Marc Lewis: Learning Addiction, Festival of Dangerous Ideas 2015

[ Music ] [ Applause ]>>Hello. My name
is Johann Hari. I’m a British journalist. I wrote a book called
Chasing the Scream: The First and Last Days in the War on
Drugs which is why I’m here. And I’m really excited
to introduce Marc Lewis. I just wanted to speak for
second about the context of the work he’s doing in
a second about who he is. Because I think it’s
really exciting and important what he saying. There’s a really profound
debate going on across the world at the moment about the nature
of addiction, what it is and of course if we don’t know
what it is, we can’t know how to turn addicts’ lives around. And I think the broader context
of the work that Marc’s doing, just so you know how brave
it is, is, you know, in 1970, Richard Nixon sets up something
called the National Institute for Drug Abuse, NIDA. And he gets a very specific job. Its job is to find evidence that
the war on drugs is a good thing and that currently banned
drugs are evil and we need to stop them and all that stuff. And the National Institute
of Drug Abuse today funds 90% of all research into currently
illegal drugs across the world, not just in the United
States, across the world. That means the vast majority
of scientists working in this field take
money from NIDA. And there are things
that NIDA won’t fund and there are things you can’t
say if you want money from NIDA. And NIDA have been big
promoters of a very narrow and very specific theory
about what addiction is. And very few scientists
challenge it because the whole, you know, imagine of 90%
of all the journalism in Australia was
funded by Tony Abbott. What picture would you
get of Tony Abbott, right? People would be afraid
to challenge it. And what Marc is doing is
so important and there are so many taboos that
he’s challenging. He’s the professor
of neuroscience and developmental psychology at Radboud University
in the Netherlands. He’s previously been a professor
at the University of Toronto. His academic work is
really prestigious. He’s published over
50 journal articles. I actually first learnt about
his work when I read his memoir, his book, Memoirs of
an Addicted Brain. For Marc, this isn’t just
an abstract question. This isn’t just an
academic question. For the, almost the whole of his 20s he had a very
serious opiate addiction which he’s written
about very bravely. His new book, which he’ll
be signing after this event and I’ll flag that up again
is The Biology of Desire: Why Addiction is Not a Disease. It’s such an exciting
thing to be able to do. Ladies and gentlemen please
welcome Professor Marc Lewis. [ Applause ]>>Thank you, Johann. That was really a very
generous introduction. I don’t feel I have to
be so brave in Australia because people are so nice. It’s great to be here. Okay, so, I’m going to
take you through this. Learning addiction, what if addiction isn’t
a disease at all? I guess that’s the
dangerous idea. Or maybe by the end
of this we might feel that the dangerous idea is
that addiction is a disease. If that’s a wrong idea and
it’s so dominant and it’s so prevalent, and that’s
kind of dangerous, right? Bad ideas are bad. Okay, that was profound. Okay, so there are number of
models of addiction and ways of conceptualising it. And of course the
disease model is the one that I will be arguing against. Its converse is the
choice model, the idea that people choose
to do addictive things or take addictive drugs. It’s a more cognitive
model, obviously. There’s other models. There’s the traumatic early
history model which implies that addiction is
about self-medication. Because if you’ve been
through difficult, difficulties in your childhood
or adolescence, then you probably
don’t feel very good. You probably have some anxiety
and depression that you have to live with and an
addiction can make you. Addiction doesn’t
make you feel better. But the drugs that you take
the eventually become addicted to may make you feel better and that was the case
for me in my 20s. And finally the learning
model, which is the model that I espouse here, the idea
that addiction is learnt. And as Johann says, NIDA is
a very powerful organisation and they define addiction
very clearly as a chronic relapsing brain
disease that is characterised by compulsive drug seeking and use despite harmful
consequences. So, the key words
here are chronic. Okay, chronic brain disease. And they talk about it,
brain imaging studies from drug addicted individuals
show physical changes, physical changes, in areas of
the brain that are critical for judgement , decision-making,
learning and memory and behaviour control. And, you know, again,
physical changes the important phrase here. And finally they
pretty much agree that in vulnerable individuals, the disease of addiction
is produced by chronic administration
of the drugs themselves. In other words, and this
is something you talked about in your book as well. The idea that drugs
cause addiction. That has been the premise. That’s been the sort of,
yeah, well, what else. But in fact both Johann
and I don’t think so. And I’ll tell you why. So, here’s the basic model. You’ve got, does this thing
work as a beamer as well? I wonder if it does. I’m used to using my finger. Oh, it does. Okay, so, that thing
there, that’s the striatum. It’s been around for a
few hundred million euros. It’s been involving
for a long time. And its job is to
make you pursue goals, to get you to pursue goals. It’s really important
for mammals to pursue goals, obviously. Food, sex and all the rest
of it, protection, shelter, escape from predators. Those are all goals. And to do that, mammals, unlike
frogs, need to be motivated. Frogs just have some kind
of circuitry that, you know, they flick, they see a fly go
by and their tongue flicks out and that’s great for a frog. But for us, we have
to be motivated. So, what the striatum
does besides, in narrowsand focuses
your attention on the goal that also pushes you
towards the goal. And that push is
basically desire. In the simplest form,
that is desire. And desire is an
extremely important emotion which directs a lot of
our activities in life. So, there’s that part,
the more ancient part. And then there’s this part, the prefrontal cortex,
dorsolateral up here. That’s one of the most
sophisticated rooms in the prefrontal cortex and
it’s responsible for judgement , decision-making,
perspective taking, all that good stuff, insight. And usually, you know,
there is a conversation between these parts
of the brain. They’re very much connected. And they have to be connected
so that you can continue to modulate your desires and
decide what’s the best way to achieve whatever you want
to achieve without getting into too much trouble. And, you know, get more
of it rather than less and so on and so forth. And by the way, both of these
systems are fueled by dopamine. So you hear a lot about
dopamine when you read about addiction in
science journals. And they used to call
dopamine the pleasure chemical. But it’s not really
about pleasure. What dopamine does is it
activates these systems to focus attention and narrow
attention and drive desire. Okay, so dopamine is very
important as you start to get closer and
closer to the goal and you really want
it, you really want it. In the dopamine, more dopamine
and it’s like, you know, it’s the only thing
on the radar. So, in addiction, what
happens is that you get, sorry, you get a kind of breakdown
of the communication between these regions. They start to become partially
disconnected when drugs or booze or gambling are on horizon. And does that sound
like a disease? It does sound kind
of like a disease, but it’s not and here’s why. Here’s why. Advantages of the disease
model, I won’t bother. I’ll let them do
their own advertising. Forget about that. Okay, the first thing is
so I’m not the only person who says addiction is about
learning, that it’s learnt. Other people say that too but
I’m one of the very few people who comes at that from a
biological perspective. So, I can talk the talk and
I can argue with the people at NIDA, the people who do
the medical neuro research because I understand
aspects of the brain. But I understand that as a
developmental psychologist, okay, not as a, so I
see things in terms of development rather
than pathology. It’s a really different
perspective. And so what I say is
that brains change with learning and development. Well, everybody knows that. The brain changes hugely
from infancy and childhood through adolescence and
it’s changing all the time. It’s supposed to change. You don’t want your liver to change a whole lot
during your lifespan or your pancreas or your lungs. Most organs you want them to
stay exactly the way they are. But your brain, no. You don’t want it to
stay the way it is. It needs to change. That’s how it does learning. That’s how it learns, is by
forming different connexions, new connexions between the
neurons between the brain cells. Those are called
synapses, those connexions, forming new synaptic
patterns all the time and trimming off the
old synaptic patterns which is called pruning. The brain is supposed to change. So, what I say is
that brains change with learning and development. So, brain change doesn’t mean
brain disease unless the brain changes seen in addiction
are very different from those seen in, wait
for it, wait for it. Those seen in, whoops. You have to be quick. Normal development. They have to be pretty
different, okay? So are they? Are they different? Well, in general, learning
equals, like I said, synaptic restructuring and
that leads to habit formation. Because as you learn stuff
you are forming habits. That’s how learning works. When you learn how to
ride a bike, you know how to ride a bike and you don’t
have to think about it anymore. Same with learning
to play the violin, same with learning language, same with learning
how to drive a car. Learning gives rise to habits. So, that’s kind of a
clue to where I’m going. In normal development,
this is what you see. You see the brain becomes
more and more blue. No, actually, that’s not
exactly what happens. What happens, this is a movie
of, taken from an MRI images from kids from the age of
4 to 20 averaged together. And what you see, this bluing, let me see if I can
make it do that again. This bluing is a process
of synaptic pruning. Okay? And if you look
at scale on the right, you see that the
colours at the bottom of the scale are
more blue and purple and those are the thinnest
parts of the cortex. So, what that means is you are
pruning and pruning and pruning which makes the cortex
more efficient. People think that brain
development is just about new synapses. Synaptogenesis. It’s not. A lot of it
is trimming synapses, pruning synapses so that
the brain becomes a lean, mean machine. Okay, a streamlined machine. That’s how it’s supposed
to go in development. And here’s, again, the bluing,
the thinning of the brain over 16 years in 8 seconds. Boom. Now you’ve
got a mature brain. Okay? All right. I just want to give you a sense
of the scale of this thing. There’s a lot of change going
on in normal development. In the height of, okay. I’ll read it. As many as 30,000 students
synapses may be lost per second over the entire cortex during
the pubertal adolescent period. 30,000 synapses per second. That’s a lot per second. Okay? So, massive, massive brain
change in normal development. So, that’s the first point. Now, and the folks at NIDA, the
disease people want you to look at this and say look, with
years of use of alcohol, cocaine and heroin, with years of
use, you get a thinning, a reduction in grey
matter volume. Grey matter volume just means
synapses basically for us. Synapses. You get a reduction
of synapses down, down, down. The longer we use drugs,
the more pruning you get. And that’s the certain areas of prefrontal cortex
and related areas. So that again something like
a disease until you think about it more carefully. When you think about it more
carefully, you recognise that pruning is important and actually makes the
brain more efficient. So, when you’re taking
drugs for years, the brain is actually
getting more efficient. It’s getting more efficient
at, you know, getting loaded. Which is maybe not such
a good thing according to our morals and stuff. But the brain doesn’t care. It’s just getting more
efficient at something because it’s repeated. It’s a repeated thing. The brain gets more efficient. But here’s the cool
part of the story. These researchers found that
when people abstain from drugs, from 40 to 60 weeks, the density of those regions
goes back up, up, up. It crosses the baseline
for normal people who have never been addicted
and keeps on going up. So, that implies that you’re
learning new stuff, okay? So, this is neural plasticity. So, pruned synapses
can be replaced through subsequent learning. That’s neural plasticity
in a nutshell. Which takes away from the idea that addiction is a
chronic brain disease. Whatever you want to call these
changes, they’re not chronic. There’s no dead ends. The brain doesn’t
suddenly stop changing. And there’s been a lot of
work on neural plasticity in the last, well,
couple of decades. Norman Doidge which,
probably some of you know the brain
that changes itself. And we know this happens. People have strokes
or concussions or traumatic brain injury,
the brain just regrows stuff. So, why shouldn’t that happen
when people give up drugs? It does happen and
here’s evidence. Okay, so I’m going to go just
a little further on this. The brain change again doesn’t
mean brain disease unless the brain changes seen in
addiction are different from those seen in,
what’s next on the list. Seen in behavioural addictions. And I won’t get into the details
but there are many addictions that have nothing to do with
drugs and I’m sure you know. Gambling, compulsive gambling. Porn addictions, sex addictions. Internet gaming addictions
is now, joined the, and many eating disorders
actually have features very much like addiction. Well, the fact is that the
brain changes seen in all of these behavioural
addictions are exactly the same as those seen in drug addiction. Okay, not exactly, but
they’re mostly the same. Which implies that
addiction goes with, that addiction is a
psychological process that yes, it’s kind of learning and
yes it involves brain change. But the brain changes are
not produced by drugs. Because if they were,
you wouldn’t see them with gambling addiction. You just wouldn’t
see them, but you do. Okay? But you do. So it’s not about drugs,
it’s about habit information. And that would take
the rest of my time so I won’t bother with that one. But just take my word for
it that there is a sequence of brain changes that
are completely parallel in behavioural and
drug addictions. And finally, brain change
doesn’t mean brain disease unless the brain changes seen
in addiction are different from those seen in
falling in love. Unless falling in love
is also a disease, which sometimes it does seem. It has all kinds of nasty,
sometimes fatal effects. But in fact, this
is just a summary of a whole bunch of research. Like with drugs of abuse, mesolimbic dopamine is a major
contributor to the formation of paired bonds in prarie
voles and particularly in the nucleus accumbens. That’s part of the striatum. Mating has been shown to
cause dopamine release in the nucleus accumbens
in rodents. Sorry, that’s just the
southern pole of the striatum. And why do they study
prarie voles? Well, it’s one of
the very few mammals that happens to be monogamous. It’s supposed to be an
analogue to human sexuality, but it’s a matter of debate. Anyway. You need
dopamine to be attractive, to be strongly sexually
attracted, that whole early phase of
romance which all you think about is the positive
features of your loved one. It’s the only thing you
want is to be with them. You don’t think about
the negatives. You don’t think about the
fact that this is going to get you in a lot of trouble. Maybe and so it’s very much like drug addiction
psychologically but also neurally. Okay, so again. These brain changes are
not specific to addiction. They’re not specific to drugs. They have to do with
learning something which is highly motivating and which involves
repetitive behaviour. That’s all you need. Highly repetitive behaviour to something that’s highly
attractive and motivating. Okay, so I’m going to skip
ahead a bit and say, so, if addiction is just
a kind of learning, then why is it sort of special? What’s special about it? And in my book, The
Biology of Desire: Why Addiction is Not a
Disease, I talk in detail about five addicts who
I interviewed on Skype. I interviewed them
very thoroughly, got to know them well. And I tell their stories,
what it was like when they got into their addiction and got
through it and tried to stop in different ways
and finally did stop. First comes Natalie. These are all pseudonyms. The heroin addiction. She’s a young women,
college girl. Brian, methamphetamine
addiction. What do I call them,
Johnny, alcohol obviously. Donna, pills, she stole pills from everywhere she could
find them and got in a lot of trouble with her family. And the eating disorders. This was Alice who got
a binge eating disorder. So, I talk about these people
and I interlace those stories with the what’s going
on in the brain. The brain stuff is pretty
light and user-friendly and I use the stories to
help you understand what it feels like. And I think it’s really
important to do this fusion between what’s going on under
the skin and what’s going on in a person’s life. I think it’s critical for us
to really understand addiction. Okay, so what, I bring to bear
three psychological issues that make it particularly hard
to break the habit of addiction. Whether it’s sex, love, drugs,
rock ‘n roll, whatever it is. The first is now
appealed, a tendency to go after immediate rewards. The second is ego fatigue. And the third is
this whole issue of personality development. How we can think of addiction as
part of personality development. It’s not just an overlay. It’s something you grow into an
and then hopefully grow out of. That’s a developmental
perspective. Okay, so first. Now appeal. So, here’s the villain,
the striatum again, this is what it looks
like on an MRI scan. And you get dopamine
flowing up to the striatum, the nucleus accumbens
and it focuses attention on the immediate goal and
that produces craving. And craving, all
addicts will say that craving is the
worst of their problems. Craving is the one
thing that trips you up. Because you can stop taking
whatever it is, methamphetamine, coke, heroin, you name it,
for six months or six years and again, if the craving
comes out, it’s hard. It becomes hard to get by it. It’s a problem. And it’s specifically
problem because all mammals and many other species actually
have this very peculiar thing. It’s a cognitive bias where
the immediate reward seems to have a lot more value
than the long-term reward. Okay? So, here’s value. The value goes up and these
are mathematical curves that define this relationship. People study this stuff. And you can see here that the
cake curve goes up a lot quicker as the guy’s approaching
the cake. Than this curve which leads
to, I guess being slim and fit or something like that,
or healthy, I don’t know. When you don’t eat cake
what the advantages are that there must be some. So, the question is, why is
that man going after the cake. And the reason is because
it seems worth more than imagined future happiness. It just seems more. And you can observe that because
the blueline goes up really fast as you approach the goal. So, that’s why it’s now appeal. As the goal gets closer, the
thing seems be worth more and we all experience
this all the time. You know, I’ve got
twin boys at home that for years I’ve done this,
they’re great for experiments. So for years, you know, when
we go into a to restaurant, we pass the mint bowl
even though we live in the Netherlands,
there’s always a mint bowl. And I say well, would you
like one mint now or would you like three mints after dinner. And for years they said
oh, I want one mint now. Right? But since they’ve
turned 7 or 8, they say, well, you know, I’ll wait for the
three mints after dinner. So now their prefrontal
cortex is pruning. They’re getting more efficient
and growing and getting better and better at regulating
and overseeing and supervising the striatum,
that goal-focussed tissue. And so that’s what
they’re learning to do, is overcome now appeal. That’s a natural
developmental process. But in addiction, unfortunately,
some of that process gets lost. Addicts lose the capacity to
think more about the future. Why? Partly because
the drive is so strong. Partly because the
thing is so rewarding. And partly just,
it’s just habit. It’s a habit of thinking
where you worry and think about what am I going
to do today. How am I going to
get some today. How am I going to pay for it. How am I going to not
get in trouble about it. So, you continue to get trapped in the present tense
and the now. And you lose the
actual habit or tendency to think about next week. And that’s obviously a problem
because you don’t then think, you don’t then plan on
recovering and getting better because you don’t
think about the future. You can’t think about
the future. It stops making sense to you. I think that’s a really
serious psychological problem for addicts. And so what you end up with
is this kind of situation. Now appeal breaks the
connexion between the present and the future and that drink
right now seems worth more than that happy marriage
that you can look forward to coming out, in six
months or whatever. Okay, so you get the idea. In brain terms, the
dorsolateral prefrontal cortex, which is supposed to
be informing, sorry, I should’ve mentioned, the nucleus accumbens is
code for the striatum. It’s the same thing, it’s that
piece of tissue in the middle. And that connexion
gets sort of broken. Or at least they
become desynchronized. Okay, so that’s now appeal. And now the second psychological
phenomenon which is pretty hard to overcome is ego fatigue. And ego fatigue is what
happens when you try to suppress an impulse
for some period of time. And it’s like holding
your arm out to the side. For some it’s easy
for five minutes but it’s not easy for an hour. And if you keep telling yourself
no, no I won’t, not can’t, no I shouldn’t, no I mustn’t. It’s hard and your brain
isn’t designed for that. It’s not good at that. So, you get ego fatigue. That means it becomes
a real strain and you eventually
tend to give in. So, that’s the second
psychological problem that addicts have. And here’s the classic
experiment is people come into the lab hungry. They’re told to come in hungry
and this was, the stuff was, it’s been investigated hundreds
of times in psychology labs. And in a classic experiment,
subjects are given a bowl of radishes and a bowl of freshly baked
chocolate chip cookies. And half the group is told
you can eat as many radishes as you want but no cookies and the other half is told
you can eat as many cookies as you want but no radishes. So, this is a perfectly
controlled psychological experiment. And guess what? After about 10 minutes of that,
the people in the, hold on, the people in the can’t eat the
cookies group do more poorly on cognitive tests. They’ve lost a certain
capacity for cognitive acuity, for cognitive override. You actually lose
some cognitive, I don’t know what to call it. Capacity for thinking, really. It’s capacity for thinking. It gets strained and
tired and wears out. And these people also give
up on the task more quickly. So, suppressing impulses is
not the right thing to do. If you have strong
impulses that you’d like to not give into,
don’t suppress them. Suppression doesn’t work. What does work is reframe them. If you reframe them, then
you can save yourself from ego fatigue. Which means, you
know, I don’t really like chocolate chip cookies. I really like something,
whatever, cheesecake. You know, or whatever it is. Or I’m having lunch
next or, you know, this is going to
wreck my appetite. You reframe the problem. You don’t get ego fatigue. But if you just try to quash
it and suppress it, then you do and that’s what addicts
are going all the time. They’re being told
say no to drugs and saying no is
exactly the wrong policy. Because what’s been demonstrated in the lab is pure
suppression brings on ego fatigue more quickly
and makes it more powerful. Okay, so that’s number two. And, oh yeah, this
is where I live in the Netherlands right now. And, you know, the cues for
drugs, especially alcohol, which is obviously a drug,
are all over the place and you can’t get rid of them. And since the cues start
this cascade of dopamine to the striatum and the desire
and the wishes and the craving, as soon as the cues are
in your environment, then the cycle starts and
then you have to say no, I won’t go there and
then you’re in trouble. Okay? Okay, and the third
part is just the way personality forms. The way all learning and
development happens is that you get this
perfusion of synapses. I use ivy as an analogy, the
ivy that grows in your garden. This perfusion of synapses
which are kind of messy and then with repeatedly experience,
repeated, repeated experience, whether it’s learning music,
learning to drive a taxi, learning to communicate with
people, learning to share. Whatever it is, that
network of synapses changes and becomes more
consolidated through pruning. It becomes more efficient,
it becomes more streamlined and that’s how the brain grows. That’s how the brain
becomes a highly efficient cognitive machine. Okay? So, but when what you’re
learning is to say yes to drugs in your learning through
repeatedly exposure that this is what
makes you feel better, this is what provides relief,
this is what, you know, this is what’s the most
important thing in your life. Then all the other goals and
all the other satisfactions that you had available to you
fall off the edge of the table. They fall off the radar. And that’s really serious. Because what you have learnt is
that this is what’s important, nothing else is nearly
as important and that learning becomes
a part of who you are. It’s not just a habit
of thinking and feeling. It’s also a habit of
attaching meanings something. Okay? This is meaningful. This is valuable. And that’s why people who give in to drugs get into
drugs cultures. Get into groups who do drugs. Get into cliques. You know, it’s not
just the drug taking. It also the whole social
fabric that it goes with becomes part of it. And you see yourself
as a druggie. I’m a drug user. I’m, you know, a
rebel without a cause. I’m a loser. Whatever it is. Or else, you know,
I’m a, whatever, subculture hero or
whatever it is. But you start to define
yourself in those terms and that’s all part of
the synoptic formation and synaptic consolidation the
goes on with repeated, repeated, repeated use, repeated
behaviour. Okay, so I’m going to, I
want to spend the last 5 or 10 minutes telling why
I think the disease model of addiction isn’t just wrong. It’s also harmful. It’s, there’s something
about that that is really bad for addicts and their families. Despite the fact that
it’s been so prevalent. And why the disease
model fails addicts. The disease model calls
for medical treatment. If you have a disease,
go to the doctor. You get medical treatment,
right? And medicalization makes
addicts into patients. You see the doctor,
you’re the patient. And patients don’t feel
that they have the power to change the goals because
they’re not formulating those goals. Somebody else is. So, when you’re a patient,
you follow instructions and you follow instructions
that are given to you by an authority. And that’s your job. And so being a patient
is kind of the converse. It’s diametrically opposed to
the feeling of generating goals and sensing empowerment
about pursuing those goals. And many experts
believe that that sense of empowerment is critical
for overcoming addiction. You have to be able to decide I
don’t want to do this anymore. This is wrecking my life. I hate it, this is shit,
and I want to be different. And once you start to feel
that way, once you decide that you want to quit,
then you’re ready and then you can do it. Okay? But if you’re a patient,
you’re never in a position to do that because you’re
always in a position of following someone
else’s instructions. So, how do we help
addicts feel empowered? Well, we need to strengthen
their desire for other goals or help them strengthen
their desire for older goals. Focus on other goals. Find those goals and, you know, the analogy that
comes to my mind. What happens when
you give the wheel to your teenage kid,
the wheel of a car? You get a whole different thing. When you’re driving,
the kid doesn’t care where you’re going, right? And the kid doesn’t care
what condition the car is in. But as soon as the
kid is the driver, your 18-year-old child,
everything changes. This is now really
important to me. I want to go there and I can get
there and I know how to do it, I want to make sure the
car’s got gas in it. I want to make sure there’s air
in the tyres, all that stuff. Okay, so there’s a whole
different attitude towards direction, towards
where you’re going. So, that’s the first thing. Capture that desire, capture it. Nuture it. The second thing. How do we help addicts
get from now to later? So, how do we combat now appeal? How do we get them out
of that eternal now, that vortex that’s sucking
them into the moment? How do we do that? I think that by helping
them identify and hold on to future goals. So, not identifying those
goals for them but helping them to envision a future self. Take aim at that self
and advancing towards that future self, okay? And that needs to
come from them. And when it does, I mean,
there’s ways to do this. There’s all kinds of
psychological approaches to helping people focus on what
kind of future would you like. Can you think about your future? Let’s think about next week. Let’s think about next month. Would you ever like
to have kids? Would you like to have a family? There’s motivational
interviewing. There’s cognitive
behavioural therapy. There’s rational
emotive therapy. There’s all kinds
of support groups. There’s contingency management. There’s mindfulness meditation. There’s a whole bunch of
psychological approaches that are useful for helping
people figure out and clarify and hold onto a sense
of who they are and where they want to go. And it’s very different from
any kind of medical approach. There’s nothing medical
about it. It’s nothing like
treating a disease. Okay, so I think those are the
directions we need to go in and I don’t have a magic bullet. You know, I don’t have a therapy
manual that I’m ready to hand out but I think these are
really important directions for us to think about. And so treatment I
think will work best by connecting empowerment
to a sense of personal time, activating desire
for other goals. There we go with the nucleus
accumbens, the striatum. I want to quit. Imagining the future self. Reactivating the bridge
to the prefrontal cortex, the dorsolateral
prefrontal cortex, connect the striatum back
to the prefrontal cortex. You can do that with
repeated trials of thinking about other goals rather than
thinking about getting high. This is who I want to
be, this is who I can be, this is who I will be. And seeing your present self
as a stage in your development, from past to present to future. So, it’s not just about now but
now is part of the continuum that stretches from who
I was to I’m going to be. I think that’s, I think
that’s the formula that we need to consider. And so, and finally, yeah,
I think that’s what leads to self-forgiveness
and self-trust. And I don’t have a lot of time
to go into that but if you think about where you’ve come from,
that helps you forgive yourself for where you’re at now. Because addicts don’t feel
very good about themselves. Right? And in order to
learn to forgive themselves for doing what they’re
doing, it helps to think about where they’ve come from. The pain and depression
and anxiety that has probably been a
pretty important factor in moving them towards
the lifestyle that they’re now living. So, that’s important and
then continue that line, that timeline into the
future and there you go. And to base this kind
of approach on science, I think we need to connect
the neurobiology of addiction with the experience
of addiction. I think that’s really important
and that’s what I try to do with my books and
there they are. And that’s all I have say. Thank you. [ Applause ]>>Great. Thanks, Marc. We’re going to take
some questions. Are there microphones at the
front here or they didn’t, I forgot to ask the guys
backstage where they are. You can see them better than me because you are shadowed
in darkness. But one and two, so, why
don’t you go forward. I’ll just ask Marc a
few questions myself. This is really fascinating
what you’re saying, Marc. I was wondering, how much
of these insights were kind of in embryo based on your
own experiences of addiction? How much grew out of your own, could you have had
these insights without your personal expense?>>Yeah, I mean, I think
when I quit, I was about 30 and it was after many attempts. And I wasn’t sure exactly
why it finally worked. I mean, I did certain things and I talked myself
in a different way. And I got sick of it, really, really sick of it,
as people often do. And, but I didn’t, I
don’t know exactly. I don’t know at the time
exactly why it worked. Now, like, 30 years later,
I looked back and thought about it a lot and I retrieved
a whole pile of journals. I’d been keeping copious notes. Because I was really
trying to, you know, talk myself out of it for years. And I went back to
those journals and I followed the
progression stop and then I started
understand it. So, it was really a
whole second take.>>That’s fascinating. Can we take someone there
at number two first of all? Hi.>>Hi. And thanks for talk. So, given this new theory
of retraining the brain and neural plasticity,
what’s your views on conventional medication
to increase dopamine uptake, this knowledge you have.>>Okay, I’m really
glad you asked that. I don’t think that medicine has
to, you know, be completely, I think medicine is
an important adjunct to addiction treatment
sometimes. It’s not necessarily for
gambling or sex addiction but for opiate addiction
in particular, for things that have
physical withdrawal symptoms, physical addictions that lead to extreme discomfort during
withdrawal, and alcohol can as well if it’s, if
you drink enough. Then medication can
be very valuable for helping addicts
move through that stage. Okay, hopefully it’s a stage. Some people go on
long-term maintenance doses of buprenorphine or methadone. And that’s probably not
quite as advantageous because you remain addicted to
do something for years possibly. That’s not the best thing. But as an adjunct to get through
the transition, sure, why not. I think, you know,
if that helps, great. But couple that with other
ways to get to the heart of the matter so that
that’s not the only change that you’re making.>>Thanks. So, we’ll go to number one. Yeah. Hi.>>Hi, Marc. I just want to note,
in regards to, like a drug induced psychosis, can the brain heal
itself from that point?>>Yeah. Drug induced psychosis. Well, you get that
with methamphetamine, if you miss sleep. So, it’s an interaction
effect between the meth and sleep deprivation. That’s what leads to
psychosis and you get that with crack cocaine as well. And very, very occasionally
you get it with psychedelics but it’s extremely rare. I mean, what can
you say about it. You know, people need sleep and people start thinking
really funky things if they get dream
deprivation for several days. So, it’s a real problem
and I know it’s a problem in Australia right now.>>Sorry, just to, to
answer your question, can people recover from that?>>Yeah. Is that
what you’re asking?>>Yeah.>>Yeah. Just what
you presented to us. The pruning of the synapses, I thought maybe there could
be some damage that’s done through that process, from
a drug induced psychosis.>>The second character
in my book as I mentioned a guy
called Brian had a methamphetamine addiction. It lasted for several years. He was deeply into it. He took a lot. And he’s fine now, he’s
in really good shape. In fact, he’s getting a PhD. Obviously, you know that’s. Fantastic person. Fully evolved.>>Is he still medicated?>>Not at all.>>It turns out meth is
a gateway drug to PhD’s. This is really–>>It’s important, yeah,
not to make too light of it. I think that it’s–>>Sorry.>>No, that was a good joke. I thought it was opiates
that led to a PhD. I don’t think psychosis
necessarily implies a brain damage. I think it means
you start thinking in a really distorted way and brain change
underlies all changes in thinking and behaviour. So, yes there’s brain
change involved. Unless, I mean in the
case of schizophrenia, obviously that’s a
chronic condition that is very difficult
to dismantle. But with temporary
psychosis of the sort you get from methamphetamine abuse,
no, I don’t think there’s, that implies lasting
brain damage, not at all.>>It’s fascinating just to
develop this very slightly because I won’t ask
if the anxiety in your question is
relating to yourself or to someone you know
but it’s fascinating. People are being
told in Australia by the government the whole time
that ice, if you use it once, you’ll become addicted. It will permanently
damage your brain. The police refer to
it as mind eating. It’s even routinely mentioned in
news reports by police officers and politicians that
ice gives you, the phrase they use it
superhuman strength. You think about it for
second, there’s nothing that can make a human being
superhuman, in my understanding. What, how would you
respond to those claims? What would you say to people
here who are hearing those?>>From your book I get
that people were saying that about cocaine back in,
what, was it the 20s and 30s?>>Yeah.>>And especially
minority groups. A lot of people definitely
get superhuman strength and do horrible things. So, it’s been used as a
political tool and a total of kind of oppression
and punishment for, in many different
contexts over time. There’s, as you also say in
your book, also Johann’s book, Chasing the Scream,
is a wonderful read. Is that most people when they
take drugs do not get addicted. Something like 15% are
likely to become addicted. The rest try it a few times, even addictive drugs I’m talking
about, try it a few times and say bad idea,
let’s move on here. Or they’re, yeah. So, that’s the first point. The second point
is that most people who do get addicted
actually recover. The majority of addicts recover. And the third point is
that a majority of those who recover recover without
any form of formal treatment. So, this kind of propaganda,
if you take it once, you’ll become addicted and,
you know, you will lead to hell and death and damnation. I mean, it’s so exaggerated. The message is so twisted
that it loses plausibility and because it loses
plausibility, it becomes completely
ineffective. It’s like the war on
drugs in the states. You know, this is
your brain on drugs and they would show a picture
of an egg in a frying pan. Well, it’s just dumb.>>Thank you.>>Thank you, and
we’ll go to number two. Hi.>>Thanks for what
you had to say. I’m curious about the other side
of this coin which is talking about prevention, talking
about curing addiction, talking about preventing it. As you say, most people who
take drugs don’t become addicted and if you talk about all of
the other things that we do that can lead to
habit-forming addictions. What does this model have to
say about preventing that? The brain from becoming
addicted?>>Yeah. I didn’t get to some
of the precursors of addiction. But the idea that some kind
of trauma, psychological or physical or sexual
abuse, neglect, and difficulties during
adolescence, social isolations. And all kinds of difficulties
lead to depression and anxiety which themselves, those are
the gateways to addiction, are depression and anxiety. People don’t take drugs or develop compulsive gambling
disorders if they feel good. They just don’t. So, the best way to prevent
addiction is to help people with psychological problems,
especially young people, deal with those problems
before they get to the age where they’re going to
get exposed to drugs. And, you know, I mean, I just
think that’s really the answer. [ Applause ]>>Yes, there.>>Thanks. There are stories which the
media often like of people with the various issues being
helped through animal husbandry. Some of those relate
to addiction. Are they simply fed stories or
is there actually a valid way of helping people transverse
those stages they need to go through to get to the end point
of the three items you listed?>>I assume by animal
husbandry mean getting a pet, and not literally marrying an
animal which we do not advocate. We’re dangerous ideas, but not
bestiality, is our line here.>>I’m only familiar
with the first one.>>Okay. Good.>>There are places, horse
farms and sheep farms where I understand that
they concentrate on that.>>So that’s like, they call
it equine therapy for example. That’s what it’s
called in the US. They have to find a nice
flashy title for it. Equine therapy. But, you know, truthfully
I don’t know. I mean, I think one of the big
problems with the disease model that I didn’t get into is
that it is the foundation for the logic of the
current rehab industry. And sometimes doctors,
psychiatrists and addicts and their families will
give me a lot of flak or really feel very resistant
to my message because they feel that I’m pulling the rug out from underneath
the rehab industry by saying addiction
is not a disease. Well, this rehab industry
is not working very well. And one reason it’s not
working very well is because it’s a hodgepodge of giving medications
like buprenorphine. Okay, fine, that
works for some people. Especially if they’re
on opiates. But also the twelve-step methods
or just, you know, ubiquitous. They keep seeping into
rehabs one after another. Even the rehabs that
say they don’t rely on twelve-step methods still
use twelve-step methods. It’s like it’s 80 or 90%. And as I think many people know, twelve-step methods are
not reliably effective. They are effective for a
small proportion of people. Well, so you get
those two things and then you get
all the other stuff. You get all the group work
and you get repeating mantras and slogans and then you
get the other offshoots into these kinds
of fringe things. Massage and yoga
and equine therapy. And probably some of it
does help for some people. And maybe being in a more
pastoral environment and a lot of these residential rehabs
indeed are in the country. And it’s nice to be in
the country for a while and it might help
you feel better. But, you know, if you’re
paying $30 to $100,000 for it, which you are per month
in the states, yeah.>>I want to take the
horse home at the end of it if I’m paying that much.>>See, some of these places
charge insane amounts of money and then they send the addicts
back to their environment in the big city where
again you’re confronted with your isolation and
loneliness and shitty life and you come back again
and again and again. So, it’s a really powerful
revolving door phenomena that, you know, it’s just,
it’s tragic. Anyway, so that was a way
for me to assert that message into my answer to your
question about equine therapy. I would imagine that as part of a multifaceted treatment
regimen, it might have, be useful for some people. I don’t think overall it’s
a well validated method.>>And it’s fascinating. Part of the resistance to
a lot of what Marc says, I was think about
Upton Sinclair, the great American writer, said
it’s very hard to convince a man of a truth if his job depends
on not understanding that truth. And there’s a huge number of
people who are making a lot of money out of the
alternative way of thinking that’s
failed so badly. Thank you.>>Yeah.>>That was just going to be
what my, how do we kind of fight against that misinformation
and propaganda and stigma as well connected to addicts
and the whole rehab cult and everything that
goes along with it. How do you fight against
that given that, you know, we’ve all had that potential
for, to become addicted. You know, and this does
[inaudible] taboo against it. It just seems so
daunting, you know.>>Yeah, I’m not saying
that rehab is bad. But there’s this rehab industry. I don’t know the stats here but
in the US, there’s something like 15,000 to 20,000
rehab facilities, residential rehab facilities. The costs truly range from I
guess 10,000 at the low level to 100,000 to 150,000 per
month at the high level. Some of these places are
really, the resorts basically. They normally don’t track their
success rates and if they do, they track their success rates
for a very short period of time. They don’t do follow up. Why? Because they’re
making shitloads of money and they don’t want
to know necessarily if things aren’t
working very well. So, what we do about that? And especially since there’s
this insidious marriage between the rehab
industry and NIDA, the folks who bring you the
disease model and support it with all the scientific,
you know, neuro babble. My stuff on the brain
is not neuro babble. That’s actually neuroscience. So, what we do about this? This is a very, very
powerful amalgam. I think there have been a lot of
questions raised in opposition. This is starting to be more and more Johann’s
book is one of them. My book is another. People like Maya Salovitz, Sally
Satel, Carol Hart, Stanton Peel. There are a number of experts who are saying something is
really wrong with the system. And I think that
weight is growing. And there’s more and more horror
stories coming from addicts who have been through
this revolving door. Like, over and over
and over again. I was actually doing
Skype counselling with this heroin addict who
just came back from a place, I guess I can name the place
because I’m not naming him. And the place is
called Cliffside Malibu. Well, just the name,
Cliffside Malibu. This is where you want
to go for a vacation. So, you wanted to go
to the high end place and somehow he got his
insurance to cover it. But he was blown away by
how crappy the care was. And this place cost
literally $100,000 a month. He said there were people there who were actually
using on the premises. One guy got his lawyer
to come in and visit him. He had uppers on one side of his
jacket and opiates on the other.>>Wow. I want that
lawyer [laughter].>>It’s like fear and
loathing in Las Vegas. But there’s nasty
stories coming out of it. People who are not
being treated well. And as a result, some
people aren’t going on it becoming worse
and becoming entrenched and some people are
getting sick and dying. So, it’s becoming
a public outcry and I think it’s going to grow.>>Great. Thank you. To the next question, hi.>>Hi, I’m a behavioural science
student from Monash University. So, I’m really interested
in the overlays of the bio-, psychosocial elements
and learning. Where do you put epigenetics
into this big picture? And, sorry, you know, just,
whether biology intersects or interfaces with your
social environment and your, the psychological
strength of the individual?>>Marc, just hold on a second. Do just want to step back and
tell people what epigenetics is? Because a lot of
people won’t know.>>Sure. Epigenerics is when environmental factors
influence gene expression later in the lifespan.>>Or later in the genealogy.>>Or, yes, even in
future generations. Yeah. So, it shows that
experience actually impacts, it doesn’t change the DNA code but it changes the way the
actual genes are expressed in the person’s behaviour, possibly in adults possibly
later development, possibly even in their own children. Epigenetics, you know, we’re
learning more and more about it and it seems to be important
in many aspects of learning. So, epigenetics can be
the case in any kind of abuseive experience
in childhood. If you have, let’s say a father
or mother who screams at you or mistreats you, that can
strongly affect the tendency toward depression or anxiety
disorders later in life. That can have epigenetic causes,
right, that certain genes, the serotonin uptake
genes will be modified. So, it’s not specific
to addiction. It’s about learning. And, you know, the thing that people sometimes don’t
understand, that you do now, having heard this talk. And seriously, is that they
think that when you’re talking about neurobiology, you must be
supporting the disease model. Oh, if I’m talking about the
brain, then I must, you know, be espousing the argument that the brain is
hijacked in addiction. Well, no. I’m talking
about the brain as a developmental
psychologist who recognises that brain change
is really important for everything that
happens to us. And so getting familiar with biological details
doesn’t get us closer to the disease model. I think it actually
gets us further away.>>To this, it gets us closer
to the social model as well and how important
the environment is in a child’s life.>>Exactly.>>Or, you know,
back in the history of the gene expression as well.>>Yeah, that’s right. Important factors that impact
on development and because–>>And in families.>>Yeah.>>Thank you.>>Kind of outcomes.>>And I guess that comes
back to the early question about prevention as well. What would you say
is relationship between that insight
and prevention?>>Yeah, that’s a
bit of a tough one. But I guess, yeah, it comes back
to the idea of trying to get in there as early as possible. Right, and to deal with, like,
if 1/100, 1/20 of the money that we invest in dealing
with addiction were invested in helping families
that are in trouble–>>Or engendering
resilience in children.>>Well, it’s worth
bearing in mind–>>Like mindfulness and self-determinism
overlaying as well.>>It’s worth bearing in mind
your government is currently spending billions of
your tax dollars trying to keep drugs physically
out of Australia when they can’t even keep
them out of your prisons. When you have a walled perimeter
and you pay people to be around the whole time. Or schools, this is
something maybe you’d want to use the money for instead. We’ll take the, thank you, we’ll take the next
question, thank you.>>I was just wondering about
with, I have a friend who used to be using ice for
many, many years. Prostitute, she went into
prostitution to fund it, etc., etc. She did quit and
she’s 10 years clean and doing brilliantly. She has a sister who’s
alcohol addicted. When her sister has gone
into rehab, she said that is so much harder than
giving up ice. You’ve got that whole physical, going through that
whole detoxing stage. Where she said with the ice,
she said it’s psychological. So, she said once she removed
herself from the environment, everything you’re saying there,
she did go to the country. Not to $100,000 dollar place. But she basically
removed herself. Now what I’m wondering
is with how we’re dealing with this ice problem that
we have which is so severe, what’s going into actually the
facts about, okay, maybe we need to be setting up places for
kids or whoever to get away from those environments? And that it’s not this
horrendous, like with opiates or alcohol when you’re severely
addicted, that it can be done under the right circumstances?>>So, changing physical and
social environments is, yeah, it’s a really powerful tool. And this is actually the
case with Brian in my book. The meth addict. He did end up in a rural
environment actually shepherding sheep for a period of time. And, you know, it’s like,
and you change your life that much, everything changes. And then the appeal of
smoking or shooting a drug that makes you feel very,
you know, the same way that it’s made you feel
the last, you know, 500 times you did it, becomes
boring at the very least and possibly unpleasant. And no longer serves
the same function. And it becomes much
easier to give us because a lot less attractive
and in fact quite repellent. So, I don’t know
what else to say. I think that’s the answer. It’s an important strategy.>>I’m wondering what
our government is doing about it, you know? And this addiction, yes,
I believe it’s more habit than addiction with ice
and maybe it just is–>>Addiction is habit, I think. It is habit. In the habit of thinking. You know, it’s almost,
it’s a belief. Addiction is actually a belief. You believe that taking
this thing is going to make you feel better even
though it very often doesn’t, especially after
the first while. Once it gets boring and
repetitive and repulsive enough, it doesn’t make you feel better
but you still believe it does. Well, that’s a habit to. It’s a habit of mind. It’s a habit of thinking
and a habit of behaviour and also habit of doing. But it’s also whole
belief system and all of that is interconnected
and all of it can change because beliefs change, right?>>Great. Thank you
for your questions. This is going to be the
last question, so yeah. Make it good. No pressure.>>Hi, Marc. Thanks very much. As I understand it,
when we’re talking about certain anxiety
disorders as well, we also talk about learnt associations
to them. So, for example, PTSD and
major phobia disorders. One of the things that they
talk about in relation to that as well is extinction therapy. And I know that you mentioned
one of the hardest things for addicts is, you know, resisting these cues
and the cravings. So, I’m wondering, is there
any place for that sort of extinction therapy
exposure to those cues in a safe environment
for addicts as well in terms of treatment?>>Yeah, good question. The thing is is that extinction
therapy is kind of the default. Because you’re driving
by the liquor store, the idea is not to go in, right? Because there’s liquor
stores everywhere. Or, you know, you’re
surrounded by people, you know the phone
numbers of your dealers. Unless you, you know,
managed to forget them. So, the cues are right
there, available, staring you in the face. And yet, you know, you’re
trying not to go there. Well, the trouble is that
you get into ego fatigue. You get into trying to
suppress the impulse. Because it is still
within your power to get. It’s not like being in a room where people are
introducing spiders if you have a spider phobia,
but spiders are in the cage. There’s nothing you
can do about that. It’s just exposure. Because we’re generally free
agents, we can walk around and can call that dealer
and get that drug if we want to badly enough, then
it’s, the impulse is there and the action is possible and
then you try to suppress it and then you get ego fatigue
and then you pull back into it. I don’t think it’s the
most effective approach.>>So, for example,
just quickly. So for smokers, I know that
oftentimes smokers say one of the hardest things in
quitting smoking is being around other people
who are smoking. But as they do that more
and more, it sort of, they, that helps them get over it. I suppose is that a
parallel at all there?>>I think, if you combine it
with what I was saying before. Instead of suppression,
reframing. So, reframing is, you know,
this is actually not fun. This actually tastes like
shit and this, you know, it’s like if you reframe
it, then you have a chance to overcome it without having
to be the victim of ego fatigue. And, you know, it just
involves a certain psychological cleverness. Which you can be helped
with by a psychologist or by anyone else who’s
got some expertise in thinking about those matters.>>Okay, don’t suppress,
reframe feels like the answer not
just narrowly but in a much wider context. It feels like a good
point on which to end. Marc is going to be
signing both his books. I recommend reading both
and they’re fantastic. In the foyer, imminently. So, please, thank him very much. Fantastic. [ Applause ] [ Music ]

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