EP. 119 — The Science of Addiction with Judith Grisel (Re-Release)

FACT-119-20210824-GriselReRun-RCv01-DYN.mp3

Speaker 1 [00:00:22] Hello and welcome to Factually. I’m Adam Conover, it’s so wonderful to have you join me once again as I talked to an amazing expert about all the incredible things that they know that I don’t know and that you don’t know, and to have both of our minds be blown together. We’re going to have a blast. Thank you for being here. Now, this episode is a little bit different. For the past month or so, I have been hard at work filming my new Netflix show. It’s called ‘The G Word.’ It’s going to be all about how the U.S. government works, all of its promises and perils and pitfalls. It’s going to be coming out on Netflix. We do not have a release date yet, but we are finally shooting it after being paused for over a year from COVID. I’m very, very excited about it, can’t wait for you to see it. However, that means that we were so busy shooting, we actually were not able to record a new episode for this week. So instead, we are going to be rerunning one of my very favorite episodes from the past. And I know what you’re saying, ‘Adam, it’s a rerun,’ but come on, we’ve been on the air here (on the internet air) for almost two years. We’ve had so many incredible episodes and I think a lot of you folks haven’t heard every single episode in our catalog. So this is a good time to dip back in and think once again about and re-appreciate one of the amazing folks I’ve talked to. All right, so let’s just get right to it. We are going to be presenting for you this week, my interview with Judith Grisel. This was an incredible interview about addiction: about her journey with addiction, my own journey with drinking, and with quitting drinking. The neurological background of addiction. One of the most difficult topics in human society. One of the most complex and difficult to understand, and one that has really impacted both of us personally. It was a really powerful episode for that reason, I thought a lot about my own experience. I heard from a lot of you who wrote in about your experiences as well, and it’s one of my favorite episodes we’ve ever done. So if you haven’t heard it, I very much hope you enjoy listening to it. If you have heard it, I hope you enjoy dipping into it again because I listened to it again for this release, and I discovered new things upon listening to it a second time. So without further ado, let’s get into it. She’s also the author of a book called ‘Never Enough: The Experience of Addiction.’ And you can find that, by the way, at our special bookshop at factuallypod.com/books and when you buy your book there, you will be supporting not just this show but also your local bookstore. Without further ado, let’s get to my interview with Judith Grisel. Judy, thank you so much for being on the show.

Speaker 2 [00:02:49] Glad to be here.

Speaker 1 [00:02:51] As I mentioned in the intro, you had your own personal experience with addiction. If you don’t mind, I’d love it if you shared some of that story with us and sort of describe how that brought you to your work studying addiction as a neuroscientist.

Speaker 2 [00:03:06] Sure. I grew up in a pretty typical family, I think, but was maybe a little more inclined to try new things than average, perhaps. So I got my first good drink at around 13 and I absolutely loved it. It changed the trajectory of my whole life. And for about the next 10 years, I never said ‘no’ to another trace of alcohol or any other mind altering drug. As a result of that, by the time I was 23, I was homeless and I’d been kicked out of three schools. I contracted hepatitis C from sharing dirty needles and I had lost the respect of everybody I knew, including myself. I ended up in treatment and which I thought at the time was going to be like a spa because it was the 1980’s and I didn’t know anything about drug treatment, but they said I had a disease and that if I wanted to live (which I wasn’t so sure about, but if I wanted to) I needed to stop using. And I thought actually that curing addiction would be easier than not picking up for the rest of my life. So that’s how I ended up, by persistence, getting into graduate school and obtaining a Ph.D., studying the brain to try to understand addiction. It took about 10 or 12 years before it began to dawn on me, that it wasn’t so easy to cure. But then I didn’t know what else to do,

Speaker 1 [00:04:39] but your thought was literally, ‘Oh man, it’s going to be hard staying clean through willpower or whatever, so I want to find a cure instead.’ That was your actual motivation?

Speaker 2 [00:04:48] Yeah, it seemed impossible to stay clean for the rest of my life. I was so young and I really thought at the time, ‘Why couldn’t this happen to me when I’m 40 and my life is already over or something?’ Which is funny because I’m 56 now. But at the time, it seemed like, ‘Forget it.’ I had so much partying left to do, and I just couldn’t imagine wanting to live without using. I thought, ‘Am I going to have to knit or bowl?’ What do people do who aren’t spending all their time getting drugs and hiding them? So yeah, it seemed relatively trivial to cure it, which is arrogant and ignorant but

Speaker 1 [00:05:32] It’s a young person’s way of looking at the world and that’s a good sort of optimism to have, I suppose.

Speaker 2 [00:05:38] Well, it’s optimism, but it’s also reflecting (I think) the perseverance and the tenacity of most addicts. Don’t tell me there’s no something to be found. You know, I’m sure I can come up with it, even if I have to hitchhike to Houston, you know?

Speaker 1 [00:05:55] And how do you feel now, being 56? You know that when you were 23, having that feeling of, ‘Oh, it’s going to be so hard to stay clean for the for the rest of my life.’ Do you have a different relationship with that idea now?

Speaker 2 [00:06:09] Oh my gosh, do I ever? It’s really funny, because I thought life was just this boring thing to be gotten through without enhancing. And I have not been bored, literally. I have not been bored in probably 30 years. I have such a full, rich life right now that it would sound like I was bragging if I went through it. But I was completely wrong. I was just completely wrong because at the end of my using, it was almost like living in a closet. All I did was worry about getting stuff and then having enough of it and then hiding that I was using and then getting more stuff and recovering from that. It was sort of like living in a small closet. It was just me and my misery that I was trying to escape; less and less successfully, it seemed, every day. And now it’s sort of like a big adventure. Not just because I’m talking to you, which is fun, but there’s a lot of wonderful stuff to experience in the world, I think. One of the ironies of regular drug use is that it seems at first like it’s enhancing things. But pretty soon it’s actually diminishing them and I think one of the questions I wonder if we could somehow do this calculus across the world, but if we if we figured out how much is it benefiting individuals and all of us and how much is it taking from individuals and everybody, I have a feeling it would come out not in our favor, the way we’re medicating so much away.

Speaker 1 [00:07:59] You’re correct that the feeling while you’re using is that it is enhancing. I have a very different experience with addiction, but I do consider myself to have been addicted to smoking for many years and I just quit drinking in the last year as I mentioned in the intro. My feeling with both of those things, I relate so powerfully to what you said a little bit earlier about that thought. When I was using those substances, I would think, ‘How do people enjoy life without doing this?’ If you’re not smoking, life must be bad, right? It must be. They’re not enjoying what I’m enjoying out of it and in the back of my mind with smoking, I think I knew that that wasn’t true. When I finally quit smoking, I had that realization of, ‘Oh, the way I used to feel just after having a cigarette. That’s actually how everybody else feels all the time.’ That’s their baseline state and so that was easy to figure out about smoking. It took me an extra 10 years to learn that about drinking, and it was the exact same lesson when I finally quit. I literally (up until about a year and a half ago) thought, ‘Well, everyone who isn’t drinking at the party or every comic who isn’t drinking right before they go up on stage, those people are having less fun than me. And that’s why I’m doing it.’ And now I know that that was wrong. It’s so interesting that you say, ‘Yeah, if we were to actually measure whether it’s bringing us joy or misery, it would probably be misery except that while we’re using it, we’re incapable of seeing that.’

Speaker 2 [00:09:34] Well, we’re incapable of seeing it but I bet most smokers could relate to this. The best cigarette of the day is always the first one. Mm hmm. That one is kind of fun and enjoyable because the brain has reset a little bit overnight, but the 10th or the 15th cigaret of the day is really smoked, only to avoid the misery of not smoking it. I’s the same with alcohol, initially it makes us feel relaxed and feel some pleasure. But regular drinkers are drinking because if they don’t drink (sort of like I described about myself) then it feels like life is bleak and there’s a lot of anxiety and tension. You can’t have any fun. I remember thinking, ‘How am I going to kiss somebody? How am I going to dance? How am I going to go to a concert if I’m not loaded?’ And in fact, it’s  kind of a myth because it makes it so that without drinking you just of fall into a hole and drinking just brings you up to normal, like you say.

Speaker 1 [00:10:46] Yeah, I also had that same thought. I think we had probably different relationships with alcohol in many ways. I had that association with, ‘Well, that’s how I relax at the end of the day. I’ve been working hard all day long and having a drink is how I unwind. And if I don’t have that drink, I won’t be able to unwind because that’s what it’s doing for me.’ And now, I unwind just as well and in fact, a little bit better.

Speaker 2 [00:11:13] A little bit better is the key thing, because the brain adapts to your regular using. So that now it’s tense and anxious and the alcohol only serves to bring you to the baseline. But you’re right that in the long run, it just perpetuates its own habit.

Speaker 1 [00:11:34] You said the first time you had a drink, you loved it. What was it about it that gave it that reaction for you?

Speaker 2 [00:11:44] Yeah. I don’t know if I romanticize it, I know it sounds like I do, but I was 13. From the outside, everything looked great but I think inside I was as insecure and anxious as a typical 13 year old girl, and maybe more. We were in the basement of my friend’s house and our parents had quite a stock and we found a bottle of Gallo Wine, a gallon of it. And I don’t think it was particularly wonderful wine.

Speaker 1 [00:12:22] Definitely wasn’t. A gallon of Gallo wine, I’m sure it was not delicious.

Speaker 2 [00:12:26] But I took a big swig. I ended up having more than half of it. I know, because I always made sure I got at least my share, if not more. The initial feeling once it hit my brain, (I guess I thought it was my gut that it was filling, but it was really filling a void in my mind or my brain or my soul, whatever you want to say) suddenly I felt – almost for the first time that I could recall – that life was just right. That I was enough, that I was OK, and that I could somehow manage to negotiate things. I remember thinking, ‘This is how people do it. This is how adults get through the day because they can drink, and it makes everything seem somehow well.’ It made my stomach warm and my chest warm and my head sort of overflowing with bliss in a way, like an oceanic sense of OK ness. It’s funny because I didn’t consciously realize that I wasn’t OK until I had that. Almost like a cat that lives outside and suddenly gets into the warmth in the middle of winter, ‘Oh, this is what I’ve been missing.’ That’s how I felt, ‘I’m never going outside again.’ And I drank. I mean, we started drinking in school. At 14, I got kicked out of school. It was a private  girls school and they didn’t like drinking. The nuns didn’t like it.

Speaker 1 [00:14:05] Yeah, and in their defense, they were correct.

Speaker 2 [00:14:09] Well, yes, they were correct. But I think for someone like me, it was really an important tool. I can see both how alcohol was a big pitfall, but also how in a way it helped me survive my adolescence because it gave me a relief valve. Just like you said at the end of the day, I had no real tools for getting through the stress and anxiety of my 1976 life, and I can’t imagine for kids today: I think they have even maybe more stress and anxiety and fewer tools to get through it. So this was a way for me to cope and from the very beginning, I used it like a tool. I liked the high, but more than that, I liked the way it took the edge off my reality.

Speaker 1 [00:15:11] But was it still doing that so many years later? What you’re describing, sounds wonderful and if that’s what drinking was like all the time, then I don’t think I would have quit either.

Speaker 2 [00:15:24] You know, it was never that good again. So I had to smoke pot while I drank, and then I had to take coke and smoke pot while I drank. And then I had some downers to go with the coke and the weed and the booze. So, no, I never really could get quite there again. But I spent 10 years trying to titrate that same feeling. What ended up happening was that, there were fewer and fewer days without it. But if I should have a day where I wasn’t using it was tedious and frustrating and bleak and uninspired so that, only altering my mind and psyche with drugs brought any solace and joy. I thought it was joy. Actually, I probably mistook the thrill for joy just like I mistook being wasted for a sense of peace. When I passed out, I thought that meant I was OK with myself. But yeah, maybe I overdid it. There were diminishing returns over time so that by the very end, I got clean and sober on July 9th, 1986. My 23rd birthday was in June, and I remember about that time thinking, ‘Gosh, I’m just turning 23, but I feel like I’m a 123. I feel like there’s nothing left to live for. I’ve sort of seen it all, and it’s either brutal or boring.

Speaker 1 [00:17:12] Hmm. And so talking about your work now as a neuroscientist, when you look back on that time in your life, do you now have more insight into what was actually going on with you? On those days where it felt so tedious, do you now know, ‘Oh, here’s what was going on in my actual brain?’

Speaker 2 [00:17:32] Yes, I absolutely do. And it turns out it’s a pretty simple fundamental principle that the brain adapts to any drug that alters the way it functions by producing the exact opposite effect. So, for example, alcohol (like we’ve been saying) helps produce relaxation. It helps you sleep. It helps you have some fun. The brain that is regularly exposed to alcohol makes your experience to be tense and insomniac and unhappy so that when you drink you kind of come out even. So, the brain is really about the business of homeostasis or keeping things stable in a sort of a middle state. The reason that’s so important is because, you wouldn’t be able to tell if something critical happened. Either something terrific or something terrible happened if you were kind of bouncing all over the place in terms of your feelings state. If you’re wasted on opiates, let’s say, and your child gets hit by a bus, you wouldn’t be able to tell. Or you get hit by a bus. Let’s say you could drive us, so you can’t tell because you’re nodding out. So therefore, the brain counteracts that so that you can have this stable base of the bus comes, you know it. Unfortunately, it does that by producing the opposite effect so that you only feel normal with the drug. I go back and forth about whether I’m a caffeine addict today. I drink caffeine every morning, reliably, first thing. And because of that, when I wake up in the morning, I don’t wake up in the morning. I drag myself from bed, the dogs and cats and children husband all get far away until I get about three quarters of the way through the first cup, which only takes a few seconds and then I’m normal, then I can put a sentence together, then I can, you know, smile and say, ‘Good morning,’ but my brain is ready for that caffeine so that if I don’t get it, I can’t wake up. Just like if you don’t get the alcohol that you regularly have, you can’t relax and have fun. If you don’t get the weed, nothing is interesting. If you don’t get the heroin, you’re suffering.

Speaker 1 [00:19:58] Well, it strikes me that we – and I mentioned in the intro to this show – we talk about all those different drugs completely differently. I mean, first of all, I am also addicted to caffeine. I’ve quit three different addictive drugs in my life. I was on Adderall (otherwise known as amphetamines) during college, I was addicted to that and I had to quit it. I quit smoking and I quit drinking. And I’m familiar with those feelings of what it feels like to quit those things. And a little bit after I quit drinking, I tried quitting caffeine too and I actually found that intolerable and I said, ‘I’m going to continue drinking.’ I switched from coffee to tea, but otherwise I’m sort of right back up to my baseline. So that’s an addiction that we sort of all accept

Speaker 2 [00:20:40] I have great news for you. The great news is that one of the criteria for addiction is that it has to be harmful to you and/or society. And caffeine is actually beneficial overall, unless you’re trying to get pregnant, which I don’t think you are. There’s no deleterious effects for most people, of a normal amount. In fact, it may protect against Parkinson’s disease and give some benefit to other parts of their physiology. So you’re kind of off the hook. Drink away.

Speaker 1 [00:21:14] So it has positive effects beyond that bounce back and get yourself to baseline homeostasis effects that you were describing, right?

Speaker 2 [00:21:24] Right. And the thing about nicotine and cigarette addiction is it’ll kill you. As will alcohol addiction as well others, or they cause you to ignore your children or forget about your job. Whereas caffeine has all these physical and mental benefits, it makes us cognitively sharper. Now, I should say in all fairness, that one of the other criteria of addiction is that you have a denial of the problem. So it’s possible that I know and I think both of us are dependent on caffeine. But whether or not we’re addicted is still open because the drug is not hurting us or anybody else.

Speaker 1 [00:22:06] So from a more medical perspective, it requires that definite harm. I was going to say also, you mentioned marijuana (THC) earlier and that’s a drug that you included in that group of drugs that we have that homeostatic response to. But that’s a drug that, in our discourse about it, we treat it as non-addictive. People say, ‘Oh, no, yeah, pots not addictive.’ But then I’ve known people throughout my life where I met someone and was like ‘This person kind of does seem that they’re addicted to it.’ Despite that sort of folk wisdom about it, is pot addictive or not?

Speaker 2 [00:22:48] Yes. Period, full stop. Because there’s five criteria, so it has to be harmful. Usually there’s denial. But then you have craving, tolerance and dependance. Dependance happens when you take away the marijuana and you see the opposite effect, so that you’re in a kind of withdrawal state. In my case, even though I loved alcohol, especially that first time and I used everything I could get my hands on. I smoked marijuana all day, every day. It was my absolute favorite drug, and if I could only have one drug, it would be marijuana. And it was so hard to give up. It took me actually 9 years before I stopped craving it. Probably my most important relationship was with marijuana, so I just thought it was perfect. Anyway, I won’t go on and on about that. The reason I loved it so much is I didn’t really get anxious. I didn’t really get paranoid. I got really interested. So the world was so much more interesting, and I have a kind of a deficit in novelty.  I have a low tolerance for boredom, let’s say. Marijuana was the perfect antidote to boredom because even if I was waitressing or just driving across town, it could be a magical experience if I was stoned enough. What ended up happening, though, is that I got tolerant to that effect, so things were less and less wonderful. I remember the first time I got stoned even more fondly, maybe than I remember the first time I drank. I was at a mall. This was in the 80’s, so malls were (maybe it was in the seventies) just coming on board. They’re kind of all the same but it was just an absolute joy, better than Disney World for sure. I laughed and just thoroughly had probably the best time of my life. But after smoking (more or less chain smoking) for about 10 years, I could only enjoy things a little bit if I was wasted. And if I had to be straight, oh my gosh. It was as if the world was in black and white. There was just no color, no vitality, nothing at all interesting. I could only drag myself out of bed with the promise of a bong hit, and I know now why that happened. Because the receptors in my brain, the proteins in my brain that respond to THC down regulate or kind of disappear with chronic using. And so the THC has less and less of an effect, which is kind of not a huge problem today because people can get such high potency THC that with the fewer receptors that are there that they can still stimulate them. It’s only such a big problem, I think, when you take the drug away. And I have talked to hundreds of people who are parents or students or retirees for whom life without smoking is bleak and boring and colorless in a way. Just like I’m sure quitting cigarets was not fun, this is not fun. They feel like the returns are diminishing because the brain is adapted to produce the exact opposite state. If marijuana makes things interesting and seem really relevant and tasty, then without it, things are boring and bland and you’re kind of stuck. So unfortunately, that is the message of all regular drug use. If you’re a 50 year old and you start smoking now, it’s probably not so harmful, but I am pretty concerned about people in their teens for two reasons, I guess. One is that their brains are developing, so when they’re developing, they’re laying down structures and pathways. If you’re doing that under the influence of drugs, then the drugs influence that organization and they do so in a permanent way. Perhaps to make things less interesting for a lifetime. But also, kids are kids because they’re supposed to be finding what is important to them. What is particularly exciting? Do they like this guy or that girl or this job or this artist or this music or this town, those sorts of explorative experiences help set their identity. And if you’re exploring with a bong on the couch, you’re less likely to figure out who and what you are and want to be, and I think you don’t really get that opportunity again. The adolescent period is the adolescent period because the brain is primed to take those experiences and mark what you care about in a way that determines your trajectory really, or helps at least constrain your trajectory. So I think we’re missing an opportunity there.

Speaker 1 [00:28:38] Well, let me ask because you were using that drug during those adolescent years and you also talk about a lot of ways in which you felt it was helping you cope, that you were using it as a tool. Do you say that that fear that you just expressed about teenagers because of your own experience?

Speaker 2 [00:29:02] Yeah, I really do. I ended up in treatment by mistake. For most kids, they have a strong liver and they’re kind of adaptable. They’re resilient in a way, and I was pretty resilient. But I think that if I had gone another 10 years, I can’t imagine that I would have been able to get through with anything that looks like the success that I’ve had. So I think that the fact that I started early drove me to an addictive state pretty early. But the fact that I stopped, basically before just about the time I was 23, I still had a few years of strong brain plasticity to depend on, and I think that really helped me get clean. I think I’ve done OK, but a sample size of one is no experiment, but I might have done better. I might of not taking so long to write my book or maybe I’d have three books. There’s a lot of ways I think, so it’s it’s hard to know. But I will say, I guess one message sort of related to this is that again, I think that the first little while without marijuana was so painful and so lonely because it was like I lost my best friend

Speaker 1 [00:30:31] Our relationships of those substances feel so personal, when you used the word ‘relationship’ earlier and I related to that.

Speaker 2 [00:30:37] Yeah, and I think in a lot of ways it’s better than a person because we control the dose, we control the time that it comes, we don’t have to put up with its shit so much. We just we get to we get to use it the way we want. I think I did feel like I had lost my best friend but now I can see that I have lots of interests and lots of peak experiences that don’t involve drugs. So I think the brain does adapt back. Now, my husband is not an addict and he’s smoked and weed (I think) and he occasionally drinks. But he, I think, would describe me as someone who has to step really hard on the pleasure pedal to get something out of it, which might be part of my strength, too. But I think I did alter my brain in such a way that I’m less satisfied than he is with the same kinds of things. Now that’s not all bad, but it’s not all good, either.

Speaker 1 [00:31:49] Well, that brings me to my next question because you describe this very singular experience you had when you were 13 years old where the drug made you feel that you were OK. I did not have that profound of an experience the first time I had a drink and I’m sure some folks listening probably feel the same way. But you’re also describing how, in a way, our brains are hard wired for addiction that the homeostasis is something that all of our brains do. So to what extent do you feel that you had your experience because you are a special type of person? That’s how we talk about alcohol, culturally, the sort of folk understanding of it that some people are alcoholics and everyone else is a moderate drinker who will never have a problem. There’s that model, and I could see fitting your story into that but you’re also describing a universal quality of our brains that lead anyone to addiction. So I’m curious about how you weigh those two ways of looking at it.

Speaker 2 [00:32:57] Yeah, it’s a great question, and one that science is constantly trying to help understand. One way to think about it is, let’s say you need 100 hundred points to be a bona fide addict or alcoholic. Some people are probably born with 90 some points. They’ve got a long family history with lots of addiction in it. They got a bad set of genes. Maybe they also are born into a stressful environment with not a tight knit family and/or lots of drugs and alcohol around. So they they really don’t need much. Other people might be born with very few points, but if they use enough of any mind altering substance, they will become dependent. If that mind altering substance is an addictive drug that’s abused like the ones we’ve been talking about, then they’re going to have diminishing returns and they’ll need the drug to feel normal. I think that one of the problems scientists have had is that addiction is not a single gene or a single cause. It’s so complex that even though we know it runs in families, we think there are probably hundreds of genes. Each contributing a tiny, tiny amount. So you might have had some really protective genes. I’d be curious about your initial experience. Did you have a lot to drink or just a little?

Speaker 1 [00:34:31] In my story I tell is that when I was 17 or 18, my cool punk friend Noah took me to the woods and he told me if I drank for Zima’s, I’d get drunk and he was right. I drank four Zimas, and I remember throwing up and having a great time. It was enjoyable but I’d drink at parties and stuff like that. It wasn’t until – It’s really interesting. I was diagnosed with ADHD as a kid and I was occasionally medicated for that. But in college, I decided to take it seriously and I decided to get an Adderall prescription. I started taking that. And that led me to develop a daily habit of drinking and smoking because they sort of felt like they fit together. I would drink to sort of cool down at the end of the day. I was never a binge drinker, who’d pass out or anything like that. But I’d have a couple of drinks every night, more while I was in college and then by the time I was in my thirties, I’d have two. A couple of whiskeys and then that’s it. That was how those things sort of fit together. And it’s funny for me because there was a point in my life where, in my mid 20’s, where I would start my day by taking an Adderall, and then I would have a cup of coffee and then I would smoke a cigarette and then I would have a couple more cigarettes. Then later in the day, I’d take a little more Adderall and have some more coffee and some more cigarettes, and then I’d drink to fall asleep. I was about 25, and I realized, ‘Wait, this isn’t sustainable.’ I realized this is maybe a little bit of a house of cards. I started systematically taking it apart. I quit Adderall first, which was like a week long withdrawal period where I slept for a week and couldn’t focus on anything. And then I quit smoking, and then it took me an extra 10 years to finally quit drinking. But I think back at the time of my life, and I wonder, ‘Well, that was not super hardcore, but that was more than any of my friends were doing.’ And I wondered why didn’t I fall further down the the slippery slope? Because in retrospect, it seems like I could have, but I’m not sure why I was able to sort of pull myself out of it without needing to go to, say, a treatment program or anything like that.

Speaker 2 [00:36:52] Well, I can point to two things, at least. One is the fact that you threw up the first time you got drunk, even though you liked it. People who get sick or who don’t feel wonderful are protected. So there’s pretty good evidence that the first drink; the experience to the first using, predicts a little bit your outcome. And the second thing was that you were 25, which is fairly mature, probably. And yet you saw that you were on a slippery slope. So I would suggest that you were smarter than me too, because

Speaker 1 [00:37:31] It took me longer than you, though

Speaker 2 [00:37:32] I would have had to be at least 55 to see it. Yeah, I didn’t see it myself, but I think we reflect the  two extremes. I think I might have been born an addict and you might have been the kind that gets addicted by regular use, which is what will happen. You were fortunate or smart enough to notice it and to back off, but I think in both cases, what we described was that there was less and less benefit. Yeah, and more and much more and more compulsion and at that point, that’s irrational.

Speaker 1 [00:38:16] Well, I have so many more questions about this, but we have to take a really quick break. We’ll be right back. So, Judith, I have so many more questions about this. One is just going back to my own experience with Adderall specifically. I have such complex feelings about that drug because it was prescribed to me, starting as a child. They prescribed me Ritalin and I went on and off of it. I finally ended up on Adderall and when I first started taking it, I felt a huge benefit from it that. I again was diagnosed with ADHD. I had trouble focusing. I had trouble doing the things that I wanted to do, I wanted to be paying attention in school because I loved my college experience, but I found myself unable to focus the way I wanted to. When I took it, I felt that benefit, right? But then years later, I realized, ‘Well, actually, maybe this isn’t giving me the benefit quite that I want.’ Now I’m trying to do creative work and it’s helpful for programing a website or something like that, which I was doing freelance at the time. But not for writing or for the spacious thinking I wanted to be doing as a creative. And I also knew that I was just straight up addicted to it, that if I didn’t have it every single day that I would feel withdrawal symptoms and I’d sleepy and upset. And so when I look back at it, I’m like, ‘Well, on the one hand, I really felt that I benefited from it. On the other hand, I think it was completely fucked up that it was given to me as a child.’ And so I have trouble knowing what to think about it. And you also described your experience with alcohol as something that that helped you cope. And so I guess I’m wondering, how do we think about addictive substances when sometimes it does feel as though we’re receiving a true benefit from them?

Speaker 2 [00:40:25] Well, it’s a great question. First of all, I think alcohol helping me cope was helping me cope with normal teenage angst. And I think that ADHD can be very serious and debilitating. So for some people, it really does impair their ability to learn in school and and in that way, derail their whole lives because they aren’t successful in fourth grade, then they’re unsuccessful in eighth grade and then they don’t get into college. So it’s a serious problem. On the other hand, it is treated with these drugs and most people feel that if you take low doses as prescribed that the benefits outweigh the costs. And I think one of the criteria for addiction is that the costs outweigh the benefits. So in that way, it’s nuanced and like you say, complex. But I do think that it’s important to ask, maybe why are so many kids unable to focus or be still and learn? And to answer that, I think maybe you can remember the bell curve or the normal distribution. Our ability to focus and stay still is distributed, normally. Some people are really great at it (and natural programmers, let’s say) and others like me are probably somewhere in the middle. And then there are some people who are naturally less able to do that. And that’s just not valued, that lower tail in our society and certainly in our schools and our curricula. So it’s really important to be able to sit still for nine hours a day and keep sharp pencils and things. And I think we have to ask about the context for those kids too. I laughed when a couple of years ago, there was a new treatment for ADHD, which was literally playing outside. I’m not kidding. As if, you know, it suddenly dawned on medical science that maybe watching screens and having sugary snacks after being in school all day wasn’t the best strategy. I think you bring up a couple of really important points. You said that when you quit, you slept for a week and couldn’t focus on anything. So there was this adaptive change by taking something that keeps you awake and keeps you focusing, your brain produces a tolerance to that. You have to kind of change things around and then,  we wonder what it would be like. And and importantly, if you wonder what it’s like and you decide to stop taking it, what it’s going to be like is the exact opposite state. So you wouldn’t be able to tell if you had ADHD still, because the withdrawal from stimulants is an attention deficit hyperactivity disorder. In some cases, it’s helpful and in some cases maybe we’re overprescribing, and it might be better to find other strategies. And I think the last thing that I really love about what you said is that it was good for some things, but not for your creativity. One of the things I’ve learned in 30 years of studying psychopharmacology is that there is no free lunch. That whatever we do, there’s something to be paid back. And I think that in this case, there is a cost and I have a good friend who’s on these. She’s an adult and a very successful scientist who’s been diagnosed and who takes these drugs. And she came to visit me for a while and she got involved in some project and she was absolutely driven. My house is kind of chaotic and there’s a lot of messes and we’re not great planners. It was really obvious that we were on two totally different tracks, so I think maybe relationships take a little sloppiness. I mean, if you’re really focused and crisp, it’s hard to be in relationship because people are such a mess. And so it almost helps to be a little loose around the edges for certain things like creativity, maybe like relationships, maybe like exploration. So we have to wonder, what does society’s values of productivity and efficiency have to do with the epidemic of attention deficit disorders?

Speaker 1 [00:45:26] That’s a really good question, and we’ll move on from this, but yeah I felt that one of the things for instance, since you mentioned relationships, was it made me bad in a comedy writer’s room. Because I’d become fixated on a certain idea and a certain way of doing something and say, ‘No, I want to execute that. Let’s do that now’ and other folks would be like ‘No, that idea is not the best. Let’s think about something else,’ and that’s a necessary part of being in a collaborative comedy environment, is having a looseness and being able to move from idea to idea and having spontaneous thoughts are not staying on one thing for too long. It’s sort of the polar opposite of the thing that I was incredibly good at when I was on Adderall. I was so good solving crossword puzzles. I did so many crossword puzzles and that sort of focused attention thing. I would almost do them compulsively and that’s kind of the opposite of creative work, is ticking those boxes over and over again. And yeah, that was why I eventually stopped was I realized it was it was not helping me with that part of my life.

Speaker 2 [00:46:34] Since I’m a professor at a liberal arts college, I might say that I wonder how the high use of these drugs is affecting higher education in general. Less creativity, more focus, more filling in the blanks and jumping over the hurdles, but less going around the edges and maybe real scholarship.

Speaker 1 [00:46:56] Yeah. And at the same time, those drugs, I think, are being taken because of the high work requirements. That I was under a lot of pressure to produce at my very loosey goosey liberal arts school. There was more work assigned than I could reasonably do. That was one of the reasons I was like, ‘I’m trying to get ahead of this. So let me let me start getting a prescription for this drug.’ Again, it helped it some things, but not in others. Well, so speaking of, I have so many questions about addiction generally. One thing we haven’t spoken about yet are addictions that we commonly understand. Behaviors that we commonly understand as being addictive, but which aren’t related to a particular drug. For instance, even on our show, ‘Adam Ruins Everything,’ we’ve talked about how slot machines are designed to create an addictive response. I want to know how that fits into the framework you’ve laid out, about how our brains are sort of designed for addiction in a way. Does that fit in?

Speaker 2 [00:48:07] Oh, sure, absolutely. Gambling is very addictive, and it’s addictive like a substance for the same reason; which is that there is a very small group of neurons (or nerve cells) in the center of the brain going from the top of your spinal cord (or a little bit beyond it) to about two inches behind your eyeballs. And these neurons release dopamine in the nucleus accumbens, and this is sometimes called the ‘messolimbic dopamine pathway.’ Every single drug that’s addictive releases dopamine in that messolimbic pathway, and so does gambling. It does so for the same reason, which is that it’s giving the brain the idea that something meaningful or salient is happening. One thing that’s meaningful is the surprise of what’s going to happen when I pull  this slot arm one more time, or when I open the door or when I push the button and these things stop. It’s a pathway designed to get us to pay attention to things that are newsworthy and certainly, gambling is designed to give you occasional news in the same way that your email is designed to give you regular news alerts. It’s addictive. We could prevent addiction if we lesioned that pathway, so we just got rid of those neurons but then we wouldn’t find life so interesting or meaningful. So you can see that drugs and gambling and email (in a way) work because they co-opt this pathway of interest and meaning.

Speaker 1 [00:50:00] Yeah, it’s hijacking something that our brains do in order for us to survive. It’s really interesting because the way you describe that, we so often talk about the substances as being addictive. That there’s something inherent in the chemical or in the plant that is what causes the addiction. But really, what you’re describing is something the the brain does to itself by the natural process of how it’s evolved to work.

Speaker 2 [00:50:31] That’s right. Yes, the addiction occurs in the brain, just like if if a tree falls in the forest and there’s no ear to hear it. Does it make a sound? The answer’s no, because the sound is in the ear, is in the brain responding to the ear.

Speaker 1 [00:50:48] If there’s heroin in a syringe, but no junkie, does there – I’m sorry, this is a terrible metaphor. I’m trying to make it work.

Speaker 2 [00:50:58] No no no. If there’s no brain, if there’s no opiate receptors to respond. So just to clarify a little bit, every single addictive drug activates that messolimbic pathway to produce pleasure and meaning and import. And we like that so much that we keep going back. Just like we go back for sex and chocolate cake. However, drugs also have their own independent effects: like opiates interact with opiate receptors, THC interacts with cannabinoid receptors, alcohol interacts with GABA receptors and other places in the brain, and those receptors and places in the brain will adapt too. So we lose the sensitivity to meaning sort of like listening to very loud music makes us deaf to sound, taking these addictive drugs or gambling over and over makes you numb to pleasure and news. But it also produces changes in other areas that make withdrawal unique. So, for instance, with regular cigaret smoking, you can’t concentrate when you’re quitting. With regular opiate use, you feel miserable when you’re quitting. With regular marijuana use, the world is bleak and boring when you’re quitting.

Speaker 1 [00:52:20] And how should we think about behaviors that – There are certain behaviors that people seem to do compulsively, but it’s less clear whether it’s an addiction per se, I’m thinking of sex addiction which my understanding is there’s conflicting studies on whether or not sex is something that we should consider addictive. Or for instance, I know there’s a lot of debate about video game addiction for example, which strikes me as a problematic classification because certainly a video game that mimicked a slot machine’s addicting mechanics might be addictive, but there are plenty of other games that don’t have such mechanics but yet which someone might play to the exclusion of their job, for example. How do we think about those gray area issues or are those gray areas for you?

Speaker 2 [00:53:12] Yeah, I can point to three things maybe. The first, when evaluating whether or not something’s addictive, is to ask whether or not the costs outweigh the benefits. So I think criteria for addiction is that it’s taking more than it’s giving. In other words, there’s diminishing returns. The second thing is whether or not there’s withdrawal when you put it away. So my way of saying this is, whether or not you’re on a dead-end path. And I think if when you have sex, you’re satisfied and you look forward to it again, but you don’t withdraw afterwards then it’s very different than a bag of cocaine, where the main effect of getting through the bag is that you want another bag. So if there’s not this evidence of dependance, where you can enjoy things without it, then you’re less likely to be addicted. The third thing is that addictions go from having a choice about using to a compulsion. So for me, when I described the closet I was living in, it was because I was compelled to get high and use every day. It didn’t matter what it took, I had to escape my reality. And so I felt less and less free, it was not even possible for me. I would occur to me to get some alcohol and then I was getting the alcohol. If I had to dig around for coins in the gutter, and I think that if you’re compulsively acting (as people who are addicted to anything will) then yeah, it’s a problem.

Speaker 1 [00:55:11] We know that this can happen with a wide range of substances and behaviors. But as we’ve already touched on, there is a really vast difference in the way that our society treats all these different substances. We’ve talked about the difference between alcohol and cigarettes or again, I grew up in a world where everyone who is using pot said it wasn’t addictive. That was received wisdom, no one ever questioned that. Which strikes me as very odd now, considering what you’ve said about it. So how do these societal ideas of addiction form and how do they get in the way of our treating addiction properly?

Speaker 2 [00:55:58] It’s hard to say how they form, I would say, as a bottom line that there is no relationship, generally, between the neuroscience of the drug use and the policy. I think that there is maybe a strong relationship between the policy and people’s beliefs. I have a nephew who thinks that alcohol is pretty okay. But in his state, marijuana is illegal, so that’s not OK. I think that we don’t have a great fidelity to science when it comes to making policy. We didn’t think that cocaine was addictive until 1986 and that’s because one of the criterion was dependance. That meant that you had withdrawal, and we thought that the withdrawal had to be physical withdrawal like you see with alcohol or opiates, where you’re having the shakes or the sweats and diarrhea. Cocaine doesn’t produce physical withdrawal at all, it just produces a kind of psychic misery. Because you couldn’t see that from half a block away, we thought, ‘Well, cocaine must not be addictive.’ I think it’s helpful to just appreciate that whatever you take the drug to do, it produces the opposite effect and the more you take it and the younger you are when you take it, the stronger the opposite effect will be. Dependance is one of the criteria for addiction and if you have dependance and it’s hurting your life (which is the hardest part to see), it’s always the last thing people will acknowledge; then it’s addictive. I don’t mean to sound quite so cynical, but I wouldn’t trust the news pundits; make your own informed decision. For instance, marijuana was interesting because there was this belief that it caused an amotivational syndrome. The question for scientists was, ‘Do people sit on the couch watching cartoons all day because they’re stoned or do they -‘

Speaker 1 [00:58:19] That’s the stereotype of of marijuana users is that makes you lazy, which is very funny in contrast to what people thought it did when it first came to the U.S., the reefer madness years where people thought it made become insane and violent. Even that cultural understanding has flipped over time. But sorry, please go on.

Speaker 2 [00:58:40] No, it’s OK. So does marijuana make you lazy or is it just the case that people who like to sit around on the couch and watch cartoons also like to smoke weed? Which is it? In my case, I think, that by regular smoking and down regulation of those places in the brain that respond to THC, I became less and less interested so that things that were pleasurable needed to be cartoons. Rather than my work or my regular friends or my family, for sure. I think we’re in a tough spot about that because what mostly seems to drive policy is economics, not neuroscience.

Speaker 1 [00:59:30] You mentioned cocaine and that makes me think of the incredibly disparate way that powder cocaine and crack cocaine were treated in the 80’s, and I think continuing today with really devastating effects. That was largely an economic (and of course) racial difference between those drugs.

Speaker 2 [00:59:53] For sure, and you can see it with THC too. Many people are in prison for trafficking marijuana. Some are getting out now, but all of a sudden it’s the greatest thing ever. Who’s got all the stock and all the farms and other things? Not those people who were in prison.

Speaker 1 [01:00:18] I mean, weed shops literally look like Apple stores now.

Speaker 2 [01:00:22] Exactly. Yeah, because there’s lots of money to be made. I think that shouldn’t be mistaken for saying that the drug is harmless.

Speaker 1 [01:00:33] Yeah. Do you have an opinion on the legalization of marijuana and other drugs, given your very nuanced understanding of the neurobiology behind them?

Speaker 2 [01:00:50] Well. Laws didn’t stop me from using, and I don’t think they’re all that effective. I do think we should be skeptical about who’s benefiting from the laws, but I’m more for education. My hope is that informed consumers will make better choices, and that’s going to be increasingly hard because really the markets are brutal and they push what’s economically beneficial. I guess people are going to have to think about whether or not this is good for them. Cigarettes are a perfect example. When it finally got through that nicotine was addictive and causing cancer and so many deaths, we slowly backed down but then it spread to other countries. So now there is still increasing cigarette use in Third World countries, for instance, and they’re coming mostly from the U.S., but also from their own places. Same with alcohol. We know it’s really damaging, but there’s so much money being made. I hope that people just look a little bit critically at the benefits to themselves, to economic interests and maybe to their communities before embracing everything wholeheartedly.

Speaker 1 [01:02:22] Right. I guess what I’d asked to finish this up here is, even just thinking about alcohol, it’s so complex. We’ve talked about how alcohol negatively affected your life and affected my life. We know it causes enormous numbers of deaths every year. Enormous amounts of misery are caused by alcohol addiction, but we also know that we tried a Grand National experiment with eliminating it. Honestly, if you go back and look at the history of the temperance movement, a lot of the temperance movement had a good argument. That alcohol was causing domestic abuse, for instance, and we know that it does. We know that alcohol is linked with domestic abuse now. So we experimented with outlawing it, that was a failure. Now we’re in a place where, we’re awash in alcohol and alcohol advertising, drinking habitually (as habitually as I did) is completely normalized. And so it often makes us feel a little rootless about how we should feel about this drug? Is this drug a normal part of life or is it not?

Speaker 2 [01:03:33] Yeah, lots to say there. I think what happens when things are restricted is that some people, probably those already prone, used more. So when the speakeasies were in vogue, there were fewer people drinking but those who did drink, drank more. And I’m kind of that way. If I go on a diet, I always gain weight. So something about the restriction is not good and in general, laws haven’t worked. The laws haven’t worked and the war on drugs hasn’t worked. So I think the answer is maybe not on the supply side as much as it is on the demand side and that is something that’s going to require a better understanding of ourselves and the long term consequences. Unfortunately, we’re doing the experiments on ourselves to find that out. But my hope is that by focusing on how the brain adapts to drugs, people will appreciate that, ‘Oh, you know, I took that sleeping pill. It worked great the first day. It worked really good. The second day, the third day. It was also good, but by the second week, I know I can’t sleep without it and I’m not sleeping that great.’ So I think that it’s just a function of how the brain is organized and what it does. Maybe it’s naive, but I think that the way forward should definitely include education and it would be terrible if we’re building roads on all the tax money we’re making from drugs and not putting it into treatment and education.

Speaker 1 [01:05:22] My last question is, do you have any advice for the person listening who is maybe having that realization about the substance or behavior of their choice where they’re listening to this, where they’re realizing, ‘Oh, maybe I am not sleeping that well’ or ‘I’m not enjoying this that much and I’ve become dependent on it.’ Do you have any advice for next steps for that person?

Speaker 2 [01:05:43] Well, I always like to start with the cheese, so let me go to the last step, and that is something that both of you and I have said. That once we are over the drug use, life is as wonderful at least as it was before. So there is hope for the long term. In the meantime, though, it’s a hard road to climb out, and my advice would be to get with other people who have managed to do it and talk to them.

Speaker 1 [01:06:13] Thank you so much. I could talk to you about this for another hour, but I’m afraid that’s all the time we have. Thank you so much for coming on the show. It’s really been wonderful.

Speaker 2 [01:06:21] Thank you Adam, it’s been great. Bye bye.

Speaker 1 [01:06:28] Thank you once again, folks, for listening this episode. Thank you to Judith for being on the show. That is it for us this week on Factually. I want to thank our producers, Chelsea Jacobson and Sam Roudman. Our engineer, Ryan Connor. Andrew W.K. for our theme song. The fine folks at Falcon Northwest for building the incredible custom gaming PC that I’m recording this very episode for you on. You can find me online at @AdamConover or adamconover.net.  Thank you so much for listening. And hey sometimes I say this and it sounds – I feel like it’s kind of a cliche, but I’ll say it at the end of this episode just because I feel like it. Please remember to stay curious.