The Future of Addiction

deal with this crushing problem. Uh So, without further ado, let's dive into the top. This episode is, uh, I'm gonna look at the future of addiction. Uh. And we're not talking about just what kind of crazy drugs would have in the future. Now, we're talking about how can we treat addiction in the future. What are some of the cutting edge and emerging techniques and technolog only do is that will be at our disposal to deal with

the disease of addiction. Yeah, and before we look at the future stuff, let's just kind of look at what's going on in the present. The number one driver of aids in the world is used heroin needles, particularly in countries where there's no needle exchange programs. So what if you could get rid of the root problem, you could eradicate heroin addiction, or for that matter, really any addiction. Yeah,

and we're not just talking instantly. Minds tend to turn to Africa, and certainly that's one of the areas concerned here, but other you know, countries that don't have needle exchange programs include such large, uh populous nations as China and Russia. Yeah, I think that people don't, you know, at least people outside of the United States don't realize what in the city is problem. This is half a trillion dollars or spent worldwide to treat addiction. So here's just one little

prism of the addiction problem in the US. And estimated one point four million Americans are addicted to pain, which was the reason for more than four hundred and eighty two thousand emergency department visits in two thousand and eight and is a leading cause of heart attack and stroke

among people younger than age thirty five. So the problem here, of course is that we have access and if you look at you know, sort of where drugs are in the time continuum of history here, Um, we have more access to drugs than ever before, and more types of drugs, and what emerges here are some highly, highly addictive substances.

I'm talking about meth, which creates one of the biggest boosts of dopamine in the brain, and prolonged use of this can lead to psychotic like symptoms, talking about strong hallucinations, really violent behavior, and studies of the brain patterns of some long term matthews have shown that up to fift

of their dopamine producing cells have been damaged. So if you listened um to the other episode on this, then you kind of know already that, Um, this is a situation where the person is just getting deeper and deeper into the hull because it's not about free will anymore, because the parts of your brand, the executive function, have been so eroded by drugs that even if you wanted

to stop, you might not be able to. Yeah, and and and that's certainly the the anti drug messaging that I think needs to be focused on more often with

meth amphetamy. Because I was reading and according to neuro psychopharmacologist Carl Hart, there's actually no empirical evidence to support the claim that meth amphetamy causes one to become physically unattractive, which hopefully they've they're calming down on that, but for the longest, like like meth mouth, you know, and the transformation of the meth addict into some sort of subhuman

hyena person has been kind of the focus. When certainly that's flashy that works on a billboard a little easier, but the reality of what's actually changing with the brain that is far scarier than some sort of decal on hide ship. I agree. I have seen the ads before where there's like this beautiful woman and then she takes out her false teeth and she takes off her makeup, and all of a sudden you see her meth attic riddled face, and they are appealing to vanity. But vanity

doesn't matter. When addiction is highly routinized in your brain, um, nobody cares anymore what they look like. So if you were to instead crack open the brain and show people this is how your brain is actually like completely mutating here, that might be a far more compelling story to people. The next one is another biggie, and that is of course heroin derived from opium, and of course this one has been wreaking havoc for for years and years. Yeah,

thirty of first time users will become addicted. In two thousand and five, two point four percent of the American population said they had tried heroin at least once. The source of that is Department of Health. And withdrawal symptoms are really acute. They arrive just a few hours after a dose swears off, and because of this, users have a really high chance for relapse. Because we talked about

this in the last episode. UM, at some point the addiction becomes less about chasing the high and more about chasing some sort of equilibrium and feeling normal again, which can only happen if you get more of the substance in your body. All right, And the next big one to hit might come as surprise because it's not crack cocaine. It is nicotine. Nicotine is a very addictive substance. But

we often overlook this why. Um, I think it's because it's legalized, right something like of people who ever try cigarettes will become nicotine addicts. At some point, you can buy it legally at the store, at the gas station used to. You can get out of a machine. Um, someone's liable too, and it's given its legality and an overall still social acceptance, um, people are liable to give it to you without it being that big of a deal as well. So and it still looks cool on TV, right, Yeah,

and it's not as big of a risk. And this is something that David Lyndon, professor of neuroscience at Johns Hopkins University, pointed out. He said, you know, hey, if you have a bag of heroin, you're not going to do a whole bag of heroin. You know you're gonna overdose. But if you have a pack of cigarettes and you have ten or twenty of those cigarettes throughout the day,

you get that little ding of dopamine each time. And he kind of yeah, he kind of like likened it to pav Offs dog, right, so he said that we're really good at training or inner dog and sort of being like, oh, I need a little pick up right now, and you get that little dopamine um pleasure feeling from it. But you're not going to necessarily, um render yourself unconscious or unable to work or any of those things. But

still it is an addiction, and it is an addictive behavior. Yeah, you hear about people being one or two back a day smoker, whereas in the panel they pointed out that that even a heavy heroine user is probably not going

to use more than through times a day. And so to go back to what one of the topics were discussed in the previous episode, chunking that idea that the brain is forming habits give X, then Y and Z and uh and then per forming a shortcut kind of a hot key for the brain for behavior encoding the memory of usage. Uh, you're going to have, what you know, twenty times uh or more per day that you're enforcing that shortcut as opposed to a maximum three times per

day with the hairin user. Yeah. And Charles do Hick, the author of UM, the Habit Loop, I think I totally slaughtered that. But um, he's talked about this and written about this at length, and he says his claim is that percent of our decisions every day that's just habit. We think we're making these decisions, but really we're just responding to environmental cues in these well worn neural pathways

in our brains. Yeah, because, if we've discussed before, habits take up energy, if they take a cognitive power, and we don't have a limitless amount of that. So we handed over to to routine, we end it over to habit so that we'll have some juice to handle the actual decisions that are coming at and of course that the problem with this is that again, your brain, your brain secretary, isn't making any sort of like, hey, this

could be a terrible thing. Don't do this. Um and your prefrontal cortex, your executive functions in your brain are already sort of um lessened by the addictive behavior. All right, The next thing we have here is prescription medication, one of the rapidly growing substances of abuse in the US. Between nineteen eighty and abuse of prescription drugs increased four and it has about the same amount of usage in

America as cocaine. According to the National Institute on Drug Abuse, drug overdose was the leading cause of injury death in two thousand and ten, and among people twenty five to sixty four years old, drug overdose caused more death than motor vehicle traffic crashes. So the National Institute on Drug Abuse goes on to say, by the way, and two doesn't intend seventy eight percent of the drug overdose depths

in the US were unintentional seventy eight percent. And I think that this is painting a story here about how prescription drugs, uh have become so accessible in people are mixing them with other drugs or mixing them with alcohol to their detriment. Yeah, I mean, it's it's important to to to to to to point out, yeah, that prescription drugs just because it's prescribed, does not mean it is necessarily a safe substance of Any of these are very

dangerous socis. I mean, any of these are amphetamines. Uh, and they're not that different from the illegal variant. And certainly methamphetamine itself is memory serves as scheduled to narcotic anyway, which means that it consuvably has a medical purpose. Uh. And it makes sense to like, which which car is going to be faster, the one made in a garage or the one made at at a at a factory. Right,

And what do we have with with drugs? Your street drug is often made in a garage, whereas your your pharmaceutical product, he's made by a billion upon billion dollar industry. So it's it's kind of like a supercharged vehicle. Yeah. And um, I'm sure that people are aware that there are ways that people get their hands on drugs that they shouldn't have. They were legal drugs prescribed and I

won't go into that. I will say that if you are interested in learning more abound fist prescription drugs, check out the documentary American Addict that goes into detail. It's pretty depressing, um, but it's also very eye opening about this topic. All Right, we're gonna take a quick break and we get back. We're going to talk about the treatments of addiction. Alright, we're back, So we've we've we discussed addiction here. Let's talk about the ways that we

treat addiction. We have several different approaches that are currently in play, and we're looking at some some new methods of tackling in the future. Yeah, and before we go into that, we should say, hey, by the way, rate of relapse is really high for addicts. I think this

is something most people know. According to the National Institute on Drug Abuse, relapse rates for drug addicted patients about forty It's similar to relapse and those suffering from diabetes, hypertension, and asthma, and drug addictions should be treated like any other chronic illness with relapse serving as a trigger for renewed intervention. So keep this in mind. Um, and we talked about this, this idea of memory encoding behavior and

there are being triggers for that. So imagine that you have just completed a program, say from heroin abuse, and you get out and UM, I think I called them before, these neural ghosts, these neural pathways in your brain, the sort of cellular scarring that's still there. It's very easy to tap into that and have that behavior express itself again. A great example of this is Philip Seymour Hoffman, which is brought up at the World Science Festival for the

panel of the Craving Brain. They said, look at this guy. He was something like ten years sober from heroin addiction, went to a rap party one night, had a beer, and then something like I don't know, was it weeks or months later, had died from heroin overdose. Yeah, I just started him down the path, opened up those pathways again in the brain, those those pathways of habit and behavior in addiction, and uh, and then then that's where he ended up. Yeah, So you know, you're not treating

something that's easily dealt with. Here, right, Just I keep coming back to the idea of a cat's cradle, right, you know where you take the shoe lace tied together and you you string it between your fingers, and it's all the different fingers holding the string out to form this pattern. And you can't you know, put a point at one particular finger and say that is the cause of the pattern, that is the cause of the the

overall design here. And just as there's no over that one finger you can pin the whole design on, there's no one finger you can remove. There's no one treatment plan that's going to to be a magic bullet against

the problem of addiction. Yeah, because in one sense, um, it doesn't really matter anymore if you have genetic dispositions to addiction, if you're in the middle of an addiction, because at that point you've got habit taken over, you've got the transfer station, there are significant changes to your brain, and now you've got you know, memory all wrapped up in it. So um. So, yeah, it is a bit of a cat's cradle. But the treatments can't really treat

a cat's cradle. You can pretty much go after individual fingers. Yeah, Yeah, there's no unified treatments. So the most widespread medication right now is in a antidepressants, because this would address the feelings of despair or you know, any sort of pre existing condition like depression that may have led to the

addiction in the first place. So the album with that though, is that you would have to really pair that with behavioral therapy because it's not just enough to say, here's a depressant and we have another a number of other medications that sort of target individual parts of the chemical cocktail involved in addiction. UM. We have, for instance, one of the most famous being a methodone which suppresses withdrawal symptoms and relieves craving. With the people are recovering from

from heroin, uh, you know, morphine addiction. UM. You have other substance such as now trek zone, which works by blocking the effects of heroin and other opiates at the receptor sites. UM. You have of course, so when you're dealing with nicotine nicotine, you have nicotine replacement therapy where essentially you're still getting the nicotine, just not through the cigarette, and that's used to help with the with the with

with the with cravings and whatnot. With alcohol, you have now trek zone, which blocks opiate receptors that are involved in the reroarting effects of drinking and in the craving of alcohol. UM. So you see all these types of medication there Again, they're going after sort of a particular point in the chain and chain of effect and uh and that. But they can't they can't deal with environment.

They can only deal with with one point in in the the chemical reaction, be it in how the brain is receiving or how the brain is dealing with withdrawal from the substance. And of course that has to have to have a behavioral counterpoint counterpoint part in order to succeed. Yeah, and in the case of methodone, that itself is highly addictive, and it's going to argue that you're just delaying the process of rehabilitation. Really, you're just moving the goalpost out.

So what do we have on the horizon in the future, And you've got some really interesting things going on. UM one is called optogenetics, and are excuse me optogenics And this is basically kind of like UM a light sensitive molecule that's beamed into the brain so far of rats, So rats that are learning certain habits, the researchers can use this optogenetics treatment to basically turn on or off neurons in the rats brains and block the behavior and block the the ability of that rat to sort of

remember like, hey, I want to go and do this. Um. And what's interesting about this is that the rats change their behavior in response to different rewards even when the light wasn't present. So after they got the initial zap with the light, they still didn't return to the bad behavior even when a significant amount of time had passed. So obviously this is happening in rats right now, not in humans. Um. But it plays into this other idea,

which is electromagnetic magnetic stimulation. Yeah, this is the form that this would likely take in the treatment of of of human addicts, and certainly this is where the research is headed. Um And and in this we would use electromagnetic stimulation outside of the scalp I hope no surgery required, uh, using transcranial magnetic stimulation on these particular parts of the brain.

Again to almost not to simplify it and say, it's just like turning the switch on and off in terms of addiction, but but but turning off that that that that craving, right, Yeah, and increasing the neural activity in the parts of the brain that deal with executive functions like willpower. Right, So that's what we've talked about that that's such a big part of this. So then you have you know, willpower being ramped up and you have the addiction behavior being ramped down. What you still have

to deal with is memory in those triggers. And David Lyndon, the neuroscientists and author of the Compass of Pleasure, says addiction is a form of learning. When we, for example, puff on a cigarette or inject heroin in our arm, we are developing associations between the act of puffing or the act of injecting all the other sensory information that's around the sites and the smells, the people were with,

the music, we're hearing, the room. We're in a situation that surrounds us and the pleasure that is produced as the result of puffing on that cigarette or injecting that heroin. Well, I hate to invoke the title of the movie anymore since it's invoked again in every every news article on

science that deals with erasing the memory. But you kind of have to go eternal sunshine of the follower's mind on that particular drug memory, because, as we discussed in previous episode, the drug memory is has has is really firmly encoded. It's not just the memory of taking the drug. Is the memory of the environment, the situation of the drug,

All these things tied up into it. So, yeah, what if you could go after that memory, if you could blast that memory sort of photon torpedo it, then you could conceivably have a leg up on beating the addiction, or you could you could just like hose it down with a chemical, which is essentially what researchers at the Script's Research Institute have done. This is from a Fall two thousand and thirteen study published online in Biological Yeah Tree.

For six days, they had rats alternate between one of two rooms, and on the odd days they were put in a chamber let's call it Chamber A and given meth. On even days they were put in Chamber B and given a sailine place debo. So a couple of days later, half of these rodents were given a choice between those two rooms, and the room associated with that meth, of course, was preferred by those rats who were injected with meth.

But the other half of the rodents were then injected with something called La trunculin a or lat A, and this is a chemical that interferes with actin and that's a protein known to be involved in memory formation. So when they were injected with lack day excuse me, latte, the animals showed no preference between rooms even up to

a day later. Again, this is all highly experimental, but it's it's giving us an idea that there are certain interventions that can happen to address all the different facets of addiction. And the researchers do point out that you don't have to worry about about this particular method being used to just erase memories willy nilly. They say that you actually couldn't take their discovery and erase your run

of the mill memory inside of the brain. Uh. They said, you can only use this to get rid of these strong drug associated memories. And of course there's gonna be many more studies and they will have to be human trials in order for this too for the FDA to approve of it um. But that gets us into this other territory in which the f d A has approved

one type of vaccine but not another. And when I'm talking about our vaccines developed by Kim d Janda, he was on that World Science Festival panel of the Craving Brain to block the effects of heroin and users, but also block the effects of nicotine and users. So guess which one is being funded? Oh well, obviously they're going to fund the nicotine one because that's your that's your kind of your your white collar drug. Everyone is dealing

with nicotine. But heroin, Oh, that's that's a dirty that's a dirty drug. That's that that's the at the bottom of the circus tent, right, that's the that's down there with the safety name. Yeah, even though an estimated twelve million to fourteen million people used heroin as of two thousand and nine, accorded to according to the United Nations Office on Drugs and Crime, and Americans uh something like

two in two thousand and eleven. So obviously it's a pervasive problem when we spend a lot of money on that um. But the vaccine itself stimulates the immune system to recognize the substance and has to be given over a period of weeks, which eventually renders the person immune

to the drug. Because how do our immune systems try work. Right, Our immune systems evolved to deal with foreign outside invaders, so our immune system doesn't doesn't look at incoming cocaine or heroin or nicotine or alcohol and say say, oh, that's bad, let's go after that. They say, sorry, that's not on our list of of suspects. We're not gonna go. We're not gonna go to right, you know. So the

idea who are this vaccine is? It is it puts those offenders on the on the suspect list for our immune system and keeps them from crossing a very important border, at least in the case of the heroine. Yeah, the blood brain barrier, because that's key here. That will actually block any psychoactive effects. So in other words, you're not

going to get high. Yeah. And what they found in the rats, or what Genda said he found is that they would give the rats like uh doses overdose quantity, right, Yeah, and the rats would survive when they were vaccinated. So of course it's not something you would want to try and human trials, but um, but it does lead us to this idea that once you take the psychoactive part out, the actual um blood brain barrier part, where it doesn't get into your brain and then affect the rest of

the system. Is that you could render this this drug toothless. Yeah, and it's it's important to know that this is not like like a lot of other vaccines. It's not a situation where you'd say, all right, give everybody in the population the heroin vaccine and then heroin doesn't work on any body. This would be more of a tool to prevent a relapse. Really. Yeah, But again, the problem here is the stigma, because of course the nicotine one has

human trials. It's brought to market. Just look at those polite people and the TV commercials dealing with their nicotine problems, right, and certainly many of our listeners are dealing with the nicotin problems. I don't want to cheapen it or anything, but it's it's far more socially acceptable. I think of your TV version of the guy who's smoking too much, and it's just a random guy. It might even be Goofy from the Disney cartoons. I finally remember him trying

to quit smoking on the cartoon. I never saw a Disney cartoon in which Goofy had to deal with a heroin problem, even though that fits the time period right the forties, you know perfect. I mean you could see Mickey tying his arm off. I mean, we're making light of this, but really, I mean this is this is something that I think is very disheartening, especially for chimd Janda, who came up with a vaccine in the first place, for heroin to stop this spread of AIDS, because of

course the vector here as uh use needles. So I think it's got to be uh, really just disheartening for him to hear from um big pharma there's no market for this. There's no market for a heroin vaccine, are you kidding? Yeah, it's because again, when you look at the huge public health benefit to something like this, it's

just it's an insane Yeah. And another thing that they said on the panel is that this just has to become more of the national discussion, and that, uh that doctors need to have medical training on how to talk to their patients about addiction, because they say right now that they're not trained in that, and that the big joke among doctors is that if a patient comes to you and says, I drink four drinks a night, you should probably double whatever it is that they say um

and you and not even really address the problem or the situation a digny deeper. Yeah, it doesn't seem like any time you're you're you're dealing with the doctor. It's like it's not maybe it's not firmly established in the public mindset that this is a safe tone and that you can actually talk about what you're putting into your body legally or illegally because it is bottom line essential

to your health. But you know, I think that if the I think that if the medical field approached it in a different way, and like, for instance, I went to um my doctor and she said, hey, Julia, friend, these tests on you. It looks like you've got some genetic predispositions for addiction. I wanted to, you know, just give you a heads up or are you in any sort of stress loops in your life that you need

help with or that you're aware of. Then it I know, it takes up more time with your doctor, but again, it's opening up the line of communication and it's taking out the stigma because you're talking about it. And if this is something that is so pervasive in society. By the way, something like eight percent of all pharmacutical suiticals are consumed by the US by people in the United States.

Those are a lot of drugs, legal drugs, but still drugs that are being distributed and um and consumed by people. So this obviously is is not just a kind of aside problem that some people have. You know, I want to point out another possible application for the vaccine that was brought up the heroin vaccine, is that, you know, we were talking about rodents that were given this vaccine, how they could take essentially almost like a lethal overdose

amount of the drug and and still be fine. Uh, there's a possibility that the vaccine could be used to treat people who are who have overdose symptoms. So healthcare professionals pick someone up or arrive at a scene someone's clearly overdosing on on heroin, they can apply the vaccine as a curative measure. Yeah, so emergency medicine could really

benefit from this. But again, I just keep pointing to this idea that if you start to talk about it, if you start to remove the stigma, then you can really get to the behavior part of it, and to the root causes of it, the depression, anxiety, whatever it is that's going on in a person's life and treat them mental health part of this equation which is so important.

And it's a shame that the whole topic becomes so political as well, because like even a story like we mentioned Philips he more Hoffman earlier, I looked him up again and was looking at some of the various articles about him, and you still see this sort of the gut reaction from from some commentators where some people, you know, we're saying, oh, well, this is you know, horrible. This is a very talented man who struggled with it with

his dean. I don't even want to say his demons, because that personifies it as something supernatural and not something that's based in in in physical illness. Um. But people were saying, oh, this is terrible. We had to deal with this disease and it eventually caught up with him. And then there's still people who are going to say, oh, well, he was just essentially saying oh well he was just weak, Oh he was just this is you know, moral failure

of his character. He was just another you know, Hollywood phony or whatnot. You like, you still see that kind of attitude, uh, you know, all over the place. Yeah.

I remember reading an op ed piece, and I can't remember if it was Slate or Salon, but there was this forty five year old dad with a family who wrote about, Hey, look, this is a reminder of the slippery slope when it comes to what you know, he would say, brain disease is when it comes to addiction, because I was someone who was on the edge and a very lucky to have not died with my addictions. And I'm forty five years old, and I realized that there are many triggers that could cause us, just as

it did with Hoffman. So there you have it, a little little luxie into the future. Uh, ways that we can deal with addiction, the way the way that we might deal with addiction. But again, there there has to be enough of investment in the public mindset um to really see this. Uh, this heroin vaccine reached the point where actually affecting world health. All right, So there you have it. Hey, if you want to explore more topics, so just this one and be sure to check out

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