Addiction Neuroscience 101

Summary

This script delves into addiction as a chronic brain disease, emphasizing its impact on the dopamine reward system crucial for motivation and survival. It highlights the staggering statistics of addiction in the U.S., the role of dopamine in pleasure and survival instincts, and how substances like methamphetamine and opioids hijack this system. The speaker advocates for evidence-based treatments, including medication-assisted therapies, to stabilize dopamine levels and reduce cravings, stressing the importance of addressing addiction with science rather than stigma or punishment.

Takeaways

• 📉 Addiction is a widespread issue in the United States, affecting 21 million people, with alcohol and opioid use disorders being particularly prevalent.
• 🏥 Opioid use disorder has become the leading cause of injury-related death, surpassing car accidents and gun violence, and was declared an epidemic by the CDC.
• 🧬 Dopamine is a crucial chemical for human motivation and survival, and addiction disrupts the brain's normal dopamine levels, leading to a constant craving for substances that artificially elevate it.
• 🧠 The brain's limbic system, including areas like the nucleus accumbens and ventral tegmental area, plays a central role in the reward system and is significantly affected by addiction.
• 🚫 Addiction is not merely a behavioral issue but a disease that can be identified and treated, contrary to common misconceptions that focus on the behaviors rather than the underlying condition.
• 💊 Medications like buprenorphine and methadone can help normalize dopamine levels in individuals with opioid use disorder, reducing cravings and facilitating engagement in therapy.
• 🧐 The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines addiction based on behavioral criteria rather than lab tests, emphasizing the importance of understanding the behaviors driven by addiction.
• 🧠 Functional MRI studies have shown that craving for drugs can light up the brain's reward areas to an extent that surpasses even the most basic survival needs like hydration and nutrition.
• 💡 The concept of 'decision fatigue' is relevant to addiction, as the constant need to resist cravings can deplete an individual's ability to make good decisions, potentially leading to relapse.
• 🛑 Society needs to address the stigma and discrimination associated with addiction, treating it as a medical condition rather than a moral failing and ensuring access to evidence-based treatments.
• 🛡️ Prevention and education about addiction should be based on accurate knowledge, avoiding simplistic scare tactics, and focusing on understanding the brain's role in addiction.

Q & A

Why is addiction considered a disease?

Addiction is considered a disease because it involves a predictable, chronic change in brain function, particularly affecting the dopamine and reward pathways, which are responsible for motivation and survival.

What are the statistics on addiction in the United States?

In the United States, 21 million people have the disease of addiction, with 15 million suffering from alcohol use disorder and 3 million from opioid use disorder.

Why is opioid use disorder a significant public health issue?

Opioid use disorder is a significant public health issue because it is the number one cause of injury-related death in the U.S., surpassing car accidents and gun violence, and was responsible for over 50,000 overdose deaths in 2015.

What is the role of dopamine in addiction?

Dopamine is a chemical in the brain responsible for motivation and reward. Addictive substances can cause an unnatural increase in dopamine levels, leading to changes in the brain that drive addictive behaviors.

How does the brain respond to different levels of dopamine?

The brain has a normal range of dopamine levels for motivation and reward. However, addictive substances can cause dopamine levels to spike abnormally high, leading to a dependency where normal life events no longer trigger the same dopamine response.

What are the parts of the brain involved in addiction and motivation?

The parts of the brain involved in addiction and motivation include the anterior cingulate gyrus, the lateral bed nuclei of the amygdala, the nucleus accumbens, the ventral tegmental area, and the periaqueductal gray.

How does the lack of dopamine affect a person's ability to function?

A lack of dopamine can lead to severe impairments in a person's ability to function, such as getting out of bed, taking care of oneself, or engaging in daily activities, as dopamine is crucial for motivation.

What are the four major areas used to diagnose addiction in the DSM-5?

The DSM-5 uses four major areas to diagnose addiction: impaired control of drug use, social impairment, risky use, and pharmacological properties, with eleven criteria in total.

How do medications like buprenorphine and methadone help with addiction treatment?

Medications like buprenorphine and methadone help with addiction treatment by increasing dopamine levels back to normal, reducing cravings and allowing patients to engage in therapy and other treatments more effectively.

What is the role of decision fatigue in addiction and relapse?

Decision fatigue can play a significant role in addiction and relapse, as the constant need to resist cravings throughout the day can deplete a person's ability to make good decisions, potentially leading to a relapse.

Why is it important to decrease cravings in addiction treatment?

Decreasing cravings is important in addiction treatment because it reduces the likelihood of relapse, as cravings are a major driver of the decision to use addictive substances.

What societal changes are suggested to better address addiction?

Societal changes suggested to better address addiction include reframing stigma as discrimination, focusing on evidence-based science rather than beliefs, and decriminalizing addiction in the criminal justice system.

How can education play a role in preventing addiction?

Education can play a role in preventing addiction by providing accurate and appropriate knowledge to young people, helping them understand the risks and effects of addictive substances, rather than relying on scare tactics or misinformation.

Outlines

00:00

🧬 The Neurological Basis of Addiction

This paragraph discusses addiction as a disease, highlighting the prevalence of addiction in the United States and the impact of substances like opioids and alcohol on the brain's dopamine levels. Dopamine is identified as a crucial chemical for motivation and survival, with normal levels ranging from 40 to 100 nanograms per deciliter. The paragraph explains how substances like methamphetamine can drastically increase dopamine levels, leading to addiction as the brain seeks to recreate these highs. It also touches on the brain regions involved in addiction, such as the anterior cingulate gyrus and the nucleus accumbens, emphasizing the survival aspect of addiction as the brain seeks to maintain dopamine levels.

05:00

🧠 The Impact of Addiction on Brain Function and Behavior

The second paragraph delves into the effects of addiction on the brain's limbic system, particularly the ventral tegmental area and nucleus accumbens, which are responsible for the reward system. It discusses how addiction affects these areas, leading to changes in behavior and an increased focus on dopamine. The paragraph also addresses the concept of craving and how it is manifested in the brain, with studies showing that the brain's response to craving for drugs can be as intense as the response to basic survival needs like water and food. The importance of dopamine levels in motivation and the role of medications like buprenorphine and methadone in normalizing these levels for treatment are also highlighted.

10:02

🍽️ Understanding Cravings and Their Impact on Decision Making

This paragraph explores the concept of cravings in the context of addiction, using functional MRI studies to illustrate how the brain's reward centers light up in response to thoughts of drugs. It compares the intensity of cravings to survival instincts like thirst and hunger, emphasizing that the desire for dopamine can override other basic needs. The paragraph also discusses the role of decision fatigue in addiction, suggesting that the constant need to resist cravings can deplete an individual's ability to make sound decisions, potentially leading to relapse. It concludes by advocating for the use of medications to reduce cravings and facilitate engagement in therapy.

15:03

💊 Medication-Assisted Treatment for Addiction

The fourth paragraph focuses on medication-assisted treatment for various types of addiction, including opioid and alcohol use disorders. It discusses the effectiveness of medications like buprenorphine, methadone, and naltrexone in reducing cravings and facilitating recovery. The paragraph also touches on the importance of dopamine in the therapeutic process, noting that a stable dopamine level is necessary for patients to engage in therapy and make lasting behavioral changes. It highlights the societal barriers to accessing these treatments and the need for a more scientific approach to addiction treatment.

20:05

🌐 Societal Perspectives and the Future of Addiction Treatment

The final paragraph addresses the societal approach to addiction, advocating for a shift from stigmatization and criminalization to a more scientific and understanding perspective. It emphasizes the importance of education and accurate information in preventing addiction and discusses the effectiveness of various treatments, including behavioral therapies and medication-assisted treatment. The paragraph concludes by reiterating that addiction is a chronic brain disease that can be managed with appropriate interventions and should not be viewed as a moral failing.

Keywords

💡Addiction

Addiction, in the context of this video, is described as a disease characterized by compulsive engagement in rewarding stimuli, despite adverse consequences. It is central to the video's theme as it discusses the prevalence and impact of addiction in the United States, particularly focusing on opioid and alcohol use disorders. The script emphasizes that addiction is a treatable condition, contrary to common misconceptions.

💡Dopamine

Dopamine is a neurotransmitter responsible for the brain's reward and pleasure centers. It is crucial for motivation and is linked to the feeling of satisfaction and happiness. The video explains how addiction hijacks the dopamine system, causing an imbalance that leads to cravings and compulsive behaviors. For instance, the script mentions that methamphetamine can cause dopamine levels to spike unnaturally high, leading to addiction.

💡Opioid Use Disorder

Opioid Use Disorder refers to addiction to drugs primarily used for pain relief, such as prescription painkillers and heroin. The video script highlights the severity of this disorder, noting that it is a leading cause of injury-related death in the United States, surpassing car accidents and gun violence.

💡Epidemic

The term 'epidemic' is used in the script to describe the scale of addiction, particularly opioid addiction, in the United States. The CDC has labeled the situation an epidemic due to the high number of overdose deaths, emphasizing the urgency and widespread impact of the issue.

💡Limbic System

The limbic system is a set of brain structures involved in情绪调节 and survival instincts, including the regulation of dopamine. The script identifies specific parts of the limbic system, such as the ventral tegmental area and the nucleus accumbens, as being integral to the experience of reward and addiction.

💡Motivation

Motivation, as discussed in the video, is closely tied to dopamine levels. It is described as the drive that prompts individuals to engage in behaviors that are beneficial for survival and well-being. The script explains how addiction disrupts this natural motivation by causing an artificial surge in dopamine, leading to a dependence on substances to feel motivated.

💡Methadone and Buprenorphine

Methadone and buprenorphine are medications used to treat opioid use disorder. The script explains that these medications work by stabilizing dopamine levels, reducing cravings, and preventing withdrawal symptoms, thereby helping patients engage with treatment and recovery.

💡Craving

Craving, as depicted in the video, is a powerful desire for a particular substance, driven by the brain's need for dopamine. The script uses functional MRI imagery to illustrate how craving activates specific areas of the brain and is stronger than the need for food or water, highlighting its role in addiction.

💡Decision Fatigue

Decision fatigue refers to the deteriorating quality of decisions made by an individual as a result of an extended period of decision-making. The video script connects this concept to addiction, suggesting that the constant need to resist cravings can exhaust an individual's capacity to make healthy choices, potentially leading to relapse.

💡Stigma

Stigma, in the context of this video, refers to the negative and often incorrect perceptions associated with addiction. The script calls for a reframing of stigma as discrimination, advocating for a more scientific and understanding approach to addiction treatment and societal attitudes.

💡Prevention

Prevention, as discussed in the script, involves providing accurate and appropriate knowledge to young people about addiction. The video emphasizes the importance of education in preventing the onset of addiction, as opposed to simplistic or fear-based approaches.

Highlights

21 million people in the United States suffer from addiction, with 15 million having an alcohol use disorder and 3 million an opioid use disorder.

Opioid use disorder is the leading cause of injury-related death in the U.S., surpassing car accidents and gun violence.

In 2015, over 50,000 people died from drug overdoses, marking an epidemic according to the CDC.

Dopamine is a crucial chemical for motivation and survival, with levels varying from 40 ng/dl on a bad day to 100 ng/dl on the best day.

Addictive substances like methamphetamine can increase dopamine levels to 1,100 ng/dl, causing the brain to crave more.

The brain's limbic system, including the ventral tegmental area and nucleus accumbens, is responsible for the reward system and motivation.

Addiction is characterized by impaired control, social impairment, risky use, and pharmacological properties, with behavior being a key diagnostic factor.

Craving for drugs can be so intense that it surpasses the survival instinct for water and food, as shown by fMRI studies.

Medications like buprenorphine and methadone can help normalize dopamine levels in patients with opioid use disorder.

Therapeutic engagement is crucial, but without proper dopamine levels, patients struggle to retain emotional memories from therapy.

Decision fatigue can lead to poor choices, emphasizing the importance of managing cravings to prevent relapse.

Behavioral therapies and medication-assisted treatments have shown high effectiveness rates in treating addiction.

Societal stigma and discrimination against addicts must be addressed to ensure ethical treatment and support.

Science-based approaches, not beliefs, should guide the treatment and understanding of addiction as a disease.

Preventing addiction involves providing accurate knowledge and education to young people about the risks and effects of drugs.

Addiction is a chronic brain disease that can be managed with treatments that are 60-75% effective, focusing on the dopamine and reward axis.

Transcripts

why is addiction a disease that we have

to understand the main reason for this

is 21 million people in the United

States have the disease of addiction 15

million of those suffer from an alcohol

use disorder and 3 million of those

suffer from an opioid use disorder an

opioid use disorder is an addiction to

things like painkillers and heroin it's

the number one cause of injury-related

death in our country the number one

cause more than car accidents and gun

violence in 2015 we had over 50,000

people died of overdose 50,000 people of

a preventable disease

the CDC even called this an epidemic and

so now what we have are people who have

a disease that we can identify that we

can treat but we're not so how are we

going to stem the tide of this problem

well let's go back and start about

thinking in a way that we can understand

addiction from a human standpoint so we

need 3 things to survive you need food

you need water need dopamine now some of

the people who get a little antsy say we

also need oxygen yes well we also need

skin but I'm not gonna really talk about

that today we're gonna talk about the

three things we absolutely need to

survive as a human in today's world and

that is food water and dopamine

we need dopamine because it's the

chemical responsible for motivation it's

this thing that's responsible for us

going and making a friend having a

mother have a bond with a baby it's the

thing that motivates us when we do good

to do better when somebody Pat's you on

the back and says good job and you go to

do something more significant that's

because your dopamine has gotten pinged

and it's just something pushing you this

invisible chemical that's pushing you

along the path on a normal day we even

know how much dopamine we're supposed to

have

so on Monday morning when I wake up and

I have to get up and I go to work I live

in the range of about 50 nanograms per

deciliter of dopamine that sits in the

central part of my brain and that's

required for me to get out of bed and go

get that first cup of coffee now what

about the worst day the really bad day

the day you you know you called your

office and you fake vomit on the phone

and you decide not to go in you're like

I just can't make it that's about 40

nanograms per deciliter so not much

lower but low enough to where you just

want to sit around and your pajamas all

day and do nothing what about the best

day ever

you know the day we're all at once you

win the lottery you have 2% body fat and

you're living on the beach all of those

things happen at the exact same time we

even know that one that's a hundred

nanograms per deciliter our brain is

meant to go all the way to there it's

not really meant to go above and we can

look at things like your favorite food

which is like 94 nanograms per deciliter

and Sachs 92 nanograms per deciliter

bummer right couldn't have predicted

that maybe they need to redo that

research but at the same time we know

that we're supposed to live within this

relative normal state between 40 on a

horrible day and a hundred on our best

day so what happens when we add a

chemical into the brain like

methamphetamine this chemical is really

important because it pushes us way past

that hundred nanograms per deciliter in

fact it actually pushes up to 1,100

nanograms per deciliter more than ten

times the amount of dopamine that our

brain should be making and then if we

look at things like marijuana or alcohol

or heroin these are things that push it

up into the high hundreds this is not

what we're supposed to be doing as we

look at this we have the normal that

we're supposed to be we have this large

jump for something like methamphetamine

and then we have these other drugs that

drive that dopamine up and when that

happens it starts to take over that part

of the brain and no longer does going to

your child's birthday make you happy

it's not happening the things that

normally make us feel happy start to

pale in comparison this is because the

brain is built to survive in fact we

know that this is a survival issue for

the brain mainly because dopamine is

what drives us to procreate to get food

to get water

like we talked about and we know so much

about addiction and all of these things

that are going on in that part of the

brain that we actually know the parts of

the brain responsible for this

motivation in this dopamine release it's

places like the anterior cingulate gyrus

the lateral bed nuclei of the amygdala

the the nucleus accumbens the ventral

tegmental area the periaqueductal gray

we know this and by the end of all of

these videos on this side you're gonna

know exactly what each of those parts do

but for now you should understand that

this area of the brain called the limbic

system which includes but it's not

limited to the ventral tegmental area in

the nucleus accumbens are responsible

for reward and the fact that we can look

on an MRI and see these parts of the

brain working and we can see them

working in a patient who is not on any

drugs and those that have been on

illicit substances for a long time and

see major differences in how these

structures work is really important

because it allows us to start to

understand things like behavior we can

see that all of the focus is on the

dopamine part of the brain remember that

nucleus accumbens and ventral tegmental

area that we talked about in that part

of the brain when you've been taking

things like methamphetamine for a long

time every time that you take the

methamphetamine it goes from a thousand

one hundred then the next time maybe

it's 900 then six hundred and five

hundred and two hundred and 100 then

you're required to take that drug even

to get you up to that normal level of 50

nanograms per deciliter let's say we

found this person we get them into

treatment and we remove that drug now we

have people whose dopamine goes all the

way down to as low as 10 nanograms per

deciliter and on their best day ever

it's only 20 nanograms per deciliter

these are numbers that matter and we're

gonna keep hammering on these because

when you have 10 nanograms per deciliter

you can't get out of bed you can't get

up to put your clothes on and go to a

job interview or to even take care of

yourself or your family when we lack

dopamine the body craves it and when you

crave dopamine you get into survival

mode and that leads to primal action and

that primal action is a lot of times the

behavior that we see how can they take

grandma's jewelry how can they steal

credit-card how can they pawn something

that they owned their brain is telling

them that they are not going to survive

if they don't get dopamine and the thing

that gives them the dopamine that they

need as far as they know is that drug of

choice behavior is so much about how we

define addiction that we even use it as

the diagnosis the dsm-5 the diagnostic

and statistic manual version 5 which is

what all psychiatrists use to help

define mental health disorders defines

addiction not based on some lab tests

not based on a urine drug screen but

very much basis it on the behaviors of a

person and we break it into really four

major areas four pillars and there are

eleven criterion in those four pillars

and when we look at it you look at

impaired control of use of the drug

meaning you can't really say no to the

next one or even the first one we look

at other things like social impairment

how much does it really mess up the

people around you and the interactions

that you have with your parents or your

friends or your spouse or people that

work and then we have risky use risky

use means do I know injecting this is

gonna cause me to get an infection in my

heart or could give me HIV or hepatitis

C but I'm still going to use it and then

we have the pharmacological properties

which are really two out of the eleven

so nine of these eleven have nothing to

do with chemistry or labs or EKGs it's

purely based on the behavior of the

person it is unacceptable that we are

removing patients out of primary care

offices in any other place in the in the

healthcare system like a hospital or an

emergency department when their behavior

is bad because of addiction because

that's how we define it that is the

diagnosis so we should assume that

behavior is a symptom and not a

frustration when we look at craving

which again is what drives a lot of this

behavior we actually have good data

around craving and how that looks so

when we look at functional MRIs of the

brain is a picture of the brain and we

can see areas light up in these areas

light up you know consistent with what

part of the brain is working and how

hard it's working we had patients who

were

dehydrated we're in starvation mode and

had not received their drug of choice

for a period of time we had patients who

hadn't had anything to drink for three

days that's a long time and these are

patients who are starting to get to the

point of dehydration where it's gonna be

survival need for water and not just I'm

a little bit thirsty so for these

patients we looked at a functional MRI

we put them in in the tube in the MRI

and we would ask them questions like

tell me about a waterfall we would play

you know sounds of waterfalls in the

background and we would sprinkle water

on their feet and take pictures of the

brain and we can look at these areas of

the brain that are responsible for

craving like the anterior cingulate

gyrus that one we talked about earlier

and it would light up to about the

relative size of a baseball we did this

for food so we had patients who didn't

get any physical food and no / oral

meaning they didn't eat any food for

five days they would get some IV fluids

and some vitamins because we don't want

to kill people that we're trying to test

but at the same time five days without

food and then we put them into the

functional MRI we then talk to them

about their favorite food we then

brought their favorite food into the MRI

suite and we kind of washed it it into

the MRI tube so they could smell it and

then we have them talk about how it

would taste and then we had them taste

it and spit it out and through all of

these we looked at the brain through

this functional MRI and in those same

areas instead of a baseball for

dehydration

we had the size of about a basketball

for starvation so we know what people

will do when they're dying of thirst or

they're dying of starvation I mean they

will rob they will steal I mean imagine

if you walk through the desert and in

three days time you walk through the

desert and you get to the end and all of

a sudden there's this pedestal with a

beautiful glass of water with

condensation coming down the side if it

was me and I walked up to that and then

somebody stepped in front of that glass

of water and said no no this is this is

my water I'd be like okay stab and I

would move them out of the way and then

I would take this water and I would

drink that water immediately because

that is survival and people get into

getting in the way of survival they

really put themselves at risk and we

know that and actually will kind of

accept that when people are looting

stores when there's a famine or when

people are doing what they can to

survive for their children or

to not die we accept those things what

about in addiction we took patients who

hadn't had their drug of choice and in

these cases for these studies it was

alcohol and opioids and so when we took

those patients and we put them in a

functional MRI and we asked him a couple

of basic questions tell me about the

first time that you used your drug and

the last time that you used your drug

that's all we really asked that craving

of just thinking about the drug lit that

brain up and it lit it up no matter if

you were 30 days 60 days 90 days or one

year it was almost exactly the same that

craving signal in the brain did not

decrease until two years and what we

found was the relative size of that

craving was not a baseball or a

basketball it was a baseball field

so the craving for dopamine and that

drug of choice so far out stretches the

desire to not die from dehydration and

starvation that it starts to make me

understand why these behaviors happen so

consistently among patients who have had

the disease of addiction

so if dopamine is lacking in the nucleus

accumbens and this is the basis for

driving this behavior then augmentation

of dopamine might make sense right if we

raise dopamine back up to normal levels

then they won't feel craving and they

won't be starving for the drug that can

it allow us to have an appropriate

conversation with a patient allow them

to be engaged in treatment so when we

look at how we do that we found that the

two medications at least for opioid use

disorder that do this are buprenorphine

and methadone by giving those

medications we actually can raise the

dopamine back up to normal levels so

that this person doesn't have to think

about I need my drug I need my drug

because what they're really thinking is

I need dopamine I need dopamine I need

dopamine and that starts in the morning

from the second they wake up and it is

there all day without this we're not

able to get patients stable enough to

have therapy do anything for them

because without dopamine in the brain

what you're not getting

is even onboarding of emotional memory

because it's required for that and so

when they go into therapy without having

their dopamine in the right place what

they're hearing is right right right Ram

they're not getting anything from that

we have three major medications for

opioids and one of those is now trekked

zone and now trucks on actually blocks

opioids so it doesn't necessarily

increase dopamine but for some people

with a less severe substance use

disorder or motivation again there's

that term motivation when we talk about

motivation I always want you to think

dopamine if you hear dopamine I want you

to think motivation motivation equals

dopamine dopamine equals motivation so

when we talk about I really want a

motivated patient or client to go get

their therapy we're talking about

someone who has enough dopamine to have

that motivation without it they're not

motivated we talked about this in a

number of different ways we talk about

it in stages of change are they pre

contemplative you know are they in the

action phase do they want to come and do

something positive for themselves we use

these really pejorative terms in

addiction medicine like well they need

to hit rock bottom first I don't think

that's an option anymore given that we

had 50,000 people died last year of

overdose because that's rock-bottom for

an opioid use disorder but for those

patients who have a lesser version of

opioid use disorder maybe something like

an out wreck zone which is a chemical

two blocks SOP or it can be really

helpful for them because they already

have that intrinsic motivation they're

already ready to move forward because

they have this dopamine we also have

other parts of the brain like where

alcohol works it works on another part

of the brain other than the opioid

receptors it works in the

gamma-aminobutyric acid receptors right

these really specific receptors that

they're the ones that make you feel

super happy after one or two drinks and

then not so super half day after four or

five drinks it's also the same part of

the brain that drugs like Vin's adays

apenas which are like ativan and valium

or diazepam

you know these are things that change

that part of the brain

what about parts of the brain that are

affected by marijuana so marijuana

releases

dopamine from the nucleus accumbens and

we found that we have a drug that

actually blocks that extra release of

dopamine so for people with a marijuana

use disorder

we even have medication that can change

the way that that dopamine is released

so for certain drugs it's all about

dopamine and for other drugs

it's indirectly about dopamine but the

final common pathway is dopamine and

whether you have the motivation to

onboard therapy and the ability to stay

retained in treatment one of the other

things to think about is the whole point

of decreasing craving is what think

about it to keep the patient from

relapsing that's the whole point because

if you have craving you're more likely

to go out and actually get a drug or

take a drug or steal something to go get

a drug so how would we decrease that

relapse so there's some interesting

research that's out there right now that

talks about the more decisions we make

in a day the less likely we are to make

a good decision later this research that

was originally done by parole board so

they looked at the decision whether or

not someone would be able to be let go

from jail out on parole and they took

the parole board and they looked at the

decisions they made in the morning when

they were fresh when they first started

making decisions versus those decisions

they made generally later in the day and

what they found that if your case was

heard early in the morning you were

three times more likely to be let go as

compared to being heard in the afternoon

everything else was the same the

severity of crimes the color of your

skin male or female it didn't matter

what it came down to was there's a point

at which your brain is done taking risk

or doing something different and for

people who know that they can stabilize

their dopamine who know that they can

feel normal risk is saying no to that

the Regular Decision the easiest

decision is to say yes to that so think

about if you wake up in the morning and

the first thing you think of is please

don't let me use today and the second

immediate thing you think of is how can

I get my drug of choice and then you

have to say no to that and then about

every five seconds after that

over and over and over again you're

having to say no to that thought and

then if you're walking down the street

and somebody comes up to you you have to

say no to that and you have to be in the

right frame of mind by the end of the

day if we haven't controlled craving in

any other way we're gonna have someone

who has run out of the capability to

make the decision that they want to make

and their brain will chemically not be

able to make the right decision it is

not like somebody draws a pros and cons

sheet on the refrigerator and starts

talking about the pros and cons of

whether they're gonna go buy drugs today

this is not how it works

decisions fatigue is a huge player in

what happens in the afternoon or

evenings for these patients because by

the end of that day they have said no

10,000 times and that 10,000 and

first-time may be the time that they

relapse and so using medications and

other therapies to significantly

decrease craving is really important we

have treatments for opioid use disorder

that are 75% effective we have

treatments for alcohol use disorder that

are 65 to 70% effective these are

numbers that are better than any other

disease I mean we have 75% rates for

like strep throat with an antibiotic

there's still 25% that don't actually

get better but when you start looking at

things like diabetes and hypertension

these are people who getting better

looks in about 45 to 50 percent we have

this thing called the a Sam criteria and

this criteria has been validated and is

used in almost every state in the

country behavioral health interventions

also have a long history of being really

helpful for these populations anywhere

from one-on-one therapy to group therapy

to self-help therapy these are all

things that when applied to the right

patient at the right time absolutely can

increase this medication assisted

treatment for all addictions that have

medications should be thought of right

out of the gates to help stabilize that

craving so that the rest of these things

can be helpful so when we look at opioid

use disorder and we have methadone which

is 75% effective

buprenorphine that's about 65% effective

now track zone which is anywhere from 25

to 60 percent effective and yet less

than 10% of people

even have access to these meds that's

amazing to me

well what about alcohol use disorder

remember we talked about 15 million

people have an alcohol use disorder and

we have medications that have for a long

time shown really effective treatment

and those are now trucks owned again

which for both of these it can't per se

gabapentin disulfiram and even baclofen

these meds that we use all the time and

feel very comfortable with can be used

to help decrease that craving so that we

can increase the likelihood the

behavioral therapies will work and then

when we look at medication assisted

treatment for marijuana we actually have

a medication for that in acetylcysteine

this is a med that's benign in all other

capacities but can help to really get a

patient successful without making it so

tough for every single person that comes

through what about society like is there

an approach that we should be taking

from a societal effort yeah I think one

we have to start really taking a hard

look at stigma and in fact I would

reframe stigma and turn it into

discrimination because we're at a point

where if you come into the emergency

department or after an overdose in your

released 30 minutes after you arrived as

compared to someone who's had chest pain

and gets admitted and gets all of these

testing that's discrimination

that's not stigma and so we have to

start understanding that we are not

doing ethical things to these patients

when they show up science is the basis

for the approach that we need to take

not a belief you can use your belief

system and how you apply the

evidence-based science in fact I think

for patients that's probably a better

way to do it but you can't use a belief

system as the science this is doing a

great disservice to patients and we have

to start pulling those together in the

way that it should be in criminal

justice world we have to stop

criminalizing these patients for having

a disease that we have a treatment for

we know that that behavior can be

defined based on craving we know that

craving can be seen on a functional MRI

we know that it's greater than

starvation and dehydration and most

importantly we know we have treatments

for this so to take someone who has very

obvious behaviors of addiction and put

them in jail

no treatment doesn't make any sense and

when we start to look at how we prevent

this disease it has to be giving

accurate appropriate knowledge to the

kids not telling them to just say no not

frying an egg in a pan and telling them

that's what their brain looks like

knowledge and education in the same

sense that we would give anyone else the

thing that I need you to walk away with

after this video is that addiction is a

predictable chronic brain disease not a

moral failing

it has treatments that are 60 to 75

percent effective it has behavioral

therapies that are well identified and

we can apply on a regular basis and that

the fundamental funnel for all

addictions is in this dopamine and

reward axis that part of the brain is

responsible for motivation and

ultimately survival and if we can use

the science to affect survival in these

patients then we will absolutely come

out ahead