the effects of alcohol, alcohol poisoning and so on. More statistics next go around. Okay, so let's talk about the brain. There's four circuits in the brain that I wanna discuss here. Just in summary and two in more detail. They're implicated in both drug addictions and in behavioral or non-drug addictions. The first system is the opioid system. I'll come back to this. The second system in the brain is the dopamine system. The third system is the self-regulation system. And the fourth system is the stress system. A word about each one of these just briefly. The opioid system represents our reward and attachment circuitry in the brain. Lemme say what that means. The opioid system is key in terms of our experience of pleasure. Interestingly to me, 'cause I didn't know this two years ago, is that it's even more instrumental in what's referred to as attachment and that's just our connecting to one another. The reason I wanna emphasize this is that if we don't connect to each other we die. If you think of a mother or a father with an infant, if that attachment system isn't functioning full on, isn't functioning well, that infant will die. It doesn't matter what species it is, including human beings. We humans require that to extend much longer than any other species. The opioid system especially connected to the attachment is absolutely necessary for our survival. All four of these systems are gonna be talking about, we require them to be functioning right to survive and all four of these are impacted by substance abuse and addiction. That's the opioid system. The dopamine system, it creates motivation for us, incentive or motivation and I'll be spelling this out in more detail. The things that we need to do that are essential for survival, even for us to get up in the morning and come to work, if there's no dopamine firing then you're hamstrung. Dopamine is what gets us moving. It jumpstarts us, it's absolutely required for survival. And I'll also be talking about how it's, this, the dopamine system is very much tied into that experience I just discussed which is craving. The dopamine system is what leads to our experience of craving. The self-regulation system in the brain, it's tied physiologically. I should say this, we were talking about the opiod system is all over the brain. The dopamine system is primarily focused here in the middle of our brain. The self-regulation system is right here. It's right here, the prefrontal cortex. What it does, also in terms of helping us to survive, is that it governs our impulse control. In particular it inhibits our engaging in self-destructive behaviors and most of those impulses or, yeah, impulses to behaviors that could get us into trouble originate here in the center of the brain, what's referred to as the limbic system. And so if you don't have the frontal cortex modulating, modifying, containing the limbic system, you're at risk of dying so again it's absolutely a survival-based system. Finally, is the stress system and this is the most obvious one tied to survival, I think. The fight or flight response and it focuses on two primary brain chemicals, think about what those are. Good, cortisol and adrenaline, I knew that you knew that. We absolutely need the fight or flight response to save us from saber tooth tigers (laugh). And all manner of other threats to our physical survival so we absolutely need the stress system to be functioning. When we talk about alcohol or drugs, this is one of the books on the reference list here. When we talk about alcohol and other drugs, as well as non-drug behaviors, they all hijack the brain. And what that means in a nutshell is that outside chemicals, if we're talking about alcohol and other drugs, outside chemicals come in and take over the normal function of what's going on inside the brain around the survival circuits in the brain. The outside chemicals come in, take that over, commandeer it and it's referred to in the literature as literally the hijacking of the brain. And so all four of these systems we just discussed which are essential to physical survival are trumped by outside chemistry. I say this only is it any wonder that addiction takes a hold the way that it does and has the impact that it does 'cause it's going, it's going right into four systems in our being that are set up by nature to protect us and to help us survive and when that goes cockeyed, when that goes off kilter, all kinds of trouble ensues obviously, right up to the point of physical death. Owing to time today, I wanna focus on just the first two systems so let's go back to the opioid system which I said is related to reward and attachment. The defining molecules of the opioid system are endorphines. And so pause for a second and think about what your associations are to endorphines. All of us know something about endorphines. We have a bodybuilder in our presence here who knows a lot about endorphines. We have a marathon runner on our staff here who knows a lot about endorphines, but all of us have some association to endorphines. Endorphines, it actually comes from endogenous morphine. That's the root of what an endorphine is, endogenous morphine and that gives you a clue of how they function. Endorphines are inside of our bodies, they're endogenous and they function just like morphine, heroin, oxycontin, other drugs that we take from the outside and by saying they function the same, they go into the same brain circuitry, they go into the same brain receptors and whether it's exogenous drugs or endogenous morphine or endorphines, they help us do a couple things. One is they help us to soothe physical pain and secondly they help us to modify and or soothe emotional pain, that's what they do. So whether it's endorphines or heroin they both have that same function. Endorphines are also the catalyst for our day to day moods. How I'm doing today requires for my endorphines to be firing at some kind of level and all of us know what it's like to get into a blue mood and some part of that, not all of it, but some part of that has to do with endorphine supply in the brain. The piece that I didn't know before I began doing this research is that most crucially endorphines are at the center of what I referred to earlier as the bonding between I'm gonna say mother and infant. They're absolutely central to that. Both mothers and infants experience an influx of endorphines in the connection, with their infant. You can imagine just the practical thing, the practical implication of that is that as I mentioned earlier, the mother needs to be able to bond significantly to be there to feed and protect and support the infant's growth. Endorphines are the chemical link of how that happens. I can just tell you a quick story. All of us in this room know Jessica who's been out for a while on, it's called maternal leave? Maternal leave, that's it, maternal leave. It's actually a whole family leave because her husband's also been home. I went to visit, Jessica had a baby. A few months back I went to visit Jessica and met Grant. I walked into the house and there was Grant. They handed Grant to me and I held Grant and I loved it. It's the first time I've held a baby that long since my own daughter was that age which a few years back. It was really touching to me and I love Jessica and it was wonderful, my own bonding with Grant. But there came a time, there came a time where it was time for Grant to feed and also I think to connect, to connect with Jessica. Whatever I'm talking about in terms of endorphines and so on, you don't need theory. All you have to do is just watch a mother and infant and as they came together, I actually went upstairs with Jessica and Grant and we talked about it for a few minutes, what the experience was like for her. She was basically describing the interiority, the inner experience of what's going on that biologists would look at from the outside in terms of endorphines is very touching to me and it was very obvious, very palpable. I think also related to this business of bonding around endorphines is that the joy that I saw with Jessica and Grant is the joy that all of us experience whether we're parents or not. Endorphines are the chemical mediator of our experience of ecstatic joy. It's referred to in psychology typically as euphoria. Our experiences of euphoria are directly connected to our influx of endorphines. The higher the endorphine level the greater the subjective experience of joy. So lemme tell you a quick story. I started music as a very young boy. My parents were both musicians and they started me on piano way too young (laugh) and I was decent at playing piano but I hated it (laugh). I wanted to be out in the playground beating up other boys. Soccer and that kinda thing. And I lived in southern Oregon in those early days of playing piano and I still remember what it was like to sit on a cold piano bench and practice, I didn't like it much. And so as soon as I could, starting in fourth grade, so I'd be nine years old, I proudly announced to my parents, this goes along the lines of the chair that I took apart, it occurs to me, I announced to them that I was gonna switch to drums. They really did have the same experience, the same expression come to think of it. That's the first time I've ever made that connection. So my second major experience of shame in my life, I wish it was only two experiences, was around making a decision I was gonna play drums. And so I started playing drums exactly 50 years ago starting this September is when I started playing drums so that's crazy to me, it's been 50 years. And I've been passionate about drums ever since then. It's really a mainstay for me. I'm actually working today on setting up another musical opportunity coming up in the next few weeks, playing drums with some people here locally. In fact, it may happen tonight. I didn't have any way to analyze this as a kid, but I know that my initial experiences, something I could always count on to evoke a sense of joy for me was drumming. It was just a mainstay. I play drums all the time. Between music and sports, those were the two things that I experienced the most joy with. There was enough joy that I played drums all the way through high school when I played in rock and roll bands. And I'd play in bands with people that were doing drugs and taking alcohol. I hope that's okay to say it, that's the truth, that's what it was. It always seemed redundant to me. Why would I do that when I could just get so high off of drumming? And so for whatever reason I made it through high school. I'd never had any alcohol or any other substance through high school. It was only after high school that I went on a trip. I got a chance to go on a trip to Europe right after high school for which I was very grateful and I was on the ferry going from Dover across the English Channel to Calais and there I was sitting by myself and there was this opportunity. I thought, you know what, i'm gonna order myself a drink. And so I ordered a Lemon Shandy. What's funny about this is now I notice that there are signs on the freeways advertising there's some Lemon Shandy drink. I never knew it even existed in the United States and now I see it. It's kind of malt liquor and lemonade, just about my speed as a first timer. And so I sat on this, I can remember this as clear as a bell. I sat on this boat crossing the English channel and they brought it to me and in good English style there was no ice and in good naive style I drank the whole thing (gulp, gulp, gulp, gulp) like this, drank the whole thing and within about five minutes, this is what I thought to myself and this is literally the case: I thought to myself, that's amazing. You can drink drumming in a bottle. That was exactly the truth, that's exactly the experience. That was my first experience. I'd never had an experience quite like that. It's like the experience I have with drumming, I just drank it. (laughter) There's good news and bad news to that story and most of which I'll spare you, but I do wanna use that as an example and you all can think about this in terms of your own experience. The natural endorphines that I got from drumming, which I'm at the opioid system and the dopamine, the natural endorphine joy that I got from drumming I still sustain it. If I drum tonight I will have that experience. I got the same thing because the alcohol chemically stimulated the same opioid circuitry in the brain as the drumming did with endorphines. Does that make sense? Alcohol from the outside, endorphines from the inside, same difference. You can drink drumming in a bottle so there it is. Now there's some bad news and I'm gonna spare you the personal bad news, but there's some bad news with this, is that in study after study and I've only discovered this in the last couple of years. In study after study of addicts, their normal baseline level for what I just described in terms of joy, and it's tied into the opioid receptors, the receptor sites in the brain, their normal baseline is found consistently significantly diminished across the brain. And this diminishment is directly correlated with the increased need then for whatever the substance is. Let's say that it's alcohol. If I've got this depressed, I can't access joy, and the only way that I can access it is through alcohol you better believe that that's gonna be mighty tempting for me to do that. By the way, while we're talking about other addictions, it might not be alcohol. It could be other addictions like a sexual compulsion or a gambling compulsion. Whatever I can do to get that opioid circuitry involved to experience just normal human levels of pleasure and joy. Lemme say just a word about that before we move to dopamine and that is that what happens in the brain is that let's say that I chose to just keep drinking Lemon Shandies. What happens is that the brain resets itself to it wants to achieve what's referred to as homeostasis and so it will downwardly move, it was downwardly regulate to where whatever happened naturally, let's use my example. If drumming provides that, but I begin to substitute Lemon Shandy, is that the brain will naturally begin to pare back. It'll actually what's called neural pruning. It'll begin to prune the receptors for opioids inside so I need more outside opioids 'cause I don't have them from the inside and there you go, there you get going in the cycle. And so you end up when you study addicts and you look at their brains, their opioid receptors are significant, they've been pruned back and so what does that mean? They need more exogenous endorphines. They need exogenous opioids to be stimulated and it can be in behaviors, it can be alcohol and other drugs. The addicts that I've known over the years and worked with, many of them say I started off drinking Lemon Shandy to get high and they'll get to a place where it's now I do this in order to try to seek feeling normal. And there's different things they mean by that, but the piece I wanna focus on right now is that in order to just get that opioid level up just within the range of feeling normal, they wanna feel like other people and it's no longer about partying or getting high. It's just trying to establish some kind of baseline that makes me feel human. Okay, so let's talk for a moment about the dopamine system. We talked about this earlier. It's called the incentive or motivation system. As we talked about, it's what gets us up in the morning. It's no less important to survival than the opioid system. If the opioid system connects us to one another, remember the example of me with Jessica and her son, Grant, the incentive or motivation that comes from the dopamine system is what motivates us and gets us moving, Without this we're stuck, we're stuck. The way I think about this is if opioids are almost like the final stage in the reward process so that when Jessica begins to breastfeed Grant, ah, that feeling for both of them, that's the opioid system, but what moves them towards that final goal of pleasure and of joy, what moves them in that direction is the dopamine system. So dopamine and opioids are both involved in our whole process of seeking pleasure, seeking reward. As I mentioned earlier it's the dopamine system that kinda jump starts us. I will give you an example of this. My daughter, Amanda, just announced a few months ago that she's due with my first grandchild, her first child, she's due middle of October and you can imagine the convergence between my being with Jessica and her baby, Grant, and now this prospect of my daughter having a baby. In fact, I was just, where was I today? I was at lunch today, yes, I was at lunch today and I saw a woman that was very full with child. I was ordering my salad and I just stopped there and the whole, I, there it is you guys. Full on dopamine and it's like everything in me is oriented towards my daughter's having a baby and just imagining into that. It's with me every day and it was so strong today at lunch that I was speechless. I just stopped ordering and just was taken by that, imagining my daughter being pregnant. That's the dopamine system that motivates us, that orients us. I'm going to visit her in a few weeks. I can't wait to see her. You know I'll be back there, in and around her delivery of her baby. That which gets us going, that which jump starts us, that's what gets us up in the morning, that which connects us to our daughters when they're having babies, that's the dopamine system. My anticipation of holding her baby is the dopamine system. When I hold her baby, that will be the opioid system. Does that make sense, okay? Dopamine is directly tied to triggers in and around substance abuse. Maybe you can just pause with me for just a moment to think about what represents the triggers or the cues for addicted behavior that you know about? If you don't know addiction in your own life, you know it in your family or with your friends. What kinds of triggers will lead people to use, lead people to crave, lead people to relapse? Okay, these environmental triggers or cues can include almost anything, but I'm gonna mention a few. One of the most common, I'm thinking about this with various addicted individuals, it can include paraphernalia. It can include drug-related paraphernalia, seeing a lighter, if they were smoking something, for certainly seeing any evidence of a syringe if somebody's an intravenous drug user. Certainly beyond paraphernalia, certain people, people that either, recently worked with somebody who lives in the neighborhood where his contact for drugs is, whenever he sees him, all that gets stirred by that. That's related to dopamine. Certain places, I've talked to a number of alcoholic individuals over the years that talk about what it's like when you have to drive down the street and see a bar, especially if it's your favorite bar, much less just going by a liquor store. These are constantly triggers. And what happens with these triggers, they stir internal craving for the substance. The strongest is the one I haven't mentioned yet and that has to do with stressful circumstances. Is that stress is most often seen as the number one (snap) trigger for drug use and it can be a relational stress. It can be a job-related stress. When that kicks in, when it's been associated, if you think about it, if opioids soothe me and I experience stress, well, I want soothing and if the opioid is connected to Lemon Shandy or heroin that connection is pretty sealed in and so that drive to seek the drug and to use it that's dopamine. Talk about dopamine in terms of natural reinforcers like food and sex. Why are food and sex related to our survival? It's kinda obvious. If I don't eat, I don't survive. If I don't have sex, then the species isn't perpetuated. These are survival related behaviors and in and around them there's huge dopamine release. But I wanna talk about something interesting that I just read recently coming outta UCLA's research. There's a Dr. Richard Rawson up there that's come up with comparing the dopamine release of certain normal natural reinforcers like food and sex with substances. So for example, if our normal sexual response, let's say that we have a baseline level like this, a normal baseline level. If our normal baseline level is, let's say a one, then our normal sexual response doubles that and so our dopamine level goes up to a two, goes up to a two. Cocaine introduced in the system quadruples that baseline level and so you go from a one to a four. And so you could say that cocaine, understood at the dopamine level, is twice as pleasurable as sex and I've had clients tell me that, had clients tell me that. All of us know something about methamphetamine and its power, its addictive power. The same research out of UCLA, methamphetamine is 12 times the baseline level which means it's twice as potent at a dopamine level to cocaine and that it's six times more powerful, more pleasurable than sex, if I'm doing the math right on that. It's 12 times our normal baseline level. I won't get into the biology of methamphetamine right now to explain why that's the case, but when you study the pharmacology of methamphetamine, it's clear of why it's twice as powerful as cocaine, just the interaction inside the brain. So with a dopamine system and when it meets these drugs it is indeed hijacked as we talked about earlier. Where our natural dopamine levels are completely trumped by these substances and because the substances are much more powerful. They may be artificial, but they're much more powerful than anything natural in our being including the natural reinforcers of food and sex. And as I mentioned before dopamine is connected to craving. When my dopamine level goes six times more than it was before, or goes 12 times more than it was before in terms of a baseline level, the experience I'll have is I wanna crave, I crave whatever it is that's gonna create that. And so if it's methamphetamine, it's gonna manifest the dopamine levels. You don't walk up to somebody and say I hope you're having a dopamine kinda day today. That doesn't make any sense, but the dopamine will manifest as craving. That's the inside version of what it's like to have heightened dopamine levels. The dopamine system, when it gets kicked up like this, and creates craving, what it does is it directs us towards the drug. One final point on the dopamine system. This is interesting. This comes out of a research at the University of Texas. Research has been done on addicted individuals is that it looks like that for many of them, a large percentage of them, that they are born with fewer dopamine receptors just from the very beginning, not as a function of drug use, but just born with that so there's a genetic, this would be a genetic component to being vulnerable. You can imagine what happens if you're born with a lower dopamine level. It's kinda like what we talked about with opioids is that you'll do whatever you can to up-regulate the dopamine level and so that's another component of what's, trying to understand the whole picture. Genetics don't express all of it. Some people say that genetics are somewhere between 40 and 60% of addiction is genetically related. Well, I've given you two examples of how it can be related to genetics is that if the opioid or the dopamine receptors are low, you're gonna be right away vulnerable. So if you're exposed to Lemon Shandy for the first time and you had that low dopamine or low opioid level, you're gonna be that much more likely to be stuck on it, to be addicted to it. Okay, just a final little flourish here. What I wanna do is go back to this. We talked earlier about the rocking chair and we use that as an image of what it's like to be, to deal with shame or to deal with a critical response. What I want to share for the last few minutes here are some common shaming attitudes that we'll all recognize. I put them in the form of questions. I'm gonna post them up here on the Powerpoint and then I want to talk into knowing just what we know today, looking at some of the information about the brain, the four brain systems and specifically the opioid and dopamine systems, how might we address the shaming or stigmatizing attitudes? If we had a longer period of time, if this was a several-hour workshop we would be working this much more in-depth, but this at least gives us a little bit of a sense of how you connect the first points on shame and stigma to the second points on the brain. The first message here, shaming message is: aren't addicts just weak? Why can't they just say no? Before I answer I want us to pause for a second and if you're watching this to just pause the video and think based on just a little bit that we've introduced here, just a few minutes today, how might you respond to this? Aren't addicts just weak? Why can't they just say no? Okay, so what I wanna suggest is this is that any one of us might start off using drugs voluntarily. I started off drinking Lemon Shandy. That was a choice that I made. But for a certain group of the population, as the drug use continues that person's brain is radically changed. That person moves from being a moderate user into being a compulsive user and we talked about how it is that the brain is hijacked. Is that for individuals that have a vulnerability, let's say they have a genetic vulnerability around dopamine, access to dopamine, access to opioids, in terms of just feeling normally happy, normally at peace, is that once the drug comes in, you remember how I talked about those percentages, once the drug comes in and haS its effect, it basically squashes whatever the brain would normally produce. Once you begin to bathe the brain in whatever the chemicals, let's say that it's alcohol, the brain will adapt to that and it will be radically changed over a period of time to where the brain is no longer able to balance itself out without the substance. And in order to feel anywhere close to normal, I'm gonna need that drug, I'm gonna need that substance, I'm gonna need that behavior. That vulnerability contributes to the kind of compulsive drug seeking that you see in addiction. A second message: isn't being addicted simply some deep character flaw? For 90% of the population that doesn't get addicted there's not a problem with this. But for the individual that starts with a drink of alcohol or with a hit of pot or with whatever the substance would be, that person, the one out of 10 adults that are currently addicted, that person is not gonna have a normal biological response. We talked about character fall, lemme just talk about the chemical cascade that goes on in the brain for an individual that is prone to addiction at a biological level. It doesn't really matter how ethically or morally upright you are, that if you've got a vulnerability to addiction for whatever reasons including genetic, that no matter what your values were before you got the drug, the drug has the capacity, do you remember when I talked about the frontal cortex and it affects our, among other things, it affects our judgment including our morality? Is if you have a substance that is 12 times more powerful than the brain's typical way of balancing itself and that substance has the capacity to come in and nullify the messages from the frontal cortex, it's basically offline. And so what you have is you're making decisions from this part of the brain, the limbic system in the interior of the brain and that person will not be making good, moral decisions. You can say they've got some deep character or logical flaw. It'd be more accurate to say that until that they're abstinent and clear of the drug, they're not gonna be able to make good, moral decisions. It gets really extreme you guys. I mentioned earlier about Jessica who we know. Jessica and Grant, is that if a substance kicks in and it's powerful enough, it can even subvert something as profound as the survival instinct of a mother caring for its infant and we all know stories or have read stories about that, but that's the rationale for it. How would it be possible for a mother to ignore her infant and in some cases let the infant die, starve, et cetera, to smoke crack or whatever the other substance would be? We're explaining the mechanism of that right now. The substance has that much power where basically the part of our brain that makes decisions, it's not even a decision for most of us, but that part can actually be smothered by the effect of the substance. A third stigmatizing message: why can't addicts just be normal? That begs a question (laugh) about what normal is, but we won't go there for right now. Think about how you feel when something good happens, anything good happens in your life. Maybe if you're into sports, your team wins the World Cup. Or you're praised for something that you've done well. Those feelings you have are your opioid and dopamine pathways at work. Thank goodness that we have those built into us because those are what move us, motivate us, create ambition within us. The first time that an addict, that is one of those one out of 10 people, the first time an addict uses a substance that normal response to joy about their team winning or to an accomplishment is completely overwhelmed by the effect of the drug. There's no comparison between the first experience and the unnaturally high intensity of a substance. The feeling of pleasure, there's no comparison. Remember when I mentioned six times as much, 12 times as much. And the bad news is the brain starts changing and adapting to that and as we talked about before, again, I'll bring it back up, the brain is hijacked. The brain begins to change and where those things that used to reinforce us, normal reinforcers that were satisfying like my team winning, they stop mattering because they can't touch something that's 12 times more powerful than that. As we've suggested the neurons in the brain that control the flow of dopamine, when they begin to experience that kind of flood of dopamine related substances coming in from the outside, there's a trimming or a pruning that goes on in the brain. It's really a case of the poor getting poorer. It's like if you already start with a slight deficit in dopamine and then you've got a substance that's overwhelming the brain's natural ability to produce opioids and dopamine and the brain begins cutting that back, you're just on this one-way spiral downward and it really is the poor getting poorer. That person's gonna feel flat, lifeless, depressed without the substance. And so I don't know what it means to talk about feeling normal when you don't have any joy in your life and as I mentioned earlier, the people that I've known that are really deepest into addiction, that's what they're seeking, could I just feel normal 'cause they don't feel anywhere near normal. It's the brain has adjusted to this other chemistry and has no access to normal joys. The goal is to be normal, to feel normal. Then finally isn't it a cop-out to blame addiction on heredity? We've already made some pointers in this direction. What do genes have to do with it? We do know more and more about what happens in the brain when any of us ingest a substance, but what we don't know is how many times it's gonna take for somebody to take a substance before they get addicted. We talked before about the 10%, the one out of 10 adults who do get addicted. A significant portion of those that are addicted are as we talked about, incapable of producing enough opioids, enough dopamine from the inside and there's more and more genetic research to suggest that as I said 40 to 60% of addiction may be related to just never having established a decent baseline experience happiness. Most of the addicted individuals I've worked with who are in recovery say, I always looked around and I saw that people looked happier than me and I just wanted to be like them. I just never experienced that until I took the substance at the beginning. Even a single experience of having that regulated is enough to get somebody hooked. I'll tell you guys a story. About a dozen years ago I was working at a local rehab and there was a young woman. She graduated from high school the summer before. She was the valedictorian in her class. She had the highest grade point average and was very popular, was a cheerleader, and had never touched any substance. She went to a party that summer, was introduced to crystal meth at the party, experimented with it, (snap) was addicted immediately, and six months later was in a rehab in California. That's how it can go for somebody. A good chance that her biology was such that she had a vulnerability to it, but like I said you don't have any way to know ahead of time. It's kinda like Russian Roulette. For nine out of 10 people maybe it wouldn't go that direction. It did that way for her. I'm gonna wind up with this last comment then is that there's a bit of a paradox at the heart of all of this and I'm aware of this talking about this material is that I could be misunderstood as giving an excuse for addiction. It's like, oh, poor addict, they've got a dysfunctional biology or their genes are wrong and so on and it's tricky because we're trying to root out the source or the causes of shame, but how do we do that without eliminating some sense of responsibility? I'm gonna include a quote up here by the Swiss psychiatrist Carl Jung who said this: "It may not belong to you, "but you're still fully responsible for it." The way I think about this in regards to addiction and recovery is that the addict, I strongly believe especially based on the information we provided, it doesn't make sense to me to define the addict as being a bad person. Addicts can do really awful things and there's no doubt about that and a lot of the therapy that's being done right now is to try to repair the damage that's been done. But at the same time the only person that can solve the addict's problems is the addict. It may not belong to them in terms of them being bad for being addicted, but they're still fully responsible to it and I don't know how to talk about this unless it's to say there's a paradox right here at the heart of what we're talking about. If there's a way to usefully distinguish between the power of the chemicals on the brain and say that that doesn't make somebody a bad person and at the same time that they're gonna have to pull themselves up by their own bootstraps. The goal is really to get the client back to what one psychiatrist I worked with called the birthday brain, to get them back to where there's enough clarity, where they have access to their resources. There's what's referred to as post acute withdrawal syndrome. That can take six months or a year for somebody's brain to reset depending on the length of the addiction and also the significance of the severity of the addiction. It can take a long time. Okay, so we're winding up. There's a goal here today and that is is there a way for us to apply the scientific knowledge to reducing these two barriers, the two key barriers to treatment of addiction, namely shame and stigma? Really if we can do that, then I think for those that are viewing this that are in training to become psychotherapists, that really allows for you to do your work in terms of helping people to get on with their lives and that's where, those of you that are viewing this, that's where you come in. If you can help get clients beyond that initial impediment to getting help and get them back to their birthday brain, then you might actually be able to help them with what most of your training is, which is helping people to get onto fulfilling, meaningful lives. I wanna thank you for being here today. It's been a pleasure being here. As I mentioned earlier, I have a bibliography that I'm happy to mail to any of you. You can write me here. It's RWeathers@CalSouthern.edu. Just write me and I'll send you a copy of the bibliography as well as to be in conversation with you. That's it for today, thank you. Appreciate very much, great, thank you. (crescendoing choral bells)
