>>> PRODUCTION FUNDING FOR "QED WITH DR. B" IS PROVIDED BY -- AMERICAN ELECTRIC POWER FOUNDATION.

BOUNDLESS ENERGY FOR BRIGHTER FUTURES.

AND BY VIEWERS LIKE YOU.

THANK YOU.

>> I'M DR. FREDERIC BERTLEY, IMMUNOLOGIST AND EDUCATOR.

SCIENCE IS EVERYWHERE AND FOR EVERYONE.

AND IT'S ALL AROUND US, SHAPING OUR LIVES EVERY SINGLE DAY.

IN THIS SERIES, WE'LL LOOK AT CUTTING-EDGE RESEARCH, TALK TO THE SCIENTISTS WHO ARE CHARTING NEW FRONTIERS, AND SOLVING TODAY'S PROBLEMS TO MAKE ALL OUR LIVES BETTER.

WHEN A SCIENTIST OR MATHEMATICIAN DEMONSTRATES A PROOF OF CONCEPT IN THEIR WORK, THEY OFTEN USE THE TERM "QED", QUOD ERAT DEMONSTRANDUM.

THAT ROUGHLY TRANSLATES TO "QUITE EASILY DEMONSTRATED."

WELCOME TO "QED WITH DR.

B."

>>> HEY DR. B.

HOW YOU DOING TODAY?

>>> GOOD.

HOW YOU DOING DIANA?

WHAT ARE WE GONNA TALK ABOUT TODAY?

>> TODAY WE'RE GONNA TALK ABOUT ADDICTION.

AND BECAUSE THIS IS SUCH A COMPLICATED FIELD, WE'RE GONNA DEVOTE TWO EPISODES TO IT.

SO, HERE IN OHIO THE RATES FOR OPIOID ADDICTION ARE NEARLY DOUBLE THE NATIONAL AVERAGE.

SO, IT REALLY HITS CLOSE TO HOME.

SO DR. B, HOW DO WE EVEN START TO LOOK AT ADDICTION FROM A SCIENTIFIC PERSPECTIVE?

>> YOU KNOW, THAT'S SO INTERESTING BECAUSE THERE'S SO MANY SCIENTISTS FROM DISPARATE FIELDS LOOKING AT THAT THIS THING CALLED ADDICTION.

AND ONE THING WE KNOW IS IT DOES CHANGE BRAIN CHEMISTRY, BUT THERE'S ALSO THE SECONDARY PIECE WHERE PEOPLE VIEW DIFFERENTLY.

AND THERE'S THIS WHOLE SOCIAL STIGMA ATTACHED TO IT.

SO, HOW DO WE USE SCIENCE TO UNPACK ALL OF THAT AND FIGURE IT OUT?

SO, SCIENTISTS ARE LOOKING AT THIS FROM SEVERAL FIELDS.

WE HAVE PSYCHOLOGISTS, BIOLOGISTS, NEUROSCIENTISTS, OF COURSE PHYSICIANS, AND SOCIOLOGISTS.

JUST PEOPLE LOOKING AT THIS WHOLE ECOSYSTEM OF FACTORS THAT ARE PLAYING A ROLE IN THIS THING WE CALL ADDICTION.

AND SPECIFICALLY WHAT WE'RE HOPING TO FIND OUT IS MAYBE AS A SOCIETY WE VIEW IT DIFFERENTLY.

MAYBE WE SHOULD UNPACK OUT TRADITIONAL OLD WAYS OF JUDGING IF YOU WILL THIS THING CALLED ADDICTION.

BUT, REALLY LOOKING TO SCIENTIFIC PIECES TO TEACH US WHAT ARE THE DIFFERENT THINGS THAT WE CAN LOOK AT HOLISTICALLY THAT CAN ULTIMATELY LEAD TO BETTER OUTCOMES FOR THE PEOPLE SUFFERING IN THIS SITUATION.

>> AND OUR FIRST GUEST LOOKS AT ADDICTION FROM A HOLISTIC VIEWPOINT.

>> THAT'S CORRECT.

WE'RE TALKING ABOUT DR. CARL HART.

BOTH PSYCHOLOGIST AND NEUROSCIENTIST AT COLUMBIA UNIVERSITY.

AND HIS RESEARCH HAS BEEN CHALLENGING LONG HELD CONCEPTIONS OF ADDICTION AND REALLY IMPACTING HOW WE THINK ABOUT THIS FIELD AS WE MOVE FORWARD.

>>> WHAT DOES SCIENCE TELL US ABOUT ADDICTION?

>> WELL, LET'S JUST STEP BACK AND JUST TALK ABOUT WHAT ADDICTION IS.

HOW WE DEFINE IT IN MEDICINE.

IN MEDICINE, WE DEFINE ADDICTION AS DISRUPTIONS IN THE PERSON'S PSYCHO-SOCIAL FUNCTIONING AS THE RESULT OF THE DRUG USE.

SO, THAT IS PEOPLE ARE FAILING TO MEET THEIR OBLIGATIONS.

LIKE AT WORK, OR AT SCHOOL, OR WITHIN THE FAMILY.

AND THAT'S ONE COMPONENT.

AND THEN THE SECOND COMPONENT IS THAT THESE FOLKS THAT WHO ARE FAILING TO MEET THESE OBLIGATIONS ARE DISTRESSED BY THESE DISRUPTIONS.

SO, YOU GOTTA HAVE NOT ONLY THE DISRUPTIONS, BUT YOU ALSO HAVE TO HAVE THE DISTRESS FELT BY THE PERSON.

SO, THAT'S THE DEFINITION IN MEDICINE.

WE DO HAVE SOME PHYSIOLOGICAL EFFECTS THAT CAN GO ALONG WITH ADDICTION, BUT THE PHYSIOLOGICAL EFFECTS IN OF THEMSELVES ARE NOT ADDICTION.

WHAT I'M TALKING ABOUT IS THINGS LIKE TOLERANCE.

THAT IS WHEN A PERSON TAKES A DRUG REPEATEDLY OVER AN EXTENDED PERIOD OF TIME, THEY REQUIRE MORE OF THE DRUG TO HAVE THE EFFECT THAT THEY ONCE EXPERIENCED FROM LESS OF THE DRUG.

SO, THAT'S TOLERANCE.

AND ANOTHER PHYSIOLOGICAL EFFECT IS WITHDRAWAL SYMPTOMS THAT MIGHT OCCUR AFTER SOMEONE WHO HAD BEEN TAKING A DRUG CHRONICALLY ABRUPTLY DISCONTINUES THEIR USE.

THEN THEY MIGHT SEE UNPLEASANT EFFECTS LIKE VOMITING, DIARRHEA, HEADACHE.

THEY CAN GO ALONG WITH ADDICTION, BUT THEY IN OF THEMSELVES ARE NOT THE DEFINITION OF ADDICTION.

>> HOW ABOUT SUBSTANCE ABUSE AND TAKING DRUGS AND THE PERCENTAGE OF US WHO WOULD BE IMPACTED BY THAT?

>> SO, IT VARIES DEPENDING ON THE DRUG.

AND THEN WHEN WE THINKING ABOUT PREDICTORS.

WHAT WILL PREDICT WHETHER SOMEONE WILL BECOME ADDICTED?

WE LIKE TO LOOK AT GENETICS BECAUSE GENETICS SEEMS TO BE AN EASY SORT OF WAY IDENTIFY PEOPLE.

UNFORTUNATELY, WE HAVE NO REALLY GOOD GENETIC PREDICTORS FOR ADDICTION.

THE RATES OF CHILDREN OF ALCOHOLICS WHO BECOME ADDICTED, THE RATES CAN RANGE ANYWHERE FROM 5% TO 50%.

AND SO EVEN THOSE NUMBERS ARE NOT THE MOST RELIABLE.

BUT, WE DO HAVE SOME PSYCHO-SOCIAL THAT ARE PRETTY GOOD PREDICTORS OF WHO WILL BECOME ADDICTED.

IF YOU LOOK AT THE POOL OF ADDICTED PEOPLE, A LARGE PERCENTAGE OF THOSE INDIVIDUALS HAVE CO-OCCURRENCE PSYCHIATRIC ILLNESSES.

THAT IS A LARGE PERCENTAGE OF THEM HAVE DEPRESSION.

A LARGE PERCENTAGE OF THEM MIGHT BE SCHIZOPHRENIC.

A LARGE PERCENTAGE OF THEM MAY HAVE AN ANXIETY DISORDER.

SO, CO-OCCURRING DISORDERS, WHETHER PSYCHIATRIC DISORDERS OR PAIN DISORDERS, PREDICT WHETHER OR NOT SOMEONE MIGHT BECOME ADDICTED.

OTHER FACTORS INCLUDE LIKE WHEN YOU HAVE PEOPLE SUBJECTIVE TO UNREALISTIC EXPECTATIONS CONTINUOUSLY, THAT ALSO INCREASES THE LIKELIHOOD OF SOMEONE MIGHT BECOMING ADDICTED.

WHEN WE HAVE PEOPLE WHO WERE ONCE GAINFULLY EMPLOYED AND THEY WERE SOMEONE IN THEIR COMMUNITY AND NOW THEY ARE NO ONE.

AND THAT ALSO INCREASES THE LIKELIHOOD THAT SOMEONE MIGHT HAVE SOME PROBLEMS WITH DRUG.

SO, YOU SEE ALL OF THESE DIFFERENT FACTORS THAT CAN IMPACT UPON THE LIKELIHOOD OF SOMEONE BECOMING ADDICTED.

>> IS THERE A DOSE DEPENDENCY ACROSS THE BOARD?

CAN YOU LOOK AT ALCOHOL, AND COCAINE, AND HEROIN, OR MARIJUANA AND SAY, YOU KNOW WHAT, A LITTLE BIT OF SOME STUFF IS NOT HARMFUL, A LITTLE BIT MIGHT BE HELPFUL, A LITTLE BIT MORE MIGHT THEN LEAD TO DEPENDENCY THAT CAN HAVE WHAT WE CALL ADDICTIVE BEHAVIOR.

SO, CAN A LOT OF THIS JUST BE REDUCED TO DOSAGE?

AND IF WE CAN FIGURE THAT OUT, RIGHT, THERE MIGHT BE SOME BENEFITS TO THE WHOLE PATHWAY OF THESE DIFFERENT SUBSTANCES?

>> A DOSE IS ONE OF THE MOST CRITICAL COMPONENT IN DETERMINING DRUG EFFECTS.

AT ONE DOSE, A DRUG IS A THERAPEUTIC.

IT'S HELPFUL.

IT'S BENEFICIAL.

AT ANOTHER DOSE, THAT DRUG CAN BE TOXIC.

THAT IS IT KILLS BRAIN CELLS, OR IT MAY KILL YOU.

SO, DOSE IS EVERYTHING.

WHEN WE THINK ABOUT SOMETHING LIKE MORPHINE OR ANY OTHER OPIOID, THESE DRUGS HAVE BEEN USED TO FOR CENTURIES IN TERMS OF A DECREASE IN PEOPLE'S PAIN.

BUT, YET WE KNOW THAT AT SOME DOSES, PEOPLE CAN FOR EXAMPLE OVERDOSE ON OPIOIDS AND HAVE RESPIRATORY DEPRESSION AND ULTIMATELY DIE.

THE SAME IS TRUE WITH SOMETHING LIKE ALCOHOL.

AT ONE DOSE, ALCOHOL IS REALLY GOOD AT PRODUCING ANXIETY RELIEVING EFFECTS.

AND AT ANOTHER DOSE, ALCOHOL CAN PRODUCE RESPIRATORY DEPRESSION AND KILL A PERSON.

SO, DOSE IS EVERYTHING WHEN WE TALK ABOUT DRUGS.

>> DR. HART, THANK YOU SO MUCH FOR JOINING US ON "QED WITH DR.

B."

>>> SO, DR. B., HOW DOES SOMEONE WHO USES A DRUG BECOME AN ADDICT?

CAN YOU TALK A LITTLE BIT MORE ABOUT THE ACTUAL PROCESS?

AND I ALSO HEARD THERE'S A GENETIC COMPONENT.

IS THAT CORRECT?

>> SURE.

SO, THERE A FEW THINGS THAT WE KNOW.

WE KNOW THAT THE EARLIER YOU GET EXPOSED TO DRUGS, THE MORE AT RISK YOU CAN BE TO BECOMING ADDICTED.

AND AS YOU MENTIONED, THERE'S A GENETIC PREDISPOSITION TOWARDS THAT.

BUT, THERE A FEW OTHER IMPORTANT FACTORS.

WE HEARD DR. HART TALK ABOUT THE SOCIAL-PSYCHOLOGICAL FACTORS IMPACTING ADDICTION.

AND THAT'S SO IMPORTANT.

SO, WHAT ARE WE TALKING ABOUT?

WE'RE TALKING ABOUT THE ENVIRONMENTAL FACTORS.

WHAT ENVIRONMENT ARE YOU IN?

WHAT STRESSFUL THINGS IN YOUR NEIGHBORHOOD, OR YOUR HOUSEHOLD, OR YOUR JOB SITUATION?

THEN LAYER ONTO THAT MENTAL WELLBEING AND MENTAL ILLNESS.

AND THEN THERE'S A THIRD LAYER.

AND THIS IS THE WHOLE IDEA OF PAIN.

WE'VE HEARD A LOT ABOUT THIS IN THE MEDIA.

THIS IDEA, WHETHER IT'S PSYCHOLOGICAL PAIN OR PHYSICAL PAIN, THOSE CAN BE TREMENDOUS DRIVERS TOWARDS ADDICTION.

SO, WE NEED TO LOOK AT THOSE COLLECTIVELY AND FIGURE OUT WHAT'S THE BEST WAY TO LEAD TO POSITIVE OUTCOMES.

>> AND OUR NEXT EXPERT ACTUALLY TALKS ABOUT SOME OF THOSE PROCESSES.

>> ABSOLUTELY.

WE'RE TALKING ABOUT DR. WADE BERRETTINI, PSYCHIATRIST, PROFESSOR AT THE PERELMAN SCHOOL OF MEDICINE AT THE UNIVERSITY OF PENNSYLVANIA.

AND HE'S AN EXPERT IN BOTH NEUROBIOLOGY AND BEHAVIOR AND HE'S GONNA UNPACK HOW THEY RELATE TO ADDICTION.

>>> TODAY, WE'RE TALKING SPECIFICALLY ABOUT ADDICTION.

WHAT'S GOING ON INSIDE THE BODY AND PARTICULARLY THE BRAIN OF SOMEONE WHO'S ADDICTED?

>> SO, THERE'S THIS INITIAL EXPOSURE TO THE SUBSTANCE.

AND TYPICALLY THE PERSON EXPERIENCES THAT INITIAL EXPOSURE IN A PARTICULARLY COMPELLING EUPHORIA.

OR A SENSE OF WELL-BEING.

AND THAT INITIAL EXPOSURE IS A BIG DRIVE TO REPEAT THE EXPOSURE.

THE SECOND PHASE OF ADDICTION IN WHICH AN INDIVIDUAL GRADUALLY USES THE SUBSTANCE MORE AND MORE FREQUENTLY.

THE THIRD STAGE OF ADDICTION WHICH WE KNOW OF AS THE TRUE ADDICTION, BECAUSE NOT ONLY IS THERE THAT COMPULSIVE DAILY TO USE, BUT THERE ARE A HOST OF NEGATIVE CONSEQUENCES FOR THE PERSON IN THEIR PERSONAL, MEDICAL, LEGAL, AND VOCATIONAL SPHERES OF LIFE.

AND THE PERSON PERSISTS IN THIS DAILY USE DESPITE ALL OF THOSE TERRIBLE NEGATIVE CONSEQUENCES.

SEVERAL THINGS I WISH THE PUBLIC GENERALLY UNDERSTOOD ABOUT ADDICTION.

FIRST, IT'S A BRAIN DISEASE.

IT'S NOT A MORAL WEAKNESS.

IT'S NOT A SIN.

IT'S A CHRONIC RELAPSING BRAIN DISEASE.

THE INDIVIDUAL'S SUSCEPTIBILITY TO THIS ADDICTION HAS COMBINED WITH THE PRESENCE OF THE DRUG IN THE BRAIN TO CHANGE THE WAY THAT THE BRAIN IS WIRED.

AND THIS CONSTRAINS SHARPLY THE CHOICES THAT THAT PERSON MAKES.

SO, IT'S NO LONGER POSSIBLE FOR THAT PERSON WITHOUT A LOT OF HELP TO JUST SAY NO.

>> ALL RIGHT, SO WE HAVE ADDICTIONS THAT INVOLVE SUBSTANCES, ALCOHOL, DRUGS.

WE HAVE THINGS LIKE GAMBLING POSSIBLY.

PERSISTENT EATING DISORDER.

ALL THESE TYPES OF ADDICTIVE BEHAVIOR, DO THEY EFFECT THE BRAIN IN THE SAME LOCAL AREA OR IS IT A DISPARATE SET OF AREAS IN THE BRAINS THAT ARE IMPACTED BY THIS ECOSYSTEM WE CALL ADDICTION?

>> WELL, THERE IS A CENTRAL MAJOR REWARD PATHWAY IN THE BRAIN.

THIS PATHWAY INVOLVES A GROUP OF NEURONS DEEP IN THE CENTER OF THE BRAIN.

AND THESE NEURONS THAT USE THE NEUROTRANSMITTER DOPAMINE, CONNECT TO AN AREA IN THE MID-BRAIN AND THEY CONNECT TO THE FRONTAL CORTEX.

THIS PATHWAY IS ACTIVATED BY ALL KINDS OF DRUGS OF ABUSE.

IN FACT, MANY NEUROSCIENTISTS BELIEVE THAT IT'S THIS SAME REWARD PATHWAY IS ACTIVATED, OR MUST BE ACTIVATED TO EXPERIENCE PLEASURE.

SO, THIS REWARD PATHWAY IS ALSO ACTIVATED WHEN WE EAT OUR FAVORITE FOOD.

OR WHEN WE SEE SOMETHING ON THE SCREEN THAT'S VERY ENTERTAINING.

THIS PATHWAY IS ACTIVATED NOT ONLY BY THESE NATURAL REWARDS, BUT ALSO BY THESE QUOTE-UNQUOTE UNNATURAL REWARDS, THESE DRUGS OF ABUSE.

>>> SO WHAT I THINK THAT DR. BARRETTINI MADE VERY CLEAR IS ADDICTION REALLY IS A BRAIN DISEASE.

>> YOU KNOW, HE DID.

AND IT'S SO FASCINATING.

BECAUSE IT COUPLES THAT FIRST OR EARLY USE WITH EUPHORIA THAT IS GIVEN TO YOU BY TAKING THAT ACTUAL DRUG.

YOU'VE NEVER FELT THAT BEFORE.

AND SO IF YOU'RE DEALING WITH PHYSICAL OR SOCIAL STRESSORS, YOU WANT TO GET BACK TO THAT EUPHORIC STATE BECAUSE OF COURSE IT FEELS BETTER.

NOW, WHAT'S INTERESTING IS NOT EVERYBODY WHO GETS THAT EUPHORIC STATE WILL NECESSARILY BECOME AN ADDICT, BUT THAT'S WHERE THE GENETIC PREDISPOSITION AS WELL AS OTHER SOCIAL FACTORS CAN ACTUALLY COME INTO PLAY.

>> YEAH, AND DR. BARRETTINI REALLY TALKED ABOUT THAT PLEASURE PATHWAY IN THE BRAIN.

AND OUR NEXT GUEST IS GONNA GO DEEPER INTO THE NATURE OF DOPAMINE.

>> THAT'S RIGHT.

WE'RE TALKING ABOUT DR. EDMUND GRIFFIN, A HARVARD TRAINED NEUROSCIENTIST AND PHYSICIAN.

HE IS THE ASSISTANT PROFESSOR OF CLINICAL PSYCHIATRY AT COLUMBIA UNIVERSITY.

AND HE TALKS ABOUT HOW DOPAMINE NOT ONLY MAKES US FEEL GOOD, BUT IS AT THE CENTER OF OUR ABILITY TO LEARN.

>>> LET'S JUMP INTO THE NEUROPHYSIOLOGY HERE.

WHAT HAPPENS IN THE BRAIN WHEN SOMEONE IS DEFINED AS ADDICTED?

>> THERE'S A SECTION OF THE BRAIN THAT'S KIND OF TASKED WITH REWARD VALUATION.

SO, THE NEUROTRANSMITTER DOPAMINE, WHICH WE'VE KNOWN FOR A LONG TIME IS VERY MUCH INVOLVED IN ATTENTION AND REWARD.

I THINK A LOT OF FOLKS THINK THAT DOPAMINE IS A PLEASURE CHEMICAL OR A PLEASURE NEUROTRANSMITTER.

IT'S ACTUALLY NOT.

IT'S REALLY A NEUROTRANSMITTER THAT TELLS THE BRAIN OOH, THAT WAS A GOOD FOR SURVIVAL.

DO IT AGAIN.

SO, YOU WIN A REWARD OR GET AN A ON A TEST, DOPAMINE SAYS OH, IT WANTS TO RECORD THE SEQUENCE OF BEHAVIOR AND THE QUEUES TO MAKE SURE THAT YOU GET IT AGAIN.

RIGHT?

YOU FIND A NICE FOOD, DOPAMINE SAYS OKAY, THAT'S WHERE IT'S AT AND IT RECORDS THE BEHAVIOR THAT GETS IT.

THAT'S WHAT DOPAMINE DOES.

WHAT DRUGS OF ABUSE DO IS THEY NEVER MISS.

EVERY TIME WE USE A DRUG OF ABUSE, DOPAMINE HAPPENS.

SO, THE BRAIN SAYS OOH, THAT WAS GOOD.

DO IT AGAIN.

SO IT INCREASES THE SALIENCE OR IMPORTANCE OF THAT PROCESS.

IT REMEMBERS THE QUEUES, IT REMEMBERS THE DRUG DEALER, THE PERSON YOU CALLED OR HOW YOU GOT IT AND IT KIND OF LOCKS IT IN.

AND EVERY TIME YOU USE IT, DOPAMINE HAPPENS.

NOW, THAT'S DIFFERENT THAN CHEETOS.

SO, IF I FIND CHEETOS, MY BRAIN RECORDS IT.

OOH, THOSE WERE GOOD.

DO IT AGAIN.

BUT, ONCE IT'S LOCKED IN, THERE'S NO DOPAMINE.

SO, ANY TYPE OF REWARD, DOPAMINE HAPPENS DURING THE INITIAL PROCESS.

BUT, ONCE WE'VE LEARNED HOW TO GET THAT REWARD, THERE'S NO MORE DOPAMINE.

ALL RIGHT?

SO, WHERE WE SEE THAT IN RELATIONSHIPS, RIGHT?

THAT EARLY THREE MONTHS, IT'S LIKE OH MY GOD IT'S LIKE SPARKS AND EVERYTHING YEAH BECAUSE IT'S NEW.

BUT, ONCE YOU LEARNED FLOWERS WORK, OR WEAR THIS TIE, THERE'S NO MORE DOPAMINE AFTER THAT, RIGHT?

YOUR BRAIN HAS ALREADY RECORDED IT.

IT KNOWS HOW TO DO IT.

WHAT DRUGS OF ABUSE DO, ONCE YOU'VE LEARNED HOW TO GET THE DRUG, THE DOPAMINE DOESN'T STOP.

EACH TIME YOU USE IT, THERE'S A RECORDING AND KIND OF A LOCKING IN OF THAT PATHWAY SO THAT THE DRUG BECOMES OVERVALUED AS IF IT WERE THIS NEW THING EACH TIME.

SO, IT REALLY LOCKS IN THE MEMORY AND PROCESSES.

MORE SUCCINCTLY, ADDICTION IS REALLY A DISORDER OF LEARNING AND MEMORY.

>> LET'S TALK AT THE GENETIC LEVEL OR THE BIOLOGIC LEVEL.

ARE SOME PEOPLE JUST MORE PRONE TO BECOME ADDICTED THAN OTHER PEOPLE?

>> YOU KNOW, ONE OF THE HIGHLY MISUNDERSTOOD THINGS OF ADDICTION IS IT'S A LOW PERCENTAGE, RIGHT?

SO, THE NUMBER OF PEOPLE, IF YOU GIVE EVERYONE LOTS OF ALCOHOL, LOTS OC COCAINE, 100 PEOPLE.

THE PERCENTAGE THAT WILL TIP OVER TOWARDS COMPULSIVE ABUSE, MEANING THEY WILL KEEP DOING IT DESPITE NEGATIVE CONSEQUENCES IS MAYBE LIKE 15, MAYBE 20% DEPENDING ON THE SUBSTANCE IS A RELATIVELY LOW PERCENTAGE.

RIGHT?

SO, SOME PEOPLE HAVE THE PERSPECTIVE OF OH, IF YOU DO OPIOIDS AND YOU'RE PRESCRIBED BY THE DOCTOR, OH MY GOD, YOU'RE GOING TO BECOME ADDICTED.

OR, IF YOU GO OUT AND DO COCAINE, YOU WILL BECOME ADDICTED.

IT'S REALLY A SMALL PERCENTAGE OF PEOPLE THAT TIP OVER TOWARDS THAT.

SO, PART OF THE QUESTION IS I STUDY AS A NEUROBIOLOGIST IS WHERE WE LOOK AT THE RISK FACTORS.

SO, WHEN WE LOOK AT THE DIFFERENT RISK FACTORS THAT HAVE KIND OF POPPED UP THROUGH EPIDEMIOLOGY, YOU KNOW CHILDHOOD ADVERSITY, TRAUMA, PRIOR USE OF ALCOHOL, OR OTHER MEDICAL ILLNESSES; IT'S VERY CLEAR THAT THOSE RISK FACTORS ARE KIND OF LOCKED IN AND TEND TO MOST STRONGLY CORRELATE WITH THE SUBSEQUENT RISK OF USE.

BUT, WE CAN START TO UNDERSTAND WHAT'S HAPPENING ON THE GENETIC LEVEL, YEAH?

SO, DOES IT RUN IN FAMILIES?

AND THE ANSWER'S YES, RIGHT?

SO, THERE ARE GENETIC RISK FACTORS.

BUT, EVEN THEN IT'S THE EARLY EXPOSURES, EARLY EXPERIENCES THAT REALLY KIND OF TIP IT OVER, RIGHT?

SO, YOU ACTUALLY NEED SOME KIND OF MIXTURE BETWEEN NATURE AND NURTURE THAT KIND OF TIPS IT OVER.

!

!musiC@!!!musiC@!

>> SO TALK TO US ABOUT HOW A SOCIETY, FIRST STARTED WITH THE MEDICAL FIELD BUT THEN BROADER, WHEN WE TALK ABOUT ADDICTION AND HOW WE DEFINE IT, AND HOW THAT MIGHT IMPACT POLICY, AND HOW WE REGARD PEOPLE WHO UNFORTUNATELY WOULD BE AFFLICTED WITH THIS.

>> SO, IF WE LOOK THROUGHOUT THE HISTORY, THE VERSION WHERE WE TEND TO MEDICALIZE ADDICTION, THAT IS I THINK IS AN IMPORTANT LEAP WHERE FOLKS ARE STARTING TO UNDERSTAND THAT ADDICTION IS AN ABSENCE OF CONTROL.

A PERSON'S STILL RESPONSIBLE FOR THE OUTCOME, YEAH?

RIGHT?

OF I CAN'T CONTROL MY STOMACH FLU AND IT MAKES ME ILL, BUT IF I VOMIT ON YOUR SHOE, I GOT TO CLEAN IT UP, RIGHT?

SO, I'M STILL RESPONSIBLE FOR THE OUTCOME, BUT IT'S A LACK OF CONTROL BY DEFINITION.

SO, THE UNDERSTANDING THAT THIS A CIRCUITRY TYPE OF BEHAVIOR AND NOT BAD PERSON-GOOD PERSON.

THAT TYPE OF NUANCE IS AN IMPORTANT LEAP THAT I THINK HAS REALLY BEEN DRIVEN BY THE UNDERSTANDING OF THE BIOLOGY OF ADDICTION.

KIND OF MOVING IT AWAY FROM THIS KIND OF MORAL BAD PERSON-GOOD PERSON CATEGORY.

BACK TOWARDS HEY, THERE'S SOMETHING GOING ON HERE AND WE CAN ACTUALLY ADDRESS THIS MEDICALLY OR THROUGH PSYCHOTHERAPY.

>>> SO, LET ME GET THIS RIGHT.

USING A DRUG IS JUST AS POWERFUL AS BEING IN LOVE ALL THE TIME?

THAT'S VERY INTERESTING.

>> IT'S REALLY COOL BECAUSE WE HAVE TO REMEMBER WHAT THE DRIVER HERE IS.

THE DRIVER IS THIS NEUROTRANSMITTER CALLED DOPAMINE.

SO, WHETHER YOU'RE IN LOVE OR YOU'RE TAKING AN ILLICIT SUBSTANCE, YOU'RE GETTING THAT DOPAMINE BEING PRODUCED.

THE THING IS WITH BEING IN LOVE, THAT MIGHT FADE AWAY WHERE AS YOU CAN TAKE THAT DRUG OVER AND OVER TO ILLICIT THAT DOPAMINE RESPONSE THAT WILL MAKE YOU FEEL EUPHORIC.

AND THAT CAN LEAD TO A POWERFUL NEGATIVE EFFECT ON OUR BEHAVIOR.

>> I'M CURIOUS DR. B., WE'VE TALKED A LOT ABOUT ILLICIT DRUGS.

BUT, WHAT OTHER THINGS CAN WE BE ADDICTED TO?

>> THERE'S SO MANY THINGS.

YOU KNOW, THERE'S CLASSIC NICOTINE.

WE HEAR ABOUT THAT.

OF COURSE THERE'S ALCOHOL.

SOCIALLY ACCEPTED, BUT YOU CAN BE ADDICTED TO THAT.

THEN THERE'S THINGS LIKE SUGAR.

THE EXTRA FRESHMAN 40 I'VE GAIN RECENTLY IS PROOF THAT SUGAR CAN BE ADDICTIVE.

BUT, THERE'S ALL THESE DIFFERENT KIND OF -- EVEN GAMBLING CAN BE CONSIDERED AN ADDICTION.

SO, THE BIG QUESTIONS THAT NEUROSCIENTISTS AND PHYSICIANS ARE TRYING TO FIGURE OUT -- WHERE IN THE BRAIN DOES THIS ADDICTIVE ACTIVITY GET LOCALIZED TO?

IN OTHER WORDS, IS IT THE SAME PATHWAY THAT TRIGGERS YOU TO BE ADDICTED YOU TO COCAINE, HEROIN, AND GAMBLING?

AND IS THAT THE SAME AS NICOTINE?

AND IS THAT THE SAME AS SUGAR?

OR, ARE THESE DIFFERENT THINGS AND HOW CAN WE PROCESS ALL THAT?

>> AND OUR NEXT GUEST IS ACTUALLY GONNA TALK ABOUT THIS WHOLE GAMBLING ADDICTION.

>> YEAH, YOU'RE TALKING ABOUT DR. EVE LIMBRICK-OLDFIELD.

AND SHE'S AT THE UNIVERSITY OF BRITISH COLUMBIA AND SHE STUDIES THIS VERY THING.

>>> TODAY WE'RE TALKING ABOUT ADDICTION.

WE'VE BEEN SPEAKING TO EXPERTS ABOUT DRUG ADDICTION, ALCOHOL ADDICTION.

BUT, YOU STUDY A DIFFERENT KIND OF ADDICTION.

TELL US A LITTLE BIT ABOUT GAMBLING.

>> IN THE DSM- THE DIAGNOSTIC STATISTIC MANUAL, IT'S CALLED GAMBLING DISORDER.

AND IT'S THE FIRST BEHAVIOR BE CLASSED AN ADDICTION.

AND REALLY WHAT IT IS IT'S REPEATED, PERSISTENT, PROBLEMATIC GAMBLING BEHAVIOR THAT CAUSES SIGNIFICANT LIFE PROBLEMS.

>> FROM A BIOLOGIC PERSPECTIVE, ARE ALL KINDS OF ADDICTIONS THE SAME?

>> ON ONE LEVEL, YES.

THE NEUROTRANSMITTER DOPAMINE IS INVOLVED CONSISTENTLY THROUGHOUT AND SUBSTANCE USE DISORDERS.

AN THE SAME REGIONS OF THE BRAIN ARE INVOLVED OR SORT OF ACTIVATED DURING GAMBLING IN THE SAME WAY THAT THEY ARE WHEN YOU CONSUME A DRUG THAT ACTIVATES THE SAME SYSTEM.

BUT ON OTHER LEVELS, NO.

IT'S A BEHAVIOR, IT'S NOT AN EXTERNAL SUBSTANCE SO THERE HAS TO BE SOME DIFFERENCES IN THE UNDERLYING BRAIN SYSTEMS.

>> WHAT DO YOU KNOW ABOUT THE NEURAL PATHWAYS ASSOCIATED WITH GAMBLING ADDICTION SPECIFICALLY, AND MAYBE ADDICTION IN GENERAL?

>> I'VE DONE QUITE A LOT OF WORK USING BRAIN IMAGING TOOLS TO LOOK AT BRAIN ACTIVITY WHILST PEOPLE ARE PLAYING A SIMPLIFIED GAMBLING GAME.

WE LOOKED AT PEOPLE WHO HAD A BROTHER OR SISTER WHO HAD GAMBLING DISORDER, BUT THEY THEMSELVES HAD NO TYPE OF ADDICTION.

AND SOME OF THEIR NEURAL PATHWAYS AND SOME OF THEIR BEHAVIORS THAT THEY SHOWED WERE SIMILAR TO THE SIBLINGS WHO DID HAVE A PROBLEM, EVEN THOUGH THEY DIDN'T HAVE A PROBLEM THEMSELVES.

SO THERE ARE THESE SORTS OF TRAITS OR TENDENCIES PEOPLE HAVE, AND SOME REGIONS OF THE BRAIN THAT ARE MORE OR LESS SOMEONE WHO WASN'T RELATED TO ANYONE WITH A GAMBLING DISORDER.

>> WHAT IS IT ABOUT THAT ADDICTIVE NATURE OF GAMBLING?

YOU KNOW, YOU MAY HAVE LOST YOUR JOB.

YOU MAY HAVE LOST YOUR HOUSE.

YOU MAY HAVE BROKEN UP YOUR FAMILY.

YOU KNOW THIS IS A PROBLEM.

YOU RECOGNIZE IT AS A PROBLEM.

BUT YOU CAN'T STOP IT.

WHAT IS HAPPENING IN THE BRAIN OR WHAT IS HAPPENING IN THE PERSON?

>> WHEN PEOPLE TALK ABOUT GAMBLING, THEY OFTEN THINK ABOUT WINNING.

BUT WITH PROBLEMATIC GAMBLING, IT'S NOT NECESSARILY ABOUT THAT WINNING.

IT'S ABOUT THE DISTRACTION, ABOUT THE EMOTIONAL REGULATION YOU GET FROM ENGAGING WITH THIS REPETITIVE BEHAVIOR.

IT LETS YOU ESCAPE FROM THE REAL WORLD PROBLEM.

AND THOSE SHORT-TERM BENEFITS, IN SOME PEOPLE, OUTWEIGH THE LONG-TERM CONSEQUENCES.

>> ADDITION IN GENERAL -- GAMBLING, DRUG, ALCOHOL -- IT'S SOMETHING THAT CLEARLY IS THERE IN SOCIETY.

MANY OF US HAVE FRIENDS OR FAMILY OR RELATIVES WHO ARE SUFFERING THIS.

AS AN EXPERT ON GAMBLING, AS AN EXPERT ON ADDICTION, WHAT ADVICE WOULD YOU GIVE TO FOLKS?

>> PARTICULARLY WHEN IT COMES TO GAMBLING, IT'S SOMETIMES REFERRED TO AS THE "HIDDEN ADDICTION," BECAUSE YOU CAN GO OUT AND SPEND THE DAY GAMBLING AND THEN COME HOME TO YOUR FAMILY AND YOU DON'T -- YOU'RE NOT BEHAVING ANY DIFFERENTLY.

THERE'S NO DRUG IN YOUR SYSTEM THAT PEOPLE MIGHT BE ABLE TO DETECT.

AND SO IT'S VERY EASY TO HIDE.

AND IT'S VERY EASY FOR PEOPLE TO NOT TALK ABOUT IT.

LIKE WITH A LOT OF MENTAL HEALTH PROBLEMS, THERE'S A TENDENCY TO HIDE IT.

REALLY IT'S JUST A CASE OF MAKING SURE THAT YOU REACH OUT TO SERVICES THAT ARE AVAILABLE.

THERE'S LOTS OF HELP LINES AND LOTS OF COUNSELING SERVICES.

THERE ARE LOTS OF RESOURCES OUT THERE FOR PEOPLE WHO ARE RELATED OR WHO KNOW PEOPLE WITH AN ADDICTION, AS WELL AS THOSE WHO HAVE ADDICTION THEMSELVES.

AND SO I THINK IT'S JUST REALLY IMPORTANT TO BE OPEN AND REACH OUT AND NEVER BE AFRAID TO ASK FOR HELP.

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>> TIME FOR TAKEAWAYS.

SO MY TAKEAWAY TODAY IS THAT ADDICTION IS REALLY COMPLICATED.

AND IT INVOLVES THE CHEMISTRY OF THE BRAIN A LOT MORE THAN I EVEN THOUGHT.

>> ABSOLUTELY.

MOST IMPORTANTLY, IT'S NOT A MORAL OR CHARACTER FLAW, BUT IT'S AN AGGREGATE OF PHYSICAL CHANGES IN THE BRAIN, POSSIBLY GENETIC PREDISPOSITION, ENVIRONMENTAL FACTORS, ALL COMING TOGETHER TO PUT YOU IN THIS PREDICAMENT OF POSSIBLY BEING ADDICTED TO SOMETHING.

THE GOOD NEWS IS WHEN WE THINK OF THIS HOLISTICALLY, WE CAN BETTER ADDRESS THE SITUATION AND HOPEFULLY LEAD TO POSITIVE OUTCOMES.

AND THAT'S QUITE EASILY DEMONSTRATED.

"QED" WITH ME, DR. B.

JOIN US ON FACEBOOK, INSTAGRAM, AND TWITTER AND WE'LL SEE YOU NEXT TIME.

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