"The Hungry Ghost: A Biopsychosocial Perspective on Addiction, from Heroin to Workaholism"

my name is Ivy Schweitzer and I have the privilege of being the co-director of the gender Research Institute at Dartmouth Institute this spring with Patti Hernandez who's sitting in the front there and this is the third in our series of public events and I usually have a prop but I kind of forgot it suppose the grid poster with all the events we had two wonderful events the next event is actually next Thursday with reducer Jones who will be talking about stories from the edge of the world and the third event will be a screening of its criminal the film that was made about the class that Patti and Aiko teach where we take students into local jails and drug rehabs to work with inmates and residents on a performance project which we then perform for the community the goal is to facilitate the voices of the inmates and the residents and the film is ten years in the making this was the 2010 film and we're going to it had its premiere in LA at the LA International Women's Film Festival in March and we will be bringing it with a panel of the director of several student alums and several women who were in the facility at the time and are in the film who will be here talking with us as well and so mark your calendars for that but and I talked about that just to give you a little background up for our third speaker dr. Gabor Ma Tei so this is so just a little cut a little bit of background Patti and I started to work on work with incarcerated people in 2004 we had students working with us on a volunteer basis and in 2007 we started offering courses at Dartmouth for credit we continued this day to this day to offer those courses in fact we're doing one this spring is called telling stories for social change and we're working with the Sullivan County House of Corrections and a group of incarcerated men what we realized in the course of a long time working with these populations is that many of these people are substance abusers with a complex array of issues involving dysfunctional families sexual and domestic abuse mental illness self and self harming although we looked around we could not find written accounts or explanations of addiction that approached these complex issues in a humanizing and humanistic way that take a broad view of addiction because as patty always says we are all in need of rehabilitation all of us oh and I almost forgot let me just interrupt myself for a second before we proceed grid is directed by a wonderful person who we need to really recognize because she makes this all possible that's Annabelle Martine no that's right so thank you Annabelle I almost forgot and Nancy where's Nancy O'Brien Nancy O'Brien is the administrator for grid and she just does yeoman service nothing would happen without her so please just give Nancy around the door I didn't want to get back I should also thank the Rockefeller Center for co-sponsoring this event all right look I forgot to do my duty here so to get back to so as patty says we are all in need of rehabilitation so patty heard about dr. Mattie's work when somebody she knew who knows if she was working with incarcerated people said I heard this great talk on Democracy Now and you should go and listen to this man because I think he is I think he's talking your language I think he's speaking in ways that were really kind of appeal to you and answer the questions that we had and Patty did go and the next year we started King dr. Guevara mah Facebook in our class in the realm of hungry ghosts close encounters with addiction now dr. Matt days innovative and holistic work on addiction and recovery comes directly out of his experiences as a family practitioner and palliative care giver for 20 years and for 12 years working with hardcore addicts in Vancouver Canada's Downtown Eastside he's also authored several best-selling books besides in the realm of hungry ghosts including when the body says no the cost of hidden stress scattered minds a new look at the origins and healing of attention deficit disorder and he's also Co edited a book called hold on to your kids which is about the importance of parents in children's lives over their peer groups which usually in this day and age of social media kind of takes over he puts his theorizing into practice as the co-founder of compassion for addictions a new nonprofit organization and this fall we'll be launching a new website offering online courses in his areas of expertise the first of which will Train health professionals working with people with addiction in harm reduction approach now he's recognized as a groundbreaker in several fields dr. Matta has been the recipient of several awards the Hubert Evans prize for literary nonfiction as well as the 2012 Martin Luther King Humanitarian Award for mothers against teen violence he is also an adjunct professor in the Faculty of criminology at Simon Fraser University he is rightly celebrated for his broad perspective on addiction that weaves together the latest scientific research with compelling human stories and his own insights struggles and spirituality what drew us to his approach was his brutal honesty about the people he treats as well as his own imperfections the utter failure and racial injustice of the so-called war on drugs and his unrelenting insistence that quote the addict is not born but made and that quote we avert our eyes from the hardcore addict not only to avoid seeing ourselves but to avoid facing our share of responsibility I can describe the effect of his work on us by citing two other works that have been important to Patti and I the first and foremost pedagogy of the oppressed by the Brazilian educational philosopher Paulo Ferreira which teaches us that words and theory must always be united with action and activism and black feminist bell hooks is appreciation of frere in her inspiring collection teaching to transgress in that essay hooks describes herself as a quote subject in resistance to the white Western patriarchal paradigm and quote dying of thirst until Farrah's ideas quenched that thirst this is how Patti and I felt on reading dr. Matias book in passages like the following about Sarina a young native woman driven to addiction and depression dr. Mattei captures what we feel every time we are privileged to work with folks in local jails or drug rehabs and what we want our students and the people who come to see the performances take away because seeing the human is the only possible way to change attitudes and thus to create just and effective treatments and policies so let me read this very short passage for those who have the book page 58 and here is where we're I'm humbled I'm humbled by my feebleness in helping this person humbled that I had the arrogance to believe I'd seen and heard it all you can never see and here at all because for all their sordid similarities each story in the Downtown Eastside unfolded in the particular existence of a unique human being and each one needs to be heard witnessed and acknowledged anew every time it's told and I'm especially humbled because I dared to imagine that Serina was less than the complex and luminous person she is Who am I to judge her for being driven to the belief that only through drugs will she find respite from her torments spiritual teachings of all traditions and join us to see the divine in each other namaste the Sanskrit holy greeting means the divine in me salute the divine in you the divine it's so hard for us even to see the human so thank you dr. Mattei for helping us to see the human please join me in welcoming dr. Gabor Monty well thank you ivy for that very kind introduction can you hear me okay yeah you can hear me at the back yeah all right the young woman in that chapter that was just quoted I call you Serena I think my name is Patricia and she died a month after the publication of the book which is I was on book tour she died of a brain abscess caused by her HIV you can read about her and her story in a chapter I dedicated to her devoted to a story so the question then is how to understand addictions I mean why would somebody persist in a behavior that ends up killing her having seen the devastation that the addiction has wreaked on her friends and family knowing of her own illness resisting even getting tested together cd4 counts fee you know that the blood count that tells us about the activity of the HIV virus and you can read the her struggle and my struggle with her over that in that chapter but love somebody do that now they're basically in North America two dominant theories and they one of them dominates social thinking and policy and the legal approach and everyone dominates the medical approach although they do get mixed together the one theory is articulated most recently by a current Attorney General mr. Jeff Sessions who who recently said we need to say as Nancy Reagan said just say no don't do it and our nation needs to say clearly once again that using drugs is bad it will destroy your life in the 80s and the 90s we had we saw campaign stressing prevention we can do that again educating people and telling them the terrible truth about drugs and addiction result in better choices by more people now just as sexual successful those prevention programs are being can be Illustrated the fact that in your country every day between 10 and 30 140 people died of overdoses which means that every month you have the equivalent of a 911 happening that's a successful that approach is that approach success can be gauged by what's happening here in New Hampshire where the risk with a number of overdoses or quad quintupled in the last five or ten years it's exemplified in this article let me just look at it here opioid use in New Hampshire is staggering according to an article published in October the 17th and the union leader so that's a successful that approach has been which your current Attorney General is not advocating so fervently welcome to the middle ages the other perspective and addictions is articulated very well by your former Surgeon General Vice Admiral Vivek Murthy as a former because he was forced to resign just a few days ago and under the new administration who in November of last year published a paper called the surgeon general's report on addiction and he meant to do for addiction or a previous Surgeon General's report in the 1960s did for cigarette smoking which is to say to a scientific look at addiction and that report showed I'm talking with a Surgeon General's report in the teeth of the opposition of the drug pushers namely the tobacco companies that it still active cigarettes actually killed people now the intent of this report on the part of Murthy was not to show that addiction kills people we already know that but to provide a science evidence-based grounding for a drug policy and drug treatment and in that to be poor it he basically goes along with the dominant medical view which is the view of the American Society of addiction medicine that addiction is not actually a choice it's not an ethical failure as he very rightly points out it what it is is the brain disease the disease of the brain and when you say well what does the source of that brain disease well in again he accepts the medical mantra that is 50 to 70 percent caused by genetic predisposition so we have these two opposing perspectives one is that it's a choice that people make a psychologist at Harvard published a book a few years ago called addiction a disorder of choice he's never treated a single addict in his whole life he's experiencing his peers theorizing about it based on some papers so you got that perspective and then you got the medicalised perspective that it's a disease of the brain caused by genetics now the two perspectives are very different the second one is much more humane it allows for treatment it does not blame people surely you don't fault individuals for having merited the wrong genes it accounts for some of the symptoms that weaker with addiction and certainly it explains relapse in a medical context and you don't blame people for relapsing into cancer rheumatoid arthritis for multiple sclerosis or depression why would you blame people for relapsing into addiction so compared to the choice model it's from a humane it's much more science-based and it's much more germane for treatment however what the two perspectives ignore what they share in common is the reality of what addiction let me give you a definition of addiction that's not at least controversial it's more or less the same as given by the American academia the Society of addiction medicine in addiction is manifested in any behavior that a person creates finds temporary pleasure or reward in temporary pleasure or release in so craving temporary relief and pleasure long-term negative consequences and inability to give it up that's what an addiction is now notice that that definition says nothing about drugs so the first thing you have to realize is when I talk about addiction when I just talk about drugs it can obviously apply to first all cigarettes which you might say the drug but also eating shopping gambling work sex internet compulsive internet watching compulsive video gaming any human behavior and the issue is not the target behavior issue is does it provide temperature and relief at the cost of long-term consequences and you find it difficult to give it so given that definition now let me ask you a question here in this room and just raise your hands please if the answer is yes not gonna ask you anything about details just by that definition how many of you would acknowledge that at some time or another you have some kind of a dictator a pattern in your life just raise your hands okay great that's how it's brought that's how widespread addictions are so the first point is let me talk about the addicts let's just get realistic about it number one number two I'm gonna ask you a question I'm not gonna ask you what you addicted to Wayne or for how long I'm just going to ask you what did it do for you would you like about it what did it give you in a short turn so if you just those who want to say just raise your hand and then tell me anybody what did it do for you yes at the bail attack escape firm from suffering escape from emotional pain yes somebody else relief relief from stress so escape from pain especially if anybody else yes a fantasy of control a sense of control right very good thank you yes relief from depression okay very good we'll take one more yes please avoids emotional discomfort okay great so was that pleasure over very good so let's just establish something the addiction wasn't your problem the addiction was your attempt to solve a problem so this nonsense to call it a primary brain disease the real question is why are you each of you have so much emotional distress or pain I get to escape from it and why is it that you didn't know how to be with the pain because life brings pain right and part of being human being is knowing how to be with the pain why do you have so much stress that you have to find relief from it and why we're not able to manage the stress in a more creative and less harmful way why did you not have a sense of agency and and control in your life why on God's green earth did you like for pleasure now these will not be explained by references to choices or genes it will be explained by looking at your life something happened and is that something that happens that we have to look at so what happened now the only way to understand human beings well let me be your quote here from somebody knew what he was talking about a long time ago this is the Buddha talking about the nature of reality and he says that everything is interconnected big news right he says content and he called that the interconnected core arising of phenomena so mouthful it just means that everything arises in connection to everything else contemplate he says the nature of interconnected core arising during every moment now there is always look at the whole picture the gestalt the unity the connections to understand anything when you look at the leaf for a raindrop meditate and all the conditions near and distant that have contributed to the presence of that leaf or raindrop or think of that raindrops I mean or the other leaf it contains the Sun when photosynthesis contains the earth minerals contains the sky the water the smart an individual entity the birth and death of any phenomenon are connected to the birth and death of all other phenomena the one contains the many and the many contains the one without the one that cannot be the many without the many they cannot go on now put top Italian modern medical terms we we talk about the biopsychosocial nature of human beings biopsychosocial means that you cannot separate people's biology from their psychology emotions and from their social relationships not means is no phenomena exist in isolation from other phenomena I'm going to give you an example there's nothing to with addictions a study in the United States last year showed that if you're black woman the more experiences of racism here to endure the greater your risk of asthma many other studies have shown that the most stressed of parents are the molecular cases of asthma but these studies have been repeated they're not controversial but I know from experience that if you ask the average medical school class or the average physician for that matter to explain the physiology behind it that are on what to do with it they would know what to say because education just focuses on the biological we don't look at the psychological emotional and the social as they affect the biology now it's very simple physiologically anybody here will be treated for asthma anybody here yes what did they give you remember I blew it on steroids thank you very much so these albuterol is a inhaler that opens up the narrow their ways and steroids suppress inflammation in Airways now albuterol is a copy of adrenaline the steroids or copy of cortisone what are adrenaline cortisol anybody know stress hormones in other words we're treating asthma which transform owns should it maybe not occur to us that stress may it's going to do with the onset of that condition by the way steroids are the Communist use medication all across medicine just we use the stress hormone in virtually every condition that we do that has to do with inflammation which should tell us something about the nature of inflammation and its relationship to stress and there's a lot of research on that's not even controversial so for example people that had suffered started stress and abuse have higher risk of inflammation as adults why because human beings and therefore their virus of heart disease and cancer and autoimmune disease straightforward relationship because you can't separate the biology from a psychology and from the social relationships it's the same in addiction so I'm saying is that to understand addiction fully the act of a perspective that's not to do with choices which is utter nonsense I don't know a single person who have a chose to be an addict where the woke up one morning and said my ambition is to be an addict if anybody here chose to be an addict please raise your hand right now and tell me why you did that and we have to get to beyond the disease model and again as I said to do that we have to look at people's lives in the context of the psychological and social relationships because yes addiction does involve the brain and we can show in brain scans that they're abnormal T's in the certain key circuits in the addicted brain which is by the way not just restricted to drugs so there's abnormal functioning in any addiction therefore to isolate drug addiction and say well that's the problem we have is a problem it's not the problem it's not separable from the general problem of addiction in a society so it's not the primary problem if the attempt to solve a problem was to understand is how did that problem arise well let's just go to the slate layer by layer as I say in my book if you understand addiction you just can't take any one single perspective you have to look at the whole picture and you have to kind of shake it up like a kaleidoscope to sit to see for many different perspectives so this with the next level first level is the attempt to solve a life problem now there's a Hungarian born like myself psychiatrist Thomas hora said all addictions on attempt to control our life experiences by external remedies he said the meaner of all addictions should could be defined as endeavors at controlling our life experiences with the help of external remedies unfortunately all external means of improving our life experiences or double-edged swords they're always good and bad no external remedy improves our condition without at the same time making it worse so that's the first level it's an attempt to somehow controlling your life experience which is what we've established in a second of all let's look at it from a more narrowly narrowly medical perspective so I was diagnosed with ADHD attention deficit hyperactivity disorder in my 50s I was successful doctor a family physician I was the head of palliative care at Vancouver largest Hospital aboard a national medical column Hawkin describe AED why you could do that if you came to my room and saw the mess in my room the disorder of my personal life my poor impulse control my lateness my disorganization my frustration and not having fulfilled my potential rated well a TD outcomes the difficulties in my marriage the troubles of my children so I was diagnosed and described let me pause here from it so again the ad DS that defined his disinherited brain disease utter nonsense it's neither inherited nor it is in disease I'll tell you what it is it's not unlike addiction in that sense the hallmark of a TD is this tuning of the absent-mindedness in it a problem difficulty as your current president demonstrates very salient lis difficulty holding to a single thought in extreme cases which he represents by the way inattention he's never had a book in his whole life now and his biographers describing is flitting about like a butterfly you know one thing to another but tuning out that have some mindedness what is that about why do we have that capacity because it's a human capacity that we all have why do we have it what is function anybody yeah don't forget something close close it's not so much trying to forget it go ahead in what sense how does it help you survive okay go ahead okay so first of all you have to have selective attention you can't be attending right now to every sensation you your brain is getting millions of bits of data from your viscera every split second you can't be attending to them all so there's to be selective attention that's one function of it but there's another one which goes back motifs about somebody else that forgetting difficult things is I'm not worth forgetting difficult things it's enduring difficult things if I were to stress you right anyone of you right now let's say that if I were to stress you right now become abusive towards you just verbally what would be your options how could you do well Sully help her out what were the options there okay you could just run away you should get out of the room right you know I'm gonna sit here listen to this guy what's salty verbal again I'm getting out of here that's one option right what's another one sorry you could confine me but fight back so flight-or-fight exactly there's a third option if you couldn't engage either one but given that different no we don't to go there just yet you're not good features yet there are several dozen people here in the room with you what else could you do you could ask for help now you know you could ask for help but what if you couldn't escape fight back or ask for help but the situation didn't give you those options now what would you do you wouldn't do anything your brain would do something you disassociate so that you wouldn't be overwhelmed so it's a coping mechanism for stress is what it is now how it becomes a medical condition I'll tell you about in a little while but it's a temperament to be a temporary thing not a long-term thing so the problem happens when quilting mechanisms that are meant to be there temporarily become long-term in other words where they where they go from being a temporary state to a long-term wait let me reach coach you for an article published by the American Academy of Pediatrics in the journal Pediatrics which is the official journal the article is from the Harvard Center and a developing child published in 2012 it's all these seminal articles that's published in a major journal and makes no impact whatsoever on medical practice here's what they say going scientific evidence demonstrates that social and physical environments that threaten human development there is a scarcity stress or instability can lead to shortened physiologic and psychological adjustments that are necessary for immediate survival and adaptation but which may come at a significant cost to long-term outcomes in learning behavior health and logistic longevity in other words the way that young children adapt to stress in their environment has them enjoyed that stress but those same coping mechanisms because sort of pathology learning problems and health problems later on and that's just the question how does that happen and what conditions engender those coping mechanisms so in any case I was diagnosed with ADHD and I was prescribed dexedrine which is a stimulant which elevates the level of a chemical in the brain called dopamine that really helped me I became a much more efficient workaholic for several years and it helped me write a couple of my books then do anything for me in terms of personal development but it certainly helped me get things done now what else elevates dopamine levels so all the stimulants do now I'll be talking about dopamine another well cocaine does crystal meth does nicotine does caffeine does so that's talking to somebody at lunchtime today who told me that money did I think it was cocaine instead of getting all hyper like a lot of people do they calm down there you get things done when somebody tells you that what are they telling you they're telling you first of all they're handing the diagnosis on the platter the thing I got a TD and about 30% of stimulant addicts according to the studies are actually self-medicating ADHD and what I'm saying about addictions is very often they're self-medicating some medications and it doesn't have to be with drugs because when I had my addictive behaviors really in the midst of those behaviors I was very focused and present no EDD then at all my memory was perfect because those activities also elevated dopamine levels in the brain just like the cocaine or crystal meth does so self medication people self medicate ADHD with pot with cannabis because it caused the hyperactive brain or with alcohol people stop making anxiety with Canada's with opiates and with with tranquilizers people self medicate depression cocaine like prozac elevates serotonin levels in the brain temporarily so people thought me to get depression with addictions people self medicate social phobia people self medicate post-traumatic stress disorder salient lipid opiates which is why a lot of the veterans coming back from your Crusades around the world self-medicate dude opiates and when that happens there goes honor or young men and women honor our heroes what they do is they get jailed and pretty bad and treated so it's a self medication for post-traumatic stress disorder relieving the symptoms temporarily so on the second level then addictions are very often about self medications and if that's the case you've got to be dealing with what they're self medicating not just with the behavior of addiction now let's go deeper let's look at the brain on addiction so I mentioned the opiates or the salt medication for for PTSD and other conditions why do the opiates work in the human brain anyway like why does this product from Afghanistan by the way I should tell you just a fact here I'm not here to talk politics I'm the stomach fat since the Western led the us-led war in Afghanistan the production has a volume has gone up exponentially congratulations and thank you very much that's just the reality now why did the opiate even work in the human brain anybody know yeah yeah well you're sort of meandering in the right ballpark but you're not quite there yeah we ever know the alarm will be assisted we have our own opiate system and so that means that we have molecules and our cell surfaces where you opium out you can bind because the opiate resembles our internal opiates sufficiently that the cell doesn't know the difference so we have receptors for them and in fact the internal gate systems are caught in internal opiates are called endorphins and endorphins literally means and dodging is morphine like substance that's what endorphin is so why do we have an internal endorphin system well we've used opiates in medicine for at least 2,000 years probably longer probably longer for what what are their salient use pain early so when I was working in palliative care every day I could get on my knees and be grateful for the opiates because without them a lot of people who died in excruciating pain from cancer and other terminal conditions but the opiates do not only sort of physical pain they also saw the emotional pain as a matter of fact the same brain center that experiences the suffering of physical pain also explains the suffering of emotional pain the division in pain and suffering I go to the dentist and unless it's something radical like a root canal I don't get my teeth flossing and my dentist is always nervous he wants to give me a ninja I hate that feeling of being frozen I said Vince I can handle the pain so I can obtain but I'm not suffering why am I not suffering because I know there's a good purpose I know that I'm in good hands I know that I can stop at any time and it'll be over soon there's no suffering this pain there's no suffering so the suffering of physical pain is experienced in the same brain center as a suffering of emotional pain as a matter fact as many of you have already said when you told me about your addictive patterns most addictions are actually all addictions distract if they don't directly soothe pain like the opiates do they distract from it alcohol what you say about somebody who's drunk too much the old expression or they're feeling no pain cannabis is what allergies are qualities as you know cocaine is a local anesthetic it's Susan nerve endings which means to say and this is my mantra you recall nothing else you might hold on to this one the first question addiction is now why D addiction but why the pain and if you understand people's pain don't look at their genes look at their lives what happened to them something happened now why do we have an endorphin system well they they play many functions in the body from the gut to the mucous membranes to the immune system but in the brain as related to addiction they serve three major functions number one pain relief and throughout the body pain relief we have to have pain relief we have to pain to survive we also have pain relief so the endorphins are responsible for the so-called placebo effect if you think you're getting help to give a hundred people a pain pill or in pain 25 will find relief because their own system over these endorphins in response to the belief that they're getting help not a imagined effect it's a genuine physiological an account of the endorsements so they're quite clean only that's one thing they do secondly they provide they account for the experience of pleasure and reward elation joy whenever you've got those emotional states you've got a lot of endorphin activity in your brain that's the second function the third function is actually the most important one and the least appreciated any possible little thing without without which human life or any mammalian life or even alien life is impossible that little thing called love opiate stop might mediate the attachment relationship even to human beings not what is attachment attachment is just like gravity is an attachment force pulling me to the ground and the ground towards me actually attachment is a psychological force that draws two people together for the purpose of being taken care of or of taking care of now when I say life is not possible without it well I think of a human infant just how long would they to survive without attachment Drive and it's the endorphins that help too much not by themselves but the important in mediating that attachment drive the attachment drive is the strongest biological drive that we have for the reason that develop we don't survive so so there was a very great man who died this week his name is dr. yak tank said it was a neuroscientist and worked with animals do him a lot and it was he that showed in a laboratory that if you took little mice and you not thought if you medically chopped up not out there endorphin receptors these little mice would not cry for their mothers on separation but what would that mean in the wild if they're separating the world from the mums and even quite for them what would that mean for them their dads that's one for the opiates are so I would like to ask mr. sessions if he human beings come to the conclusion for whatever reason but without this particular substance they will not experience pain relief pleasure reward or sense of belonging how are you gonna take that away from them put a sign on a highway just say no just say no to pain relief say no to pleasure and relief say no the human connection is one sex trade worker told me the first time that she did hair when she said it felt like a warm soft hug now I mentioned dopamine dopamine is the incentive motivation chemical without that the listless lack vitality we don't do anything in fact we can't live so dopamine flows when you're exploring a novel object or a novel environment dopamine flows when you're seeking food or seeking a sexual partner in any activity that involves motivation incentives you got the dopamine functioning and all the addictions activate dopamine functions the stimulants drugs and was most directly but not exclusively so you tell human being without that particular behavior or substance feels no vitality no incentive no motive a no sense of being alive to say no so that's the second brain circuit involved in addiction the third one somebody already mentioned when you're stressed and you don't know how to regulate your stress addiction is one way now I mean we're meant to be stressed because if I was being abusive towards Patti she'd have to be stressed stressed means that she that her emotional apparatus in her brain would trigger the hypothalamus which is a gland in the brain and which controls the autonomic nervous system at the same time to actually be going to cascade of neurological and hormonal influences that would result in the release of the stress hormones adrenaline cortisol that would help her escape or fight back so we have to be stressed this is not a bad thing it's necessary for life but if we're stressed chronically nor we're in trouble because those same stress hormones can also rate you intestines then your bones give you us to process make you depressed give you heart disease and suppress your immune system so you're more prone to of cancer and then we end up using a stress hormone to medieval system has run out they give them extra stress hormones to keep their bodies from the into inflamed and in a nutshell there's a story of a lot of heart disease and how to immunity than cancer only we don't connect us to people's lives that's in my book when the body says normal so we have to have stress regulation and the addict doesn't have it those circuits have not developed there has to be a way of dampening the stress otherwise it'll kill us again helpfulness short-term negative in a long term so that excuse the addictions to regulate their stresses to lower their stress levels which then immediately raises the question let's say a bunch of geniuses were together in Washington or in Ottawa in the case of my country and they were trying to figure out what should we do about addiction as well all the research shows which it does that stress is the biggest driver of addictive relapse so these geniuses then come together and they say hey I got it let's stress people let's ostracize them and exclude them and criminalize them and suppress them and judge them surely that will help which is the logic behind the war on drugs which there isn't a war on drugs you can't make worn inanimate objects here's the one human beings and which human beings I'll tell you about in a minute so the special relation circuits don't work and finally impulse regulations so impulse regulation is important for human life I mean I may have an impulse a sexual impulse or a kind of behavior impulse or now you know one of the hallmarks of a DD by the way is for impulse control which means that if you're an adv male really disregulated you might have this impulse to grab women by their crotch you might even talk about it and boast about it publicly which in this country gets you elected as president so lack of impulse control now there's nothing wrong with the sexual impulse but there's something wrong with acting it out in certain situations but that's okay because here in my brain your brain there's a part of being I'm pointing to it actually it's called the right orbital frontal cortex whose job it is to regulate impulses in other words the cortex doesn't so much initiate behaviors as to inhibits it in inhibits them the impulses arise from the lower brain centers the cortex says no not right now not here now if you do brain scans on drug addicts which have been done the Communists have been finding is abnormality in the part of the brain that regulates impulses so if somebody astutely said the Palvin addiction is not lack of free will but lack of a free want nothing to say no with the question is so these four circuits the opiate the dopamine the stress regulation the impulsive agency really what happened what happened here well the Admiral Vice Admiral Mercy's report basically says that the drugs once you start using interfere with these circuits which they do but what happened before so what the brain theory of addiction told ignores is the scientific information or the brain actually develops it turns out that the human brain develops an interaction with the environment so which service developed physiologically biochemically which systems get coordinated and which do not depends very much on the environment so if you were taking a child with good genes and good eyes and you put in a dark room for five years he'd be blind thereafter for the rest of his life because the circuits of vision require light waves to stimulate the no light waves the brain says why should I develop visual circuits I might as well put that energy into hearing or touch or snow so this exists the environment that triggers the genes to create the proteins that lead to the development of brain circuits so I'm going to quote you now from the same Harvard article from the Harvard Center the developing child journal Pediatrics to design clothes in which they not so much break new ground as they summarize the collate the research that I've been expand for a couple of decades now and is being added to all the time the architecture of the brain is constructed to an ongoing process that begins before birth continues into adulthood and establishes either of sturdy or fragile foundation for all the health learning and behavior that follows they didn't say some of the health they said all the health learning a behavior that follows and they said the architecture of the brain is constructive an ongoing process that begins before birth now what does that mean that means that the emotional experiences of the moment during pregnancy are already having impact on the brain of the developing child so after 9/11 there was a study done of women suffered PTSD from 9/11 while pregnant one year later their children still had abnormal stress hormones levels which meant there be more prone for inflammation and more prone for addiction unless that's reversed but the point is what happened to in pregnancy and impact well long after the pregnancy and you can show this women who are abused in pregnancy the kids are much more like to be diagnosed with ADHD or other problems seven or eight years later which means as I point out in my book on my appendix on prevention the you want to prevent addiction by going to schools and telling kids so bad drugs that you just don't and the reason you don't is because the kids in who listen to adults are not at risk and the kids who are risk are not listen to adults the beginning of the prevention of addiction needs to begin at the first prenatal visit and how you look after pregnant women and the stresses that they're under it and on birth and all that so that's the first paragraph second paragraph the interaction of the genes and experiences literally shapes the circuitry of the developing brain because genes are turned on and off by experience and it's critically important spy and now they give the essential quality that's needed for healthy brain development is critically influenced by the mutual responsiveness of adult-child relationships particularly early childhood years so they're less essential vanessa condition needed for the healthy development of the brain is the presence or emotionally attuned emotion available consistently available non-stressed non-depressed parenting caregivers because when parents are stressed or depressed or distracted or traumatized whatever they can't be that responsive to their children as much as they want to be want to know why the rates of ADHD are going up in this country and of course the industrialized world want to know why so many kids are being diagnosed with all different mental health conditions look at that paragraph because the planting environment in this culture has become so stressed not moving genes very little early genes mostly the rule is the environment and other bands are developing now one all about my ADHD look at my infancy I was born in Budapest Hungary 1944 73 years ago to Jewish parents to Jewish mom my father was away in forced labor and at 2 months of age when I was 2 months of age the German army occupied Hungary which at that time was the only Eastern European nation where the genocide had not yet exterminated the youth population and I was our tune and a day after the Burma marched into boy fest my mother phoned the pediatrician to say would you please gonna see Gabor because his client all the time the doctor said sure welcome but I should tell you all my Jewish babies are crying of course what did I as a two-month-old know about Germans and genocide and Hitler and all that nothing was a reacting to my mother stress levels at the University of Washington Seattle they D and eg study electroencephalograms a six month old infants whose mothers were depressed Cassandra fashion comparing them to the EGS of infants of mothers who are not depressed you could tell from the charts electroencephalogram whose mother was the person whose wasn't the child Mother's emotional states program who capacity to respond to the child program the child's brain circuitry so I'll read you a paragraph here the child is very open and can feel the pain and suffering going on in its immediate environment the child is aware of its own body and can also feel the rigidity and pain and the body of the mother of anyone else he is with if the mother is suffering the baby suffers to the plane never gets discharged now could I fight back as a two-month-old could I escape Korea square halt and we lived under German rule for the first year of my life you can imagine my mother's mine States especially after her parents are killed in Auschwitz and she didn't know if my father was dead or alive that's an extreme situation I grant you but but it doesn't have to be that extreme as I'll tell you in a minute what does an infant do with that well there's a very limited number of brain defenses available against that much stress one of them is to tune out but when am i tuning out but my brain is developing when every second literally every second millions of connections are being made in the brain when dopamine circuit is developing you take infant monkeys measure the dopamine levels separated from the mothers measured again a week later way down this is how the addicted brain and how they and how the mentally challenged brain develops what are my children to them were diagnosed with ADHD there is genetic really my kids are small their parents was a workup their father was a workaholic doctor why was their workaholic doctor because what message did I get as an infant I got the message that the world didn't mommy why did they get that message because my mother was so unhappy my infants and children are narcissistic no matter hold they are because it is a question of development and me narcissistic you really think it's all about you so my mother is unhappy which she was it's gotta be because I'm not good enough animal I'm not wanted especially when I was a year old she gave me to a stranger in the street to save my life and I didn't see her for a month but three or four weeks I should say so you get this core sense that you're not wanted I question whether my mother loved me or not before she did it's a question of what message do I get well how do you compensate for nothing wanted one wonderful way to compensate is to go to medical school now they're going to want you all the time and the more they want you the happy you get and the more dicta you get to being wanted what message do my kids get when I'm not at home or from home not depressed but when I'm working I'm all fired up and I'm always answering the beeper and how is that for my wife so they go up in a stressed environment how do they deal with it they tune out their brains develop in a certain way this is probably passed on trauma for one generation to the next without meaning to just automatically and this is why things are in families not because of genes now what do we find when we look at addicted populations well in the downtown east side of Vancouver which is you might say the ground zero for addiction in North America's we have more addicted people there in a few squirrel radius than here any other small area of North America it's also where we have North America's first lie detection site but people actually bring their drugs understand they inject under supervision I was the doctor there for couple years what we find well in 12 years have worked there I did not have a single female patient who had not been sexually abused as a joke no one all the men had been traumatized but 25 30 % had been sexually abused or used another way now this is the conditions under which the brains developed this is also given the pain not why the addiction but why the pain that's why the pain and what do we find if you look at large population studies the same thing the adverse childhood experience studies the AC studies now let me just ask Olivia familiar with them 1 2 3 4 5 okay the AC studies look for godsakes look them up adverse childhood experiences studies AC studies done in California 15,000 adults largely Caucasian but half of them University educated the more diversity the child had exponentially the greater risk of ADHD of addiction mental illness autoimmune disease everything under the Sun specific addiction it was exponential what's an adverse childhood experience physical sexual or emotional abuse that's one point for each of those and they rarely just come in singles they come in bunches Vance in the family a plan benedicted a plan B mentally ill a pending jailed a divorce neglect for each of these the risk of addiction goes up exponentially for reasons that on account of what I told you about pain and the brain development should be obvious in other words the source of addiction is trauma it's that simple and trauma cannot a word by the way that's mentioned in medical schools literally it's not go down to the medical school in your university here and ask them how many lectures they get on trauma I'm talking about emotional train I'll guarantee you not a single one in four years ask the mermalair should they get on brain development what I just given you here again to you not a single line naturally we don't understand that view of how to treat addictions now I'll have to stop because I will need sufficient time for questions and arguments and comments let me just make the point again that in all addictions is the same brain circuits so it doesn't matter where there's addiction to a draw go to work or the gambling or whatever it is trauma does not have to be the overt big t trauma it's sufficient that if the mother is depressed when the child is young it's sufficient that the plan says to stress themselves to attend to the child they're not being abusive to just being inattentive or emotionally unavailable just as if you're growing a plant in your backyard you could hurt it by cutting it or poisoning it but how else could you hurt it just by depriving it of irrigation or minerals or sunlight the same with human children now the semi had a copy of Hungry Ghost area Kennedy's birth thank you so maybe I'll talk about drug policy and treatment during the question period if anybody asks oh let me read you just one paragraph here from the book Detective Sergeant populace behead of Toronto Sex Crimes Unit rescued children from the purveyors of internet pornography at the global male and Canadian newspaper reported on his retired from retirement from police work six years at that job had not ignored him to the horrors they witnessed kapag Leslie the article says still can't get used to the sounds of crying and pain in the graphic videos being raped and molested that he is seen all too often on the web it's beyond horrible to listen to the soundtracks of these movies said Canada's best-known child porn Club but it is the silent images of desolate children that they're most at his heart they are not accepting just they're not screaming just accepting he said of the infant's captured in his pictures they have dead eyes you can store that tell that their spirit is broken that's their life now their dead eyes what do they mean it's another brain defense you just shut down your emotions because it's unbearable you push them down what's another word for pushing something down depressing what do you think depression is about I inherited brain disease it begins as a coping mechanism but the other point is naturally when you shut down the pain so you won't feel your vulnerability you also stop developing for them because for development you need to be vulnerable nothing goes when it's not vulnerable a plant doesn't grow over it's hard and take it goes where it's green and soft and vulnerable a car station animal like a crab cannot go inside a hard shell it has to mold make itself very vulnerable you want people to go make it safe for them to be wrong but the second point is if the same compassionate cop had transferred to the drug squad who you think he'd be chasing in the streets the same kids that he didn't rescue and there's your drug policy in a nutshell you failed to protect young children distressed by their parents we don't deal with trauma and then their brains developed in a certain way and then they turned to certain substances that were arbitrarily we declared to be criminal activities it's quite okay to kill yourself with cigarettes or alcohol not okay to do that with our own so we've permitted them socially to be abused and then we punish them for having run away from their pain by using those particular systems and for that reason you have millions of people in the jails in your country in your country so that you probably notice because President Obama said this in a in a speech but I'm very glad to see him so well there was a report in your town this morning he's gonna speak to a Wall Street firm and get only four thousand dollars for an hour-long speech which I think you're getting me very cheap here actually but I was Louie I was I was worried about him I was going to make it after the presidency but looks like India okay but as he pointed out in one of his speeches the Americans make up 5% of the world's population 25% of was jail population so in the world every fourth person every fourth of fifth person in jail is a citizen of a land of the free that's as much sense that drug policies make me comes to treatment mr. Louison in my final point the good news is that the brain can develop even later people can heal that's a capacity inside all of us but we don't need to be punished we don't need to be ostracized me to be dealt with compassion and understanding and we need to deal heal the trauma that underlies the addiction and then we can worry about at the same time as we try and regulate the behavior we need to deal with the underlying trauma because if we don't all that happens is you don't go from one addiction to another you might give up your drinking but you eat a lot you might give up your smoking but you start drinking you might give up this then you're in the back you know sexually if something's going to happen because the addiction process is the same the targets can be different so I'm a by the way we use this word recovery for the word healing from addiction what does it actually mean to recover something what's the word mean in English what do you do when you recover something you get it back which means to say that whatever you got back wasn't destroyed in the first place if it was you couldn't get it back and those of you that have recovered if you have what did you find again yourself exactly which means that there's a to self that was never destroyed never damaged couldn't be damaged to the destroyed and you got it back so to complete my talk here and I'll quote from the Catholic monk Thomas Merton who said in order to gain possession of ourselves we have to have some confidence some over victory an oath in order to keep that hope alive we must usually have some taste of victory you must know what victory is and like it better than defeat which means that if you want people to recover we have to hand them that taste of victory which means to see them as a human being so they can see themselves as a human being and now they can start healing so everything we're doing and socially and legally and in a treatment industry which is focusing on the behaviors Navya looks at the trauma never even considers that there's a real essential human being in there just all about the behavior no wonder it was failing so spectacularly and I'm not happy knowing thank you very much thank you so question exponent yes and then you have a shot because we don't have any mics sorry what they were also really addicted to with the criminal element it was the chase in the regardless and trying to get away with getting a bit illegal substances and for many years I have thought that it's in the United States we said you can use whatever if you choose to give so long as you're not going to hurt me yeah don't drink and drive and that's really pushing and I'd like to know what you think about what might happen if we first got away with it get away visit criminal element and of course we would be putting as many people well ok fair enough no I think they were overstating it in any addiction the very idea of participating the behavior already gets the dopamine juices flowing so am I in my deep in the depths of my my shopping addiction which I described in the book the anticipation itself we already make me feel alive it wasn't illegal but it was illicit in the sense that I was lying to my wife about it so yeah there's something to that what we know is in Portugal where they have decriminalized the personal position of drugs drug use has gone down a little bit a lot more people are in treatment now it's not the problem of the diction is people are ashamed of it and are usually lying about it so if you listed in a sense even if it's not illegal it's not the criminality that they were after is the illicit myths that they were after city of Miami would go out of business if the cops were getting paid attention so their state money which is my point so that when people say the war on drugs is a failure no it isn't the war in Iraq was only a failure if you really think that was about what it was about then it was a failure what was about what if but not it wasn't a failure for everybody a lot of people need a lot of money not fit the military got a lot of budget out of it the same with the war on drugs some people are sick some people are succeeding beautifully as a result of the war on drugs it's just a comment but the group that I work for at the hospital we walked away from a crack applying for a grant from the state of New Hampshire because and it was with pregnant and parenting women who were in addiction or you know in medically assisted treatment and they wanted them in their own house or apartment that they were paying for fully themselves and with a job with kids there a new baby or something within six months and we just you know we just had to walk back and said it's an ethical issue we do not believe that this is and when you talk about the stress unlike the stress we would have put on those mothers who we had taken that money and insisted that this we would have failure all over the place end and babies sanely and this was you know the Stace out that was a good idea I never should have done a little bit about enabling the state that and Ziggler and how soul is anyway it means that we're differently so are you kneeling I friend who is an addict and he comes to drink with me and for months I didn't know that he was trying to quit and know that you do and now that I do I'm in a position of having to make a rule and not make a rule or decide so it's okay for you to be in a vulnerable place with me even though our other friends don't want you to be in that place and my other friends consider me as an enabler because because I might not be drawing the same line you're making same rules that they are yeah that's a tough one in general I think is going to make an error err on the side of compassion you didn't make them into adventure you're not going to stop them from being a bit very but it's a question of what's it like for you what is it likely being with them and is drinking and you know that it's that fun what's it like wait I I prefer to see a mazzantini be and that if this is what they couldn't feel like eating my feet with me then if I would rather put it in a place where you can feel feel safe addressing pain many feels and not not okay well that's I mean if you're gonna make a mistake make it on that side it's all day you're not he didn't cause his calls and you're not going to stop it he can and maybe to get some compassionate friendship now that's however you got to watch that one because you might really veer into caretaking and kind of that's enabling and you'll be doing that at your own expense so you got to believe as long as you're really clear on that one where you coming from I won't argue with you but there's a bit of a line there you have to draw okay yes it's over there go ahead can you think of it a lot of the causes of addiction and trauma this project through deeply rooted in structural issues yeah Julien country does it really work to address granting those so the question is that it's these are big structural questions so how do you address them as outpatient or the causes are okay so as I'm understanding a question the problems that I'm describing our structural they're part of the culture at what level don't give me a distant well look in Canada I'm happy to say that the Health Minister the federal health minister is tweeting out my book all the time and it's quoting it which is a great step forward and we'll expect that to happen a new administration right now really really rapidly taking giant steps backward right now you addressed it up whatever level you functioning at so on the local level for example it's not like you don't have supervised injection sites but you know with all the hair on that's why aren't there in some of the larger centers places what we can actually bring their drugs get clean needles sterile water attorney key and get resuscitate available to those I know you know so harm reduction in Vancouver we have a clinic where people who can't use methadone or suboxone just doesn't work for them how'd she get heroin prescribed tonight now that means another Dinah Street of a Centon overdose who they're not buying some adulterated stuff that somebody spiked with Sentinel so whatever level that you act you should deal with what the problems immediately in front of you so people should have much more access to methadone low low threshold access to suboxone or methadone treatment policy should incorporate anybody will deal with addiction at all needs to be trained in trauma at least understanding trauma then don't they're not so there's multiple level approaches depending on what oh where are you working in and you know it's your policy maker but for God's sakes get educated you know base your policies on evidence there's all kinds of evidence about treatment and harm reduction and criminalization and what works and what doesn't but the last thing that politicians ever look at is the evidence so just whatever level you're at just do what you can and so it's all I can say I'm financing your question but that's the best I can come up with maybe M yes yeah well so treatment so if I was running a treatment facility first of all first of all no one-size-fits-all so the suspects crew is great for about 15-20 percent of eyes but great 15 points then is really good but there's no one side that so first one nobody should be coerced in a treatment nobody should be forced into a 12-step group that's never how it's designed you can't force somebody to admit that they're powerless utterly meaningless you're just making them powerless even more when you do that harm reduction should be a part of it because again most of what no one-size-fits-all so some people you know you cater right now like this person says well you're right right now there's so much pain in your life you know what to do with it you're going to use something that's what's gonna do let's at least make it as safe for you as possible that does not encourage anybody to stay or become addicted or their nonsense or point to all the studies but it's very helpful now here a treatment facility the treatment first of all once a detox so like you get somebody even if you can get somebody up here on not a detox and they kick them back into society haven't taught them a thing you haven't helped them developers even being you have to talk to skills you haven't doesn't deal with the trauma their self-loathing their shame their pain and you throw back a little what's gonna happen they're going to relapse so treatment facilities need to once you get somebody off the drug even while you're still using say methadone studying with the other issues the trauma that drove it in the first place the lack of social skills get them out into nature get them out on the line get them cultivating a garden give them a sense of meaning and purpose of community and commonality lot of compassion a lot of patience lot cheaper than the one effective method what's the conversation to how to treat an adult addict to where well for London you have to get civilized first as Gandhi was once asked about well he thinks about Western civilization he said I think it'd be a good idea same at the u.s. you're barbaric when it comes to child care policy if six weeks maternity leave biologically it's a scandal biologically that kids should be with the mother for at least nine months for 18 or 24 months daily full-time or a mothering parent of either gender or any gender for that night so first of all support for prenatal in dealing with their stresses not just talking about blood tests and all the sounds but actually what's happening in your life then birth practices that traumatize infants the medicalization of birth the high cesarean section rate all that stuff I keep going on about that then if you're going to have kids in daycare because the parents have to work make sure that they care see that remember that is Harvard article says that the brain develops from before birth to adulthood that means that the daycares in the schools and the kindergartens need to be in the brain development business and what is the necessary condition for brain development responsive adults now as in one of my books hold on to your kids we point out we my co-writer and I in that book children's need to attach they just do they can't function without it so does a duckling duckling hatches from the egg print imprints on the mother duck if she's there but what will the duckling imprint on if the mother duck is not there anything that moves including a toy which developmentally is a disaster because the toy can't bring up that duckling now what I'm doing are kids throwing them into these daycares with poorly paid under trained staff they don't see the parents of all day who are they around the whole day other kids who they imprint on other kids I've got this ridiculous pure culture where kids are more related to each other than they are to adults and we've given them technology to stick to keep it that way so they go on Facebook where they have friends and where people like them in other words they getting their attachment needs pseudo met pseudo met because nobody on Facebook we knows them there is no the image that they portray so if I get real about human needs and it would cost so much less than what I'm saying now so if you understand those issues they do suggest you check out all my books I only got for them so it's not terribly expensive but particularly hold on to your kids and also my book on ADHD which talks a lot about child development but you know pay attention to this Harvard article that was published five years ago did lots information okay shonkoff eight sh o NK o FF and the bunch others generated yes how does the messy question everyone a study as I read it with stumbled across needles like it was stumbled upon its phenomenon he was treating all these people it was somebody funny and what happened was he stood looking his way good I mean they were going back and he couldn't figure it out and he sat down and talked to them it turned out all the women had complexities disabilities all the men had family they were medicating for free by eating a lot not just because it was company but because they wanted to be invisible especially with tacklers people who migrated in America that began the a study the reason I read that was because the June I'm a journalist has been a story about women who are survivors of domestic violence 2 5 10 20 25 years later because of the biologist chef you're going to come back we're coming down with catastrophic rates and things you've never played it right asthma you know arthritis hydrate well those things you think about but other things he wouldn't think that and including belittle your cancer and and I just wonder about the fact that addicts are kind of the canary in long line they're the ones who are the most visible well they also if I may just 85 is interrupt for a moment there also the content of mine in another sense and this is what's genetic here they're the most sensitive ones and the most sensitive you are the more hurt you are when stuff happens and the more rich you are the more you have to escape from the pain that's the only genetic thing over on you but anyone no no that's it I just was thinking that what we're reviewing really isn't just a diction reviewing the whole span of human trauma and human disease and one way to understand it is biology of stress and that's really important inflammation and fight-or-flight and wrong hormones that are right for a single situation but if they are the way you cope is something over 5-10 years it becomes such a problem in our system that it's an exhibit mall we do it but I'm just thinking a baby there's something we need to learn cymatics and dealing with people in all kinds of situations it's interesting what they studies first of all you're quite right that's how it started and Vince felitti was a internal medicine specialist in San Diego did this amazing thing would you describe you actually listen to this patient and that's how he learned so they invaded these studies now limiters done interesting with these studies so they were generated in a Kaiser Permanente system in California so five years ago I was invited to go to San Diego where felitti works to beef a talk on addiction and the month before I come down the organizer to talk there it is phone call with me and say well could you suggest some literature that supports your point of view I think yes the adverse charge recent studies done in a Kaiser system in San Diego really this is the organization that generated the studies so what what selita's work has shown is that the statistical relationship because early child experiences and the adult outcomes that you described what my work is shown is why it's like that so whether it comes to physical illness in the book when the body says no or addiction and hundred loss or ADHD in scattered you know that that my advantage being that is a family physician I was very aware of all the literature at least I made myself over and also I could see families multi-generational which specialists never do you know so I just had a broader over anyway I think we're coming to the end of this Conclave I'll be happy to sign books for some of you that want to bind them let me also mention my website will they'll be offering online courses later on issue you can sign up for the mailing list and lots of my lectures are on YouTube which costs you no money at all and just watch them and share them if you find it helpful to do something so there are books outside for sale just try it out we will lobby here and we're going to put dr. Pinette name right here this on book so people want to cut a line up in the front [Applause]

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Length: 94min 9sec (5649 seconds)

Published: Thu May 04 2017