The One You Feed - Maia Szalavitz on Addiction - Re-Release

Episode Date: July 30, 2019

Maia Szalavitz is an American reporter and author who has focused much of her work on the topic of addiction. She is the co-author of Born for Love and The Boy Who Was Raised as a Dog, both with Dr. Bruce D. Perry. Her latest book is Unbroken Brain: A Revolutionary New Way of Understanding Addiction  In this paradigm-shifting interview, Maia Szalavitz explains that addiction is a learning disorder, a developmental disorder, which is a different way of thinking of addiction than it being a disease or a moral failing.Need help with completing your goals in 2019? The One You Feed Transformation Program can help you accomplish your goals this year.But wait – there’s more! The episode is not quite over!! We continue the conversation and you can access this exclusive content right in your podcast player feed. Head over to our Patreon page and pledge to donate just $10 a month. It’s that simple and we’ll give you good stuff as a thank you!In This Interview, Maia Szalavitz and I Discuss…Her book,  Unbroken Brain: A Revolutionary New Way of Understanding AddictionThat your brain becomes what it does – that the more you repeat an activity, the easier it becomesHow addiction is a developmental disorder and how learning is critical to addictionThe problems with discussion about addiction as a diseaseArguing that addiction is a disease and then treating it like a moral failingAddiction resets your priorities and causes one to make different decisionsAddiction = compulsive behavior that continues despite negative consequencesHow illogical it is then to try and address addiction by focusing on implementing additional negative consequencesThe complexity of addiction, genes + culture + timingThe developmental history that gets you to addictionHow the drug isn’t the problem and our efforts to get rid of it isn’t a helpful solutionAddiction as a learning disorder that is characterized by a resistance to punishmentThe problem with “rock bottom” is it’s not helpful scientifically, and it implies a moral component of having to reach a point of extreme degradation before you can stop.What the motivation is that turns people to recoveryHow addicts keep using because they can’t see how they can survive any other wayRecovery begins when you start to see that there are other optionsPeople with addiction are living at a point of learned helplessnessThe role of hope and other ways of managing their lifeAddiction as a coping mechanismThe pleasures of the hunt vs the pleasures of the feastWanting vs LikingDifferent motivational statesAddiction as escalating wantingStimulants and chasing that satisfactionThe effectiveness and usefulness of 12 Step ProgramsThe role of medicine in a developmental disorderLooking at addicts as students who need to learn better coping skills rather than sinners who need to be forced to repent.Maia Szalavitz Links:maiasz.comTwitter Calm app – Reduce your anxiety and stress and help you sleep better. Meditations for anxiety, adult bedtime stories, soothing music, calm masterclasses with many One You Feed Guests. Visit www.calm.com/wolf for 25% off a Calm Premium SubscriptionPeloton – Looking for a new way to get your cardio in? The Peloton bike will make you rethink the way you look at cycling classes!  Visit onepeloton.com and enter Promo code “WOLF” to get $100 off of accessories with purchase of a bike.  Westin – Westin resorts have wellness offerings that are curated just for you to help you eat, move and sleep well. Explore at westin.comIf you enjoyed this conversation with Maia Szalavitz, you might also enjoy these other episodes!Dr. Gabor Mate’Judson BrewerSee omnystudio.com/listener for privacy information.

Hi everyone, a quick announcement from me. This is a reissue of a wonderful episode we did about addiction and I am re-releasing in honor of a friend of mine who is dealing with their own addictions at the moment and I thought this would be a perfect time to re-release it and it's been on my mind and it was a wonderful talk. So I hope you enjoy and we'll be back with a new episode next week. You can't get addicted if you don't learn that the drug helps you do something. Welcome to The One You Feed. Throughout time, great thinkers have recognized the importance of the thoughts we have. Throughout time, great thinkers have recognized the importance of the thoughts we have.

Quotes like garbage in, garbage out, or you are what you think ring true. And yet, for many of us, our thoughts don't strengthen or empower us. We tend toward negativity, self-pity, jealousy, or fear. We see what we don't have instead of what we do. We think things that hold us back and dampen our spirit. But it's not just about thinking. Our actions matter. It takes conscious, consistent, and creative effort to make a life worth living.

This podcast is about how other people keep themselves moving in the right direction. How they feed their good wolf. I'm Jason Alexander and I'm Peter Tilden and together our mission on the really no really podcast is to get the true answers to life's baffling questions like why the bathroom door doesn't go all the way to the floor, what's in the museum of failure, and does your dog truly love you? We have the answer. Go to reallynoreally.com and register to win $500, a guest spot on our podcast, or a limited edition signed Jason bobblehead.

The Really No Really Podcast. Follow us on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Thanks for joining us. Our guest on this episode is Maya Salovitz, a neuroscience journalist and author who specializes in mental health coverage with a particular focus on addiction, drug policy, neuroscience, and media criticism of reporting on these issues. Her new book is Unbroken Brain, Why Addiction is a Learning Disorder and Why It Matters. And here's the interview with Maya Salovitz. Hi, Maya. Welcome to the show. Thanks so much for having me.

I'm excited to get you on. Your book is called Unbroken Brain, A Revolutionary New Way of Understanding Addiction. And listeners will know that addiction comes up from time to time on the show. I myself am a former addict, so we will get into a lot of detail on that. But let's start like we always do with the parable. There's a grandfather who's talking with his grandson. He says, in life, there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love. And the other is a bad wolf, which represents things like kindness and bravery and love. And the other is a bad wolf, which represents things like greed and hatred and fear. And the grandson stops and he thinks about it for a second.

He looks up at his grandfather and he says, well, grandfather, which one wins? And the grandfather says, the one you feed. So I'd like to start off by asking you what that parable means to you in your life and in the work that you do. I really like this parable because I feel that it is incredibly relevant for addiction. Addiction is a lot of repetitive behavior. And the more you repeat the behavior, the more likely you become to repeat the behavior because of the way human learning works. because of the way human learning works. So that is a very true statement about the nature of what will happen if you continue to repeat a behavior. Yeah, I first heard it in some 12-step meeting somewhere, and it kind of knocked me on the head at that point, because it was so clear to me that I don't even know that I had been feeding the bad wolf so much as the bad wolf had been eating me recently. But it just is a very straightforward to me like, oh, if I take these sort of actions, then I'm going to

have good things happen. And if I don't, then I'm going to continue to get more of what I've been getting. Yeah, I mean, obviously, like all of these things, it's oversimplified. But I think it's really important to realize that, yeah, your brain becomes what it does. And the more you, you know, repeat an activity, the easier it gets to do that activity, and then the more likely you become to repeat it. Now, this is great if that activity is exercise, or being kind, or, you know, that kind of thing, but it is not so great if it is harmful drug use. Right. Absolutely. So let's start with the core premise of the book. And I'm just going to quote you here. You say addiction is a developmental disorder, a problem involving timing and learning

more similar to autism, ADHD and dyslexia than it is to mumps or cancer. So talk to me about what you mean by that, developmental disorder. Sure. So, I mean, if you think about developmental disorders, they tend to have several things in common. The first one is that they tend to affect like specific kinds of learning. So with autism, you have a problem with social learning, but you don't necessarily have a problem with other types of learning. With dyslexia, you may have a problem with reading, but not with other things. So it's about a specific thing. It's also the case that if you have one of these conditions, they tend to start at a particular phase in life. So there are three important phases of brain development in human life. And the first one

is prenatal. The second is zero to five. And then the third is like adolescence and young adulthood. All of these disabilities tend to start at a specific time. So autism and ADHD start in early childhood, whereas you wouldn't see schizophrenia or addiction generally until adolescence or early adulthood. So that gives us a clue as to kind of what's going on in the brain in relation to these things. And the other thing I mean when I talk about addiction as a developmental disorder is that learning is critical to addiction. You can't get addicted if you don't learn that the drug helps you do something. Because for one, you wouldn't know what to crave, so it would be kind of hard to buy it,

right? And secondly, if it doesn't give you comfort or pleasure or some sort of relief, you're unlikely to be repeating it. Exactly. And so you talk about this being a learning disorder, and the way that we tend to think of addiction is it's either thought of as a disease, which is probably the more common paradigm this day and age, or a moral failing. And both those things are confusing, and I agree with a lot of what you say about that, and we'll get into that in a minute, but talk about the implications if addiction is a learning disorder and not either a disease or a moral failing. Well, let me speak to the disease thing first. In the United States and worldwide, because of our influence, this disease idea has really

taken off. I don't mind if you call a learning disorder a disease, but the way we've seen addiction as a disease has been deeply problematic because basically we argue in public that addiction is a disease. Meanwhile, we criminalize people with it. We also argue in public that addiction is a disease and the treatment is meeting confession and prayer, which isn't how we treat any disease or learning disorder. So what has happened is that the dominance of the 12-step paradigm for addiction has meant that we end up trying to argue that addiction is a disease while treating it as a moral failing. And this mixed up mush of things really kind of makes the disease idea problematic when it wouldn't have otherwise been. So there's

that. Now, the moral failing business is just, you know, I mean, when you see people with addiction desperately trying to stop and then relapsing over and over, it's kind of hard to think that they're choosing to lose everything and to, you know, be in these dire straits because they're having so much fun. Anybody who sees addiction knows that this is not driven by everything so fun, so I'm going to give up all the rest of the good things in my life. Like that just isn't what happens. So, you know, so that point of view is outdated and not especially useful. So I see the learning disorder idea as kind of a way to really get at the complexity of addiction, which is that like, it's not about you being a total zombie and having no control over your behavior the way some of the extreme disease models present it.

But it's also not about, you know, freely choosing with ultimate freedom the way some of the moral models present it. What happens when you learn a habit is that it changes the way you react to things. And when you learn in the way that addiction is learned, what it basically does is reset your priorities, just the way when you learn to fall in love, which is another learning process, interestingly, when you learn that, it shifts your priorities. And that means that you will make very different decisions. Like if I get a new boyfriend or something, I might get interested in something I'm completely uninterested in normally, right? I think that when we bring learning into it, we understand the way addiction really is and the way it really appears as opposed to these sort of

idealized pictures of sin or disease. And I'm saying disease as in the disease model that we are stuck with, not the idealistic medical disease model that you might have in the absence of the history of the 12-step thing. Yep. Let's explore that a little bit further because the learning piece makes sense to me. I think we're going to need to go into a little bit more what you mean by that. But let's start with the statement you just made about you learn to fall in love or you learn to be addicted, which the second one I understand. And at the same time, my reaction to alcohol and drugs was very prominent from the get go, right? The minute I tried it, there was a very strong reaction there. And so help me understand. Have you ever heard of love at first sight? Yeah, exactly. Yeah. I mean, so it's, the thing is that like, there are a lot of people who take, let's say an opiate and it's like, oh my God, this is the best thing ever. This is totally

amazing. Oh, I love this. You know what? I don't want to ruin my life. I am never going to do this again. That is actually the most common reaction to taking a substance that is ultimately blissful. That's the healthy reaction to it. So the thing with people with addiction is that you're not addicted at the moment that you have that euphoric response. You only become addicted after you continue to repeat it despite negative consequences. So while you can sort of put the start of your addiction at that kind of love at first sight moment, the actual process needs to happen before you are actually addicted. Does that make any sense? I agree. I think what I was driving at

was something that you explore in the book also, which is that these substances are often used as a coping mechanism. And so the addiction may begin, the process of becoming addicted to that substance may begin when you try that substance. But for lack of a better word, the seeds of that addiction have very likely or very possibly been planted before that. Oh, absolutely. And, you know, I mean, given that the vast majority of people who take even the most addictive drugs do not become addicted, we have to look at what's going on with that person beforehand. You know, if your life's already messed up and you get this blissful experience, you are far more likely to say, yeah, I want to give up what I have because what I have is horrible. For, you know, and this is, you know, this is something that seems better.

And this is something that seems better. Also, especially if you have any kind of social anxiety, drugs seem to solve them in a variety of ways. One is that they tend to be taken in social settings and other drug users tend to welcome you as long as you use drugs, which is unlike most social settings, right? And so there's that bit that makes it easier. right? And so there's that bit that makes it easier. There's also just the pharmacology so that if you're a person who's very anxious, like alcohol or opioids might take the edge off. And if you're a person who's kind of understimulated or depressed, like a stimulant might, you know, really make you engaged in things. And so when you see that you can use these substances to control the way you respond to the world, if you're dysregulated, they're going to be way more attractive. Is that the developmental part of this? Yeah.

You know, we all start out with some kind of initial temperament. You know, we might be shy or bold or, you know, oversensitive to stimuli or undersensitive to stimuli. All of this stuff genetics is going to give us. And then we have the environment where, you know, you may get tons of love and support. You might not, you might have some predispositions that are really extreme, that, you know, may lead to mental illness in certain situations. And those things are all kind of percolating during your development. And, you know, if you, let's say, like, you know, in my case, I felt really different from other kids from very early on because I was extremely oversensitive. And also, like, I was reading very early and got, like, labels gifted. And so I just, my interests were completely different to

the interests of other kids, basically. So I just sort of got absorbed in ideas. And that would have been fine if I hadn't then decided that I was a bad person because I couldn't really connect with people. So that sort of internal decision of seeing myself as bad led to a cascade of things that ultimately sort of led to depression and probably then led to addiction. And so the developmental piece is sort of how all of these things interact over time in this kind of spiraling fashion that creates the complexity of the conditions we end up seeing in people. Yeah, you say that the role of learning and development in addiction means that

cultural, social, and psychological factors are inextricably woven into its biological fabric. And I really like that because I've always thought that the disease model of alcoholism or addiction was, particularly when you treat it, as you mentioned, via moral mechanisms, it didn't make any sense. And that this felt felt like the word I would have used is a syndrome than a disease or a thing. It's this complex bringing together of all these different factors that happen to equal addiction. Yeah. And I mean, I think, you know, the same is true of really all developmental disorders and all psychiatric problems, because all psychiatric problems are neurodevelopmental disorders. Like you don't suddenly appear fully fledged person with schizophrenia without the developmental

history that gets you there. Like it's not like even though the symptoms might suddenly appear in your 20s, it's not like your brain hasn't been going down that path for a long way. Right. And so people have historically left development out because it is so complex and individual. But, you know, reductionism can sort of only get us so far. It's great to, you know, like say, okay, look, we can get this rat to press a lever and it will take a ton of coke. Well, yeah, you would press a lever to take a ton of coke if you had nothing else to do.

Right. Well, yeah, you would press a lever to take a ton of coke if you had nothing else to do. Right. Also, so, you know, so it's like we have to bring in, you know, we've got to start with the reductionist stuff, but then we've got to bring in all these other pieces like genes, like culture, like timing, and then see, you know, a lot of neuroscience and, you know, psychiatry is now heading in this direction and trying to, you know, now that there is big data and you can calculate these things with so many variables, we're being able to bring this stuff in and look at it more scientifically than, you know, we could in the past. of this, and I don't want to spend a lot of time on it because we already covered it in an episode with Johan Hari's, his book, Chasing the Scream. But one of the big implications of this is drug exposure alone doesn't cause addiction. So the drug itself is not the problem here. And our efforts to get rid of all the drugs is really a misguided and futile attempt. And we may talk a little bit about why punishing addicts doesn't work later, but I did want to just reference that for listeners.

If you're interested in that sort of thing, Maya's book definitely talks about it, and our interview with Johan Hari does also. I'm going to stay a little bit away from the policy implications of that and focus more on the personal implications. But I did want to make sure we got that in there, because that's a big part of what you talk about. Yeah, I think, you know, basically, if addiction is compulsive

behavior that occurs despite negative consequences, and we've spent the last 100 years of policy trying to fix it with negative consequences, it's pretty ridiculous. And, you know, in the book, I talk about how, you know, it's kind of like trying to stomp out OCD hand washing by like banning soap. Now, you can have a harm reduction effect sometimes if you like ban a particularly harsh soap. Right. But you're not dealing with the underlying problem. But our supply side efforts have basically done the opposite. So we push people from, you know, pharmaceutical drugs, which are certainly dangerous, but at least you know, the purity in a dose to fentanyl where, you know, we're just getting so many deaths. Yep, we could probably spend two episodes on the failure of American drug policy

and all the ways that it's misguided. But again, we'll save that for for a different time. But I do want to talk about that idea, though, that this is a learning disorder that is characterized by a resistance to punishment. Let's talk about that, because this idea of having to hit bottom is very prevalent. And I'll have to say, like, I still there's a part of me that feels well, I have an interesting experience with this. So let me have you talk about that first. Sure. The problem with the idea of bottom is that it can only be defined retrospectively. So let's say I'm a person in recovery, and I'm happily in recovery for several years.

I believe that the thing that preceded my recovery was my bottom. Now I relapse. Suddenly I have a new bottom. Now I relapse again. Suddenly I have a new bottom. I don't know what my bottom is till I'm dead, really, right? Yep. So it's a useless concept scientifically. It's also a really moralistic concept because it kind of means that you have to hit this point of extreme degradation before you can stop. And that is just not what the research shows. If you just ask yourself this question, who's more likely to recover?

A doctor with a thriving practice who's just gotten into trouble or a homeless guy? And it's quite obviously the doctor, right? Yes. Yes, it is. We know this instinctively that like, if you have more resources, you are going to be more likely to recover just for obvious reasons. But the whole idea of hitting bottom tells us to take resources away from people and to try to continue to inflict negative consequences until there comes some point when this thing that is defined by not responding to punishment suddenly decides to respond to punishment. I'm Jason Alexander.

And I'm Peter Tilden. And together on the Really No Really podcast, our mission is to get the true answers to life's baffling questions like why they refuse to make the bathroom door go all the way to the floor. We got the answer. Will space junk block your cell signal? The astronaut who almost drowned during a spacewalk gives us the answer. We talk with the scientist who figured out if your dog truly loves you

and the one bringing back the woolly mammoth. Plus, does Tom Cruise really do his own stunts? His stuntman reveals the answer. And you never know who's gonna drop by. Mr. Brian Cranston is with us today. How are you, too? Hello, my friend. Wayne Knight about Jurassic Park. Wayne Knight, welcome to Really No Really, sir. God bless

you all. Hello, Newman. And you never know when Howie Mandel might just stop by to talk about judging. Really? That's the opening? Really, no, really. Yeah, really. No, really. Go to reallynoreally.com. And register to win $500, a guest spot on our podcast, or a limited edition signed Jason bobblehead. It's called Really, No, Really, and you can find it on the iHeartRadio app, on Apple Podcasts, or wherever you get your podcasts.

The first time I got sober, it came as a result of some pretty serious negative consequences pending, as did your sobriety also at least seemed to be motivated initially by some negative consequence. So I while I recognize the idea that having to hit a bottom is a fallacious concept, because I actually got sober again many years later after I had a relapse and I didn't hit any sort of bottom and got sober. So I don't totally believe in the concept, but I'm curious about what then do you believe is the motivation that turns people towards recovery if it's not avoidance of negative consequences? I think this, you know, like if people continue using,

despite losing their families, losing their homes, losing their jobs, losing their loved ones, you know, practically losing their lives many times, you know, this is a very inefficient way of spurring recovery, right? And it is quite likely to end up spurring death instead of recovery. So you're saying it can work in some cases, but it's a pretty bad way to make it happen. Well, yeah. And I mean, what do you mean by work? Like, I mean, for me, I got arrested and I was facing a horrendous sentence because it was New York in the 80s, and I had a lot of cocaine and we had the Rockefeller law. I kept using for another two years after that. So, you know, and my life was constantly getting worse during that time. I was using during

the peak of the AIDS epidemic in New York City when 50% of people were infected, 50% of IV drug users. Like what I think happened, you know, certainly I was, you know, cognitively terrified and aware of the potential consequences, but I kept using because I felt like I just couldn't survive any other way. I just couldn't see that I had other options. And I think recovery comes when you begin to be able to see the options. And I like to use this analogy of like, let's imagine you're a prisoner in a cell and there's a rug on the floor and you have no idea that like under that rug is like a trap door that you could just walk out, right? If you don't know that that's there, you can't escape. But once you know that it's there, you can.

And you can't make somebody sort of suddenly see the light through negative consequences. Like sometimes they do and sometimes they don't. And you can't make them suddenly see the light by like being loving and kind, because sometimes that helps and sometimes it doesn't. It is a very complicated process that's highly individual. I tend to prefer the loving, supportive, hopeful approach because A, it does less harm and B, it is more likely to work on something that doesn't respond to punishment generally. But, you know, there is a mystery as to how human behavior change occurs. And it's not a simple thing. But I do think, you know, insight is sort of necessary, but not sufficient. Yeah, it is a fascinating subject of why some people get sober and others don't. It has mystified me the whole time that I've been in recovery. I think it

ultimately was at the bottom of the complete undoing of my belief in the spiritual type of God that is often talked about because I was like, well, that doesn't make any sense. It's just a mystery. And what you said there is interesting because I was pushed to go into treatment because of some seriously negative consequences. But you're right. It was the sudden appearance of hope that probably kept me going or got me interested in trying. So that is a different way to look at that situation. So that is a different way to look at that situation. Yeah, I mean, you know, like I was writing something today about learned helplessness, which is basically this paradigm that they use for studying depression.

And you can create this basically in animals by doing horrible things to them like unpredictable, uncontrollable stress. And basically when you do this after a while, the animal just stops struggling and says to hell with it. And at that point, when you want to test an antidepressant, you basically see if it keeps the animal trying longer, right? And drugs that are effective at being antidepressants keep the animal from giving up, right? But once you get to that point of learned helplessness, that's where a lot of people with addiction are kind of living. And without giving them hope, without giving them insight and a sense that they're worth it, it's very hard to get them to change.

And it's going to be, you know, I mean, I think we need to recognize the role of trauma here. You know, I mean, I think we need to recognize the role of trauma here. If you've been severely traumatized and drugs are the only thing that allows you some moment of peace, you are not going to give that up until you find some other way of managing. And so like a lot of how harm reduction works is by helping people learn other ways of managing before they give up the drug when they're not yet ready to do so, so that when they do, they have a way of soothing themselves, basically. Yep. And we recently had an episode where we talked about trauma and the role of trauma or, you know, what's known as adverse childhood experiences on later life behavior, addiction being one. And we had,

we had Gabor Mate on who talks a lot about this. But I think what you just said there is really important, which is that a lot of people are using addiction, as we said earlier, as a coping mechanism. It's not seen as the problem by us in the beginning, because it's actually a wonderful solution to an existing problem, at least for a period of time. And so I really think that's an important piece of this, which is how do you cope with life in the absence of a substance? As a matter of fact, I think that's probably 95% of what recovery seems to me to be about is those coping mechanisms. Yeah, and I mean, you know, in the past, sort of under the disease models, the idea that people who are still actively learning

or people who are still actively using could learn was like, oh, no, they're still active. They don't learn anything. And that's just not the case. Harm reduction programs have shown this over and over and over again. Like people do use clean needles. People do use safe injection facilities. People do begin to learn ways of coping before they quit. So it is simply not the case that active users can't learn and can't change and can't make improvements to their life. So, you know, it's kind of weird that we have this idea that like we should just take everything away before we help people get stuff that's going to allow them to stay sober. problem. Like, even, you know, regardless of whether it's going to stop somebody, or whether it's going to help somebody towards recovery, it just seems like, you know, harm reduction is just a good idea. But given our misguided policies, often we don't do that, although we seem to be doing more of it these days. Well, and I think like, you know, here again comes a problem that

is unfortunately part of the 12-step ideology, which is this notion of enabling. And, you know, it's the idea that, like, unless you remove all the support from somebody with addiction, they won't change. And again, we've seen that that's not the case, but the biggest opposition to harm reduction has come from people who believe that you are enabling the person to inject or to do whatever it is that

you don't want them to do by actually helping them stay alive. And I just find the moralism in those arguments to be really appalling because it's basically like, we think you're better off dead than addicted. Yeah, it is pretty bad logic. And as somebody who thankfully escaped HIV and AIDS but did end up with hepatitis C, I am aware of that issue pretty intimately. Yeah. No, and I mean, it's like, you know, and hep C is just much harder to prevent being able to change than HIV because it's just a much hardier virus, unfortunately. Right. Another area that was very interesting to me that I'd like to talk about is this idea of there being two types of, this is probably not the right term, I'm just going to use it, mechanisms

that, different types of mechanisms that are happening in addiction. And you refer to it, or a researcher referred to it as the pleasures of the hunt versus the pleasures of the feast. And then you also refer to it as liking versus wanting. Can you walk us through that? Because I just thought that was fascinating. Sure. No, I mean, I find this really interesting, too. And I think it can kind of teach us a lot about how we behave, because if you think about it, you know, pleasure isn't singular. Like you have pleasures that are about desire and about, you know, I mean, sex is really the obvious one here. Being excited and having desire is pleasurable. It can also be pleasurable to be satisfied in that. So like the hunt would be

the desire part and the feast is where you are satisfied and satiated and comfortable. So wanting is like that desiring bit and liking is like the satisfaction of that. And, you know, sort of these very primitive models of addiction where it's all dopamine, dopamine, dopamine never made that distinction. And it didn't make any sense because if you constantly escalate wanting, it becomes severely non-fun. I mean, who wants to live in a permanent state of unsatisfied desire? That's like hell, right? Yep. You know, you could permanently, you can escalate contentment and satisfaction all you want. You may not be very motivated to do anything, but you will be happy.

satisfaction all you want, you may not be very motivated to do anything, but you will be happy. But if you constantly escalate desire without satisfaction, you know, that's like the Rolling Stones, it's not going to be good. So, you know, we do need to distinguish between these things, because they refer to different motivational states. And they are, you know, I mean, cocaine is sort of a classic example of a drug that escalates wanting rather than liking. And you can just be doing coke and doing coke and wanting and wanting and wanting, and you're never satisfied, and it ultimately becomes very unpleasant for that reason. Opioids, on the other hand, are sort of more satiating drugs, and although they can escalate wanting as well,

although they can escalate wanting as well. But, you know, it's like this is why it is a lot easier to do maintenance with opioids than it is with stimulants, because if you have something that you can get to a satisfactory level of, it's a lot easier than if you have something that's constantly escalating desire, right? And by maintenance, you mean things like methadone as an example? Methadone, buprenorphine, heroin itself possibly. Yeah. So, yes, that is what I mean. And I think like, you know, when we understand that addiction is defined as compulsive behavior despite negative consequences,

we can see that maintenance can be recovery because you might still be physically dependent on a maintenance drug, but you aren't having compulsive behavior despite negative consequences, so you are not in active addiction. Thank you. I'm Jason Alexander. And I'm Peter Tilden. And together on the Really No Really podcast, our mission is to get the true answers to life's baffling questions like why they refuse to make the bathroom door go all the way to the floor. We got the answer.

Will space junk block your cell signal? The astronaut who almost drowned during a spacewalk gives us the answer. We talk with the scientist who figured out if your dog truly loves you and the one bringing back the woolly mammoth. Plus, does Tom Cruise really do his own stunts? His stuntman reveals the answer. And you never know who's going to drop by. Mr. Bryan Cranston is with us today.

How are you, too? Hello, my friend. Wayne Knight about Jurassic Park. Wayne Knight, welcome to Really No Really, sir. God bless you all. Hello, Newman. And you never know when Howie Mandel might just stop by to talk about judging. Really? That's the opening? Really No Really.

Yeah, really. No really. Go to reallynoreally.com and register to win $500, a guest spot on our podcast or a limited edition sign Jason bobblehead. It's called really no really and you can find it on the I heart radio app on Apple podcasts or wherever you get your podcasts. That makes total sense for cocaine for people who have been down that road. You know, it is as describe it, escalating cycle of never being satisfied and chasing that satisfaction for long and awful periods of time. Whereas, as you said, with heroin or other drugs,

there is a satiation point where you're like, all right, I don't want anymore until you're no longer at that satiated point. Right, exactly. And so what's the role of wanting then? Is it just that as you come down from that, now. And so what's the role of wanting then? Is it just that as you come down from that now you want again because you're not there? Yeah, exactly. And I mean, this is again why maintenance works, because if you just stay at a steady state level of the drug in your system, you don't escalate either wanting or liking. You are just, you know, normal. What about alcohol? Where does alcohol fit in that? Alcohol is complicated because it's such a dirty drug and it does, and I mean dirty in the sense of that it activates multiple complex things as opposed to being very simply targeted to something.

So, you know, initially alcohol acts like a stimulant. It has this biphasic effect. So first you feel kind of excited and up and then you feel kind of tired and sedated. And a lot of people sort of make a mistake with drinking where they think like, oh, if I drink more, I'm going to get more of that excitement, but you actually get more of the sedation. So one way to learn about moderation is to realize this and to not drink more when you think you should. But anyway, like, yeah, so is is kind of both and that I think that's one of the reasons

why you know a drug like naltrexone which blocks opioids is probably more useful in alcohol than it is in opioids because with people with opioid addiction they tend to be chasing a really strong opioid effect and completely preventing that, completely preventing even your natural opioids from working may not be so good for some people. Yes. But with alcohol, where you're not blocking the direct thing and there's other things going on, it may be more manageable and it may also, you know, help with moderation. Yeah, I think that's an interesting idea.

I explored this with someone not too long ago about was naltrexone a good idea? And the concern was, yeah, it's blocking opioid receptors and this person is wrestling with depression to start with. So is this really the best approach? I mean, you know, it's interesting because I think naltrexone and Vivitrol, which is the long-acting version of it, I think they're very similar to antidepressants in that some people they're going to work great for and actually make their mood better, and then other people they're going to be a disaster for and make them kind of suicidal. And you really need to figure out which group you fall into before you take something that's going to last a month, right? Right. And you should not be coerced into, you know, taking anything like this. The other thing that we really, really need to know about naltrexone is whether Vivitrol actually increases overdose death risk during the month or two after you stop it because it could potentially sensitize the

receptors. And we really don't know this yet. Meanwhile, we do know that the other two drugs, methadone and buprenorphine, cut mortality by 50% or more. And so, you know, if I'm making a choice, and they also don't block endogenous opiates, I'm going to tend to think that they should be the first choice. So let's now wade into the territory where the knives are going to come out from someone somewhere listening or who knows, but we're going to wade into the sensitive territory of 12-step programs and are they effective, are they useful, etc., etc. And so I'm going to just state a little bit of what you say in the book, and then you can agree or disagree, and then we can kind of go into the discussion. And you talk about how, A, you recovered from a 12-step or via a 12-step program,

so there is that piece, and the fact that 12-step programs have been inserted into our national drug policy in a way that is very injurious. And I think that's a point that hopefully a lot of us, anybody can agree on, which is that, you know, making 12-step programs the place where you just push everybody who's got any kind of problem against their will is probably not a great idea. So with that in mind, tell me what else, you know, kind of where you are with the idea of 12-step programs today in your life and in general. Yes. I think that 12-step programs are absolutely wonderful self-help for people who find them helpful. And the only way to find that out is to try it for yourself, basically. Some people are going to go and they're going to find a warm, welcoming community and feel as though they are part of something and they get the social support that they need. And it helps them, you know, remain sober and avoid relapse and all that good stuff. Other people are going to go and say, this is moralistic, this is religious, this is

spiritual. I don't like this. I don't feel comfortable here. And it's just not their thing. You know, with any other condition, we would not accept 80% of treatment being a program that involves taking moral inventory and turning your life and will over to a higher power. Like, we would consider that alternative treatment at best. And we would definitely not mandate it for anybody. And the fact that we do mandate it for people and we do have large percentage of

our treatment program saying that, you know, this is the only way to recover, it's an outrage. That doesn't mean the 12-step group as self-help are bad. It just means that it should never have been married with medicine. And, you know, AA itself says that in the eighth tradition that, you know, we shouldn't be paid for doing 12 step work and teaching other people about the 12 steps. Well, that's exactly what goes on in 80 percent, at least, of American treatment centers every day. And so a lot of, you know, AA old timers and, you know, NA people are like are like yeah like we should never have accepted this kind of weird marriage because you know in i like to use the analogy of like cancer treatment like it may be that your face is the only thing that allows you to like show up for all that horrible chemo right but you don't ask your face-based support group leader for what dose of chemo should be the best, right?

Yeah. You ask your oncologist this, right? And you work with your doctors on the medical aspect, and you keep the faith stuff, you know, as the support. You know, and this doesn't mean you can't be as religious and as believing and as spiritual as you like. It just means that modern medicine is different. And while we can have these things support and complement each other, when we try to mix them, it does not work very well. that occurs with just the 12-step ideology is that it kind of has been used to encourage this very insulting and demeaning form of treatment

where, you know, you get counselors saying, you know, when is an addict lying when their lips are moving, you know, and where you get, like, all this, like, stuff aimed at forcing you to hit bottom and, you know, sort of forcing you to feel like you're immoral and bad. And you for women and minorities, that can be really harmful. I'm sure it's harmful for some men, too. But it's like especially harmful for groups that have historically

been powerless. We don't need to be told that anymore. Thank you very much. We need to be empowered. Yeah, for sure. I agree with a lot of that. Talk to me about medicine, though, and the role of medicine in a learning or developmental disorder or in a, where we said earlier that most of what constitutes recovery is a means of coping with things, which is not exactly a, is that a medical thing, how to cope with something? I mean, again, like, you know, this gets to our weird disciplinary boundaries. I think that, you know, I mean, is cognitive behavioral therapy simply teaching? Is good teaching therapy?

Like, to me, like, that ends up, like, being semantic, right? But if, you know, I think the reality is that if we see people with addiction as students who need to learn better coping skills rather than sinners who need to be forced to repent, we will have a much better power dynamic in our treatment centers, right? And people will feel a lot better about themselves. And, you know, so I think, you know, yes, a lot of what is needed for recovery is stuff that is needed for mental health in general. And given that most people with addiction either have trauma or mental illness or both, you need to figure out what the person is trying to cope with and what skills they lack and then help them find them.

And that's going to be a really different process for different individuals. I mean, like giving, you know, a CEO job training and a GED is not very sensible. Some of the ones I've met might, I mean, it might help is all I'm saying. Well, right. Okay. Current company that I might know at this time in my life, not, I don't mean you guys, whoever you are is listening. I'm teasing too, but like the, um, the point just more being, if you, you know, again, if you have like no education and no work history and no home, you're going to need very different things than if your primary problem is depression and you've got a home and you've got a husband and you've got kids and all these other things. all these other things. It's really going to depend, you know, like giving depression treatment as the primary approach for addiction to somebody who's homeless. Well, that situation is pretty

darn depressing, right? It's unlikely to, so, you know, so you need to be sort of sensible and, you know, like biopsychosocial thing often gets tossed around. But if you actually recognize that and actually really enact that, then you will provide the appropriate things for people, you know, as needed. And I mean, I think this is why we often get this ridiculous thing where, you know, oh, if you're going to go on methadone, you must have counseling. Well, the data doesn't support this and it's expensive. Why don't we just give counseling to the people who want counseling? You know, it just like it seems, it seems, you know, again, it's sort of this moralistic controlling thing going on. And once we understand that people with addiction are people like any other people and they have the range of goodness and badness that everybody else has, you know, we can start, you know, recognizing humanity, treating people just like people and figuring out, like deal with what they have going on inside them and and

we need to like help them rather than you know trying to harm them yeah and i think that's a great place to kind of wrap the conversation up i think what you said there is is so important and i think that i couldn't agree more that treatment for these things needs to be, it's a, it's a cliche word, but holistic, right? That I've always thought that about depression too. It's like my depression responds to a lot of different things. And I would say my addiction does too. It's, it's a variety of factors I have to deal with for that to be effective. So being kind to each other is always a good message. So thank you so much for taking the time to come on. The book again is called Unbroken Brain,

a Revolutionary New Way of Understanding Addiction. And I'm sure this is going to get some people stirred up, which is always good. So thank you so much for coming on. Thanks again for having me. Okay. Thanks. Bye. I'm Jason Alexander.

And I'm Peter Tilden. And together, our mission on the Really Know Really podcast is to get the true answers to life's baffling questions like why the bathroom door doesn't go all the way to the floor, what's in the museum of failure, and does your dog truly love you? We have the answer. Go to reallyknoworeally.com and register to win $500, a guest spot on our podcast,

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