Everything I see ads, even just people talking to me, everything saying you need more right right right, from social media to working to consumption, whether it's buying or partaking. It feels like there's just no balance between things. Yeah, and when we stopped and looked, we realized there was a term that was being thrown around a lot without knowing about it, and that's addiction. Yeah. People are like, oh, I'm addicted to this new game. I'm addicted to the
Pumpkins spice latte, to work to expresso Martiniz. But what is addiction really? I'm TT and I'm Zachiah, and this is Dope Labs. Welcome to Dope Labs, a weekly podcast that mixes hardcore science with pop culture and a healthy dose of friendship. Now, in this episode, we're going to talk about substance use and what's happening in the brain and the psychological, social, and cultural environments that nurture this
type of chronic brain disorder and its symptoms. This episode is for informational and educational purposes only, and it is not intended to be medical advice. And so now that we have that out the way, let's dive into it. TT, what are our questions. Well, I think for me understanding what addiction is so like the term addiction because like we were saying, everybody's throwing it around. I want to
know what addiction really is. Yeah, and like where's the line, Like where is it that you're I like something a lot and I want more of it versus I'm addicted. And if there is a line, what's happening in our brains that crosses that, you know? And it's interesting because we see the casual use of the word addiction, but also we see like the villainization of addiction to different types of things as well, Like there seems to be
like a higher even in addiction. Right, there's like these respectability politics that are in play where it's like some things, it's like, okay, addicted to television is fine, but addiction to this other thing is awful.
Yeah.
Oh, addiction to TikTok is bad, but addiction to Instagram is okay. I don't know how some of these things work socially, and so I'm curious about the history of addiction a little bit. And we haven't even touched on drugs, right, right, I feel like there are so many questions I don't even know where to start, right, so we should probably bring in our expert. This is a perfect time because the questions are just going to keep pouring out.
We need answers.
Today we're talking to doctor Zinga Harrison.
Oh doctor and Zena Harrison. I'm a physician.
My specialties are psychiatry and addiction medicine. I have been practicing both for over the last twenty years. I'm co founder and chief medical officer of Eleanor Health, where we we care for people with addiction and a longitude a model and then also author of the book An Addiction, Six mind changing Conversations that Could Save a Life. The big issue I'm trying to tackle is just how scary it's been to talk about addiction, because the things we don't talk about kill us.
I am a person who doesn't mind uncomfortable conversations, right, and that's the conversation I think is very taboo and makes people uncomfortable, which is interesting because the stats tell us that almost one in six people over twelve are diagnosis having a substance use disorder. I want to set the stage when we say addiction, and I really want people to understand what addiction is and what it isn't.
I love the stat that you dropped.
One in six people is diagnosed with a substance use disorder, So I would say substance use disorder is the medical diagnosis of a subset of the addictions, meaning the addiction is to a substance kind of a partner.
Statistic to that is forty six.
Percent of Americans, so one and two if you let me round up to fifty percent report themselves or someone close to them has struggled with the substance.
So that's one out of two.
So broad definition, you can think of addiction as continuing to engage in a behavior despite negative consequences, outweighing positive consequences or positive benefits, and so if you that's that's
kind of like the broad definition. The official definition, which is given to us by ASAM American Society of Addiction Medicine, defines addiction as a brain disorder that leads to compulsive behavior that can be drugs, alcohol, which is a drug, vaping, which is a drug, smoking which is a drug, sex, gambling, shopping, social media, all of these different behaviors that run through
the same neuro biological pathway. But so a brain disorder that leads to compulsive behavior that has negative physical, mental, social, and emotional consequences. So that's kind of like, what's super important about that medical definition is if I asked Yusekiah.
Stroke is a disorder of what organ in your body?
Brain?
Asthma is a disorder of what organ in your body.
I know the answer to this because I have asthma and that's the lungs.
But you say, addiction is a disorder of what organ in the body, and people don't even think of it as a disorder of an organ in the body.
The answer to that is.
Brain addiction sounds like a cousin or maybe even a sibling to obsessive compulsive disorder. Yes, So that was the first thing that I thought, And the second is how easy it is to miss things because of what part
of them we choose to look at. So if you focus on the choice or what the thing is that's abused, maybe you may say, oh, well, addiction to alcohol is not the same as addiction to drugs or addiction to gambling, or somebody who gambles a lot and puts themselves in a precarious situation is not the same as someone who does drugs and it's like, well, if you look at the pathway, that's very different than if you just look at the I don't even know what the term is for it, the choice I don't need.
Yeah, the symptoms, the symptoms, And so I think to kind of to just use a medical term love that you said as a sibling or a cousin of OCD.
Absolutely right.
So OCD uses all of the same neurotransmitters as addiction.
Ah okay.
And so if you think of obsessions medically, obsessions, we define them as thoughts, intrusive thoughts that keep coming back.
Compulsions are the behaviors.
That people do to decrease the impact of those thoughts on them. And so if you think about addiction, you could think about the obsession as being the craving. Although cravings are not just cognitive, they're not just thoughts. Cravings are actually a whole brain and body experience. But you could think of cravings as the thought and using a substance, sex, drug, social media, shopping, whatever, as the behavior that relieves the
distress from those intrusive thoughts. So nailed it, like a plus, Yeah, that was amazing. So the second part of what you say, which is like what we decide to focus on, and I said symptoms. So what I really want people to understand is addiction is a chronic condition that.
Starts in the brain.
Yes, anything that starts in the brain affects your entire body physically. Our brain is responsible for our thoughts, so it affects your thinking. Our brain is responsible for our emotions, so it affects your emotions. Our brains are responsible for our decisions, so it affects your behavior. Our brain is responsible for our impulse control, so it affects your impulse
control and our thoughts. Feelings, decisions, and impulse control are how we interact with the world, and so anything that starts with the brain is going to impact the way
we interact with the world. And what you're saying is when you look at addiction, just starting with the way a person interacts with the world, you think they're a bad person, they don't have good judgment, they are morally bankrupt, when in reality, it's a series of neurobiological things that are happening in the brain that turn into what we experience.
The brain is our experience of the world. Brain, it is it constructs all We just did an episode with a neuroscientist. She's a PhD student at PEN and she talked to us about pain, and she talked to us about like natural opioid release and the expectation of relief.
And immediately it made me think about if you have these intrusive thoughts and then you have this compulsive behavior, and that's probably reinforced by another neural network that says you can expect relief, you can expect this thing, and so you're reinforcing some of these pathways in the brain. Okay, so let's talk about brain circuitry really quick. Okay, so this is a chronic brain disorder. But for people who are saying, okay, you keep saying brain disorder, what does
that mean? What's happening? Can you talk more about reward and learning and impulse systems so that we can help people understand why this isn't something that you just snap your fingers and are done with it.
So, okay, I want you to think about your brain. We're going to break it down into a number of different parts. The first breakdown we're going to do is your deep brain. So the deep brain is the part of the brain that we share with all animals. That's where our instincts are. That's where our impulses generate. That's where our motivation for survival is. That's the dopamine pathway. That's where our like breathing and heart rate and all of this is controlled. Okay, okay, deep brain on top
of your deep brain. When humans think about the brain, you think about that little picture that we see pointed to the side that looks like a fist with all of the folds in it, right right, that's your what we call cerebral cortex. So your cortex is the part of the brain and humans that has really developed hugely, and that's where our higher order thinking is.
So that's where our impulse control is.
That's where what we call our executive decision making, so like taking in information, deciding.
What it means, and then choosing to do something about it.
And then that command center sends back down through the deep brain to the body to tell.
It everything to do.
And so I tell people, I want you to think about three parts of the brain as it relates to addiction. First is in the deep brain. It's called the ventral tegmental area VTA. From the nerds out there, Okay, the VTA has a neuron in it and any external stimulus. So something outside of your body in the world triggers a dopamine signal, okay, that sends forward to another part that is still in your deep brain, your nucleus cucumbents.
The nucleus cucumbents then packages that dopamine signal and sends it forward to your CEO of your brain and body, which is your prefernal cortex. Your CEO of your brain and body says, this is what the outside world is telling me, and then it takes information from your inside world and it decides what does that.
Mean and what we are going to do about it.
So what I just described to you is the three neuron or nerves that make up your dopamine pathway. Our dopamine pathway evolutionarily speaking, keeps us alive.
Okay.
So anything that generates a dopamine signal, your brain interprets as I need this to survive. The natural things that make a dopamine signal, our food need it to survive. M water, needed to survive mm hm, sex, needed for the species to survive mm hm.
Because yes, to keep us humans, all species.
The population.
Right, the population alive, Yes, yes, yes, but there's another component of sex that's pleasure and connection. But we'll get back to the survival part.
What else do we need nurturing?
Because what happens the little human baby, what happens the little animal babies with no nurturing?
They buy right, you're.
Out of here.
Those are the four natural determinants of dopamine. Here's what's crazy. You look at the drugs we have that people get addicted to. You look at the behaviors we have that people get addicted to. I'll talk about drugs right now. You can think of a dopamine signal from food as a light bulb starving.
The ventral teg mental area says we need to eat. Pain. Light bulb.
You see some food. The nuclear cucumbents is like, that's food. They package that information inside that make your stomach growl. Right, you feel hungry outside, you smell something. Your brain takes all that information. It says, I need to make a plan to eat so that we can stay alive. Yeah, that's the brightness of a light bulb pain. It's a great idea. Meth amphetamine. The size of that dopamine signal is ten to the ninth.
Okay, so ten to the ninth. Ten to the sixth is a million times, and so ten to the ninth is a billion And so that means that your brain interprets dopamine signals way more than anything else.
And your brain interprets a bigger dopamine signal as more important.
Period.
Yeah, So when people quote choose meth amphetamine over their family, it's because the myth amthetamine dopamine signal is ten to the ninth, the nurturing signal.
One billion times one million times.
Magnify it. And so the message that is sent forward with urgency to your CEO is we need this to survive, make a plan to never go without it. And as addiction kindles, like think about a fire, right, we go from that first ember, it gets.
Bigger and bigger, and bigger and bigger.
Your CEO becomes less and less able to refute that message.
Now this, I am having a dopamine response here because I enjoy this type of stimulation. Okay, there's so much evolutionary biology, and there are so many things that our brain primes us for that are historical that no longer exists, right, and so I love the example to give us a range to understand magnitude between something really simple like hey, we need something to eat. You talked about vaping. Something that has incredible marketing for young people, fruity flavors. We
see it all across social media. Packages beautiful packaging, cool yes, and so you know, so there's all of that going on. I think about marketing for food, and I'm also then thinking about what kind of signals do we see. I'm also thinking about social media. I don't know if you've seen it's on Netflix. It's a documentary. Oh unknown number. I thought that that was such a crazy documentary, like I could not believe it.
Okay, no spoil or alerts for the listeners, but mind below now.
And so I was thinking about what would make a person do this. I'm thinking about what we know about social media and the dopamine hits people get with the gamification of these different platforms. And I'm wondering because you know, you can't just override your biology.
At least, I don't think you can write.
And that's what I've learned from my friend, and so you would probably have to replace it with something else, right, Yeah, So when we think about things that are taking over our dopamine pathway, how do you get rid of them?
You have to empower people with information.
Right, So if we go back to our childhoods, just say.
No baby, that black T shirt their yes, those good letters, it is etched into my memory.
Okay, just say no.
It doesn't work because it doesn't give people the information why they should say no, right, Like, empower people with information and then honor the choices that they make about it. So, for example, we can think about addiction. I describe to you the three neuron pathway. This is now like the three stages, right, One you have intoxication, Two you have withdrawal.
Three you have craving.
The combination of withdrawal and craving drive you back to use whatever. That behavior is intoxication. So when you think about social media actually brilliantly designed because your mind and your own business, and they trigger you with a notification, yeah, and then you know that notification is sitting there, and then you develop withdraw right, like those obsessive thoughts around what is that notification that.
I didn't see?
And then you go on social media and you scroll, scroll, scroll, and you get intoxicated because it is giving a dopamine and no, most likely through the connection pathway. Right, And so the way I think we help protect people against this is one not making it as if.
Those people over there have addictive behaviors.
All of us have some addictive behavior of some sort because we are all wired with the dopamine pathway. So my addictive behavior may be food, My addictive behavior may be shopping, My addictive behavior may be alcohol. My addictive behavior for some people may be exercise.
Right, whatever, work.
Let's not forget work, because I actually, I actually say it all the time.
To people like I use work like a drug.
I love work when I'm not working, I have withdrawal, I have cravings for work when I'm not working. When I am working, I binge yes. I work to my detriment. I work to negative consequences. I get lots of positive feedback for this, and it makes my addiction loop worse. Right, So, like all of us have something that is addicted to us,
because that's just the neurobiology of have we built. So if we can accept that, that gives us compassion for the person whose addiction happens to be alcohol, for whose addiction happens to be opioid, for whose addiction happens to be cocaine, and then we empower yourself with the prefernal cortex can be trained to top down control that deep brain. It requires a supportive environment, It requires community and belonging,
It requires education and knowledge and empowerment. And so how do we address environments, how do we address cultures?
How do we address psychological needs?
All of that allows us to create an environment that a prefernal cortex can be trained.
This is also blowing my mind a little bit. So I was reading something about the genetic risk and they put it at about forty to sixty percent. What do we know about genetic risks as it relates to addiction? Is there a hereditary component to it? What's the state of things right now?
Yeah, it's a multi gene an environment interaction.
I lay out this framework that says every chronic condition has biological inputs, psychological inputs, and environmental inputs. And the environment is both cultural environment and physical environment. And so if you look at all three of those, This is
how the book is laid out into six sections. The first three sections are inherited, So inherited biological, that's your DNA, inherited psychological, your childhood, inherited environmental, the culture and physical environment you were raised in.
When we look at.
Inherited biological forty to sixty percent of your risk for developing an addiction of any sort is coded in your DNA the day you.
Are born, forty to sixty percent.
If we look at the forty to sixty percent inherited risk through your DNA for any addictive disorder, that.
Is higher than high blood pressure.
Ooh, that is higher genetic loading than asthma, that is higher genetic loading than type two diabetes. So whereas we look at addictions so more realistically, like you just chose to have addiction. It's really because it's hard to separate feelings, behaviors, and thoughts from like who you are as a person.
Doctor Harrison, How do you even go about talking about something like this, Like how do you prepare your kids to understand this type of risk at like a biological level when it comes to the genetics of it all.
I have a very robust family history of addiction of all sorts and mental health conditions from both sides. Maternal side is loaded, paternal side is loaded. What that allows me to do is practice generational prevention with my kids. Right, so from four years old, I start training my kids into the understanding of addiction as a chronic medical condition that deserves and requires compassion for the people who are
suffering from it. And then as they get older, I can say, listen, this is what Mom gave you in your DNA. Risk for high cholesterol, risk for alcohol use disorder, risk for cocaine use disorder ADHD, resilience, high IQG.
Like these are all the things that come in my DNA. But because you know.
You are most likely on the sixty percent end of that spectrum based on our family history, like sixty percent of your risk for development an addiction you were born with courtesy of mom. Right, then, when you go to a party in high school and the kids are on a line of cocaine, they might be able to do a lot of cocaine and have fun. Right, they might be able to binge drink. Let me tell you what happens in our family. They might be able to hit the bong for marijuana. Let me tell you about this
schizophrenia risk in your DNA. And then that empowers people to choose maybe differently.
I love that because what it really highlights is this, huh, this lack of compassion that is actually artificially creating, because I think if we were to say, oh, this person has breast cancer and they inherited this from their family, we wouldn't say, well, why did they smoke cigarettes? If they knew that their mom or grandma had breast cancer. We wouldn't say why did they live in this neighborhood where they would be exposed to carcinogens or whatever. We
wouldn't do those things. Yeah, we would not villainize people for working with the cards that they were dealt, you know what I mean mean, But if you're dealting that hand of cards and you have the exposures and are facing substance abuse, what's the path for it? If you're trying to recover and someone's making this about morals and choices.
I think the answer to your question is one teach people how to have the conversation to undermine the moral high ground, because the true moral high ground as humans is when we see someone suffering, we meet them with compassion and support, not judgment.
I'm curious about relapsing and how we should be, how we should understand it or think about it, like you know you've already said we should be meet we should meet people with compassion, Like what is what should you expect based on what we know is happening biologically?
Yeah, so I'll come back to this foundational idea for our conversation that I want people to understand. Addiction is a chronic condition. In medicine, When we say something is a chronic condition, that means you have periods of relapse and periods of remission possibly right, Okay, So in medicine, when we say in illnesses and remission, this means a period of time where you either don't have symptoms at all or your symptoms don't rise to diagnostic threshold.
Okay, when we.
Say you're in a period of relapse. First of all, illnesses relapse, not people. So this is what I should have said earlier is the key. And when you said what can we do? Like, we accidentally send so much stigma in our language.
So he's in even saying.
Drug abuse because like abuse is a crime, right, substance use disorder is a diagnosis.
Addiction is a condition. But like abuse is a crime, it automatically conjures up a bunch of stuff for us.
Yes, and so when we say you relapsed, use your cancer example again, when a person has breast cancer, they do chemo and radiation and the breast cancer goes in remission. If the breast cancer comes back, we don't say that woman relapsed.
We say the cancer returned.
The cancer returned, right, the cancer relapsed. And so the same thing with substantute disorders. So to answer your question, there was this foundational study done in twenty ten, one of my favorites by McClellans, and he looked at individuals with substance Hue disorders whose symptoms were severe enough that they needed.
An impatient hospitalization.
Okay, okay, and then he also looked at people with asthma, people with high blood pressure, people with diabetes, same thing, symptoms severe enough that they needed a hospitalization. And then he looked one year later, what percent of people were following medication recommendations and what percent of people were following
psychosocial recommendations. When we look at addiction, we didn't have any medications except methodone for addiction back in twenty ten, so this study didn't wasn't a methodone study, so it only had were they following psychosocial recommendations at one year? Pretty much evenly across addiction asthma, diabetes, hypertension, seventy percent
of people were not following medication recommendations or psychosocial recommendations. Right, And then when they looked at what percent of people experienced a relapse of their illness within one year of that impatient's day for addiction, high blood pressure, diabetes, asthma, it was about fifty five percent across.
All of them. Wow, the symptoms of their illness had returned.
And so to ask your question, what can you expect in the first year of remission from a substance use disorder, approximately fifty five piece percent and people will experience or relapse. That is a dramatically high number that is reflective of our system's inability to address the biological, psychological, and environmental triggers of the illness.
Right as you get to.
The second year, that number only falls a smidge is probably still about fifty to fifty five percent. As you get to the third year, it falls a smidge is about forty five to fifty percent. The risk of relapse of a substance use disorder falls back to that of the general public that never had an addiction at the five year mark. And so when we think about a thirty day rehab, y'all.
That ain't it When you think about a five day detox y'all? That ain't it?
When you think about a ninety day residential stay, y'all, that ain't it?
Right?
So when you say, is it something like eleanor health, Yes, because we're trying to stay engaged with people for that entire five year period of remission to practic This is what we call in public health secondary prevention. So try to prevent the symptoms from returning, just like you do with breast cancer.
Wow. I really like how you explained that, and I appreciate you correcting me because I want to learn and I want to get it right. I don't want to be out here saying the wrong thing.
Yeah.
Yeah. And for folks that want to do something little like even as small as just shifting your language. Is there any language that everyone should switch to? Is there an activity or exercise you think that people can do to reorient their minds in order to be more tolerant.
Yeah, the very first thing.
I just want to train people into two kind of like ways of thinking and two ways of talking.
First.
This is for any illness, any chronic condition, addiction, included that person is not a diabetic, that person is not a schizophrenic, that person is not an addict.
Because what you're.
Doing when you say that is like making it as if there is nothing else you need to know about that person, and nothing else about that person that matters, or that they and the illness they have are equivalent, right, And so instead, that's a person with diabetes, that's a person with schizophrenia, that's a person with addiction.
Right.
And so if you just lead with the person in your words, then you also start to lead with the person in your thinking, and then you also start to lead with the person in your behaviors. So strike the word addict. Yes, that's a person they have an addiction to.
Right.
The second thing I would say to to try to strike and we use it. I'm gonna say three things you just talked about it relapse, right, Illnesses relapse not people. Yes, you can say that person's alcoholism relapse, or that person's opioid addiction relapse, or that person had a return of their symptoms. It's an extension of the first, which is leading with the person, and the third.
Clean and dirty.
So I think this language and kind of these depictions probably started with good intentions. Addiction is devastating and scary, and it steals the people we love from us. Opioids steal them kind of fast, like you can die right now. Alcohol cigarettes steal them slow, long and painful, right, methamphetamine, cocaine, et cetera. And so it was like, make this so scary so nobody will ever want to try it, and make it so awful, so that nobody will ever want
to quote be one of the people. But unfortunately, it's just not how it works. And then once you do it so much, even if it starts with good intention and it has negative impact, it starts to just get ingrained in us, and we're like kind.
Of thoughtless about it.
And so that's what I would say to people who are listening. If you want to be part of the solution, be thoughtful. Be thoughtful that is a person periods. Start from there, and be thoughtful about that person as you would be thoughtful about any other person, as you would want someone to be thoughtful about you.
Yes, being thoughtful. I mean, it's so simple, but it's absolutely something that is missing, like culturally, like at the very foundation of how we interact with folks. But at a system level, how does our system treat substance abuse disorder?
Yeah, just a quick look back at history. Before eighteen sixty five, there were no illegal drugs. There were drugs, but there were no illegal drugs. And then the series of laws that started to be developed. The first set of laws were targeting Chinese immigrants, made opioids illegal. The next set of drugs targeted Mexican immigrants and made cannabis illegal and even changed the name cannabis and start calling it marijuana so it will be associated with Mexican people
and conjure up kind of like negative. When we look at the percent of people who are in prison and jail, the overwhelming majority are associated with substance use disorders. When you look at who is disproportionately jailed rather than offered treatment, that is black people, people of color, LGBTQ people, people with physical and other mental health disabilities, immigrants, people whose first language is not English, that's here in this country.
And so it follows the exact same because those are all cultural constructs that are pulling into every single facet of our life. For example, suboxone is a medication that we had to treat opioid use disorder. Really well done study out of an er showed that a black person with opioid use disorder who exp sperienced and overdose significant enough to take them to the er, it's thirty five times less likely to receive a prescription for suboxone than the white counterpart.
Thirty five times.
And that's the prescription.
That's not even the prescription, that's not even the psycho social support, that's.
Not going to none of it.
That is just purely in the biological realm, like not even a prescription. If you look at who has access to suboxone, it is higher socioeconomic White populations. Disproportionately lower socioeconomic populations have more access to methadone, which is extremely difficult to use because you have to go to the clinic every day at five am and all this kind of stuff, right, and so those cultural inequities are pervasive in every facet of our life, and substance use disorder has not been spare.
H doctor Harrison, I have learned so much today, even down to my language. I now understand just how much I've learned from television and movies. And it was wrong, and I'm wondering why Dare didn't teach me a lot of the things. Honestly they were saying they were teaching us, teaching they weren't teaching us, and like, this is something that we always talk about Zee. Unlearning is sometimes so
much harder than learning. So going back and like changing the way that you think about things and how you approach certain situations and the word your word choice, it's so important. And doing the work of unlearning and then relearning.
Is so.
It is it is a sign of compassion, like to understand that there is a different way of living in this world that can make folks feel more included, more considered, more thought about in choosing that I think is one of the greatest things about humanity. It's one of the most important things that we can do while we're here on this earth. That's right, t T. That's beautifully said.
You can find us on X and Instagram at Dope Labs podcast TT is on X and Instagram at dr Underscore t Sho, and you can find Zakiya at z said So. Dope Labs is a production of Leimanada Media. Our supervising producer is Keegan Zimma and our producer is Issara a Sevez. Dope Labs is sound designed, edited and mixed by James farber Limanada Media's Vice President of Partnerships and Production is Jackie dan Singer. Executive producer from iHeart
Podcast is Katrina Norvil. Marketing lead is Alison Canter. Original music composed and produced by Taka Yasuzawa and Ali suji Ura, with additional music by Elijah Harvey. Dope Labs is executive produced by us T T Show Dia and Zakiah Watki