The Craving Brain: Neuroscience of Uncontrollable Urges

01:27:24
https://www.youtube.com/watch?v=p0lL1MN2yCs

Resumo

TLDRThe event discusses the enormous impact of addiction in the United States, emphasizing that over 25 million people suffer from addiction, costing around $600 billion annually. Healthcare professionals and scientists on the panel highlight that addiction is a chronic brain disease, where repeated drug use leads to long-lasting brain changes. Researchers are examining whether there are identifiable characteristics in the brains of addicts, even before substance abuse begins. Questions also arise about the possibility of reversing brain damage caused by addiction. The challenges are significant given the stigma surrounding addiction and the lack of integration into healthcare systems. Notably, children or adolescents developing addiction is particularly prevalent, given the plasticity of teenage brains. Earlier diagnoses could potentially lead to more effective interventions. Emerging treatment strategies are focusing on understanding genetic predispositions, developing addiction vaccines, and utilizing cognitive therapies. However, pharmaceutical companies are hesitant to invest in addiction treatment development due to financial unprofitability. The talk concludes by emphasizing the need for more scientific research to reduce the stigma and improve treatment outcomes for substance abuse disorders.

Conclusões

  • 👥 The U.S. faces a massive addiction crisis, affecting millions and costing billions annually.
  • 🧠 Addiction is a chronic disease of the brain, not a simple lack of willpower.
  • 🔬 Scientists are exploring brain differences in addicts to find identifiers and treatments.
  • 🧬 Genetics play a significant role in addiction susceptibility, accounting for 50% of the risk.
  • 💉 Researchers are developing vaccines for substances like heroin to prevent addiction.
  • 🧱 The stigma of addiction prevents proper healthcare integration and treatment.
  • ⏳ Adolescence is a critical period due to brain plasticity; interventions here can be very effective.
  • 📉 Reversibility of brain damage from drug use is possible but varies by individual and circumstance.
  • 👨‍🔬 Pharmaceutical investment is lacking due to unprofitable perceptions of addiction treatment.
  • 🔄 Research into behavioral and cognitive therapies offers promising future treatment avenues.

Linha do tempo

  • 00:00:00 - 00:05:00

    The event discusses the grim statistics of addiction in the United States, with millions of addicts and substantial economic costs. Highlighting the importance of scientific research in understanding the brains of addicts, exploring whether addiction-related brain changes can be reversed, and the potential for vaccines to combat addiction.

  • 00:05:00 - 00:10:00

    Seth Manukan, a journalist and former addict, shares his personal journey with addiction, beginning in childhood. Despite his achievements, he recounts the challenges and dangerous behaviors during his addiction, emphasizing how close he came to death multiple times.

  • 00:10:00 - 00:15:00

    He stresses the misconception of addiction as a willpower issue, acknowledging societal progress in recognizing addiction as a disease. Panelists will delve into the scientific underpinnings of addiction that challenge the willpower narrative.

  • 00:15:00 - 00:20:00

    Research psychiatrist Dr. Nora Volkow, explores the effects of drug addiction on the brain, highlighting changes in the dopamine system and the need to treat addiction as a chronic disease akin to cancer. She underscores the significance of integrating addiction treatment into healthcare systems.

  • 00:20:00 - 00:25:00

    The discussion touches on the politics of addiction, with new healthcare reforms offering insurance to addicts. The case of Philip Seymour Hoffman is used to illustrate the lasting impact of addiction-related brain changes.

  • 00:25:00 - 00:30:00

    Doctor experts discuss the all-encompassing nature of addiction-related brain damage and the potential for reversibility. Advances in brain recovery understanding provide hope, but more research is needed to accelerate this process.

  • 00:30:00 - 00:35:00

    Further examination reveals brain adaptations caused by addiction, like vivid memories, and how they contribute to relapse. The panel discusses the dynamic nature of the brain and the potential for reversing some damage.

  • 00:35:00 - 00:40:00

    Brain imaging studies highlight the dopamine D2 receptor activity differences in addicts and non-addicts. These findings underline addiction's physical and potentially reversible brain changes, stressing the necessity of continuous research.

  • 00:40:00 - 00:45:00

    Discussion of addiction genetics notes a significant genetic component, but it's not definitive. Environmental influences also play crucial roles, emphasizing the importance of targeted interventions and preventing exposure to harmful substances.

  • 00:45:00 - 00:50:00

    Adolescent vulnerability to addiction is explored, with early exposure to drugs like nicotine potentially setting the stage for later addictions. The Adolescent brain's heightened receptivity to substance effects is highlighted.

  • 00:50:00 - 00:55:00

    Panelists discuss preventative measures for adolescents, highlighting the necessity for early intervention and drug testing to manage addiction risks effectively.

  • 00:55:00 - 01:00:00

    Innovations in addiction treatment, such as developing vaccines to block addictive drugs' effects, are detailed. While challenges exist, these approaches show promise for relapse prevention and saving lives.

  • 01:00:00 - 01:05:00

    Further, audience questions address vaccine development hurdles, the role of pharmaceutical industries, and necessary policy interventions to incentivize addiction treatment research.

  • 01:05:00 - 01:10:00

    stigmatization issues are confronted, with addiction viewed as a moral failing by some, impacting healthcare systems and treatment availability. Education and scientific understanding are identified as key to reducing stigma.

  • 01:10:00 - 01:15:00

    Panelists express optimism about the role of advancing science and knowledge in reducing addiction stigma. They draw parallels to how cancer was destigmatized with increased understanding.

  • 01:15:00 - 01:20:00

    The economic impact of addiction is highlighted, underscoring why pharmaceutical interest in addiction treatment is crucial. The discussion outlines the need for ongoing, potentially lifelong, treatments, akin to managing chronic diseases like hypertension.

  • 01:20:00 - 01:27:24

    The conversation closes by reinforcing the idea that while there is no single cure for addiction, progress in treatment development offers hope, supported by the commitment to better understanding and addressing substance dependence.

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Mapa mental

Mind Map

Perguntas frequentes

  • What is the yearly cost of substance abuse in the U.S.?

    It costs approximately $600 billion annually.

  • Why is adolescence a critical period for addiction?

    Adolescence is crucial as brains are more plastic and vulnerable to addiction, with most addicts beginning use during this time.

  • Can addiction be seen as a willpower issue?

    No, addiction is a disease with genetic and neurological factors, not merely a lack of willpower.

  • What potential treatments for addiction are being researched?

    Researchers are exploring vaccines and studying brain changes to find treatments.

  • What are the challenges of treating addiction as a healthcare issue?

    Challenges include stigma, lack of resources, and integrating addiction treatment into healthcare systems.

  • Can damage from drug abuse be reversed?

    Some damage may be reversible due to the brain's reparative abilities, but recovery varies.

  • Is there any genetic component to addiction?

    Yes, approximately 50% of addiction risk is genetic, with various genes influencing vulnerability.

  • Why do drug companies hesitate to develop addiction treatments?

    Lack of incentives and perceived market profitability deter them.

  • Are there vaccines for addiction?

    Vaccines are in development for drugs like heroin but have not yet reached the market.

  • What role does dopamine play in addiction?

    Dopamine pathways are impaired in addicts, affecting reward processing and contributing to addiction.

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  • 00:00:10
    good evening I'm so glad to be with
  • 00:00:13
    everybody tonight and so happy to see so
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    many people turning out for this
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    wonderful and interesting event as we
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    all know I've done so much reporting on
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    this and know firsthand a lot about this
  • 00:00:24
    but the numbers are frightening and
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    staggering when it comes to Addiction in
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    this country there are more than 2 3
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    and5 million addicts in the United
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    States the costs are staggering the
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    substance abuse costs 600 billion dollar
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    every single year but The Cutting Edge
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    scientists here on this stage tonight in
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    just a few minutes are doing incredible
  • 00:00:46
    work and will be joining me on the stage
  • 00:00:49
    and to talk about that finding out about
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    how the brains of drug addicts
  • 00:00:54
    alcoholics smokers and perhaps even
  • 00:00:57
    people who are obese may be different
  • 00:01:00
    have special different characteristics
  • 00:01:02
    we're also going to talk about whether
  • 00:01:04
    or not you can tell an addict's Brain
  • 00:01:06
    before they begin abusing a substance
  • 00:01:10
    and whether or not the damage that
  • 00:01:11
    addicts do to their brains can be
  • 00:01:14
    reversed so they are learning that there
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    is a physical change in brain also from
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    adolescence to adulthood and this of
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    course may explain why so many young
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    people tend to get addicted in their
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    teenage years there are also vaccines on
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    the horizon if you can believe this that
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    might be able to block the effect of
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    addictive drugs and therefore May combat
  • 00:01:34
    Addiction in this country there is of
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    course so much urgency in their work and
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    their study and it's not just because of
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    the numbers of addicts and not just
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    because the cost of addiction in this
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    country every single year but most
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    importantly the impact of addiction and
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    addicts and what it has on their lives
  • 00:01:52
    and the lives of their loved
  • 00:01:54
    ones my name is Seth manukan I'm 42
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    years old uh I attended Harvard
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    University and I currently am the
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    associate director of mit's graduate
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    program in science writing I've written
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    three books my most recent book the
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    Panic virus um about vaccines and autism
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    uh won the National Association of
  • 00:02:15
    science writers science and Society book
  • 00:02:18
    award I'm very luckily and happily
  • 00:02:21
    married with two children and for the
  • 00:02:24
    better part of 10 years I was a drug
  • 00:02:28
    addict I started experiencing fairly
  • 00:02:32
    severe anxiety around when I was 7 years
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    old I became obsessed with my walking
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    and obsessed with my breathing and
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    eventually by the time I was eight or
  • 00:02:43
    nine uh I began to have a lot of trouble
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    sleeping I never sought out drugs
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    consciously because of anxiety uh I
  • 00:02:53
    thought of myself as someone who was um
  • 00:02:56
    countercultural to the extent that a
  • 00:02:59
    white middle class child living in
  • 00:03:01
    Newton Massachusetts could be
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    countercultural but was also aware from
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    very early on that I was not using drugs
  • 00:03:12
    in a way that was conducive to having a
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    good time I I was sharing needles um
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    with uh people who I knew were not safe
  • 00:03:25
    I went through a couple of phases of
  • 00:03:28
    pretty severe
  • 00:03:30
    crack use on one particular occasion I
  • 00:03:33
    became convinced that I had somehow
  • 00:03:35
    spilled some crack uh on the floor of
  • 00:03:39
    the kitchen of the rental apartment
  • 00:03:41
    where I was living and so um I ended up
  • 00:03:43
    essentially like digging up lenium uh to
  • 00:03:47
    see if there was like you know crack
  • 00:03:50
    residue on it my family had not
  • 00:03:55
    completely cut off contact with me but
  • 00:03:57
    were very close to that they had changed
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    locks on the house they started to check
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    in with each other on a daily basis to
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    see if something had happened to me
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    there were so many points in that period
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    of my life when I was addicted where you
  • 00:04:16
    know
  • 00:04:16
    literally one tick of the clock one
  • 00:04:21
    second difference um and I wouldn't be
  • 00:04:26
    here when Philip SE hoffen died
  • 00:04:30
    it did really affect
  • 00:04:31
    me he had been sober for over 20 years
  • 00:04:37
    and uh you know then he picked up and
  • 00:04:41
    now he's dead um and just the speed with
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    which that
  • 00:04:45
    happened it made
  • 00:04:48
    me realize the vigilance that um I need
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    to have
  • 00:04:57
    to um never forget the fact that I spent
  • 00:05:03
    the better part of a decade as a drug
  • 00:05:12
    addict I feel very lucky that I made it
  • 00:05:15
    through there were a lot of people that
  • 00:05:19
    I used with that
  • 00:05:24
    didn't biggest misconception about
  • 00:05:26
    addiction is the sense that it's a
  • 00:05:28
    willpower issue
  • 00:05:32
    we have come a long way towards
  • 00:05:34
    recognizing that addiction is a disease
  • 00:05:37
    but we still have a long way to
  • 00:05:39
    go we'll be talking a lot more about
  • 00:05:42
    that willpower um debate because as Seth
  • 00:05:45
    just pointed out even though for decades
  • 00:05:47
    the AMA has classified addiction as
  • 00:05:50
    alcoholism for example as a disease so
  • 00:05:53
    many people in society now still view
  • 00:05:55
    this as you aren't strong enough you
  • 00:05:57
    aren't committed enough you you just
  • 00:05:59
    don't have enough willpower to stop and
  • 00:06:03
    the science and the scientists you're
  • 00:06:04
    about to meet will tell you that in many
  • 00:06:07
    cases it is not about willpower at all
  • 00:06:10
    it is about something much more
  • 00:06:12
    fundamentally scientific so let's meet
  • 00:06:15
    our
  • 00:06:16
    panel as a research psychiatrist and
  • 00:06:18
    scientist our first participant
  • 00:06:20
    pioneered the use of brain Imaging to
  • 00:06:22
    investigate the toxic effects and
  • 00:06:25
    addictive properties of abusable drugs
  • 00:06:28
    her Studies have documented changes in
  • 00:06:30
    the dopamine system affecting among
  • 00:06:32
    others the functions of frontal brain
  • 00:06:34
    regions involved with motivation drive
  • 00:06:37
    and
  • 00:06:38
    pleasure as the Director of the National
  • 00:06:41
    Institute on drug abuse for the past 11
  • 00:06:43
    years she perhaps more than any
  • 00:06:45
    individual is guiding us on how we
  • 00:06:47
    research drug abuse and addiction please
  • 00:06:50
    welcome Dr Nora
  • 00:06:52
    volov hello
  • 00:07:01
    our next participant is the chair of the
  • 00:07:03
    Neuroscience department and director of
  • 00:07:05
    the Freedman brain Institute at Mount Si
  • 00:07:07
    University Medical Center his research
  • 00:07:10
    aims to better understand the molecular
  • 00:07:12
    mechanisms of addiction he is a leader
  • 00:07:14
    in the study of how drug addiction
  • 00:07:16
    impacts gene expression please welcome
  • 00:07:18
    Dr Eric
  • 00:07:25
    nestler our next participant is the Eli
  • 00:07:28
    Callaway Jr chaired professor at the
  • 00:07:30
    scripts Research Institute he developed
  • 00:07:33
    a vaccine that blocked the effects of
  • 00:07:35
    heroin addiction and hopes to extend the
  • 00:07:37
    research to Other Drugs such as nicotine
  • 00:07:40
    and alcohol as well as other drugs
  • 00:07:42
    please welcome Dr Kim
  • 00:07:48
    jand and our final participant is a
  • 00:07:51
    psychiatrist and neuroscientist at
  • 00:07:53
    Columbia University and authored
  • 00:07:55
    research on nicotine being a gateway
  • 00:07:58
    drug to cocaine
  • 00:08:00
    with Eric and Denise candell he also is
  • 00:08:03
    working currently on how the Adolescent
  • 00:08:05
    brain looks different than the adult
  • 00:08:07
    brain and how that can make them more
  • 00:08:09
    susceptible to addiction the adolescence
  • 00:08:11
    please welcome Dr Amir
  • 00:08:18
    LaVine and before we start I just want
  • 00:08:21
    to encourage you uh feel free to jump in
  • 00:08:23
    uh if you somebody says something that's
  • 00:08:25
    interesting that you can elaborate on um
  • 00:08:28
    this isn't a sign
  • 00:08:30
    answers only but I do want to start with
  • 00:08:32
    you Dr volov um before we start to
  • 00:08:35
    examine how the addicted brain actually
  • 00:08:37
    looks can you just give us a broad sense
  • 00:08:39
    of the state of addiction the play of
  • 00:08:41
    addiction the politics of addiction in
  • 00:08:43
    this country that's a complex question I
  • 00:08:46
    can say what we know from science we've
  • 00:08:49
    come to recognize that repeated drug use
  • 00:08:52
    uh changes the brain in longlasting ways
  • 00:08:55
    and that has led to the concept not just
  • 00:08:57
    that addiction is a disease of the brain
  • 00:08:59
    but that it's is a chronic disease which
  • 00:09:01
    is very relevant for treatment because
  • 00:09:03
    it means that you require continued
  • 00:09:05
    treatment and in that respect is not
  • 00:09:07
    different from cancer which we for most
  • 00:09:10
    of the cancers we cannot cure but we can
  • 00:09:12
    treat and so is the situation with drug
  • 00:09:15
    addiction unfortunately even though the
  • 00:09:18
    science has shown that the it's a
  • 00:09:21
    disease of the brain it has been very
  • 00:09:23
    difficult to incorporate into the
  • 00:09:25
    healthcare system and as a result of
  • 00:09:28
    that um many many cases of drug
  • 00:09:31
    addiction are never recognized or
  • 00:09:33
    prevented or treated and so when you're
  • 00:09:35
    speaking to me about the question on the
  • 00:09:37
    politics I think that there's a lot to
  • 00:09:39
    do yet in order to be able to bring
  • 00:09:41
    addiction into the healthc care system
  • 00:09:44
    and also to change the attitudes because
  • 00:09:47
    uh addiction is still highly highly
  • 00:09:48
    stigmatized and as a result of that
  • 00:09:51
    people that are addicted themselves are
  • 00:09:53
    afraid to ask for help and the families
  • 00:09:56
    don't speak about it because they don't
  • 00:09:57
    want to be stigmatized
  • 00:09:59
    and now that Healthcare reform is coming
  • 00:10:02
    up for the first time we're going to
  • 00:10:04
    have the opportunity of getting
  • 00:10:06
    Insurance to people that are addicted to
  • 00:10:07
    drugs but otherwise is basically the
  • 00:10:10
    resources have not been there to help
  • 00:10:12
    address the problem you were talking
  • 00:10:14
    about the long-term damage that drug
  • 00:10:16
    abuse does to the brain you just heard
  • 00:10:17
    Seth manukan in that video talk about
  • 00:10:19
    Philip Seymour Hoffman 23 years sober um
  • 00:10:24
    reportedly picked up a drink at a rap
  • 00:10:26
    party for a movie one cocktail is what
  • 00:10:28
    led him down that slippery slope back to
  • 00:10:31
    heroin and that's how he died yeah know
  • 00:10:34
    and it's a very unfortunate but really
  • 00:10:36
    do epitomize uh that's uh knowledge that
  • 00:10:39
    we have that the changes are very
  • 00:10:41
    longlasting and persist months or years
  • 00:10:45
    after the person has stopped taking the
  • 00:10:46
    drug which is why I come back to the
  • 00:10:49
    sense we need to recognize that it's a
  • 00:10:51
    chronic chronic disease and that people
  • 00:10:53
    that have suffered from it have to be
  • 00:10:56
    cautious and sustain some level of
  • 00:10:58
    treatment in in order to prevent them
  • 00:11:00
    from relapse what and and we see I mean
  • 00:11:02
    that is a very tragic story but
  • 00:11:04
    unfortunately it's not as unique and you
  • 00:11:07
    see it people that have been able to
  • 00:11:09
    stay drug free for 10 years then
  • 00:11:11
    something stressful happens and they
  • 00:11:13
    relapse and they escalate immediately to
  • 00:11:15
    the same levels that they were taking
  • 00:11:18
    before 10 years prior so it this is what
  • 00:11:21
    characterizes the process of uh drug
  • 00:11:23
    addiction there are essentially
  • 00:11:25
    permanent physical changes in the brain
  • 00:11:28
    at several levels M that could be seen
  • 00:11:30
    as molecular cellular scars of the
  • 00:11:33
    addiction and these can last a lifetime
  • 00:11:35
    so that when a person like Philip seor
  • 00:11:37
    Hoffman comes across a drink for the
  • 00:11:39
    first time or heroin for the first time
  • 00:11:41
    the relapse can be very rapid and severe
  • 00:11:44
    but I'm I'm just curious and this is to
  • 00:11:46
    all of you the damage that you do to
  • 00:11:49
    your brain by chronic drug abuse or by
  • 00:11:52
    alcoholism is any of it reversible we
  • 00:11:55
    always hear that you know some drugs
  • 00:11:58
    permanently Dam for example you know
  • 00:12:00
    crystal meth a large a completely
  • 00:12:02
    synthetic drub does that do irreversible
  • 00:12:04
    damage are you is that done there's
  • 00:12:06
    nothing you can do ever to to fix your
  • 00:12:08
    brain
  • 00:12:09
    again I'm smiling because it's obviously
  • 00:12:11
    something that I've been in very much
  • 00:12:13
    interested on looking at and Depends
  • 00:12:16
    when you have would have asked me that
  • 00:12:17
    question but there's been tremendous
  • 00:12:19
    tremendous advances in our understanding
  • 00:12:21
    about how the brain actually repairs
  • 00:12:24
    itself a lot of it driven by work done
  • 00:12:27
    on the recovery of the brain when
  • 00:12:29
    someone suffers a stroke and now the
  • 00:12:32
    rehabilit tra brain injury exactly the
  • 00:12:34
    rehabilitation process allows for them
  • 00:12:36
    to recover significantly function and
  • 00:12:39
    we're making advances to try to
  • 00:12:41
    accelerate that process so I would say
  • 00:12:44
    that there as of now there is
  • 00:12:47
    significant recovery but it's also
  • 00:12:49
    variable some some people recover faster
  • 00:12:51
    than others depends on your age depends
  • 00:12:53
    how many drugs that you have had but it
  • 00:12:55
    also depends on your genetics but I also
  • 00:12:58
    see it that very optimistic and I'm not
  • 00:13:00
    one of those fluffy optimism optimists
  • 00:13:03
    but actually based on what we know of
  • 00:13:06
    the science where it's going that in the
  • 00:13:08
    future we will be able to accelerate
  • 00:13:10
    that process of recovery but that's my
  • 00:13:13
    perspective I mean my colleagues here
  • 00:13:15
    agre that that it is possible can you
  • 00:13:18
    elaborate Dr volov gives me a lot of
  • 00:13:21
    grant money so I can't disagree with her
  • 00:13:24
    no no no Eric come on U no I agree I
  • 00:13:27
    think the brain has a norm enormous
  • 00:13:29
    reparative processes and a lot of the
  • 00:13:32
    things that drugs do to damage the brain
  • 00:13:34
    are probably reversible probably the
  • 00:13:37
    aspect that persist what amount of time
  • 00:13:40
    well I think it varies from person to
  • 00:13:42
    person and type of change to type of
  • 00:13:44
    change but uh one of the things that
  • 00:13:47
    lasts the longest is are the memories
  • 00:13:51
    associated with drug use and the
  • 00:13:54
    conditioning the learning that occurs uh
  • 00:13:57
    as Nora mentioned a person could
  • 00:13:59
    come across a stressful experience be
  • 00:14:01
    absent in for years a bit of stress
  • 00:14:04
    basically dark periods that every person
  • 00:14:06
    has different points in their lives come
  • 00:14:09
    about and those memories of how to deal
  • 00:14:11
    with the stress come up as the easiest
  • 00:14:15
    thing to do is to go back to drug to
  • 00:14:17
    make you feel better not just that it's
  • 00:14:19
    not just that that's your sort of go-to
  • 00:14:21
    knee-jerk
  • 00:14:22
    reaction I've also heard that the actual
  • 00:14:25
    memories that you form while abusing
  • 00:14:28
    alcohol abusing drugs are more Vivid
  • 00:14:31
    more powerful in a sense is that the
  • 00:14:35
    case yes think yeah I think you have to
  • 00:14:37
    look at the brain it's it's Dynamic it's
  • 00:14:39
    not static it's constantly being
  • 00:14:41
    remodeled whether you're taking a drug
  • 00:14:43
    or not taking a drug and um you know
  • 00:14:46
    that's the difficulty of treating these
  • 00:14:48
    disease caused by this is because
  • 00:14:51
    there's so many processes that if you
  • 00:14:53
    block maybe one receptor it can go down
  • 00:14:55
    another pathway but you know one of the
  • 00:14:57
    things that is to your question question
  • 00:14:59
    of memory of why it's exactly on On
  • 00:15:01
    Target we we remember things that are
  • 00:15:04
    emotionally rid right so when the Twin
  • 00:15:07
    Towers came down each one of us
  • 00:15:08
    remembers what they were doing and this
  • 00:15:10
    is because it was horrific it was
  • 00:15:13
    unexpected and when events that are
  • 00:15:15
    unexpected and Salient occure you
  • 00:15:18
    liberate dopamine and dopamine then
  • 00:15:20
    stimulates and high concentrations a
  • 00:15:23
    specific type of proteins that results
  • 00:15:25
    in this immediate um conditioning and
  • 00:15:29
    conditioning is a memory that will label
  • 00:15:31
    you when you are exposed to the same
  • 00:15:33
    situation not just to remember
  • 00:15:35
    conceptually but to feel it and drugs by
  • 00:15:39
    their pure nature drugs increase
  • 00:15:41
    dopamine so when you take a drug You Are
  • 00:15:44
    by default activating this memory
  • 00:15:46
    process that that Eric was speaking
  • 00:15:48
    about which we call conditioning and
  • 00:15:50
    this conditioning will lead you to
  • 00:15:53
    desire that drug the next time you're in
  • 00:15:55
    the same environment so you become
  • 00:15:57
    conditioned and those are the memories
  • 00:15:59
    that actually stay with you and will
  • 00:16:02
    drive the behavior even years after you
  • 00:16:04
    have not seen the drug is that why I've
  • 00:16:06
    heard addicts talk about the fact um in
  • 00:16:09
    particular one heroin addict I knew who
  • 00:16:11
    would she told me about her using dreams
  • 00:16:14
    like you you hear addicts in recovery
  • 00:16:16
    talking about that a lot the dreams that
  • 00:16:18
    they have of either drinking or shooting
  • 00:16:21
    up or doing whatever it was that they
  • 00:16:23
    did that led them to get into trouble
  • 00:16:25
    that's actually very common and um I'm
  • 00:16:27
    also I'm I'm a clinician as well as a
  • 00:16:29
    scientist and I actually wanted to say
  • 00:16:31
    that there is a lot of hope I have I
  • 00:16:32
    mean just from my own clinical practice
  • 00:16:34
    and experience I've known um I known
  • 00:16:37
    quite a few people who were able to um
  • 00:16:40
    become sober even from crystal meth and
  • 00:16:42
    other drugs and actually really resume a
  • 00:16:44
    very productive life um but they do talk
  • 00:16:46
    about uh drug dreams and they have
  • 00:16:48
    different attitudes to cope with those
  • 00:16:50
    drug dreams some people say okay they
  • 00:16:51
    wake up in the morning and they just
  • 00:16:53
    laugh at it and they say okay I had a
  • 00:16:54
    drug dream and I can move on or even
  • 00:16:57
    like okay I got a chance to try it out
  • 00:16:59
    without really relapsing so they have a
  • 00:17:02
    positive attitude and but some people
  • 00:17:03
    are really traumatized by it and it's
  • 00:17:05
    really hard for them it's just I've
  • 00:17:07
    heard that they're Vivid that way and I
  • 00:17:08
    wondered if that was related to the fact
  • 00:17:10
    that the memory itself the imprint on
  • 00:17:12
    the brain has been so all right well
  • 00:17:14
    let's we've got some slides let's start
  • 00:17:16
    U with one of the slides that you have
  • 00:17:18
    of a brain addicted to uh cocaine in
  • 00:17:20
    this case what what are we looking at
  • 00:17:23
    well what you're looking at there is
  • 00:17:24
    actually um we're measuring images um
  • 00:17:28
    that reflect the concentration of a
  • 00:17:30
    protein that we call dopamine D2
  • 00:17:33
    receptor and it's a protein that is very
  • 00:17:36
    important because because it regulates
  • 00:17:38
    the function of the cortical processes
  • 00:17:41
    it regulates it actually allows us to
  • 00:17:43
    exert control you see the control
  • 00:17:46
    subjects and in the center of the brain
  • 00:17:47
    you see high red areas because that's
  • 00:17:50
    where you have very high concentration
  • 00:17:51
    of these D2 receptors then you see a
  • 00:17:54
    metamphetamine abuser with much lower uh
  • 00:17:57
    coloring red on the center of the brain
  • 00:17:59
    because the receptors are down the
  • 00:18:01
    dopamine D2 receptor and then you see a
  • 00:18:04
    control subject to the I don't know I
  • 00:18:07
    actually have to look back to your right
  • 00:18:09
    and you see that color and you also see
  • 00:18:11
    that in the alcoholic is down and this
  • 00:18:13
    is a very typical uh change that we
  • 00:18:15
    observe across a wide variety of
  • 00:18:17
    addictions people that are addicted to
  • 00:18:20
    drugs have a reduction in the expression
  • 00:18:22
    of these proteins that dopamine D2
  • 00:18:24
    receptors and these decreases in the
  • 00:18:26
    expression of dopamin D2 receptors in
  • 00:18:29
    humans and in animal models and Eric has
  • 00:18:32
    done a lot of work here to actually are
  • 00:18:34
    associated with impulsive behaviors and
  • 00:18:37
    a propensity to engage in compulsive
  • 00:18:39
    behaviors when you are exposed to um
  • 00:18:42
    rewarding
  • 00:18:43
    stimuli and and this is because again
  • 00:18:46
    this these areas in the center of the
  • 00:18:48
    brain which we call the striatum and in
  • 00:18:50
    these areas that D2 receptors allows us
  • 00:18:53
    to regulate the frontal cortex the
  • 00:18:55
    frontal areas of the brain here which
  • 00:18:57
    are crucial for our ability to exert
  • 00:19:00
    self-control whether it is uh
  • 00:19:02
    controlling our emotions or our desires
  • 00:19:05
    but but proper signaling through these
  • 00:19:07
    D2 receptors is necessary for the
  • 00:19:09
    function of our prefrontal cores so
  • 00:19:13
    basically what we're looking and I'm
  • 00:19:15
    just curious were these people did these
  • 00:19:19
    alcoholic brains and methamphetamine
  • 00:19:20
    abuser brains look this way before they
  • 00:19:23
    began abusing methamphetamines and
  • 00:19:26
    alcohol well unfortunately when when you
  • 00:19:28
    are doing these clinical studies it's
  • 00:19:30
    very difficult to have measures before
  • 00:19:32
    they take out uh drugs and so in this
  • 00:19:35
    case we do not know if these decreases
  • 00:19:37
    are due to the use of drugs or whether
  • 00:19:39
    they were like that and that make them
  • 00:19:41
    vulnerable but we can take these
  • 00:19:43
    findings and then bring them into an
  • 00:19:45
    animal model in the laboratory and ass
  • 00:19:48
    say for example and this has been done
  • 00:19:50
    both in rodents and in nonhuman primates
  • 00:19:52
    where you measure that D2 receptors
  • 00:19:55
    before and after longterm exposure to
  • 00:19:58
    the draw
  • 00:19:59
    and stories have shown that indeed when
  • 00:20:01
    you give in non-human primates repeated
  • 00:20:05
    administration of cocaine you bring down
  • 00:20:07
    the levels of dopamine D2 receptors in
  • 00:20:10
    the brain so we do know that repeated
  • 00:20:12
    use of drugs will bring them down but as
  • 00:20:15
    for this particular subjects we cannot
  • 00:20:18
    be ever certain whether this is the drug
  • 00:20:21
    it's it's very likely that that drugs
  • 00:20:23
    are contributing to the reductions that
  • 00:20:25
    we can say and and if these two um
  • 00:20:29
    brains this alcoholic and this drug
  • 00:20:32
    addict were able to remain sober would
  • 00:20:35
    their brains go back to looking like the
  • 00:20:36
    control subjects we've uh we've tried to
  • 00:20:39
    look at that and in the metamphetamine
  • 00:20:41
    abusers where we have been more
  • 00:20:44
    successful we have seen actually some
  • 00:20:47
    recovery in some individuals but not in
  • 00:20:50
    others so we see a tremendous
  • 00:20:52
    variability on the rate of recovery of
  • 00:20:55
    the brain when a person stops taking the
  • 00:20:57
    taking the drug and and uh we are not
  • 00:21:00
    certain exactly what's determining the
  • 00:21:02
    ability to recover after abstinence one
  • 00:21:05
    of the factors that's likely to play a
  • 00:21:06
    very important role is your age the
  • 00:21:08
    younger you are the the more resilient
  • 00:21:11
    your brain is and the faster it recovers
  • 00:21:13
    but also the characteristics of the
  • 00:21:15
    drugs that you're taking uh we see the
  • 00:21:17
    worst outcomes when we have people that
  • 00:21:20
    take multiple drugs of abuse that's
  • 00:21:22
    appears to be particularly harmful for
  • 00:21:24
    example combination of alcohol and
  • 00:21:25
    cocaine methamphetamine and alcohol
  • 00:21:28
    those are very harmful and it is very
  • 00:21:30
    likely that obviously genetics play a
  • 00:21:32
    role we're going to get to genetics in a
  • 00:21:34
    in a moment but you also had one more sh
  • 00:21:36
    slide you wanted to show us uh uh
  • 00:21:38
    because you've studied obesity and and
  • 00:21:40
    think that actually addiction to food
  • 00:21:42
    may be very similar to I mean a lot of
  • 00:21:45
    people don't view that we have a hard
  • 00:21:47
    enough time getting people to accept the
  • 00:21:48
    fact that addiction to alcohol or
  • 00:21:50
    addiction to methampetamine is a
  • 00:21:52
    sickness addiction to food is something
  • 00:21:54
    else well it's interesting because the
  • 00:21:56
    reason why we started to work with
  • 00:21:58
    obesity was we were showing
  • 00:22:00
    systematically these reductions in
  • 00:22:02
    dopamine D2 receptor acoss a wide
  • 00:22:04
    variety of types of addiction and there
  • 00:22:07
    was a there's a certain similarity in
  • 00:22:09
    the phenotypic expression that you see
  • 00:22:12
    in in obesity of compulsive food
  • 00:22:14
    consumption despite the fact that people
  • 00:22:17
    don't want to eat anymore and despite
  • 00:22:19
    its very adverse consequences so at that
  • 00:22:22
    time I was very interested to see if one
  • 00:22:24
    would observe the same changes in D2
  • 00:22:27
    receptors uh in a in a presentation that
  • 00:22:30
    behavioral is very similar but did not
  • 00:22:33
    require the administration of a a
  • 00:22:35
    chemical artificial substance and that's
  • 00:22:38
    how we ended up studying obesity and
  • 00:22:40
    long and behold we identify these
  • 00:22:43
    changes that you see there that in obese
  • 00:22:45
    individuals by the way these are
  • 00:22:47
    morbidly obese individuals uh they did
  • 00:22:50
    have also like we had seening people
  • 00:22:52
    that were addicted to drugs a reduction
  • 00:22:55
    in the levels of dopamine D2 receptors
  • 00:22:57
    in their brains okay uh let's turn uh
  • 00:23:01
    very quickly to Dr nestler um I wanted
  • 00:23:04
    to pick up this whole dopamine issue
  • 00:23:06
    with you because you've gone deeper into
  • 00:23:07
    the smaller amount of dopamine that has
  • 00:23:09
    just been released in adx MH let's watch
  • 00:23:12
    the video that we prepared uh it will
  • 00:23:15
    show uh a um cartoon of a brain and then
  • 00:23:19
    focusing in uh on on a particular part
  • 00:23:22
    of the brain which makes uh has neurons
  • 00:23:24
    that make the chemical transmitter
  • 00:23:26
    dopamine uh while we're waiting for the
  • 00:23:28
    video I could just give you some
  • 00:23:29
    background a human brain has about 100
  • 00:23:31
    billion nerve cells so that's a big
  • 00:23:34
    number each nerve cell communicates with
  • 00:23:37
    thousands of other nerve cells at points
  • 00:23:39
    of contact called synapses that means a
  • 00:23:42
    single human brain has about 100
  • 00:23:44
    trillion
  • 00:23:45
    synapses um and uh for what it's worth
  • 00:23:49
    that's a bigger number 100 trillion than
  • 00:23:51
    the total number of stars that Einstein
  • 00:23:54
    estimated was in the entire universe so
  • 00:23:56
    in the single human brain so so now
  • 00:23:58
    we're focusing in on the center part of
  • 00:24:00
    the brain where there are chemical
  • 00:24:02
    transmitters released from the end of
  • 00:24:04
    one nerve cell those little uh yellow
  • 00:24:07
    spheres would be another one transmitter
  • 00:24:10
    that's another transmitter this is
  • 00:24:11
    supposed to be a dopamine nerve cell and
  • 00:24:14
    in the course of chronic Drug
  • 00:24:16
    Administration what we and other groups
  • 00:24:18
    have seen that certain drugs of abuse
  • 00:24:20
    actually causes a shrinkage of these VTA
  • 00:24:23
    dopamine nerve cells so a physical loss
  • 00:24:27
    in the robustness of the cells and a
  • 00:24:29
    loss of dopamine release and that
  • 00:24:32
    coincides with what Norah had and
  • 00:24:34
    colleagues have shown that there is
  • 00:24:36
    fewer receptors that recognize the
  • 00:24:39
    dopamine so in a an addict's brain
  • 00:24:42
    there's an impaired dopamine nerve cell
  • 00:24:45
    and an impaired ability to detect the
  • 00:24:48
    dopamine leading to a dramatic reduction
  • 00:24:51
    in the ability to experience reward so
  • 00:24:55
    throughout life we walk around we eat a
  • 00:24:57
    good meal
  • 00:24:59
    uh someone uh tells us they love us we
  • 00:25:02
    see a friend have sex whatever a reward
  • 00:25:04
    might be uh that releases dopamine and
  • 00:25:07
    keeps us going an addict does not have
  • 00:25:10
    in the extreme does not have those same
  • 00:25:13
    experiences because their dopamine
  • 00:25:15
    pathway is impaired so they so natural
  • 00:25:18
    reward is impaired and because they're
  • 00:25:21
    feeling short circuited exactly they go
  • 00:25:24
    out and abuse something to try get that
  • 00:25:26
    reward the easiest way to feel normal
  • 00:25:28
    again is by taking the
  • 00:25:30
    drug so by taking the drug does it does
  • 00:25:34
    it elevate More release of dopamine does
  • 00:25:37
    it bring them back up to where probably
  • 00:25:40
    never back to where they would be with a
  • 00:25:43
    person who has a normally functioning
  • 00:25:45
    dopamine system getting a a strong
  • 00:25:48
    natural
  • 00:25:50
    reward and is is do you have other
  • 00:25:52
    animation too or is that the only one
  • 00:25:54
    you have I have one more but I don't
  • 00:25:55
    need to show it now no let's show it
  • 00:25:57
    okay let's show one more this one
  • 00:25:59
    relates to this these videos look like
  • 00:26:02
    space aliens or something this is
  • 00:26:05
    supposed to be the a branch of a nerve
  • 00:26:07
    cell that those mushrooms are really
  • 00:26:10
    what are called spines that are
  • 00:26:13
    protruding from the uh dendrite what's
  • 00:26:16
    called a dendrite to receive incoming uh
  • 00:26:19
    information let's run the video one more
  • 00:26:21
    time please and what happens and I think
  • 00:26:24
    that this type of growth of these spies
  • 00:26:28
    growth of new synapses is what's
  • 00:26:31
    mediating now you'll watch and you'll
  • 00:26:32
    see drug exposure gradually
  • 00:26:35
    progressively over time leading to an
  • 00:26:37
    increase in these uh Detectors of
  • 00:26:40
    synaptic transmission this is probably
  • 00:26:43
    among the mechanisms that are mediating
  • 00:26:45
    these lifelong
  • 00:26:47
    memories I'm sorry you lost there sorry
  • 00:26:49
    about that so the beginning do everybody
  • 00:26:51
    have a PhD in
  • 00:26:53
    Neuroscience I left mine at home um the
  • 00:26:57
    beginning was is a normal person's brain
  • 00:27:00
    and then after chronic drug addiction
  • 00:27:02
    you grow more of these things
  • 00:27:04
    connections yes and how does more of
  • 00:27:06
    those connections why is that a bad
  • 00:27:09
    thing it probably depends on where in
  • 00:27:11
    the brain this is occurring but in the
  • 00:27:13
    part of the brain that we're talking
  • 00:27:14
    about these increased connections
  • 00:27:16
    represent uh very powerful memories that
  • 00:27:20
    would per for example draw a connection
  • 00:27:22
    between feeling stressed taking drug as
  • 00:27:25
    a way to relieve the stress got it and
  • 00:27:27
    that's the way we are beginning to
  • 00:27:30
    understand how the brain mediates those
  • 00:27:32
    phenomena did you want to add something
  • 00:27:34
    no I really like this finding because
  • 00:27:36
    that she relates to some of my findings
  • 00:27:38
    later on so you really liked your cool
  • 00:27:41
    video well let's talk about genetics
  • 00:27:43
    because you mentioned that a moment ago
  • 00:27:45
    and I'm curious um first of all one
  • 00:27:50
    quick
  • 00:27:51
    question can you look at a brain of
  • 00:27:54
    somebody and tell if they're going to
  • 00:27:55
    become an addict in other words right
  • 00:27:58
    now not right now that would be a great
  • 00:28:01
    goal so is there a gene we we keep
  • 00:28:05
    hearing that there's a genetic link for
  • 00:28:07
    addiction but I mean that would mean you
  • 00:28:10
    were born an
  • 00:28:11
    addict is is I'm curious I'd like to
  • 00:28:15
    hear all of you Weighing on that it's
  • 00:28:16
    different from eye color or height which
  • 00:28:19
    you're born with brown eyes you'll have
  • 00:28:20
    brown eyes for Life uh the genetics that
  • 00:28:23
    underly common chronic disease whether
  • 00:28:27
    it's psychiatric disease or diabetes and
  • 00:28:29
    Asthma is much more complex and what
  • 00:28:32
    we're talking about are genes that
  • 00:28:34
    confer a risk for an illness not a
  • 00:28:37
    deterministic uh shity that they will
  • 00:28:40
    get that illness so for example the
  • 00:28:41
    genetic risk for addictions is about 50%
  • 00:28:44
    that's really heritable that's more
  • 00:28:46
    heritable than high cholesterol high
  • 00:28:48
    blood pressure what do you mean by 50%
  • 00:28:51
    50 half of the risk for addiction is
  • 00:28:53
    genetic really yes and what is it what
  • 00:28:56
    what is it for cancer for for many
  • 00:28:59
    cancers it's even less than 50% so
  • 00:29:02
    addiction is actually pretty genetic the
  • 00:29:05
    challenge is is that unlike something uh
  • 00:29:09
    for example Huntington disease which is
  • 00:29:12
    caused by an abnormality in a single
  • 00:29:13
    Gene and if you have that abnormal copy
  • 00:29:15
    of the gene you will get Huntington's
  • 00:29:17
    disease with 100% Assurance that's not
  • 00:29:20
    the case in addiction because only half
  • 00:29:23
    of the risk is genetic and the rest
  • 00:29:25
    depends on all sorts of other things and
  • 00:29:27
    we can't at this point look at that Gene
  • 00:29:30
    I mean it's not like the breast cancer I
  • 00:29:32
    mean we haven't it's been very hard to
  • 00:29:33
    find them I mean this is one of the
  • 00:29:35
    major focuses of naida but you know one
  • 00:29:38
    of the things in terms of what Eric was
  • 00:29:40
    saying we are coming to realize that
  • 00:29:42
    it's not like with Huntington where you
  • 00:29:44
    identify a gene and you know you're
  • 00:29:45
    going to develop the disease but what
  • 00:29:47
    we're understanding is that these genes
  • 00:29:50
    are influencing the way that the brain
  • 00:29:52
    develops and ultimately functions so the
  • 00:29:54
    risk that they are imposing has to do
  • 00:29:56
    with the fact that your brain will be
  • 00:29:58
    responding to an environmental insult in
  • 00:30:01
    a different way one of the one most
  • 00:30:03
    investigated is for example a gene that
  • 00:30:05
    gives you that modifies the way that the
  • 00:30:08
    amigdala which is a lyic area responds
  • 00:30:11
    to stress so if you have this Gene that
  • 00:30:14
    is a high-risk Gene it will make you
  • 00:30:16
    much more vulnerable to depression but
  • 00:30:19
    only if you are in a stressful
  • 00:30:21
    environment the same thing for example
  • 00:30:23
    since now it's so much in the news the
  • 00:30:25
    association between certain people
  • 00:30:27
    taking marijuana and then developing
  • 00:30:29
    schizophrenia what now is coming to
  • 00:30:31
    realize is that if you have a certain
  • 00:30:33
    Gene which is has a a risal yeld that
  • 00:30:36
    makes you more vulnerable to
  • 00:30:38
    schizophrenia if you smoke marijuana
  • 00:30:41
    then can accelerate the process so we're
  • 00:30:44
    understanding genes as influencing the
  • 00:30:46
    risk and this is not just for drug
  • 00:30:47
    addiction for all of the mental diseases
  • 00:30:50
    U for basically most of them but even
  • 00:30:52
    for many of the medical diseases such as
  • 00:30:55
    diabetes or obesity you may have a gene
  • 00:30:57
    that creates a vulnerability but if you
  • 00:30:59
    don't expose to the environmental insult
  • 00:31:03
    it will never happen which is from the
  • 00:31:05
    policy perspective and from the health
  • 00:31:07
    care perspective very important because
  • 00:31:09
    it doesn't mean you are predestined to
  • 00:31:12
    develop the disease but you can actually
  • 00:31:15
    do
  • 00:31:15
    interventions that can um help that
  • 00:31:19
    individual that can protect that person
  • 00:31:22
    from the development of these conditions
  • 00:31:24
    so when you hear people in recovery say
  • 00:31:25
    I was born an addict
  • 00:31:28
    you you don't think that's possible I
  • 00:31:30
    mean other things in life have to
  • 00:31:32
    conspire I mean this is what a lot of
  • 00:31:34
    what you do right I think they basically
  • 00:31:36
    they were born with their propensity um
  • 00:31:38
    and then things happened that actually
  • 00:31:41
    drove them to become an addict but
  • 00:31:42
    certainly if there's a family history
  • 00:31:43
    there's a much much greater risk or
  • 00:31:46
    perhaps born with you know we just had
  • 00:31:47
    we don't have that slide up anymore a
  • 00:31:49
    brain that doesn't uh as
  • 00:31:53
    efficiently uh ex whatever it is
  • 00:31:56
    exchange dop
  • 00:31:59
    experience dopamine or perhaps even a
  • 00:32:01
    tendency to really try to do things in
  • 00:32:04
    the most to go all the way as much as
  • 00:32:08
    they can so it can be good if you're in
  • 00:32:09
    a certain job but it it may not be good
  • 00:32:12
    if you're a child and you're taking one
  • 00:32:13
    candy and then you can't stop and you
  • 00:32:15
    want another and another and another so
  • 00:32:16
    it's just a propensity and it depends on
  • 00:32:18
    what you're going to do with it and what
  • 00:32:20
    about I was so interested to hear in
  • 00:32:22
    this video this with Seth manukan
  • 00:32:24
    talking about always feeling anxious as
  • 00:32:26
    a child so many addicts um will tell you
  • 00:32:30
    you know of that feeling always a
  • 00:32:32
    feeling different other not fitting in
  • 00:32:35
    but also you're hearing more and more
  • 00:32:37
    lately about this this anxiety
  • 00:32:40
    component right I think that there's
  • 00:32:43
    there's a lot of what we call
  • 00:32:44
    comorbidity with the drug addiction so
  • 00:32:47
    people who suffer from addiction often
  • 00:32:49
    time a lot of the time also suffer from
  • 00:32:50
    other psychiatric disorders and
  • 00:32:52
    oftentimes as I'm going to talk about
  • 00:32:54
    the importance of adolescence it starts
  • 00:32:55
    early on and anxiety is a major it's one
  • 00:32:58
    of the most common uh disorders in
  • 00:33:00
    adolescence and in children and uh and
  • 00:33:03
    if they can find something that will
  • 00:33:04
    help them then they will use it sure if
  • 00:33:07
    you spent your entire childhood fighting
  • 00:33:09
    panic attacks every day or every week
  • 00:33:11
    and and all of a sudden somebody says
  • 00:33:13
    you know have a glass of wine or have a
  • 00:33:15
    beer and you feel a lot more comfortable
  • 00:33:17
    in the world you could understand why
  • 00:33:19
    somebody might begin to abuse that yeah
  • 00:33:21
    all right um let's talk also there
  • 00:33:24
    there's one other um term that you've
  • 00:33:26
    brought out the gene expression did did
  • 00:33:27
    you talk about that already I don't
  • 00:33:29
    think so but I could talk about it now
  • 00:33:31
    or why don't we move on you want no go
  • 00:33:33
    ahead and talk about it now the
  • 00:33:36
    um right
  • 00:33:38
    now a lot of these changes that we're
  • 00:33:40
    talking about are mediated through
  • 00:33:43
    changes in gene
  • 00:33:45
    expression and it's a hard concept to
  • 00:33:48
    explain what you're seeing here is the
  • 00:33:49
    DNA double helix we know that the DNA
  • 00:33:52
    double helix encodes messenger rnas
  • 00:33:56
    which is that purple line pointing up to
  • 00:33:59
    the top of the screen and the messenger
  • 00:34:01
    rnas then encode proteins and it's the
  • 00:34:03
    proteins in the cell that mediate most
  • 00:34:05
    of functions and changeing gene
  • 00:34:09
    expression is an important way in which
  • 00:34:11
    cells change in a very stable way and
  • 00:34:14
    the best analogy I like to use is when
  • 00:34:16
    you go to the gym to exercise the reason
  • 00:34:18
    you're you get stronger is because every
  • 00:34:20
    muscle cell in a muscle bundle upon use
  • 00:34:24
    that cell makes more muscle proteins
  • 00:34:27
    because the gene gen expression of those
  • 00:34:28
    cells of those genes is increased to
  • 00:34:31
    make more mes RNA more protein the
  • 00:34:33
    muscle cell gets bigger the entire
  • 00:34:35
    muscle gets bigger and stronger and in
  • 00:34:38
    the same way those changes occur in
  • 00:34:40
    nerve cells in the brain and that's how
  • 00:34:42
    we learn and we think that drugs of
  • 00:34:44
    abuse represent a maladaptive type of
  • 00:34:47
    learning where through changes in gene
  • 00:34:49
    expression uh very long lasting uh
  • 00:34:53
    maladaptations occur like a shrinkage of
  • 00:34:55
    dopamine cells like a growth of new CN
  • 00:34:57
    es that mediate some of the pathologies
  • 00:35:00
    associated with addiction I think Amir
  • 00:35:02
    is going to talk more about that well
  • 00:35:04
    thank you for introducing air because I
  • 00:35:08
    actually already did but um we've
  • 00:35:10
    already seen a lot about how adult
  • 00:35:14
    brains and and an addiction but you've
  • 00:35:17
    got some amazing statistics actually on
  • 00:35:19
    gateway drugs right so uh part of my
  • 00:35:21
    work was to look at the effect of um
  • 00:35:24
    nicotine on cocaine because uh I think
  • 00:35:26
    more and more not see addiction as a
  • 00:35:29
    developmental disorder we think about
  • 00:35:31
    addiction uh as something that just
  • 00:35:33
    happens to adults but in truth is it
  • 00:35:36
    really has its root stem in adolescence
  • 00:35:39
    that when first that's when first people
  • 00:35:41
    most of the people who become addicted
  • 00:35:42
    try drugs um what percentage of addicts
  • 00:35:45
    get addicted in adolescence um so I
  • 00:35:47
    think for example 90% of people who will
  • 00:35:50
    become smokers start smoking before
  • 00:35:52
    they're 18 and only 10% will become
  • 00:35:55
    smoker if they start to smoke after the
  • 00:35:56
    age of 18 so that's like a very it's a
  • 00:35:59
    massive difference U but it's not only
  • 00:36:01
    for cigarettes or nicotine it's also
  • 00:36:03
    true for other elicit drugs and for
  • 00:36:06
    example if you start uh using an elicit
  • 00:36:08
    drug before you're 18 you're 20 you have
  • 00:36:10
    a chance of we have a 25% chance of
  • 00:36:12
    becoming addicted but if you start using
  • 00:36:15
    an elcd drug after the age of 21 you
  • 00:36:17
    only have a 4% chance of becoming
  • 00:36:19
    addicted so adolesence is um is a
  • 00:36:23
    crucial time for the development of
  • 00:36:25
    addiction and I started to become very
  • 00:36:28
    interested in that because I looked at
  • 00:36:29
    the effect of nicotine on cocaine and I
  • 00:36:32
    found that actually nicotine has a very
  • 00:36:34
    unique ability to um basically loosen
  • 00:36:37
    the DNA and Eric was talking about gene
  • 00:36:40
    expression and when that DNA is loosened
  • 00:36:43
    what happens is that when cocaine comes
  • 00:36:44
    along then genes that are related to
  • 00:36:47
    addiction and this work is very much
  • 00:36:48
    relies on Eric nesler's work um then
  • 00:36:51
    there's a much more massive increase of
  • 00:36:53
    Gene U of gene expression that's related
  • 00:36:56
    to addiction wait so your saying that if
  • 00:36:59
    I get this right 97% of cocaine users
  • 00:37:02
    smoke first right so that's basically
  • 00:37:04
    that's another Finding it's like
  • 00:37:06
    basically people go through a certain
  • 00:37:08
    sequence and I remember I had one of my
  • 00:37:10
    patients my one of my first patients in
  • 00:37:12
    residency and he described to me he had
  • 00:37:15
    when I saw him he had uh cocaine induced
  • 00:37:18
    psychosis I remember how he walked into
  • 00:37:20
    the ER if it were yesterday he was very
  • 00:37:22
    guarded he wouldn't speak um he he was
  • 00:37:25
    25 years old and he was was he was
  • 00:37:28
    completely like he basically blurted
  • 00:37:30
    something about wanting to kill himself
  • 00:37:31
    before others get to him and we admitted
  • 00:37:34
    him to the floor and I remember that
  • 00:37:35
    time I didn't have an appreciation to
  • 00:37:37
    that part of his history because he said
  • 00:37:39
    that he started smoking when he was 12
  • 00:37:42
    um he came from a very affluent family
  • 00:37:44
    in greenish Connecticut and his parents
  • 00:37:46
    divorced and he didn't have a lot of
  • 00:37:47
    supervision he started smoking at 1200
  • 00:37:49
    and drinking but at the time he was 15
  • 00:37:52
    he started smoking marijuana and by the
  • 00:37:53
    time he was 16 and a half he started
  • 00:37:55
    using cocaine and then that's when his
  • 00:37:57
    life went from wor from really bad to
  • 00:37:59
    horrible and worse and he was a Castaway
  • 00:38:02
    teen and and then he dealt with a lot of
  • 00:38:05
    other really horrible consequences but I
  • 00:38:07
    didn't pay attention at the time to the
  • 00:38:09
    fact that he followed a very specific
  • 00:38:11
    sequence of events he started smoking
  • 00:38:13
    and drinking and then he went on to
  • 00:38:15
    marijuana and then he went on to cocaine
  • 00:38:17
    and in my research I started looking at
  • 00:38:20
    the effect of nicotine specifically on
  • 00:38:22
    cocaine and I found that nicotine has
  • 00:38:24
    this effect that it increases gene
  • 00:38:27
    expression
  • 00:38:28
    that's related to addiction one of the
  • 00:38:30
    genes is the FB Gene is it just for
  • 00:38:32
    cocaine um so we haven't actually now we
  • 00:38:34
    haven't looked at other drugs but the
  • 00:38:36
    mechanism the fact that it opens up the
  • 00:38:39
    DNA that he loosens the DNA and enables
  • 00:38:41
    expression more suggests that it could
  • 00:38:43
    possibly do it also for other drugs I
  • 00:38:45
    mean it would it would it otherwise I'm
  • 00:38:47
    it it sort of scientifically strange to
  • 00:38:50
    think that you know nicotine would only
  • 00:38:53
    make you more susceptible to be a
  • 00:38:55
    cocaine addict you know not a meth
  • 00:38:57
    addict so actually we looked at
  • 00:38:58
    methamphetamine and it also has the same
  • 00:39:00
    effect with methampetamine with
  • 00:39:02
    methampetamine what about heroin so we
  • 00:39:04
    haven't looked at that yet but maybe I
  • 00:39:06
    mean how do you know it's causal I mean
  • 00:39:07
    maybe you know an addict's an addict
  • 00:39:09
    right so now other people are looking at
  • 00:39:11
    alcohol and to see whether that also has
  • 00:39:13
    the same whether it works through the
  • 00:39:14
    same system of loosening up the DNA that
  • 00:39:17
    increases the expression of the the
  • 00:39:19
    effect of other um other drugs later on
  • 00:39:22
    but what I found actually later in
  • 00:39:24
    adolescence was something very different
  • 00:39:25
    I didn't expect that I thought that
  • 00:39:27
    nicotine would do that even more so in
  • 00:39:29
    adolescent but I found something very
  • 00:39:31
    different because when I looked at the
  • 00:39:33
    Adolescent brain uh at basine I saw that
  • 00:39:37
    the G the the DNA was already loosened
  • 00:39:39
    up in that particular area in the brain
  • 00:39:41
    in the nuclear circum so at Baseline the
  • 00:39:43
    Adolescent brain is much more sensitive
  • 00:39:45
    to the effect of almost any other drug
  • 00:39:47
    of abuse and so if you um expose the
  • 00:39:50
    Adolescent brain to any any of those
  • 00:39:52
    drugs you'll get more of that growth
  • 00:39:55
    that Eric described because the DNA is
  • 00:39:57
    more open basically open to soaking up
  • 00:39:59
    new
  • 00:40:00
    experiences and to so more of that brain
  • 00:40:03
    change that you were just talking about
  • 00:40:05
    happens in adolescent brains who abuse
  • 00:40:07
    drugs and alcohol there's a good reason
  • 00:40:09
    to believe that because that DNA is more
  • 00:40:11
    loose and that you would get more
  • 00:40:12
    expression and more growth and a
  • 00:40:14
    stronger propensity to addiction and
  • 00:40:16
    that would agree with the fact that so
  • 00:40:18
    why are 25% of people like more like
  • 00:40:20
    likely to get addicted to a drug if
  • 00:40:22
    you're exposed I think we're going to
  • 00:40:24
    see a video of that the DNA so this is a
  • 00:40:28
    compact DNA um that you see that often
  • 00:40:31
    time in in adults and what I saw in
  • 00:40:34
    adolescence was something was a very
  • 00:40:36
    different picture was something more
  • 00:40:37
    like that a much looser DNA so the the
  • 00:40:41
    the gene expression so the genes that
  • 00:40:43
    are over there basically can get
  • 00:40:45
    expressed a lot more in that particular
  • 00:40:49
    stance when it's more loose the DNA is
  • 00:40:51
    more at what age do they revert to the
  • 00:40:54
    adult sort of picture so the work that I
  • 00:40:58
    do is is in um is basically basic
  • 00:41:00
    science work is in animal models in mice
  • 00:41:02
    and in mice I see that this change uh
  • 00:41:06
    reverts back um I guess the human
  • 00:41:08
    equivalent will be around
  • 00:41:10
    25 something like that and yeah the a
  • 00:41:13
    younger brain is more resilient as you
  • 00:41:15
    said and more able to recover so it's a
  • 00:41:17
    it's a bit of a dual-edged sword right
  • 00:41:20
    the plasticity can go both ways adaptive
  • 00:41:22
    and maladaptive okay so he can learn
  • 00:41:25
    much more like M so can he has this
  • 00:41:28
    capacity to learn uh in a in an amazing
  • 00:41:31
    way datalist brain but uh but he also
  • 00:41:34
    has the capacity to change and it's more
  • 00:41:37
    plastic and of course when you talk
  • 00:41:39
    about an adolescent experence
  • 00:41:40
    experimenting with drugs or alcohol
  • 00:41:42
    you're talking about you know I don't
  • 00:41:44
    know how many teenagers I've interviewed
  • 00:41:46
    and you know it can't ever happen to me
  • 00:41:48
    nothing bad will ever happen to me I
  • 00:41:50
    mean this sort of inferiority not
  • 00:41:53
    inferiority complex the the exact
  • 00:41:55
    opposite of that actually um I I'm not
  • 00:41:58
    vulnerable this invulnerability right so
  • 00:42:01
    I like to call that the the Daredevil
  • 00:42:03
    brain the D brain devil brain and so I
  • 00:42:08
    because I'm a child psychiatrist and I
  • 00:42:09
    think that that time that age adolesence
  • 00:42:12
    is a key to study and understand a lot
  • 00:42:14
    of the molecular processes that happen
  • 00:42:16
    in the brain so I started after I saw
  • 00:42:18
    this finding that the Adolescent brain
  • 00:42:20
    is just so different than the adult
  • 00:42:22
    brain I started looking at other
  • 00:42:24
    molecules and part of what I'm finding
  • 00:42:26
    now is some of the very some of the
  • 00:42:28
    molecules that are responsible for
  • 00:42:30
    encoding fear in adults are expressed a
  • 00:42:33
    lot less in the Adolescent brain so even
  • 00:42:36
    the very Machinery that encodes fear is
  • 00:42:39
    expressed Less in the Adolescent brain
  • 00:42:41
    so you can try to scare them until the
  • 00:42:43
    cows come home but the very Machinery
  • 00:42:46
    that exists to actually encode that fear
  • 00:42:48
    is expressed in a much much lower grade
  • 00:42:51
    no we see them all the time even in not
  • 00:42:53
    talking about substance abuse but
  • 00:42:54
    engaging in such teenage risky Behavior
  • 00:42:57
    so you're going to say oh if you do that
  • 00:42:58
    it's going to be horrible something bad
  • 00:42:59
    is going to happen and they were here oh
  • 00:43:01
    risk I want to take that risk I want to
  • 00:43:02
    try it yeah exactly yeah yeah like I've
  • 00:43:06
    got a son about to enter adolescence and
  • 00:43:09
    I'm dreading it because he's got that
  • 00:43:10
    kind of I can do it of course you
  • 00:43:14
    know it really is important to
  • 00:43:16
    understand that this adolescent time is
  • 00:43:18
    so crucial uh for the development of
  • 00:43:20
    this disease because then it has
  • 00:43:22
    implications in terms of prevention in
  • 00:43:24
    terms of intervention in terms of what
  • 00:43:25
    we can do um and and and that's why I
  • 00:43:28
    think it's really it's important to
  • 00:43:29
    understand it's it's a really crucial
  • 00:43:31
    time and think and especially if their
  • 00:43:33
    brains are more plastic and especially
  • 00:43:35
    if intervention can actually help them
  • 00:43:37
    recover more and just one last question
  • 00:43:39
    before we move on to Dr Janda um if if
  • 00:43:42
    if you intervene and get the Adolescent
  • 00:43:47
    help while they're still an adolescent
  • 00:43:49
    in other words is there a better chance
  • 00:43:51
    of success because the brain is so
  • 00:43:53
    plastic or there's better plasticity as
  • 00:43:56
    you put it um and and they Haven it sort
  • 00:43:59
    of settled in and formed and set into
  • 00:44:02
    adulthood brain well I think what
  • 00:44:04
    happens is that like especially
  • 00:44:06
    addiction as we tal it's a chronic
  • 00:44:08
    disease and it takes time to evolve and
  • 00:44:10
    so if you catch it earlier on before it
  • 00:44:13
    gets to the end stage of it then you
  • 00:44:15
    have a much better chance of actually
  • 00:44:17
    preventing it from getting to the end
  • 00:44:19
    stage because sometimes I have like when
  • 00:44:21
    I some of the patients that I see when
  • 00:44:23
    you see them at the end stage it's
  • 00:44:25
    really it's it's it's I think a lot of
  • 00:44:27
    people don't unless you have a a
  • 00:44:28
    personal like experience of it of
  • 00:44:30
    someone that you know they don't really
  • 00:44:32
    realize how horrible they can be I I
  • 00:44:34
    have one patient and now she's an
  • 00:44:36
    alcoholic and now thank God she's been
  • 00:44:38
    sober for many years but at the very end
  • 00:44:40
    stage of her disease she used to drink
  • 00:44:42
    alcohol she had horrible gastritis
  • 00:44:44
    because of the alcohol uh she would buy
  • 00:44:46
    bottles of vodka and then she would
  • 00:44:48
    throw it up but she would want the
  • 00:44:50
    effect of the alcohol so she would
  • 00:44:51
    collect it and drink it again to get the
  • 00:44:54
    effect so this so it's not just
  • 00:44:57
    something that oh I don't have self-will
  • 00:44:59
    anymore it's not about self-will anymore
  • 00:45:02
    it's a very different disease but that's
  • 00:45:03
    at the end stage and it doesn't start
  • 00:45:05
    like that how long had she been drinking
  • 00:45:07
    when she was at that stage she's been
  • 00:45:09
    drinking since she was a teenager and
  • 00:45:10
    she was in her 30s in her 30s it doesn't
  • 00:45:13
    start like that and it can it I think
  • 00:45:16
    some of the findings are that even if
  • 00:45:18
    you do one intake session in research
  • 00:45:21
    you call you call a subject in and you
  • 00:45:23
    you talk to them about their drinking
  • 00:45:25
    history that is enough any self to
  • 00:45:27
    actually change their drinking history
  • 00:45:29
    to change their drinking behavior for a
  • 00:45:31
    few weeks later on they drink less Rec
  • 00:45:34
    just having to sort of go over what have
  • 00:45:36
    you been drinking over the past like
  • 00:45:38
    year or so so that's enough to actually
  • 00:45:41
    even Institute a change well I guess
  • 00:45:42
    because that would force you to you know
  • 00:45:45
    I think a lot of addicts avert their
  • 00:45:46
    eyes like I you know or tomorrow
  • 00:45:48
    tomorrow I'll wipe the Slate clean and
  • 00:45:51
    get up and run 10 miles and B a cake and
  • 00:45:55
    you know go be fantastic at my job and
  • 00:45:58
    whatever um but it I think if you have
  • 00:46:00
    to just sit and tell somebody what you
  • 00:46:02
    drank or what you did it makes you fully
  • 00:46:06
    accountable for your own behavior and
  • 00:46:08
    you're less able to avert your eyes from
  • 00:46:10
    it I think like like one uh that patient
  • 00:46:12
    recites one of the sayings in AA is that
  • 00:46:15
    denial is not a raver in Egypt that's
  • 00:46:17
    one of countless sayings in AA yes um I
  • 00:46:22
    also hear that other places though too I
  • 00:46:23
    think it's just denial anyway what did
  • 00:46:25
    you want to add something no because I
  • 00:46:27
    do want to reiterate on the notion as
  • 00:46:29
    we're addressing the problem of
  • 00:46:30
    substance use the most important thing
  • 00:46:32
    that we can do is prevention and for
  • 00:46:34
    prevention strategies to be effective we
  • 00:46:36
    have to Target children and Adolescent
  • 00:46:39
    and and Eric was saying yes it would be
  • 00:46:41
    fantastic if we had a genene or a brain
  • 00:46:43
    that could tell us who's going to become
  • 00:46:45
    addicted and yet we know who are the
  • 00:46:47
    most vulnerable any kid that has a
  • 00:46:50
    mental illness is at a much higher risk
  • 00:46:52
    of use of substance than any others so
  • 00:46:55
    one of the strategies that is very very
  • 00:46:57
    relevant is to be able to identify when
  • 00:47:00
    you have a kid that's taking drugs to
  • 00:47:03
    rule out whether there is an underlying
  • 00:47:05
    mental illness that's driving the use of
  • 00:47:07
    drugs because again one of the meats
  • 00:47:09
    that a lot of people have is people take
  • 00:47:11
    drugs in order to feel high and have a
  • 00:47:13
    good time but a lot of people take drugs
  • 00:47:15
    in order to feel better and so you have
  • 00:47:18
    an indicator if you already have a
  • 00:47:21
    teenager consuming high doses of drugs
  • 00:47:24
    you want to be able to rule out the
  • 00:47:26
    possibility that there is a mental
  • 00:47:28
    illness because if you properly treat it
  • 00:47:30
    then you prevent the escalation further
  • 00:47:32
    you meaning you're talking about
  • 00:47:33
    depression depression anxiety attention
  • 00:47:37
    deficit hyperactivity disorder um I mean
  • 00:47:40
    difficulties with
  • 00:47:43
    extraversion all of these put a higher
  • 00:47:47
    risk for the kid to take drugs because
  • 00:47:49
    they they may basically want to to to
  • 00:47:52
    fit better and so they may take drugs in
  • 00:47:54
    order to do that or to just feel better
  • 00:47:56
    if you're very anxious and you drink
  • 00:47:58
    alcohol that calms you down if you take
  • 00:48:00
    marijuana that calms you down if you
  • 00:48:02
    have ADHD and you cannot sustain
  • 00:48:04
    attention you take cocaine that will
  • 00:48:06
    temporarily help you so this is
  • 00:48:09
    something that right now we can do and I
  • 00:48:12
    think again emphasizes the importance of
  • 00:48:16
    doing prevention measures because
  • 00:48:18
    clearly all of the data has shown that
  • 00:48:21
    substance abuse can be prevented we've
  • 00:48:23
    been very good with tobacco not perfect
  • 00:48:26
    but we've brought it down by 50% in
  • 00:48:28
    teenagers in less than 10 years so
  • 00:48:31
    prevention strategies work and to bring
  • 00:48:34
    screening and prevention into Primary
  • 00:48:36
    Care absolutely screening for uh when
  • 00:48:39
    you go to a doctor doctors should ask uh
  • 00:48:42
    how much alcohol you're drinking you SM
  • 00:48:44
    actually that like two like 2% of a
  • 00:48:47
    doctor's education deals with substance
  • 00:48:49
    abuse I mean it it's amazing how many
  • 00:48:52
    doctors don't ask y they're not trained
  • 00:48:56
    they're not trained to recognize it so
  • 00:48:58
    as a medical student you never really
  • 00:48:59
    are taught how substance abusers come
  • 00:49:02
    you feel embarrassed because it's highly
  • 00:49:04
    steti how how am I going to ask this old
  • 00:49:07
    lady whether she's drinking more I mean
  • 00:49:10
    there is there is that that absolutely I
  • 00:49:12
    mean I mean it is unfortunate but it is
  • 00:49:15
    the truth so you rather not ask and then
  • 00:49:17
    if you ask and they tell you yes I'm
  • 00:49:19
    drinking one half a bottle of whiskey a
  • 00:49:22
    day do you really want to know what are
  • 00:49:23
    you going to do well and I actually had
  • 00:49:26
    a doctor doctor tell me once in an
  • 00:49:27
    interview that whenever he would ask a
  • 00:49:29
    patient how much he or she was drinking
  • 00:49:31
    every day double it you double or triple
  • 00:49:34
    yeah like nobody ever tells the truth
  • 00:49:36
    it's like oh no I only had one glass of
  • 00:49:38
    wine you know you know but the glass was
  • 00:49:41
    like a a Big Gulp cup you know so but
  • 00:49:46
    also I also think that with adolesence
  • 00:49:47
    it's even more of a problem because
  • 00:49:49
    adolescence you're program not to tell
  • 00:49:51
    your parents everything no one tell no
  • 00:49:53
    adolesence tells their parents
  • 00:49:54
    everything
  • 00:49:56
    important I'm working on an hour on
  • 00:49:58
    children and anxiety and that's an very
  • 00:50:00
    interesting thing to think of it that
  • 00:50:01
    way that if you if we were more aware of
  • 00:50:04
    the fact that anxious kids uh kids who
  • 00:50:06
    are are depressed or have ADHD would be
  • 00:50:09
    kids who would be much more um
  • 00:50:12
    susceptible to turning to something
  • 00:50:16
    altering to make them feel better I
  • 00:50:18
    think we could it would be a big step
  • 00:50:19
    forward towards prevention another big
  • 00:50:21
    step toward prevention obviously would
  • 00:50:23
    be a vaccine and we've seen sometimes in
  • 00:50:25
    Vivid frightening detail how addiction
  • 00:50:27
    can alter the brain in so many ways Dr
  • 00:50:29
    Kim Janda and his team have developed a
  • 00:50:32
    vaccine to block the effect of heroin
  • 00:50:35
    tell us about this Dr
  • 00:50:37
    Janda well um we've context we've been
  • 00:50:41
    developing a number of vaccines I
  • 00:50:42
    originally started developing a cocaine
  • 00:50:44
    vaccine back in the late 80s and then we
  • 00:50:47
    moved into nicotine uh we've done
  • 00:50:49
    methamphetamine but heroin over the last
  • 00:50:52
    five years we've been something we've
  • 00:50:53
    been working hard on um we I was mainly
  • 00:50:56
    interested interested in developing the
  • 00:50:57
    heroin vaccine actually for um third
  • 00:50:59
    world countries really yeah why um well
  • 00:51:04
    actually if you look there's a been a
  • 00:51:06
    increase in
  • 00:51:08
    HIV with heroin abuse because uh sharing
  • 00:51:11
    of needles and so there and so in places
  • 00:51:14
    like in Africa places like Russia they
  • 00:51:17
    don't have exchangeable needles even
  • 00:51:18
    China it's frowned upon they don't have
  • 00:51:20
    methodone clinics and so um vaccines
  • 00:51:24
    over the do we have that slide can show
  • 00:51:27
    vac the
  • 00:51:28
    history um yeah vaccines have kind of
  • 00:51:31
    taken a back seat and uh they've been
  • 00:51:34
    known for Chinese employing variation
  • 00:51:36
    since the year 1000 it's kind of amazing
  • 00:51:39
    because what they used was dry pules and
  • 00:51:41
    they would snort it oh but think about
  • 00:51:45
    that actually vaccines nowadays flu
  • 00:51:47
    vaccines are actually inhaled they're
  • 00:51:50
    internasal this was known back in
  • 00:51:52
    thousands of years ago people have used
  • 00:51:54
    this um vaccines are very inexpensive
  • 00:51:56
    ensive um I would easily argue that the
  • 00:51:59
    two greatest advances over the last 75
  • 00:52:01
    years have been
  • 00:52:03
    antibiotics and vaccines polio so how
  • 00:52:07
    did these vaccines work I mean how does
  • 00:52:10
    a heroin vaccine work how does a heroin
  • 00:52:12
    vaccine work so um yeah considering as
  • 00:52:16
    my colleagues have talked about uh the
  • 00:52:18
    reason why we started to develop
  • 00:52:19
    vaccines is because you've seen the
  • 00:52:20
    complexity of the brain um and trying to
  • 00:52:23
    develop uh specific agonists or
  • 00:52:25
    antagonist for these receptors and
  • 00:52:27
    there's not just a single receptor
  • 00:52:29
    that's controlling addiction for let's
  • 00:52:31
    say cocaine or Methamphetamine or heroin
  • 00:52:34
    uh the other U thing I want to bring up
  • 00:52:36
    is heroin is not the drug heroin's a pro
  • 00:52:39
    drug the real drug is what's called six
  • 00:52:42
    AAL morphine which then morphs into
  • 00:52:44
    Morphine Morphine is then the actual
  • 00:52:47
    drug um and the reason why heroin is
  • 00:52:50
    made is because it crosses the blood
  • 00:52:51
    being buried very quickly heroin has a
  • 00:52:53
    very short halflife in the body it's
  • 00:52:55
    like 20 30 seconds um and so in creating
  • 00:52:59
    these vaccines we have to look at how
  • 00:53:01
    the drug interacts with the body and how
  • 00:53:03
    the body interacts with the drug so it's
  • 00:53:05
    a little bit different than developing a
  • 00:53:06
    vaccine let's say against influenza or
  • 00:53:09
    HIV uh it doesn't have doesn't the
  • 00:53:13
    immune system is programmed basically to
  • 00:53:16
    remove foreign Invaders um our immune
  • 00:53:18
    system was not developed to say cocaine
  • 00:53:21
    is foreign or heroin is for foreign
  • 00:53:22
    maybe 10,000 years from now our our
  • 00:53:24
    immune system will be more highly veled
  • 00:53:26
    and say well yeah maybe those are
  • 00:53:28
    foreign substances so it doesn't it
  • 00:53:29
    doesn't recognize that so what we did
  • 00:53:32
    over the years is tried to develop ways
  • 00:53:35
    to stimulate our immune system to
  • 00:53:37
    recognize drugs of abuse as being
  • 00:53:39
    foreign and this is just for drugs or
  • 00:53:41
    could this also well actually um uh I've
  • 00:53:45
    developed a vaccine uh for obesity
  • 00:53:48
    too um if you want to get into we can
  • 00:53:50
    talk about that later I know people are
  • 00:53:52
    more interested in that but um uh well I
  • 00:53:55
    shouldn't say more interested but it's
  • 00:53:56
    another aspect but uh but vaccines you
  • 00:53:58
    know the way we use the word vaccine is
  • 00:54:01
    you take it before you so you don't get
  • 00:54:02
    the problem I mean I don't understand
  • 00:54:05
    you take this vac that's I mean that's
  • 00:54:06
    true in one sense but vaccines are being
  • 00:54:08
    developed now for like staff or um uh
  • 00:54:11
    other bacterial diseases where you may
  • 00:54:13
    have the problem you can take the
  • 00:54:14
    vaccine to clear the infection so that's
  • 00:54:16
    not completely true that it's it's not
  • 00:54:19
    preventive it's also going to be
  • 00:54:20
    therapeutic uh so the vaccines aren't a
  • 00:54:24
    typical vaccine like you'd say for polio
  • 00:54:25
    you get a shot maybe wouldn't have to
  • 00:54:27
    have another one for many years the
  • 00:54:29
    vaccines um have to be given over a
  • 00:54:32
    period of several weeks and then you
  • 00:54:34
    build up an immunity to the drug and
  • 00:54:36
    then it'll last for a period of time and
  • 00:54:37
    just like if you a foreign Invader of
  • 00:54:40
    bacteria you it takes a little bit of
  • 00:54:42
    time to clear the infection our own
  • 00:54:43
    immune system could do that and it'll do
  • 00:54:45
    Wan off the same thing with the drugs
  • 00:54:47
    it'll it'll Wan off and then you have to
  • 00:54:49
    re be reboosted it'll it'll kick back up
  • 00:54:51
    again but so what it does is remove the
  • 00:54:54
    effect of the drug no what it does is um
  • 00:54:56
    do we have that one picture showing the
  • 00:54:58
    the the
  • 00:54:59
    brain oh right there so you you see the
  • 00:55:03
    little red dotted lines at the neck uh
  • 00:55:05
    the immune system typically doesn't
  • 00:55:07
    cross the bloodb brain barrier it's not
  • 00:55:09
    privileged to do that so what the
  • 00:55:10
    vaccine does is it blocks the drug from
  • 00:55:14
    crossing the blood brain barrier in some
  • 00:55:16
    cases depending on the drug just like I
  • 00:55:17
    said how the drug reacts with the body
  • 00:55:18
    the body reacts with the drug you can
  • 00:55:20
    create a vacuum and it can pull the drug
  • 00:55:22
    out of the brain depending on how
  • 00:55:24
    strongly these antibodies bind the drug
  • 00:55:25
    so if somebody had taken the vaccine and
  • 00:55:27
    then decided they still wanted to go do
  • 00:55:29
    heroin What would happen to that person
  • 00:55:31
    what would happen that if the vaccine
  • 00:55:33
    worked well they wouldn't they wouldn't
  • 00:55:35
    get the potential psychoactive effects
  • 00:55:37
    for the drug but wouldn't you still have
  • 00:55:39
    the potential life-threatening effects
  • 00:55:41
    of the drug lifethreatening you mean of
  • 00:55:44
    overdose of right um actually with the
  • 00:55:47
    heroin vaccine we haven't published this
  • 00:55:49
    data but we've we've um in rodent models
  • 00:55:52
    we've gone as high
  • 00:55:53
    as uh 35 to 40 migs per kig of heroin
  • 00:55:58
    and typically four migs will kill an
  • 00:56:01
    animal and they're perfectly fine
  • 00:56:03
    they're happy as little clams running
  • 00:56:05
    around so they have no effect so this is
  • 00:56:08
    actually it's kind of interesting
  • 00:56:10
    because with this vaccine that we've
  • 00:56:11
    developed here um it could be used as a
  • 00:56:16
    overdose therapy too at the same time
  • 00:56:18
    right here in New York City actually
  • 00:56:19
    right now the police officers I think
  • 00:56:21
    just last week are now equipped with the
  • 00:56:24
    shots for when overdoses I'm just I'm
  • 00:56:28
    asking only because it I I it raises the
  • 00:56:30
    concern that if somebody's on the
  • 00:56:32
    vaccine and they think I want to get
  • 00:56:34
    high um and dog G it this didn't do
  • 00:56:37
    enough I'm I'm going to keep doing more
  • 00:56:39
    and more and more and try and override
  • 00:56:40
    my vaccine and kill themselves in the
  • 00:56:42
    process so as we' heard the vaccine is
  • 00:56:45
    to be used when people have lapses so it
  • 00:56:48
    will prevent a relapse that's where we
  • 00:56:50
    see the importance of it um that uh like
  • 00:56:54
    you heard uh maybe you hear particular
  • 00:56:57
    song or a particular place a particular
  • 00:56:59
    smell and you take the drug you know a
  • 00:57:02
    taste of the drug and then what happens
  • 00:57:04
    is you're going to relapse maybe but the
  • 00:57:06
    vaccine if in place would prevent that I
  • 00:57:10
    mean there's there are potential caveats
  • 00:57:12
    where one could say well you could take
  • 00:57:13
    more and more of the drug to surmount it
  • 00:57:16
    and that's that's a possibility because
  • 00:57:18
    the the vaccines are like little sponges
  • 00:57:19
    they can only take up so much you have
  • 00:57:21
    to ring those guys out um so depending
  • 00:57:25
    on the the drug they they're all
  • 00:57:27
    different so not one vaccine is the same
  • 00:57:28
    for all drugs it's it's it's different
  • 00:57:31
    but in with regards to heroin it's very
  • 00:57:33
    special because as I said it's heroin
  • 00:57:36
    morphs itself into multiple different
  • 00:57:38
    drugs before it gets into the brain and
  • 00:57:40
    so you don't have many of the issues
  • 00:57:41
    like you have with cocaine or
  • 00:57:43
    Methamphetamine that lasts very long
  • 00:57:44
    periods of time if you can stop it from
  • 00:57:46
    getting across the bloodb brain barrier
  • 00:57:49
    you can kind of win the battle because
  • 00:57:50
    once it's over there it doesn't come out
  • 00:57:51
    easily morphine doesn't cross readily it
  • 00:57:53
    doesn't go across easily either so you
  • 00:57:56
    there's some advantages with some of
  • 00:57:58
    these vaccines that that um depending on
  • 00:58:00
    the drug they could have for like
  • 00:58:01
    overdose where in certain ones they
  • 00:58:03
    can't I in I I did a story on mothers in
  • 00:58:08
    rehab um and most of them were there for
  • 00:58:10
    alcohol abuse but um we there was one
  • 00:58:13
    woman who was there for heroin addiction
  • 00:58:16
    and she said that heroin was the most
  • 00:58:18
    addictive drug is that
  • 00:58:22
    true um you know I'm not a clinician but
  • 00:58:25
    um I know when we put these animals on
  • 00:58:28
    long-term AIS for heroin they just look
  • 00:58:30
    terrible from The Other Drugs we've used
  • 00:58:32
    Like Cocaine methamphetamines really
  • 00:58:35
    quite bad too but heroin they just look
  • 00:58:38
    awful um we think that heroin and
  • 00:58:40
    stimulant stimulants would be cocaine
  • 00:58:43
    and
  • 00:58:43
    methamphetamine amphetamine are probably
  • 00:58:46
    the most addictive it's a really hard
  • 00:58:49
    question makes something more addictive
  • 00:58:51
    versus a hard question to answer because
  • 00:58:53
    we would have to do a study and it would
  • 00:58:55
    be impossible to do it go to a large
  • 00:58:57
    State University campus 40,000 kids
  • 00:59:01
    treat a thousand of them with Heroin a
  • 00:59:04
    thousand of them with amphetamine a
  • 00:59:05
    thousand of them with marijuana and then
  • 00:59:08
    stop it suddenly and see how many are
  • 00:59:10
    hooked that's a good study to fund but
  • 00:59:14
    you know
  • 00:59:15
    so you can't do the study but you can't
  • 00:59:18
    answer the question without a study like
  • 00:59:20
    that so we're left really not knowing
  • 00:59:23
    how intrinsically addictive each of
  • 00:59:25
    these substan is is but there are some
  • 00:59:27
    indirect uh data that gives you an
  • 00:59:30
    incline in terms of how addictive drugs
  • 00:59:32
    are for example the epidemiologists who
  • 00:59:35
    like to measure everything that they can
  • 00:59:36
    get their hands on actually assess the
  • 00:59:39
    number of people the percentage of
  • 00:59:40
    people that when they get exposed to a
  • 00:59:42
    drug will become addicted to them and
  • 00:59:44
    then they rank them and interestingly
  • 00:59:46
    the drug that comes on top is actually
  • 00:59:48
    nicotine but that's that has a caveat
  • 00:59:51
    because nicotin is legal so it's a
  • 00:59:53
    widespread availability increases the
  • 00:59:55
    lik hood that you will be repeatedly
  • 00:59:57
    administering it but if you take just
  • 01:00:00
    the illegal drugs um heroin actually has
  • 01:00:03
    the highest percentage something like 25
  • 01:00:06
    to 30% of people that get exposed to
  • 01:00:08
    herin will become addicted and then if
  • 01:00:11
    you take those numbers you have a
  • 01:00:13
    methamphetamin is also highly addictive
  • 01:00:15
    and and and then marijuana is probably
  • 01:00:20
    has the lowest rate and it's only 9% of
  • 01:00:23
    people that get exposed will become
  • 01:00:24
    addicted but also depends at what age so
  • 01:00:27
    if you are less than 18 60% of them will
  • 01:00:31
    become addicted to to marijuana so that
  • 01:00:33
    gives us a sense in population basis how
  • 01:00:36
    do they spare one versus the other
  • 01:00:38
    considering just elicit substances then
  • 01:00:41
    we have another way clinically to try to
  • 01:00:44
    determine which is when you start to
  • 01:00:45
    take the drug regularly how much time
  • 01:00:48
    does it take you to escalate until lose
  • 01:00:51
    control and in that one metamphetamine
  • 01:00:53
    is probably one of the fastest drugs
  • 01:00:56
    within less than one year you can get
  • 01:00:58
    people very very severely addicted but
  • 01:01:01
    opiates also create these very fast
  • 01:01:04
    escalation and finally the animal models
  • 01:01:07
    so what we we assign the addictiveness
  • 01:01:10
    of drugs to their ability to their
  • 01:01:11
    potency to increase dopamine in the
  • 01:01:13
    brain and of all of the drugs the most
  • 01:01:16
    potent drug that we currently know in
  • 01:01:18
    terms of its ability to increase
  • 01:01:20
    dopamine is metamphetamine so you take
  • 01:01:23
    all of this information and you come
  • 01:01:24
    exactly to the conclusion of what Eric
  • 01:01:26
    was saying that probably the most
  • 01:01:29
    addictive drugs that we have independent
  • 01:01:31
    of the F legality or not legality have
  • 01:01:34
    to do with methamphetamine and and and
  • 01:01:36
    heroin that's that's what I and cocaine
  • 01:01:39
    also is a high but but there it
  • 01:01:41
    goes and getting back to the the other
  • 01:01:44
    point too is how these drugs are being
  • 01:01:47
    taken so um you know in the 70s they
  • 01:01:51
    were going to try to legalize cocaine if
  • 01:01:53
    you go back to the Carter and and
  • 01:01:56
    looking at that and it wasn't until I
  • 01:01:58
    think it was 84 which crack hit the
  • 01:02:01
    scene and crack is nor will tell you is
  • 01:02:03
    extremely addictive and people have this
  • 01:02:05
    misconception what crack is crack is
  • 01:02:07
    cocaine you you just you take cocaine
  • 01:02:09
    you heat it up sodium bicarb let it
  • 01:02:11
    crystallize out get these large crystals
  • 01:02:13
    it's smoked and the thing about that is
  • 01:02:15
    smoking it gets the bra brain much
  • 01:02:17
    quicker than snorting it or injecting it
  • 01:02:19
    and so like that or with methamphetamine
  • 01:02:22
    these people go on these runs for
  • 01:02:24
    several days taking it in um so again
  • 01:02:27
    depending on the drug can impact how
  • 01:02:29
    you're seeing the the addiction take
  • 01:02:31
    place um the other thing is is
  • 01:02:33
    interesting is kind of cost supply and
  • 01:02:36
    demand so with Heroin when we see uh
  • 01:02:40
    more drug enforcement in terms of
  • 01:02:41
    bringing it in the country we also see
  • 01:02:43
    an increase of what's called synthetic
  • 01:02:45
    opioids so things things like fentanyl
  • 01:02:48
    which was made in the 60s it's about 100
  • 01:02:50
    to 500 times more potent than uh
  • 01:02:54
    morphine it's actually probably not more
  • 01:02:57
    potent it just crosses the blood brain
  • 01:02:58
    barrier easier it's very easy to make so
  • 01:03:00
    there's you know we've all seen breaking
  • 01:03:02
    bad there's these Rogue chemists out
  • 01:03:03
    there who are making this you've heard
  • 01:03:05
    of things like China White so what
  • 01:03:07
    happens when when the heroin demand you
  • 01:03:09
    know so heroin's not pure it's it's cut
  • 01:03:10
    up with different things and you can use
  • 01:03:13
    very small amounts of of these synthetic
  • 01:03:15
    opioids to give the addict the so-called
  • 01:03:18
    need and so that's another thing that I
  • 01:03:20
    think we have to contend with is is that
  • 01:03:23
    these other things are being mixed in so
  • 01:03:25
    you say well he overdosed in heroin that
  • 01:03:27
    may not be potentially true he could
  • 01:03:29
    have overdosed on one of the synthetic
  • 01:03:31
    opioids also involved getting back to
  • 01:03:33
    your vaccines have they been tested on
  • 01:03:35
    humans they have uh cocaine and nicotine
  • 01:03:38
    have have been have gone are gone are in
  • 01:03:41
    clinical trials and when might these
  • 01:03:43
    things hit a market hit the market um
  • 01:03:46
    well when the FDA feels they're good
  • 01:03:48
    enough to be approved that's some of
  • 01:03:50
    them are are still uh uh they're still
  • 01:03:53
    uh lacking in terms of getting the
  • 01:03:56
    immune response strong enough there's a
  • 01:03:58
    lot of variability as you might
  • 01:03:59
    obviously diversity in our population
  • 01:04:01
    and and so the vaccines can work well on
  • 01:04:04
    some people and don't work so well in
  • 01:04:06
    others um so those are some things that
  • 01:04:08
    we need to look at a little more closely
  • 01:04:11
    um and the other big thing is you're
  • 01:04:13
    saying how quickly we can move these
  • 01:04:14
    things forward um I don't know any drug
  • 01:04:17
    company that's working on any of these
  • 01:04:19
    vaccines except for one company that's
  • 01:04:21
    working on nicotine they will not work
  • 01:04:23
    on any of these heroin I have
  • 01:04:26
    tried to go to Every major company
  • 01:04:30
    biotech companies Wall Street people
  • 01:04:32
    saying hey would you be interested in
  • 01:04:35
    funding a heroin vaccine moving forward
  • 01:04:37
    that we could develop and it's really
  • 01:04:39
    they're saying wow this is really
  • 01:04:40
    interesting you know I I knew someone
  • 01:04:42
    that overdosed on this um it's great
  • 01:04:44
    work you're doing fantastic but H we
  • 01:04:48
    just don't see a market for
  • 01:04:51
    it really it's they cost it's it's how
  • 01:04:55
    much they think they're going to get
  • 01:04:56
    back but there clearly is a market for
  • 01:04:59
    it and drug companies want profits I
  • 01:05:01
    mean why wouldn't they want to Market
  • 01:05:03
    something that they could readily sell
  • 01:05:07
    sell I you know what it maybe you know I
  • 01:05:10
    don't know a lot of hmos that cover you
  • 01:05:13
    know crack addicts or heroin addicts so
  • 01:05:15
    nicotine smoking one thing but they're
  • 01:05:18
    not you know in terms of what they're
  • 01:05:21
    going to get back if they're going to
  • 01:05:22
    try to go forward and make this minorcan
  • 01:05:24
    comment more but the develop of
  • 01:05:26
    vaccine the vaccine itself is extremely
  • 01:05:28
    inexpensive that's why I thought for
  • 01:05:30
    third world countries for her once you
  • 01:05:32
    have the vaccine made it's inexpensive
  • 01:05:34
    but to move these through clinical
  • 01:05:36
    trials cost probably 40 $50 million at
  • 01:05:40
    the end of the day and so for them to
  • 01:05:42
    put that investment in that and what
  • 01:05:44
    they're going to get back in return is
  • 01:05:46
    what drives these things I think and so
  • 01:05:50
    yeah the value is there and you know you
  • 01:05:53
    asked me at the beginning about policy
  • 01:05:54
    issue and this is is one of the most
  • 01:05:56
    sensitive ones because the science in
  • 01:05:58
    the whole field of substance abuse is
  • 01:06:00
    Advanced to the point that we could have
  • 01:06:02
    much better intervention not just based
  • 01:06:04
    on immunotherapies vaccines and
  • 01:06:06
    monoclonal antibodies but actually on
  • 01:06:09
    medications but we have this huge gap
  • 01:06:11
    because the pharmaceutical industry does
  • 01:06:14
    not feel that there is a profit to be
  • 01:06:16
    made on the development of this uh type
  • 01:06:19
    of medications now this was reviewed
  • 01:06:21
    many years ago more than 15 years ago by
  • 01:06:24
    The Institute of Medicine that came back
  • 01:06:26
    and said there should be an
  • 01:06:28
    incentivization of the Pharmaceuticals
  • 01:06:30
    to go after that just like we've done in
  • 01:06:32
    vac vaccines in this country if you
  • 01:06:34
    don't incentivize the companies are not
  • 01:06:36
    going to develop vaccines for many of
  • 01:06:38
    the diseases of childhood my perspective
  • 01:06:41
    is you are not going to be making money
  • 01:06:43
    with tanks but if there is a war you
  • 01:06:46
    need to develop tanks and you then
  • 01:06:48
    create an incentive because this is that
  • 01:06:51
    was mood lighting everybody phal company
  • 01:06:55
    yes no
  • 01:07:00
    so the bottom line is that that this is
  • 01:07:02
    an issue where if we were to create
  • 01:07:05
    incentives that actually would cost no
  • 01:07:08
    money to the government you just for
  • 01:07:10
    example increase the patent that they
  • 01:07:12
    could get and theom had a whole list of
  • 01:07:14
    incentives that could be made to
  • 01:07:16
    accelerate the process what Kim is
  • 01:07:19
    saying is actually very very relevant
  • 01:07:21
    with respect to uh the heroin vaccine
  • 01:07:24
    because the the injection of heroin is
  • 01:07:28
    the number one driver of the HIV
  • 01:07:30
    epidemic in many countries in the world
  • 01:07:34
    and yet this could be completely averted
  • 01:07:37
    if there was a treatment intervention
  • 01:07:40
    such as a vaccine for heroin and so so
  • 01:07:43
    we what is very exasperating is that you
  • 01:07:46
    have the knowhow you have the knowledge
  • 01:07:48
    you know the road but there is not the
  • 01:07:51
    resources to move forward in that road
  • 01:07:54
    and yet you know that the cost of not
  • 01:07:56
    moving forward in that row are just
  • 01:07:58
    gigantic so that's a little bit of the
  • 01:08:00
    issues that we play with policy on a
  • 01:08:02
    field that is
  • 01:08:04
    stigmatized so it's stigmatized in the
  • 01:08:06
    healthcare system and it's not
  • 01:08:08
    considered one that is worthwhile of
  • 01:08:10
    investment by private stigmatized in the
  • 01:08:12
    Health Care system I understand you know
  • 01:08:15
    definitely when you talk to addicts or
  • 01:08:19
    addicts
  • 01:08:20
    families co-workers I you understand the
  • 01:08:23
    stigma but why in the healthcare I mean
  • 01:08:26
    I not saying I agree with that I think
  • 01:08:27
    it's a terrible thing people who are
  • 01:08:29
    drug addicts are difficult patients it's
  • 01:08:32
    they're difficult for the system they're
  • 01:08:34
    difficult for doctors and nurses just as
  • 01:08:36
    they're difficult for their family
  • 01:08:38
    members it's just the it's just it's
  • 01:08:40
    part of the disease and also the other
  • 01:08:43
    thing too they are not disip patients
  • 01:08:45
    because because they are in themselves
  • 01:08:47
    in a lot of turmoil but also because
  • 01:08:50
    there is that belief that they are to
  • 01:08:52
    blame for the consequences of their
  • 01:08:54
    disease and that is
  • 01:08:56
    societ is telling them that yeah but
  • 01:08:58
    that's the Healthcare System says it's
  • 01:09:00
    it's a lifestyle choice and and when I
  • 01:09:03
    came tonight I was I was asking well how
  • 01:09:05
    can an insurance deny the treatment for
  • 01:09:08
    a substance abusers whether it's
  • 01:09:09
    nicotine or it's alcohol and and the
  • 01:09:12
    justification were to one of them there
  • 01:09:14
    are no treatments that work and the
  • 01:09:16
    other one this is a lifestyle Choice
  • 01:09:18
    well a lot of the diseases that we
  • 01:09:21
    develop in chronic many of them are
  • 01:09:22
    related to behaviors that we are doing
  • 01:09:25
    and yet we never question it so so we
  • 01:09:28
    treat Addiction in a different way
  • 01:09:30
    because we have the sense that the
  • 01:09:32
    person is choosing to take these drugs
  • 01:09:35
    is doing them on themselves and then
  • 01:09:38
    coupled to the fact that these
  • 01:09:40
    individuals have a lot of emotional
  • 01:09:42
    disruption and and and because of the
  • 01:09:45
    the way that drugs affect their brain
  • 01:09:47
    they tend to lie they need the drug and
  • 01:09:50
    they will do anything that they can in
  • 01:09:52
    order to get the drug when they are
  • 01:09:53
    actually addicted will you have
  • 01:09:55
    perfectly teed up our second um Seth
  • 01:09:57
    manukan video because he talks about
  • 01:09:59
    willpower the issue of willpower um
  • 01:10:02
    because so much you're right so much of
  • 01:10:04
    the country um the prevailing attitude
  • 01:10:07
    and even people who think oh no it's a
  • 01:10:09
    disease will actually then go ahead and
  • 01:10:11
    treat an addict like you know what get
  • 01:10:13
    your you know what together um I
  • 01:10:16
    actually have a really good example that
  • 01:10:17
    same patient that I described before
  • 01:10:19
    once described to me how while she was
  • 01:10:21
    at work she was reading everyone the
  • 01:10:23
    people were reading the New York posts
  • 01:10:25
    and they were reading about this woman
  • 01:10:26
    that was arrested at the supermarket
  • 01:10:28
    while she was trying to shop for food
  • 01:10:30
    with her kids and she was arrested
  • 01:10:31
    because she was snorting heroin at the
  • 01:10:33
    same time and so most people's reaction
  • 01:10:37
    were oh my God what a horrible mother
  • 01:10:39
    but her reaction my patient was oh my
  • 01:10:41
    God I can't believe she was actually
  • 01:10:43
    able
  • 01:10:44
    to go through with it and try to take
  • 01:10:47
    care of her kids despite this horrible
  • 01:10:48
    illness because when she was when she
  • 01:10:51
    was drinking she didn't want anyone
  • 01:10:53
    around her her kids were with her with
  • 01:10:55
    were with their father and she couldn't
  • 01:10:57
    take care of her kids so I think we all
  • 01:11:00
    have this idea yeah it's an illness but
  • 01:11:02
    then when we see something like that
  • 01:11:03
    it's hard for us to really relate but it
  • 01:11:06
    is an illness and that woman was trying
  • 01:11:07
    to take care of her kids while having a
  • 01:11:09
    really difficult illness trying to
  • 01:11:11
    battle really difficult illness you I
  • 01:11:12
    want to make a comment because just
  • 01:11:14
    because a lot of public here is that you
  • 01:11:17
    know you're asking why haven't some of
  • 01:11:18
    these things move forward quicker and
  • 01:11:20
    part of it is the politicians and the
  • 01:11:24
    money coming in the only person that's
  • 01:11:25
    funding my research is naida right here
  • 01:11:29
    that's it and the money that's coming in
  • 01:11:32
    the NIH has been stagnant for many years
  • 01:11:36
    um it's been the most difficult times
  • 01:11:39
    that I've ever seen in terms of trying
  • 01:11:41
    to get money to do research in these
  • 01:11:43
    areas I used to have a lot of hair and I
  • 01:11:45
    don't have any hair any I'm going to
  • 01:11:47
    start doing research on that
  • 01:11:49
    next um so I think the the part of it is
  • 01:11:53
    with the politicians feel the adct it's
  • 01:11:55
    a moral failure of the individual versus
  • 01:11:57
    the a disease right until they can get
  • 01:11:59
    around that that it's not a moral
  • 01:12:01
    failure they're not going to put more
  • 01:12:03
    money into it if they don't put more
  • 01:12:05
    money into it you know we can't you know
  • 01:12:07
    move forward with some of this stuff so
  • 01:12:08
    I know we're trying to cut taxes and all
  • 01:12:10
    these other things but you know if I
  • 01:12:14
    hate say if the NIH if we don't get more
  • 01:12:16
    infusing money into this our whole
  • 01:12:18
    system academics in TR to doing research
  • 01:12:20
    and and the things I'm trying to do is
  • 01:12:21
    going to collapse
  • 01:12:31
    well said uh let's take a look at this
  • 01:12:34
    video that Seth made on Willpower and
  • 01:12:36
    then I'd like to discuss this with all
  • 01:12:37
    of you that and the stigmatizing of the
  • 01:12:39
    disease of addiction I've had some um
  • 01:12:43
    neuropsychological testing since I've
  • 01:12:45
    been sober uh you know partially to find
  • 01:12:50
    out how my brain works um and the thing
  • 01:12:54
    that really struck me is how valuable
  • 01:12:58
    that information would have been uh you
  • 01:13:01
    know not to me probably but to my
  • 01:13:04
    parents and to um doctors who were
  • 01:13:06
    treating me when I was 15 um and that is
  • 01:13:10
    something that I find very
  • 01:13:12
    exciting this obviously that he makes a
  • 01:13:15
    compelling case for what you just made
  • 01:13:17
    which is that we need to study this but
  • 01:13:20
    you know getting back to that story you
  • 01:13:21
    told about your patient the alcoholic um
  • 01:13:24
    who was so desperate I mean that is such
  • 01:13:27
    a vivid example of the fact that this
  • 01:13:29
    isn't a matter of willpower but how much
  • 01:13:32
    do you bump up against that all of you
  • 01:13:34
    in in in your work I know that in the
  • 01:13:37
    reporting that I've done on this issue
  • 01:13:40
    um and my experience in this issue that
  • 01:13:42
    that is it's a huge thing I mean people
  • 01:13:44
    it's it's a little bit like talking out
  • 01:13:45
    of both sides of your mouth we can all
  • 01:13:47
    say all the right
  • 01:13:48
    platitudes sometimes about how we look
  • 01:13:51
    at the disease of addiction in this
  • 01:13:52
    country but the fact of the matter is we
  • 01:13:55
    we we look we don't look at them the
  • 01:13:57
    same way we look at a cancer patient or
  • 01:13:59
    even you know somebody with diabetes
  • 01:14:01
    it's it's it's not seen that way it's
  • 01:14:03
    seen as something you can control one of
  • 01:14:07
    the troubling aspects of addiction is
  • 01:14:09
    that we think that drugs of abuse
  • 01:14:11
    actually damage the parts of the brain
  • 01:14:14
    that mediate willpower and Free Will and
  • 01:14:17
    the ability to make an informed Choice
  • 01:14:20
    requires the brain functioning correctly
  • 01:14:23
    and it's the drugs that damage the
  • 01:14:25
    brain's ability to do that irreparably I
  • 01:14:27
    don't think irreparably but for a long
  • 01:14:30
    time and it's hard to get over it it's
  • 01:14:32
    in a way I like the metaphor of actually
  • 01:14:35
    because I think it describes it very
  • 01:14:36
    very nicely you're driving in your car
  • 01:14:39
    and you see a cat Crossing and you want
  • 01:14:42
    to break you don't want to hurt the cat
  • 01:14:45
    but if your brakes are not working no
  • 01:14:47
    matter how much you want to stop you're
  • 01:14:49
    not going to be able to stop and you're
  • 01:14:51
    going to hurt someone so the the the the
  • 01:14:54
    real it and I think that's one of the
  • 01:14:56
    reasons why it's so very difficult for
  • 01:14:57
    people to understand even if they
  • 01:15:00
    theoretically say it's a disease of the
  • 01:15:01
    brain because we're all use uh to
  • 01:15:04
    basically have control of our urges we
  • 01:15:07
    all once in a while fail right I mean we
  • 01:15:10
    have to be honest too but most of the
  • 01:15:12
    time we can control our urges so the and
  • 01:15:15
    we also value very much that ability to
  • 01:15:18
    make a decision and carry through so
  • 01:15:20
    it's very difficult to understand that
  • 01:15:23
    that that process
  • 01:15:25
    happens because certain structures in
  • 01:15:27
    the brain are there that allow you to do
  • 01:15:29
    that and if those structures don't work
  • 01:15:32
    even if though you say I'm not going to
  • 01:15:34
    take the drug you don't have the
  • 01:15:37
    neurobiological substrate that will
  • 01:15:39
    allow you to stop just like you have no
  • 01:15:41
    breaks and how quickly after you begin
  • 01:15:44
    to abuse drugs or alcohol do you lose
  • 01:15:46
    that capacity to break well one of the
  • 01:15:50
    things that we were discussing at the
  • 01:15:51
    beginning was the notion to the extent
  • 01:15:53
    that the the vulnerability for addiction
  • 01:15:56
    and for example now we recognize that
  • 01:15:58
    one of the factors that make you more
  • 01:16:00
    vulnerable is if you are born already
  • 01:16:03
    with a a system a frontal system that
  • 01:16:06
    does not enable you to regulate your
  • 01:16:08
    emotions and desires as well so there's
  • 01:16:11
    variability we all have different sizes
  • 01:16:14
    well that work all of our brains work
  • 01:16:16
    differently and there are people that
  • 01:16:17
    are born with stronger or weaker so that
  • 01:16:20
    for example could be a factor that makes
  • 01:16:22
    you vulnerable but the repeated use of
  • 01:16:25
    drugs by themselves can weaken those
  • 01:16:28
    areas of the brain how long it takes
  • 01:16:30
    again is is very variable depends on
  • 01:16:32
    drugs age of initiation and all of these
  • 01:16:34
    things that we have discussed can we
  • 01:16:36
    recover and as Eric said um again we
  • 01:16:41
    that's what we do therapeutically we are
  • 01:16:43
    doing interventions to try to strengthen
  • 01:16:46
    those systems so in the past uh we were
  • 01:16:49
    much more negative now we're developing
  • 01:16:52
    not just therapeutic interventions based
  • 01:16:54
    on Behavior Behavior but a big area on
  • 01:16:56
    science in Neuroscience is the use of uh
  • 01:16:59
    devices like electrical stimulation or
  • 01:17:02
    magnetic stimulation to strengthen
  • 01:17:04
    certain areas so all of these we do that
  • 01:17:06
    already we are doing it there are
  • 01:17:08
    there's research going on to for example
  • 01:17:11
    use these uh stimulation devices for the
  • 01:17:13
    treatment of depression there's research
  • 01:17:16
    using it for the treatment of drug
  • 01:17:17
    addiction to improve executive function
  • 01:17:20
    and there's several there are many
  • 01:17:22
    evidence-based behavioral interventions
  • 01:17:24
    that can help us strengthen executive
  • 01:17:26
    function so so there there is the more
  • 01:17:29
    we know about the brain the better we
  • 01:17:32
    are in in our ability to do tailor
  • 01:17:35
    interventions to try to strengthen
  • 01:17:38
    systems that may be weaken in this case
  • 01:17:40
    by drugs or by other
  • 01:17:43
    circumstances and and yet so much of the
  • 01:17:46
    language that you hear in recovery is
  • 01:17:48
    focused on it seems almost to be like
  • 01:17:50
    willpower like you one day at a time in
  • 01:17:53
    AA and and making those decisions not to
  • 01:17:57
    take drugs or drink I mean trying to
  • 01:18:00
    rebuild those systems in the brain and
  • 01:18:02
    regain control but that's why I keep ask
  • 01:18:04
    and I must have asked this 10 times
  • 01:18:06
    tonight well how long does it take for
  • 01:18:08
    that the brain to rec from person to
  • 01:18:11
    person tremendously and I think one
  • 01:18:12
    important lesson is that people go
  • 01:18:16
    through treatment they fail they should
  • 01:18:18
    go through treatment again and they may
  • 01:18:21
    fail again it doesn't undo the successes
  • 01:18:23
    of the past treatments and sometimes
  • 01:18:25
    people need to go through treatments a
  • 01:18:27
    dozen times before all of a sudden
  • 01:18:29
    something clicks and they're able to
  • 01:18:32
    maintain AB contributes to the stigma
  • 01:18:34
    Associated to the disease doesn't it I
  • 01:18:35
    me relapsing exactly and I think that
  • 01:18:39
    you know is the addict probably begins
  • 01:18:42
    to
  • 01:18:42
    feel you know anguish and Powerless and
  • 01:18:46
    their families and their families
  • 01:18:48
    frustrated impatient get it together MH
  • 01:18:51
    but there's also another aspect that I
  • 01:18:53
    sort of mentioned before is that that um
  • 01:18:55
    there's a much higher risk in
  • 01:18:56
    adolescence and uh and that it doesn't
  • 01:18:59
    start with cocaine it usually starts
  • 01:19:00
    with smoking and drinking and that
  • 01:19:03
    that's an age where we can intervene a
  • 01:19:05
    lot more we actually have well you seem
  • 01:19:08
    to think that you have a little bit of
  • 01:19:09
    power over your kids or that you can
  • 01:19:12
    even other interventions that I know
  • 01:19:13
    that people don't like because it seems
  • 01:19:16
    like an invasion of privacy but like but
  • 01:19:18
    like drug testing for example so we
  • 01:19:20
    really try to shy away from it but it is
  • 01:19:22
    a tool we we would love it in psychiatry
  • 01:19:24
    if we would have tools diagnostic tools
  • 01:19:26
    we hardly have any diagnostic tools we
  • 01:19:28
    it's not like in other areas of medicine
  • 01:19:30
    where we can take blood pressure or
  • 01:19:31
    doing echocardiogram but we do have the
  • 01:19:34
    ability to do drug testing to know
  • 01:19:36
    whether kids have been exposed or not
  • 01:19:38
    exposed especially if they're high risk
  • 01:19:39
    or you see that they've changed their
  • 01:19:41
    behavior um because this idea that maybe
  • 01:19:44
    they'll tell you uh what they're doing I
  • 01:19:47
    think is really it's not very realistic
  • 01:19:49
    if you understand what adolescence is
  • 01:19:50
    about and how to adolescence actually um
  • 01:19:53
    how to adolescence like work in the
  • 01:19:55
    world um but we have certain tools that
  • 01:19:58
    we underutilize I think and if you ask
  • 01:20:00
    all most of the clinicians that I know
  • 01:20:02
    if you ask them about whether children
  • 01:20:05
    like adolescents should be drug tested
  • 01:20:07
    certain adolescent that are at high risk
  • 01:20:09
    you will you get in resounding yes but
  • 01:20:11
    if you ask the public it would seem like
  • 01:20:12
    no that's an invasion of privacy you
  • 01:20:15
    should trust them you should talk to
  • 01:20:16
    them that people have this aversion to
  • 01:20:18
    the idea but you can really know what's
  • 01:20:21
    going on with a teenager it's very
  • 01:20:22
    simple it's a very simple test to do and
  • 01:20:24
    then you'll know what they're exposed to
  • 01:20:26
    and I've had patients um I have one
  • 01:20:29
    patient that by the time she was 16 and
  • 01:20:31
    a half she probably did everything under
  • 01:20:33
    the face of this planet she did heroin
  • 01:20:35
    she did everything and one time she was
  • 01:20:37
    doing some mushrooms in school and she
  • 01:20:38
    had all these epiphanies and she wrote
  • 01:20:40
    it down in a journal and she lost the
  • 01:20:42
    journal she was uh then summoned to the
  • 01:20:45
    to the counselor's office with her mom
  • 01:20:47
    and she had a party that weekend and she
  • 01:20:49
    was like they sent her home she was
  • 01:20:51
    crying and crying and crying on the car
  • 01:20:53
    came home ran
  • 01:20:55
    upstairs UNC uncontrollably sobbing into
  • 01:20:58
    the pillow and then the mother said okay
  • 01:21:00
    she said it's the only first it's the
  • 01:21:02
    first time I've ever tried anything I've
  • 01:21:03
    never done anything sobbing into the
  • 01:21:05
    pillow and the mother said okay I
  • 01:21:06
    believe you it's fine you can go to the
  • 01:21:07
    party and that patient she is an adult
  • 01:21:09
    when she told me the story she said at
  • 01:21:11
    that moment she was like smiling into
  • 01:21:13
    the pillow saying sucker I got her um
  • 01:21:16
    but that patient went on to go to
  • 01:21:18
    college and she was raped and she
  • 01:21:20
    suffered other consequences and you can
  • 01:21:23
    intervene you can intervene in
  • 01:21:25
    adolescence um but we I don't think
  • 01:21:27
    we're utilizing all the tools that we
  • 01:21:29
    have yeah that you mentioned in that
  • 01:21:31
    story I mean we we're obviously focusing
  • 01:21:33
    tonight on the brain and the science of
  • 01:21:35
    addiction but the very real life
  • 01:21:37
    consequences of addiction go you know
  • 01:21:39
    Way Beyond just the damage that you do
  • 01:21:41
    to your body when you're taking that
  • 01:21:42
    drug or too much alcohol but placing
  • 01:21:46
    yourself in positions where I mean so
  • 01:21:48
    that was that's one of there was there's
  • 01:21:50
    a fantastic book by a young woman named
  • 01:21:52
    Corin zelus called smashed story of a
  • 01:21:54
    drunken girlhood and um she was a
  • 01:21:57
    straight A student phenomenal like
  • 01:21:59
    really smart girl who was drinking
  • 01:22:02
    alcoholically from the time she was a
  • 01:22:03
    sophomore in high school and kept it all
  • 01:22:06
    hidden you know as another friend of
  • 01:22:08
    mine Mary Carr who's an amazing writer
  • 01:22:11
    she wrote a book called lit about her
  • 01:22:13
    journey as an alcoholic Harvard
  • 01:22:15
    professor and mother of a son and as she
  • 01:22:18
    said about um alcoholic women pardon the
  • 01:22:21
    language oh we are sneaky [ __ ] you
  • 01:22:24
    know so I mean they're you're dealing
  • 01:22:26
    with you know a a a population that will
  • 01:22:30
    will as you said lie about what they're
  • 01:22:33
    doing for a variety of reasons but you
  • 01:22:36
    know mostly so that they can continue to
  • 01:22:37
    do that so it sounds like what we've
  • 01:22:39
    reached is sort of an impass which is we
  • 01:22:42
    have the stigma that's preventing more
  • 01:22:44
    of the research and funding for more
  • 01:22:46
    research and at the same time if we had
  • 01:22:49
    more science that we would get from the
  • 01:22:51
    research we would have less stigma it's
  • 01:22:53
    like you know how do you how do you
  • 01:22:56
    break that
  • 01:22:57
    impass well I think to break that impass
  • 01:23:00
    with knowledge because I remember when I
  • 01:23:02
    was born in Mexico and I was growing up
  • 01:23:04
    in Mexico and I remember clearly the
  • 01:23:05
    woman the neighbor across and she
  • 01:23:08
    developed cancer and people were
  • 01:23:10
    speaking like in a secret and nobody
  • 01:23:12
    dared to speak out of cancer and I
  • 01:23:13
    remember very clearly how s stigmatized
  • 01:23:16
    cancer was then that disappear and then
  • 01:23:19
    I went into Psychiatry and mental
  • 01:23:21
    illness are still stigmatized where
  • 01:23:23
    addiction continues to be so and I think
  • 01:23:26
    a lot of it is the lack of understanding
  • 01:23:28
    and we have the sense we we because we
  • 01:23:31
    don't really understand how the brain
  • 01:23:33
    works so we have the assumption that a
  • 01:23:35
    lot of our behaviors and thoughts and
  • 01:23:38
    and the capacities that we give for
  • 01:23:39
    granted are automatic and we don't
  • 01:23:42
    realize that they are not until we lose
  • 01:23:44
    them and so it's very difficult to
  • 01:23:46
    conceptualize and I think that one of
  • 01:23:48
    the other aspects that has made it much
  • 01:23:50
    hard very hard for the healthare system
  • 01:23:53
    to to bring It Forward forward as a as a
  • 01:23:55
    as another disease is that we have very
  • 01:23:58
    few medications that we can use in the
  • 01:24:00
    treatment of drug addiction I think if
  • 01:24:02
    we had vaccines I think if we could have
  • 01:24:05
    actually more potent and efficacious
  • 01:24:07
    medications against drug addiction it
  • 01:24:09
    would be much more easy to accept and
  • 01:24:12
    comprehend and and and and that will
  • 01:24:14
    start to erase some of the stigma so I
  • 01:24:17
    so I'm optimistic that knowledge and
  • 01:24:20
    technologies will will change this and
  • 01:24:22
    there has been progress
  • 01:24:24
    the knowledge basee today compared to 20
  • 01:24:27
    years ago is really vast we know a lot
  • 01:24:29
    about the brain a lot about addiction
  • 01:24:32
    and there have been some improved
  • 01:24:33
    treatments and there will be more and as
  • 01:24:36
    the treatments come then the stigma will
  • 01:24:38
    be reduced but but they are very I mean
  • 01:24:39
    I want to I mean they we do have
  • 01:24:41
    treatments I don't want to say we don't
  • 01:24:43
    we do and they are very valuable but the
  • 01:24:45
    reality is that if you compare where we
  • 01:24:47
    are in drug addiction treatment versus
  • 01:24:49
    where we are on HIV I mean there's there
  • 01:24:53
    there's a cute Gap and and yet that HIV
  • 01:24:57
    which is a devastating disease is a a
  • 01:24:59
    new disease and we invested the
  • 01:25:02
    resources National mobilization to fix
  • 01:25:05
    that disease we we're not curing it but
  • 01:25:07
    people can live very healthy lives and
  • 01:25:10
    die of something else even for nicotine
  • 01:25:14
    nicotine which kills how many people in
  • 01:25:16
    the United States what's nida's estimate
  • 01:25:19
    of the cost of drug abuse and alcoholism
  • 01:25:22
    it basically more than half a trillion
  • 01:25:24
    dollar a year
  • 01:25:27
    unbelievable I mean I I given that cost
  • 01:25:30
    just that like we're not even talking
  • 01:25:33
    about the human suffering involved but
  • 01:25:35
    just the financial cost alone you would
  • 01:25:37
    think would be enough to drive a drug
  • 01:25:40
    company to want to cash in on all those
  • 01:25:43
    people you wanting to alleviate that
  • 01:25:46
    pain yeah but you have to look at the
  • 01:25:48
    we've been talking about the fluidity of
  • 01:25:50
    the BL brain the complexity of the brain
  • 01:25:52
    I think what you know people want is you
  • 01:25:54
    know just like if you had a you had a
  • 01:25:57
    bacterial infection aha take this you'll
  • 01:26:00
    be good in two weeks okay and ah you you
  • 01:26:04
    have cocaine addiction oh take this
  • 01:26:06
    you'll be cured in about a month uh it's
  • 01:26:08
    just not going to happen that way and so
  • 01:26:10
    I think because there's no concrete
  • 01:26:14
    piece that someone can say you can take
  • 01:26:16
    this and it'll take care of you it's
  • 01:26:18
    it's difficult to fund something you you
  • 01:26:20
    can't give me this end point right where
  • 01:26:22
    people want and so you know the goal
  • 01:26:25
    posts keep changing I don't think people
  • 01:26:27
    you know people who are investing in
  • 01:26:29
    that that bothers them but but I mean
  • 01:26:31
    you
  • 01:26:32
    know the brain's complexing the fluidity
  • 01:26:34
    it's going to and you have to just
  • 01:26:36
    recognize that we're now used to taking
  • 01:26:38
    blood pressure medication uh cholesterol
  • 01:26:40
    medication every day for the rest of our
  • 01:26:42
    lives so it may be that a person who has
  • 01:26:44
    an addiction once a treatment becomes
  • 01:26:46
    available will do the same but that's
  • 01:26:48
    okay we just need those I can't
  • 01:26:50
    imagine who you know if you if you could
  • 01:26:53
    tell any addict that I've ever met if
  • 01:26:55
    you take this pill once a day every day
  • 01:26:58
    for the rest of your life this horrible
  • 01:27:00
    thing will go away I mean I can't
  • 01:27:02
    imagine who would say no to
  • 01:27:05
    that I mean zero time I just said
  • 01:27:08
    exactly oh we run out of
  • 01:27:10
    time well thank you so much this has
  • 01:27:12
    been a fascinating discussion and you've
  • 01:27:14
    been a fascinating and wonderful
  • 01:27:16
    audience tonight we really appreciate
  • 01:27:17
    you being here have a great night
Etiquetas
  • Addiction
  • Substance Abuse
  • Dopamine
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  • Behavioral Science
  • Teenager
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  • Healthcare Policy
  • Vaccine Development