Video URL: https://www.youtube.com/watch?v=PaINkG9A5cY
the jurogan experience it's something that people used to call the addictive personality we don't really call it that anymore we just use the idea of the disease model so we say that somebody has the disease of addiction it's a chronic relapsing and remitting problem people come to it with different degrees of vulnerability and the risk for it can essentially be summarized as nature nurture and neighborhood and just to briefly describe that if you have a biological parent or grandparent with addiction you are at increased risk compared to the general population of getting addicted yourself if you have a co-occurring mental illness you are at increased risk of getting addicted if you have certain character traits like you're more impulsive you have a hard time putting a break between the idea to do something and actually doing it you are are you at increased risk for addiction so that's kind of all in the sort of nature risk category there's also the nurture piece of it so if you grow up in an environment where you experience a whole lot of trauma you are at increased risk for becoming addicted if you grew up in an environment where your caretakers model using drugs and alcohol or other addictive substances or behaviors as a coping strategy you are an increased risk of becoming addicted or even if they just implicitly condone it and then that brings us to the whole neighborhood idea and this i think is a really under recognized aspect of our risk for addiction which is just simple access so if you live in an environment where you have more access to highly reinforcing drugs and behaviors you're more likely to try them and just simply in being exposed especially with the increasing potency variety and novelty of drugs today your increased risk of becoming addicted so if you go see a doctor who's more free with their prescription pad you're exposed to opioids or benzos you're more likely to to get addicted if you grow up in a culture where people are playing a
lot of video games you're more likely to try them more likely to get addicted so this nature nurture and neighborhood are the risk factors but again people bring different degrees of vulnerability to this problem of addiction and some people are more vulnerable than others and you may indeed be in that category where you're just some somebody who you know once you find something that's reinforcing for you you just go whoop and you just want to do it again and again and again when you say reinforcing what do you mean by that i mean that it's rewarding in some way rewarding right so it's it's it's pleasurable at first now the thing about addiction and the way that it changes our brains is that that thing that initially is pleasurable and has us engaging in approach behaviors if we continue to consume that substance or engage in that behavior it ultimately actually puts us in a dopamine deficit state such that we want to continue to do that behavior not to feel good but just to stop feeling bad and that's kind of one of the fundamental things about the disease of addiction it's innate vulnerability to start added to the changes that occur in the brain as a result of ongoing consumption of our drug and those brain changes are what drive continued compulsive use so that's the difference between being enthusiastic about something that you enjoy versus something that consumes your life so you're kind of chasing the dragon like the initial fur like that's what they talk about it with heroin addiction right don't they say chasing the dragon yeah the initial rush that you get from the first um uses of it you're always chasing that but really what you're doing later on in life is just trying to not be sick yes not having it in your body makes you feel terrible right so so interesting that that term chasing the dragon it comes in part from as you describe like the elusiveness of trying to recreate that initial high which with continued use becomes harder and harder but it also literally comes from when heroin is inhaled so if you put it
on a piece of tin foil and you light it underneath you get this kind of smoke then that plume looks like a dragon's tail so it's got a couple of different meanings but yes um i mean what you're saying is exactly right and the way that i describe this to patients and describe it to medical students is imagine that in your brain there's a balance kind of like a teeter-totter in a kid's playground and one of the most interesting findings in neuroscience in the past 75 years is that pleasure and pain are co-located which means the same parts of our brain that process pleasure also process pain and they work like opposite sides of a balance so when we do something that's rewarding or reinforcing or pleasurable our balance tips slightly to the side of pleasure we get a little release of dopamine the pleasure neurotransmitter in that part of our brain our reward pathway and we feel good but the thing about that balance is that it wants to remain level and the brain will work very hard to restore a level balance or what's called homeostasis and it does that by tipping the brain an equal and opposite amount to the side of pain so again the way the balance restores homeostasis is to tip to the opposite side that's the come down after using that moment of wanting to do it again the hangover if we wait long enough that feeling passes and balance is restored but if we don't wait and we continue to use our drug again and again we end up with a balance that's essentially weighted to the side of pain and i imagine that like these little neural adaptation gremlins hopping on the pain side of the balance not very scientific i know but the point is that with repeated use we get enough gremlins on the pain side of the balance to fill this whole room and then we're essentially working from a dopamine deficit state we've down regulated our own dopamine we've down regulated our own dopamine transmission and those gremlins like it on the balance so they don't get off after the hangover is over or the acute withdrawal they can persist there for weeks to months to years which is why people with addiction even when their lives have become so much better will relapse because they're
not walking around with a level pleasure pain balance they're walking around with the balance tipped to the side of pain they're experiencing the universal symptoms of withdrawal from any addictive substance or behavior anxiety irritability insomnia dysphoria and intrusive thoughts of wanting to use their drug again now with enough time elapsed and again with people in people with severe addiction it can take months to years those neuro-adaptation gremlins will hop off we will regenerate our own dopamine and our own dopamine receptors and and our level balance or homeostasis will be restored is it scientific to call them gremlins super scientific watch the entire episode for free only on spotify