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.

The Craving Brain: Neuroscience of Uncontrollable Urges

01:27:24

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

Summary

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.

Takeaways

👥 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.

Timeline

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.

Mind Map

Video Q&A

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
00:00:15
many people turning out for this
00:00:17
wonderful and interesting event as we
00:00:20
all know I've done so much reporting on
00:00:21
this and know firsthand a lot about this
00:00:24
but the numbers are frightening and
00:00:26
staggering when it comes to Addiction in
00:00:28
this country there are more than 2 3
00:00:30
and5 million addicts in the United
00:00:33
States the costs are staggering the
00:00:36
substance abuse costs 600 billion dollar
00:00:40
every single year but The Cutting Edge
00:00:42
scientists here on this stage tonight in
00:00:44
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
00:00:51
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
00:01:16
is a physical change in brain also from
00:01:19
adolescence to adulthood and this of
00:01:21
course may explain why so many young
00:01:23
people tend to get addicted in their
00:01:25
teenage years there are also vaccines on
00:01:28
the horizon if you can believe this that
00:01:30
might be able to block the effect of
00:01:31
addictive drugs and therefore May combat
00:01:34
Addiction in this country there is of
00:01:36
course so much urgency in their work and
00:01:39
their study and it's not just because of
00:01:41
the numbers of addicts and not just
00:01:44
because the cost of addiction in this
00:01:46
country every single year but most
00:01:48
importantly the impact of addiction and
00:01:50
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
00:01:57
years old uh I attended Harvard
00:02:00
University and I currently am the
00:02:02
associate director of mit's graduate
00:02:04
program in science writing I've written
00:02:07
three books my most recent book the
00:02:09
Panic virus um about vaccines and autism
00:02:13
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
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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
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nine uh I began to have a lot of trouble
00:02:47
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
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white middle class child living in
00:03:01
Newton Massachusetts could be
00:03:04
countercultural but was also aware from
00:03:07
very early on that I was not using drugs
00:03:12
in a way that was conducive to having a
00:03:14
good time I I was sharing needles um
00:03:20
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
00:03:59
locks on the house they started to check
00:04:02
in with each other on a daily basis to
00:04:05
see if something had happened to me
00:04:08
there were so many points in that period
00:04:13
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
00:04:44
which that
00:04:45
happened it made
00:04:48
me realize the vigilance that um I need
00:04:55
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
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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
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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
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regions involved with motivation drive
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and
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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
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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
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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