What Does It Take To Beat Addiction? With Nikki Sixx, Dr. Adi Jaffe, Dr. Abraham Palmer and Dr. Sandra Sanchez Roige.

Episode Transcript
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Speaker 1 (00:04):
I'm Baryton Day Thurston and this is Spit and I
Heart Radio podcast with twenty three and me. This is
the podcast that explores how DNA is changing our lives
and the world around us. So what does it take
to overcome addiction? America is sick. Americans are dying, Towns
are being destroyed, economies are crippled all by addiction, and

(00:25):
the numbers are devastating. On two people a day die
of drug overdoses, and they're killing more people than car
crashes and gun homicides combined. Prescription opioids and heroin are
the prime contributors to these stats. Once hooked on prescription painkillers,
many people turned to heroin, which is often cut with
more lethal drugs because it's cheaper and easier than getting

(00:45):
another refill. Heroin used in the US has more than
doubled and heroin deaths have more than quadrupled in just
the past decade. These statistics are beyond alarming, and they're
leaving us wondering what is it going to take to
beat this addiction epidemic. In part one of this episode,
I sit down with two people who are actively using

(01:06):
their experience, their influence, and their voices to help answer
that question. Nikki six founding member and Bassis of the
world renowned rock band Motley Crew and six AM three
time New York Times bestselling author, public speaker, philanthropist, photographer,
and addiction recovery advocate. There was a whole inside me

(01:27):
that wasn't my fault, but later we've become my responsibility.
And Dr A. D. Jaffee, a world renowned mental health expert,
lecturer at u c L, A addiction specialist and author
of the Abstinence myth. Genetically, there are actually a few
dozen markers that are important when it comes to us

(01:47):
understanding whether somebody is more or less likely to become
an addict. After my conversation with Nikki and A. D.
I was left wondering is there a way to identify
addictive or impulsive behaviors earlier before people succumb to a actions.
Listening to part two of this episode, where doctors Abraham
Palmer and Sandra Sanchez Roger of the University of California,

(02:07):
San Diego School of Medicines Department of Psychiatry share their
latest research. They discovered a genetic signature that correlates a
person's ability to delay gratification with reduced chances of addictive behavior,
meaning those that place more value on instant gratification over
delayed gratification are more likely to experience addictive behaviors. Not
everybody's felt the same deck of cards. Not everybody goes

(02:30):
into these situations with the same strengths and weaknesses. Some
people are very vulnerable to these substances which are prevalent
in our society, and that shouldn't be seen as a
personal weakness, that shouldn't be seen as something that they
are blamed for. This is going to be interesting, this

(02:51):
is going to be fun, and this is going to
be very real. Let's begin with Nikki and a d.
You both have some shared experiences. You both landed in
some beautiful places. Nikki, I want to start in the
beginning with you. What was your childhood and family life
like and how can you anchor that story of your

(03:13):
own addiction into those experiences. I was born in San Jose, California.
My father was the first in our family to be
born in America. His parents, my grandparents, were immigrants from Italy.
My mom met my dad she was eighteen. He was
about forty two years old. I was two years old
when of my sister, Lisa was born with Down syndrome.

(03:35):
They were told to not take her from the hospital,
that she wouldn't live six days, much less six weeks
or six months. My dad was very passionate about bringing
her home, and they couldn't take care of her. It
was nineteen sixty they didn't have the ability, and they
didn't have the finances. My dad was like a construction

(03:58):
worker and my mom was a stay at home mom,
so that my sister went to a home and I
was told that. I was very upset about that. I
was very excited I was gonna have a sister. I
was very upset as my first kind of thing I
can connect to what what might be an abandonment for me.
My dad left right after that, so I was about three,

(04:20):
and then my mom left right after that, and I
went to my grandparents, and I didn't know that I
had been basically abandoned until I hit, you know, maybe
my teens. I started to have a lot of anger
towards my mom and my dad and everybody else has
a mom and a dad, even if they were divorced.

(04:41):
I'm living in Idaho with my grandparents, are traveling every
six months. I become a very shy kid because I
was always the new kid in school. I didn't have
any roots. I didn't know who my family was, and
I didn't know until I was a little bit older.
I actually didn't even know who I was. And the
one thing that I had was music. I go back

(05:01):
in time and I remember that was the thing. I
think music actually saved my life. I think without music,
I might have ended my life early through either drugs, alcohol,
or some other other ways. So I always look at
music as like the thing that saved my life. That's
a that's a deep story, and it's kind of actually amazing.
So many parallels, but you hear and I can see

(05:22):
all the work you've done by this moment to recognize
all those old patterns, right, because it's really interesting how
different and yet how similar our stories are. My family
stayed together all the way through. My dad died of
cancer about ten years ago, still married to my mom,
but a lot of tumultuous elements of their relationship. They

(05:42):
almost separated multiple times, you know, place being thrown in
the house and yelling and shouting and a very emotionally
withdrawn family. We moved to the States and we moved around,
and I was the new kid in school and I
was an immigrant, and I needed ways to fit in
and so which I can totally relate to you at
around the same age and well, I mean for me,
it was fourteen, so maybe a little bit later than

(06:03):
than the moving around started for you. And I was
always really socially anxious until the first time somebody handed
me a bottle of vodka at a sleepaway camp and
knew drinking was bad, but the only reason I drank
it at first was because I wasn't gonna be the
weird kid to say no. And I had a few
SIPs and I remember it burning down my throat, just
being disgusting. But I'm not gonna be the one throwing
up this stuff either, because all the kids are gonna
make fun of me. And then fifteen minutes later it

(06:26):
hit and I was good, Like for the first time
it as long as I can remember, I didn't care
what other people thought of me. I didn't feel awkward.
I could talk to girls, all these things that I
wanted to figure out, but like you said, I didn't.
I didn't have a word for it. I didn't have
a name for it. I didn't recognize this was going on,
and now I found a solution. And I immediately after
that sleepaway camp, I was drinking every weekend at fourteen,

(06:49):
and it gave me a group of people with whom
when I drank, at least, because I still didn't feel
like I belonged if I wasn't drinking, but when I drank,
I felt okay. And then we came around the same way.
Everything came the same way, because as long as I
could belong, everything supposedly in my head would be okay.
But then that took me down some pretty dangerous routes.

(07:09):
You know, within five to ten years. It developed quickly
because the first drive, the first impetus, was just to
be all right and to just belong. And it sounds
like that's really really similar. I'm sure everybody listening to
totally understand why you would have that coming from that
background was the same for me. My earliest memory was
we I think we were living in Lake Tahoe and

(07:31):
there were these kids on the playground and one kid
had a little envelope and he had some seeds, which
then I know, like a gardener that was he was,
actually there were sunflower seeds he said it was you know,
it was pot and I was like, I don't really
even know what that is. I mean that I was
very young, I found out and I fit in, and

(07:54):
all of a sudden, I wasn't the new kid in school.
So it's the same thing. There was a whole inside
me that wasn't my fault, but later we become my responsibility.
There's always that thread back to either a single experience.
For some people experience of severe trauma in a moment,
but typically it's not one experience. It's almost an entire

(08:16):
existence that is centered on not fitting in, feeling less
than being outwardly mocked. One of my clients today it
was telling her mom just regularly called or miss Piggy, like,
I don't know how you develop without having struggles and
ideas about what's going on with your weight. When that's
the way that people are supposed to love you and
support you, relate to you. As humans, we want to

(08:38):
feel comfortable. We we need for that to happen, and
we're supposed to get it from our socialization. And if
I'm not going to get it from the group of
people that I was born into, I'm gonna find it
somewhere else. We're going to talk about the biological piece
of this a lot here today as well. But some
people I'm one of those people. I don't know if
you are, but um, I have a proclivity to be
experimental and try stuff out, be a little bit more

(09:00):
maybe um inquisitive, inquisitive, impulsive, some of these other things
that some of the people I was born around, and
so when these things would show up, I was pretty
quick to jump on them and not really do a
lot of forethought and sit around and go, well, I've
heard this is bad. These kids want me to fit in.
What do I do? I just I jump on it.
It's also hard when the people that are saying it's

(09:21):
bad are actually not treating you good. So now you
have some guy that's got a thing of something, and
even though you don't really know him, it's like, oh,
he's he's cool. Those guys are always cool to me,
Like the guy that had the weed, the guy that
you know they had a secret party and someone's I

(09:43):
was like, wow, that's so much cooler than my existence.
My existence is my mom ignored me, my dad ignored me.
Kind of a thing I think about and curious what
you think about this, Do they know? Like I don't
think my mom I knew what she was doing. I don't.
I don't don't know the pressure my dad had being

(10:04):
thirty years older than my mom in like the sixties,
and he left and was my mom crazy? I've heard
she was. I never really knew her. There's a child
with down syndrome, there's financial he just he left. Did
my mom know? Did they know? Shipping me off? And
and even even it's like almost maybe not fair that

(10:25):
I say shipping me off like I was like a
bottle of water. Maybe they just didn't have any other tools,
and maybe they thought they were saving you. Maybe what
you've both done a beautiful job of establishing is the
whole that addiction tries to fill a sense of lack
of community, of loneliness, of abandonment, of belonging that you

(10:46):
might not get from the people around you. So, Dr Jaffie,
how do we scientifically understand what addiction actually is? So
I want to be really clear from the outset. Well,
a lot of people listening might think that this is
a completely agreed upon idea. It's not. And there's a
lot of debate among scientists in the industry in general
about what addiction is. And everybody's heard the addiction disease

(11:09):
model for that's one of the predominant models in the
United States, for instance. Addiction absolutely has both biological and
environmental and psychological components. Everybody will acknowledge that the question
and I talked about this lot. There's a whole chapter
in the Absent Smith literally dedicated to this part. Is
for about a hundred years now, we've been fighting about
who rules that kingdom, right, like is it more biology

(11:31):
or more psychology or is all the environment. I think
that's a somewhat uniquely American thing that we kind of
want to know who one out, like who beats who
beat who? Did biology beat psychology? And I think the
reason I like this conversation he is I don't think
there's really a winner. I think it becomes individually determined
by each person's experience. So addiction is literally in a
clinical sense and name we have given. We don't use

(11:53):
it in the clinical terms anymore. Alcohol use disorder for instances,
the name for what alcoholism is. An alcohol use disorder
can have a you know, a low level, of moderate level,
or severe level, and what it is is a collection
of symptoms. It's a set of things that show up together,
Drinking more than you want to, more frequently than you
want to, not being able to stop with yourself when

(12:13):
you say that you would um having consequences social, relational,
employment based consequences of health that a mass, and that
you still cannot correct your behavior based on right. And
so the idea of an addiction is engaging in the
behavior or substitutes of some sort that is negatively impacting
your life in a multitude of ways, normally actually includes

(12:36):
cravings within it, somewhere where even when you're not using,
you are looking for and wanting the thing, and that
it shows up for a long enough period of time
with consequences to a mass, and the correction doesn't end
up resulting. That's really as broad of a definition as
you can have for addiction. And I include four criteria
in the books of spiritual, Psychological, environmental, and biological. And
for me, spiritual is anything that connect you to something big, right,

(13:00):
Like my purpose now is to help other people struggling
with this. That's a big enough spiritual thing for me,
the helping of other humans. From the biological point of view,
I think this is a really important thing to talk about,
because there's no doubt that biology plays a part. I mean,
I know for you, Nikki, a big part of your
story was heroin. That's you talk about, but it was
the other stuff too, you know, you talk get my

(13:20):
hands on yeah, right, But you say something about heroin
that I used to say about meth which was I
used everything until I found that, and when I found that,
I was good. I did. I stopped drinking when I
found that. Heroin one for you and meth one. You
were doing music, you had another job. I became a
drug dealer. And I've read your story and it's it's fascinating.
Everything in my life was drugs. Yeah, but everything you

(13:43):
were headed on one way, and that just took your
knees out from underneath you. Do you feel that there
is an invisible line. Let's just use alcohol as a
young example. The guy gives you some vodka. You feel
like you fit in. You're getting some girls, like thinking
your kids. You you got a new bicycle, going to
some parties. You're drinking more. You throw up a couple

(14:05):
of times. You throw up. You know on your new bicycle.
There's signs that should keep going in one day I
crossed the line. Do you remember when that was? Kind
of don't And I've always wanted to ask somebody else,
So I think this is there's an invisible line. I don't.
I don't think there really is. And from a biological

(14:26):
stamp when things absolutely happen right, neither National Student on
Drug Addiction, in one of their papers a while back,
that's about twelve fifteen years ago, talked about essentially has
switched being thrown, which is a question you're asking biologically
in the brain. The thing is, we've never found that switch.
And it's not only that we've never found it, but
the story typically for people progresses along a continuum. Right,
things continue to get worse, and that line is sometimes

(14:48):
perceived in hindsight. So when you get to the end
of the story, you can look back and say, well,
that's when things change. Like Matthews, I had no problem
admitting that I was addicted to meth. When I was
addicted to it, I didn't call myself an addict because
I didn't understand that people like for you to take
on them, Yeah, like that wasn't a thing for you.
I told all my friends, AM like, I'm addicted to
I would wake up every day and just you use
meth after I just fell asleep because it was no

(15:10):
reason for me to do it other than the fact
that it had now served this role in my life.
So biologically, a whole slew of things happened for hairin
for instance. Right, we know that one of the main
reasons why after continued hair on you is people have
a hard time stopping. Your body regulates so much to
the influx of opioids that all these normal processes that
were never a problem for you, like eating and digesting food,

(15:34):
just feeling comfortable in your skin literally so you're not
crawling with pain everywhere. All those things have now changed
because of the biology of the drug. And when you
take the drug away, you experienced severe pain diarrhea. Like
these things happen to your body. Doesn't make it anymore, right, yeah,
and you and so this pain reliever that your body
used to make naturally for itself, your body has now

(15:55):
disregulated how it works and it has changed. That is
an absolutely biological fact of what happens to a heroin addict. Now,
the fact that that happens, we used to think is
the only reason why people got addicted to heroin because
they couldn't stop the heroin use afterwards. But we know,
and I'm wondering about your experience, and the same thing
is at some point you kicked it. So at some
point even that was not enough to keep you from

(16:16):
the use. But what was the difference? To me, the
difference becomes the psychological components, the environmental components, and the
spiritual components. Something changed about those other ones that allowed
you to push through the biological piece because the biological
people never go away, it will always be there. What
to me is interesting and why I wrote the book
about the absence Smith is people pretend like recovery, like

(16:37):
getting over addiction. We just kind of define. I hope
that was good enough for you to find what addiction
is it is. But I want to jump in with
because you talk about sort of overcoming the biology, which
for this show comes back to genetics and predetermination or
predisposition or heredity or inheritance of a proclivity to have

(16:58):
an addictive personality or any physiology. So where are genetics
in the story of what addiction is? Sure? As an
umbrella to all this, I want to make sure that
we stay connected to the idea that while biology absolutely matters,
there is no known period, point blank predetermined genetic makeup,

(17:20):
specific combination of alleles and genes that creates an addict
or an alcoholic that does not exist. When people talk
about an alcoholic personality or an addictive personality, they're talking
about the more complex thing that we were talking about before. Right, Genetically,
there are actually a few dozen markers that are important
when it comes to us understanding whether somebody is more

(17:43):
or less likely to become an addict. But the thing
is they run the gamut from how your liver processes
the drugs. Right. So, for instance, we know that there's
an alleal called l d H two two which has
to do with a specific enzyme in your liver that
helps break down one of the by products of alcohol aldehyde.
If you can't break down aldehyde, then you know formaldehyde. Right,

(18:05):
everybody knows the name of that chemical. Aldehyde is toxic
to your body. And if you know anybody who drinks,
this happens a lot in Asian populations, drinks a tiny
amount and gets really flush and sweaty. Their body can't
process alcohol. There's a chemical reason for that, and it's
because an enzyme and your liver doesn't exist to break
down this by product, which means that as soon as
you start drinking, your body goes into a toxicity sort

(18:26):
of state essentially, well not even just detecting it, just
being flooded with aldehyde, and so you can't process the
chemical appropriately. Those people don't drink a lot, so that
has to do with the biological predetermination. Those crowds that
literally have an allergic reaction literally when they drink it,
which was the opposite of us. But that's a kind

(18:47):
of a good thing. Yeah, well, so here's the interesting thing, right,
This is what's interesting. Biologically, they're less likely to use alcohol,
but that doesn't remove their ability to become addicted because
they'll find something else to fill the gap. Biologically, we
end up chasing, well, what is the thing that's impacting.
So so so some of this is about literally how your
liver or your gut eliminates or processes the substance. So

(19:08):
that's one thing, and we have a lot of different
variants genetically. The next piece is then what happens once
it's in your bloodstream in terms of what receptors is
it able to connect to, what systems in your body?
Does this chemical attached to there's a reason why the
drugs we use, other drugs we use, right, TC attaches
to all these molecules all over I mean not just
your brain, your gut, all over your body their TC receptors,

(19:30):
opioids the same thing. All over your body. There are
molecules that attached to one another. And so the variance
because we don't all have the exact same receptors, whether
your receptor is more active or less active, will mean
that when the drug enters your system, you'll have more
of a reaction or less of reaction. Weirdly, people actually
have the opposite notion of how this happens. People struggle

(19:52):
with alcohol primarily have a reduced sensitivity to alcohol, not
a heightened sensitivity to alcohol. What does that mean? That
means that they drink more or in order to get
the same effect than other people around them, So they
become heavier drinkers from beginning. That starts setting up all
those other biological processes. And there's some people that I've
experienced in my life that would drink, you know, morning, noon,

(20:14):
night pass out. You're like that guy's not getting out
of bed for three days. He's going to be the
worst hangover up at seven o'clock in the morning in
the gym, goes to launch, has a drink and does
it again. How does that happen? So tolerance is an
amazing thing. When I drank, I get two day hangovers.

(20:35):
In the end of my drinking career, I would it
would like, you know, you move up in the chain.
It's great. You know heroin use, right, if we just
go to that when people start using heroin, a small
amount delivers a huge bang and creates a massive effect.
I mean, once you get out over the nausea part, right,

(20:56):
you have to get over that. Once you get over that,
then it gives you this really big hay off in
terms of feeling euphoric and and settled in a way
that people have never felt before. You start using more
and you need more and more drug, right, that's kind
of the standard. And not only that, but then sometimes
you need just a little bit like do you ever
have those times where I'm sure you did one you
needed to use not a lot, like, not enough to

(21:16):
get high, but enough to be able to function. Yeah,
So it's like you find this middle ground. So that
guy you're talking about, his body is so tolerant of
alcohol that he actually needs it for all his systems
to operate normally based on what the new normal is
for his body. And here we're having a biological conversation
about addiction, right. But the issue is, like we said before,

(21:38):
if you have these five genes and you come from
this cultural background, like your parents are from this country
or this area of the world, and you were born
this weight, you will become an alcoholic. That marker doesn't exist,
especially because we now know so much more about genetics
than we used to with the concept of epigenetics. So,
for instance, let's say that you came with the most

(21:59):
heavy weighted biological predetermination for addiction. Right, Let's say all
the genes were lined up to give you the highest
risk of becoming a drug addict. If you are born
in a relatively stress free environment and are wealth fed
and nourish and taken care of, there are protective epigenetic
systems in your body there can manage and essentially control

(22:20):
some of that negative impact of your blueprint. So in
that case, it could be a social thing that could change,
that could totally flip flip you on your head. You
can trauma, you get beaten, you get raped, you could
be predetermined and live in a you know, in Himalayas,
and you know, meditate every day and have this beautiful,

(22:41):
peaceful life and you go down into the city and
something traumatic happens and it triggers a lot of stuff
and then you have your first experience. Yeah, there's so
much in that story actually, right, because here's what you're
talking about're talking about a person who's predetermined, but living
in an environment and the psychological state of being that
doesn't push you towards addictive behavior. And there he's safe

(23:03):
with all the biological predetermination. Safe And do they know,
do they feel it, do they feel out of whack
or it's just in it's in the genes. We're getting
into really good stuff. Because the idea for me is
your biology is what I call your machine. It absolutely
determines who you are. I always equate this always two cars, right,
like if you have driven multiple if you all if

(23:25):
you drive different cars, then they act differently. They have
a different personality to them, from torque to speed, to
gas mileage, all that stuff. But it's not like a
Ferrari feels awkward because it's got high low end torque.
That's just that's the way it is right, whereas a
prius is kind of steady across its power line and

(23:47):
it's really efficient in terms of use of gasoline. So
I call the biology the thing that presets your your system.
What are you primed for? Like, if you're primed for inquisitiveness,
since station seeking is kind of the way we talk
about it, or impulsivity, that's actually not necessarily a bad thing.
Long term, you're more likely to be entrepreneurial, You're more

(24:07):
likely to try other things that people are afraid of
that can be exciting and really successful. There's not a
bad element to that. Once we get into negative behaviors
like problematic drug use, et cetera, then you cross over.
So we're in an age where even children are being
encouraged pursue your passion. On our social media, the people

(24:27):
who are winning and succeeding saying you gotta know your passion, man,
you gotta pursue that thing you love. And Nikki, you
have pursued your passion, you know, musically, creatively, photographically, and
we have benefited from that passion, and and saying with you,
Dr Jeff, you have this passion for helping other people.
You've written books, you got podcasts. But where do you
think about the line, the threshold between the positive impact

(24:51):
of pursuing your passion versus the destructive impact of pursuing
a passion for meth? But listen to the passion, right, Nikki?
You talked about music was one of those two was
I think drugs are addict The behaviors are just a tool,
that's all they are. In the beginning, you found music
and that was one of the things that allowed you
to organize, control, be okay in the chaos that was

(25:11):
your life early on. And I never thought of it
quite like that. But I remember being with my mom
living in Los Angeles driving in this car. I can
still see the dashboard. I don't know where we were,
but there was a park and there was a lake,
because it could have been like Balboa Park or something.
I love how connected you out of this moment? And
I remember hearing Petulia Clark's song Downtown and the lyrics

(25:36):
are really colorful and they tell this story about you
know downtown and what you know sunshine, And I remember
that moment like yesterday, and that was the moment I
fell in love with music. And what you just said
was interesting because it could have been at that moment
that I was like, all this chaos is happening, but this, this, this,

(25:59):
this brings me piece. So I don't think we can
separate the two right Without the pain, do you had experienced,
the music wouldn't have had that power. And for me,
I can tell you with certainty, I was a punk
growing up like a fourteen years old. There was no
purpose to my life. The purpose came because I came
through this drug use nightmare. Right that when I woke

(26:23):
from I had a million dollar bail, seven fifty thousand
dollar bail. My parents found out it was a drug dealer.
When I was pretending I was a musician, like my
life had devolved, it had imploded. And when I finally
dug my way out of that three or four years later,
and I ended up back in school by necessity because
I could not get a job because I had nine
felonies on my record. When that happened is when I

(26:46):
went I now have my purpose. And if I didn't
have that pain, I wouldn't have had the purpose. I
don't think we can separate the two so much. I mean,
if you listen to Gary v or any of the
people really are pushing people towards purpose. It's the same thing, right,
get you get driven into the ground, and out of
that pain, you discover the thing that rescues you from it.
The problem for me was that nobody along the way,

(27:08):
this is what I try to do for people. Now,
Nobody along the way paused and said, I see you
in pain. Nobody along the way came and said what
can I do to help relieve? That was that because
of some of the people in your environment. In my environment,
the first time I was introduced to heroin, I actually

(27:28):
don't want to even say who it was because it's
you know, they're actually not here anymore because of drugs.
But there was other people. They said, hey, do you
want to try some some junk And I said yeah,
And I'll tell you why. I said yeah, because these
guys that I thought were so cool, like Johnny Thunders
and the New York Dolls and Keith Richards and all

(27:49):
these guys that were shooting dope were so cool and
that that was my goal. That was my goal, and
I did it. And I literally wanted to become a junkie.
That was I remember when I got clean, I was like,
how sick? That was? Why did I not go, oh,
I'll try it. I was like, not only will I

(28:12):
try it, this is who I am. And because it
gave me something, it gave me a connection to something
that was My goal was to be, you know, a
successful musician and outlaw rock and roller, to to live
life the way I wanted to write the lyrics the
way I want to write. I'm gonna tell my story.
I'm going to live the bohemian life. And I died,

(28:36):
as did the guys that were in that room. They're
all dead. And you came back. I came back, and
you've outlined the amount of work it took to do
that right. So and it, but it gave me purpose.
You know, last night I was laying downstairs with my wife.
We were talking about doing the show, and I was
very excited about it, and she said, you know, I

(28:57):
believe that you were spared because this is your mission.
Your mission is not to be Keith Richards Jr. Yeah.
I like rock and roll. I like it really loud
and it's snotty. That's not my that's not my purpose.
My only purpose. She wants to be a father, is
to be an advocate for sobriety. It's to help. The

(29:20):
next kid that comes up and someone says, hey, man,
you want to try junk and he goes that guy
Nikki six is pretty cool. He's still doing it. He's
a photographer, he's an artist, he's still making music, musicals, movies,
and he's sober. Maybe that is my purpose. I think
that's one of the reasons for me why we have

(29:41):
to speak out. For instance, I'll tell you flat because
I want to be clear about this, I'm not fully sober.
I kick drugs. That's been eighteen years since I use meth.
I drink socially. Now. Part of the reason I talked
about this is that purpose you just connected to is
so important in my opinion, to find what every moment
is about for you. Right. I don't know how you
feel about this, but when I get one of those messages,
whether it's Instagram or Facebook, from somebody who read the book,

(30:04):
I saw my story, saw one of my talks, and
they say, you find you finally spoke to me in
a way that nobody had before. And I'm gonna whatever
the next thing is they're about to do to change
their life for the better. It's the biggest gift you
because get it's it's amazing. What are the ways that
you found your way back? And and how are we

(30:25):
making mistakes and what we expect from people. I think
people put a lot of weight on themselves. I know
we put a lot of weight on people. You go
called turkey, you do the specific program or doesn't count
your weak because you've succumbed to this temptation repeatedly. I
suspect all that is false and that there are other

(30:46):
ways out. But you've both been through it. You're experts
in different ways. What have you seen that works to
bring people back from that? Can you talk? When I
gave you the bracelet? You talked about this experience you
had after a relapse. Do my just talking about that
right now? Yeah? I've been sober nine almost nine years,
maybe a little under that. I decided to try it on,

(31:11):
but not just to try it on. I had a
good excuse. I had a crazy relationship I was in.
I was in a band that was crazy. I had
drifted far enough away that I couldn't really remember what
it was like to have my skin feel like sand paper.
I feel like my guts were like hanging out of

(31:33):
my mouth. As I was going through Heroin withdrawal. You know,
when you're throwing up and you have diarrhea at the
same time, there's only one toilet. It's not pretty. It's
not a glamorous rock star living the life, designer clothes,
driving a Ferrari. It's it's disgusting. It's the bottom and
you literally do want to die. And I forgot, I'll

(31:56):
be honest, I forgot for a second, and I had
some good excuses in my alcoholic brain, and so I
tried it on, tried a couple of beers, someone had
a little bump, cheated on my wife. My whole life
went in the toilet. And I literally put myself into
rehab before I got like addicted again, before I had

(32:20):
done any more damage. I had already done enough damage.
And a short week or so, and I remember being
in the desert at this rehab, and I kept waking
up at four o'clock in the morning for some reason
every morning, and I was like, Okay, I get it.
You want to talk to me, So you weren't supposed

(32:41):
to leave the room till six o'clock in the morning.
And it was kind of weird for me because I
was dorming with like eight other guys and they're like,
I'm like, why am I? I went from a mansion
to this rundown rehab and a desert with eight other
guys in there. I just was like, So I went
out and I went for a walk in the desert
and as the sun was coming up, I hit my

(33:02):
knees and I said, I will never use again if
you can just help me see the way, and I will.
I will help other people. I've had people say, yeah,
that's a great story. It is a great story because
it worked. I don't know if there was a spiritual intervention.

(33:24):
I don't know what it was, but it was action
right and determination and a program. And there's many people
around me, so I had to make a choice. But
to answer your question about the slip and about shame
and about guilt and stigmas on the least six ammen.

(33:46):
We wrote a song called maybe It's Time, and it
is about that moment when you are like, you know,
maybe it's time. You know, I put maybe It's time
because you know it's gives a little. It should have
literally been called it is time, but it didn't sing
right uh and editing his album right now right here,
but previous to that. I wrote a song called Accidents

(34:09):
Can Happen, which was about falling off the wagon, and
it's really just one day. It is a mistake, it's
an accident, and accidents can happen, inspiring people that have
fallen off the wagon to go again, go back at it.
Sometimes we don't get it the first time. With diets,
we don't get it the first time. If you have

(34:29):
a sex addiction, we can't get it the first time.
You're an overspend or you're living beyond your means, it
takes us time. Who does it does get anything? But
how horrible if you mess up and everybody points at
you and says what's wrong with you? And you say,
you're right, what is wrong with me? And you go
back to your past that's what started in the first place,

(34:52):
and exactly which is the problem. And so you were asking,
I wanted to hear that story because I think it's
so important a for people to hear that you can
be okay. I mean, we can use whatever market you
want for okay. And I think we should broaden that
definition a little bit than just sobriety. You can be

(35:13):
okay for nine years, screw up royally and come back Now,
there are a couple of things that happened because, in
my opinion, some of the misinformed focus we put on
only how many days in the growth of sobriety do
you have? Because we put so much focus on that
thing and not on anything else, you go from having
nine years to zero days, and in everybody's eyes, you've

(35:35):
not become abject failure because yeah, you used to have
two thousands some days, but now you're back at zero.
So the person who came in last week and it's
their first time getting any help is now better than
you somehow based on this measurement. And as you just
pointed out, it's really a bad thing. I've seen it.
I've seen it up. And not only that, but you
know when I hear the story that you tell you

(35:56):
weren't back to zero in that moment you've checked yourself
into treatment. First of all, that is not at all
the same guy that had first been struggling. That's the
number one. Secondly, when you were waking up at four
o'clock in the morning, you weren't looking for self destructive
anything anymore. You were trying to solve a problem. And
I don't know, we talked you talked about a tiny bit,
but it sounds like there were a lot of problems

(36:17):
that were amassing, and because you were sober, it felt
like what a lot of people feel like as well.
I'm sober, so everything must be good. But I'm in
the wrong relationship. I'm in the wrong this, I'm in
the wrong that I'm took on a job I shouldn't take.
Life starts sucking because we're not measuring success by any
other means other than the sobriety. And now you don't
have a buffer. Yeah, there's no so in buffer. So

(36:37):
as soon as you find that buffer again, those problems
are still there. I had not dealt with my mom.
I had not dealt with my dad. I had not
dealt with the traveling and the moving and feeling where.
I remember when I was in Idaho and I was
like growing my hair along and I was in and
I remember these kids started, you know, calling me, calling

(37:00):
me gay, and I remember that I was so young.
I never heard the word, and I was like what
I had literally went to the library and looked it up. Later,
my mom asked me if I was a transvestite. I
went to scho what is that? Because I had purple
fingernail polished. I was emulating David Bowie. I was like

(37:23):
writing me I was an artist. But those like things
like as I got older, like I never I wasn't gay.
If I was, I would have embraced it. But it
was like lots of messaging, abandonment, travel, who are you?
Why do you look like different? You're different? And then
and then I was sober, but a lot of that

(37:44):
was still in my universe. So so my whole point
about recovery is we have to really broaden how we
measure success. One of the tools that I give everybody
I work with is this wheel of life I changed
a little bit. There's one you can find online and
if anybody goes to by the way to ignited dot com,
you can download a free one just right now, and
it's got ten areas of life. Do an assessment. Figure

(38:06):
out how you're doing, how are your family relationships, how's
your personal growth, how's your financial situation, what's your living
environment like, how's your purpose? How are you contributing to society.
There's all these different areas, and I gotta tell you,
you can have thirty seven years sober and had gotten
sober the day after you dragged the first time, and
if you're scoring zero and all these other areas of life,

(38:26):
I can tell you one thing, you're miserable and sobriety
has nothing. And some people call that dry like a
dry drunk dry drunk. I don't even know if that's
you know, it's at least an a term. People use
it in the rooms a lot. Because if you broaden
this definition, what I think will end up happening for
us over time is we can take somebody in your situation,
for instance, who has fallen off the wagon, like used again,

(38:48):
and say, well, we we saw this because all the
scores and everything else in your life were going down.
You used to be really happy in all these areas,
and you get less less happy if you are assessing that,
at some point somebody would go, what's going on with this?
Like the relationship score is going from an eight two
years ago to a three. You can't be married with
a three score in your relationship. That's not happy, right,

(39:10):
And that's the goal. And you came from that background,
so you know what impact that has on somebody growing
up in a household or living around that kind of relationship.
And so if we don't pay attention. And here's where
I think biology is an important base, right, like the car.
It's the thing that you build the restaurant, because it's
your machine that you build a psychology in the environment on.
But if you don't understand what you built on top

(39:32):
of that base, you're leaving everything up the chance, right
for those who are trying to solve this epic sized
problem that we have political leaders, business leaders, loved ones, children, doctors. When,
in your experience, should we be doing more or less
of to get us closer to that better place? Well,

(39:53):
I mean there's so many answers to that. To be
honest with you, I'm so happy that the conversation is
being echoed around the world all over the place. You
can't pick up the news, you can't turn on the
news on your phone. It's there. It's this is an
epidemic and it's like you did the numbers in the beginning.

(40:18):
We know what the numbers are. They're devastating. There's a
lot of answers to that, and some of the stuff
that you're talking about is important for people to hear.
There is recovery programs, but there's stuff that I feel
that people don't talk about and before we get into
what is the big answer, you know, is is it
a government issue? Is that you know, is it better regulations?

(40:43):
Yes to all this stuff in my opinion, But I
think there's other stuff that people that are looking to
get sober could be looking at as well, and that
is setting themselves up for success. I believe that acupuncture
is something and cut pressure is something that can really
help addicts get off drugs. One tool, only one tool.

(41:06):
I'm noticing a lot of evidence for that, especially about opiates.
A lot of evidence abound acupuncture in particular for opiated
And I do acupuncture, and it's really interesting being a
recovered heroin addic and alcoholic and everything else addict acupuncture
opens up these pathways for me that I wish I
felt when I was a little boy. And now I'm

(41:28):
on herbs from the acupunctures, and I've been doing transcendental
meditation for about ten years. That is another thing. So
sometimes I think it's like, for example, if you're going
to get surgery on your shoulder, and I'm only referencing
that because I just had rotator cuff surgery. I went
to a specialized chiropractor. He did a lot of work

(41:50):
with magnets. So we did a lot of stretching, a
lot of working aligning my body. Acupuncture, I focused on diet,
I focused on re physical therapy. So when I went
and got it, I was as good as I was
going to get to get it. You know, it's confusing
because you have people that are like so bad, You're like, hey,

(42:12):
before you go to rehab, let's do all these things
to make the possibility of your recovery better. It's a
bit of a weird concept, but I think it's something
I would like to see in the conversation. First of all,
I love these I love the Eastern tools, and more
and more of those things are being incorporated into more
traditional recovery like meditation and mindfulness is now a part

(42:37):
of pretty much every recovery program you would hear about.
And if it's not and you're checking some out, do
not go there, right because one of the things that
the meditation and mindfulness allow you to do is develop
awareness around some of these issues that you have been
running away from for decades and you don't even know
you need to address them until you look inside for
a little bit. But you asked, kind of how do
we start solving this problem. Yeah, these kinds of conversations,

(42:59):
first of all, are the the way we start solving
the product. We're fixing it right now. I love it. Well,
here's the problem, and I talked about this in my
tech talk. I talk about the labels that we have
on and I get your you've been in a recovery
for a long time and you've readjusted what being an
addict means in your head because you've shifted it. But
for a lot of people, i'd say the vast majority
of people who live in the world, addict is a

(43:19):
really negative label. And what it means that you're a
loser who's unmotivated, weak willed, maybe even stupid. Are you
once for a bad person? You're not trustworthy? Not you lie? Yeah,
and so addict has that label on top of it.
What ends up happening unless we completely as a society
change the meaning of the word addict. What happens is

(43:41):
when you tell somebody that they're an addict, they will
do everything they can to run away from that. And
that is the reason why, in my opinion, based on
the research I did when I was doing research, people
with addiction problems don't go get help. Why Because as
we stand in the current system of care, the first
thing you have to do. I experienced this in the
first forty five minutes and rehab. The first thing you

(44:02):
have to be able to do is to identify as
an addict. And we also all know that addicts have
to quit forever. That's the other thing. The forever word
is very fearful. It's tough, and I'm just trying to
get through this day. Sometimes. It's the reason I wrote
this book called The Absent and Smith is there are
people who are in danger, and what I mean by
that is like their substances can kill them in the

(44:23):
next because the way they're doing things. Sometimes for those people,
we do need to separate them and save them by
isolating them so they can't get their drugs. For everybody else,
which is the majority of people who have problems with
drugs and alcohol and behaviors, that quitting forever and having
to label myself an addict to get the help are
really big barriers. And what I'm really hoping we can

(44:43):
start changing is let's explain to people that there are
things you can do to make yourself better, even if
you're not ready to do any of that other stuff.
You can start using smaller tools to make your life better,
to stop running away and ace. You know you talked
about shoulder surgery. If you do more massage to your shoulder,

(45:04):
then it will damage itself less than the long term
if you would have done it. So we can get
into some preventative work and things like that around getting
people to take better care of themselves. In general, I
think not enough people like Nicky come out and talk
about I used to be like this, but now I
do these other things and I'm better for it, and

(45:27):
I have different role models, so that we can shift
the overall conversation of what an addict is, first of all,
but more importantly, in my opinion, what it means to
be struggling with addiction. Because most of the news stories
we hear are about people who die from overdose, parents
who got arrested because they neglected their kids and don't
care about them, or rock stars or celebrities who screwed up,

(45:49):
drove into a poll, got arrested, killed themselves. The vast
majority of the stories we hear are negative stories about addiction.
There are not enough of these stories to say, you
know what, I've been there I made it out to
the other side, and here's here are the tools that
I use so that people who are stuck you can
start looking up to somebody like Nikki and say, if
he can do what I can do it. I feel

(46:10):
that if we have a big picture, we would like
to be part of the voices that steer whatever current
administration we have towards better laws, better regulations. We would
like to see that happen. That is a big ass
tug boat to turn that thing around. But during that time,

(46:34):
and without getting into politics, some of these conversations you're saying,
and if they could be tangible. So when I mentioned
meditation to people, a lot of people just gloss over
and they go, Wow, Nikki is going to be sitting
on a hill going on. It's not what's happening. I
am daily trying to become a better man. I am

(46:55):
every day looking at yesterday's behavior. I'll journ at night
and I'll be like, this is what happened, and hey,
I kind of blew it. I sent an email and
I could have just been a little bit kinder, and
then I will try to implement that into my next day.
All these little tiny steps, if we could get that

(47:18):
messaging out there somehow to addicts, whether it's through recovery,
through messages, through books like that you've written, through podcasts,
and getting people with the louder voices celebrities to talk
about it in a way that gives addicts hope. For me,

(47:38):
it was your junkie, you gotta go to rehab or
you're gonna die, And yes, thank god, but that's not
everybody's story. Everybody's story is not that some people stories
about marijuana. Some people's stories about that they were beat
as a kid and that they need sleeping pills to

(47:59):
deal with uh, you know, night's stress. I mean it
goes on. How do we get people to be feel
healthy so that this is something that they want to embrace,
it's not something that they're being beat up over, something
to run toward rather than something to run away from. Absolutely,
what's the one thing you'd say to somebody who's listening

(48:21):
that's also suffering from addiction. The one thing is that
there's a way out of this. I don't care how
far down you've gotten. I don't care how many relationships
you've destroyed, arrest, you've had, struggles, you've been through a
little I've seen it all, Nikki, You've seen it all.
It doesn't matter how hopeless you feel in this moment.

(48:44):
There's a way out of this. When you're in the
throes of whatever it is that you're addicted to, you
don't think you can get out, and most of the
messaging coming to you is what's wrong with you. So
it's really hard when you're in a hole and you
have people throwing dirt on top of you, you know,
and so you're like, well, I think I'll just stay

(49:05):
in the hole and do what they want me to do.
And I'm here to say that, you know, you could
get out of that hole. You don't have to be
engaged with the people that are in your life that
are either enabling you or whatever they're doing to you.
I had a kind of an eye opening moment probably
about fifteen years ago. I was in therapy and I

(49:28):
kept talking about these issues with my mom the therapists.
It's like those things that burn into your brain. I
can still see the sun shining through the window and
there was like dust like in the you know, in
the light, you know that. And I kept talking about
my mom and my mom this, and my mom said this,
and my mom was putting me down about this, and

(49:50):
I'm like a grown man with like a family, and
I'm still struggling with this mom thing. And the therapist said, hey, Nikki,
you don't have to love your mother. She abandoned you,
and that set me free. So if there's anything I
can say to people, is just because people are your

(50:12):
you know, biological family, they may not be the best
source for you to find recovery doesn't mean you can't
love him. I still love my mom, you know, right
up until she passed away. But I didn't let her
have the power over me to keep making me feel bad,
which I don't know could have maybe led to something

(50:35):
might have manifested itself in anger depression. So that's one thing,
you know, I'd like to say to people. Let me
ask you both, what are you working on that you
want people to know about? Right now? We have just
wrapped up filming and editing of the Netflix movie about
Motley Crue called The Dirt. So that's a very different

(50:57):
project than the Heroin Diaries musical, which is going to
open next year. A lot of people have asked me
Heroin Diaries musical. The point of it is that you
can use art to spread messages. I've been doing it

(51:18):
in songwriting, whether I want to rile people up or
I want to get people to think. It's been happening forever.
It happens with all versions of art, paintings throughout history
and self expression. So we've put together a fantastic musical
and it's just beautiful. You're gonna see your pain and
struggle and addiction and recovery and better and messaging on

(51:42):
top of that and some of the stuff we've talked about.
So that's that's what I'm working on right now, and
it's been a real passion project. It helped a lot
that a lot of people thought it was a weird idea,
So there's still that little side inside of me and
I'm sure it's society. Oh you're gonna tell me no, Okay,
here we go. Yeah, I love it. So, you know Ignited,

(52:03):
which is the company I started just to help people
with across any area. I've struggled with sex addiction issues
as well, and so my wife and I do a
lot of work with couples around that. You know, some
of the same personality traits that led to me using
drugs and meth and all those things earlier on in
life are still there, and I need to learn how
to live with my machine, just like everybody else that
I talked to. So ignited with not spelled. I g
n t D is the big project that I'm taking

(52:25):
on that involves podcasts, It involves writing this book, and
involves doing a workshops with my wife, and it involves
an addiction course. You know, one of the things that
I'm trying to do for people is make rehab not
the thing they have to do to get help. Shame
is such a huge component of this. We need to
lower the shame hurdles to get help and make it easy,

(52:45):
not easier easy, for people to get help. I joked that, like,
the barrier should be so low that you could fall
into recovery right literally, because you shouldn't have to want
to quit. You're you're almost doing like pre recovery. It's recovery.
Recovery will split it. And so on that note, I

(53:09):
will have us run toward the end of this conversation.
Thank you both very much. I want to say in
conclusion that the idea of these contributing elements, even what
addiction is, has been really valuable. That the biology the
machine is but one of at least four components, the psychology,
the environment, the spirituality, and that sense of purpose that

(53:33):
trying to fit in to be cool is something we
can redefine. Your hell cool, Nikki, You and you redefine that,
I think for a lot of our our listeners, and
that we can be better, and that we need more
tools to be able to do that. All of our
lives are worth living, every single life is worth saving,
and every single person suffering from an addiction has the

(53:54):
ability to beat it. Some use different tools than others
in that journey, but none of us is ever too
broken or too scarred. We wouldn't be here. We would
not be here, So thank you both for being here.
This has been beautiful. After my conversation with Nikki and

(54:15):
a D, I was left with two burning questions I
had to explore. First, what's a trusted resource I can
send people to for more information on prevention, treatment and help. Second,
how can we better understand predisposition to addiction to better
identify behaviors and patterns before they turn into addictions. My

(54:37):
first stop was the Surgeon General's Office, which turned me
on to the National Opioid Action Coalition visit no AC
at n o a C dot org to learn more
about the facts and stats and to get connected to
help and treatments. If you or someone you love is
battling opioid misuse, there are resources to help you be
the one to break down the stigma and get treatment assistance.

(54:59):
Visit n o AC dot org to learn more. My
next call was too doctors Abraham Palmer and Sandra Sanchez
Roger from the University of California, San Diego School of Medicines,
Department of Psychiatry. They are trailblazing new research that just
discovered a genetic signature for delayed discounting. What does that

(55:22):
mean and why is it important? Let's have them explain.
Thank you both for jumping on the line to continue
our discussion about addiction, about health and and about the
science of addiction. The place I want to start is
what do we know about addictive behavior as far as

(55:43):
is it something we're born with? Is there a predisposition
to it? Where are we without understanding right now? We're
all born with different brands, and our brands are different
at birth because of the genotype that we have, because
of genetics, because of what we got from our parents,
and also because of important things that happen while our
brain is developing, which could be trauma or infection in

(56:06):
the mother, could be exposure to drugs by the mother.
And so we go into this with different decks of cards.
And one of the things that is different as a
result of that is the risk that each person has
to develop drug addiction. Some of us are unlikely to,
some of us are very likely to. That's a fundamental
thing for understanding why we would look at the genetics

(56:28):
of drug abuse is that we're trying to dissect some
of the risk factors for drug abuse, particularly those genetic ones.
I guess that we can answer that question with another question,
which is um, whether we can explain the predisposition or
addiction with genetics um. But to answer this question then

(56:49):
I have to give a little bit tour as to
what do we mean by addiction really? And I would
like us to vision a spiral right now, and we
may all starts, or some people may be predisposed. For example,
with personality traits of sensation seeking, you may be more
likely to try and new things, especially if you're another lesson.

(57:11):
You said sensation seeking, So that is foolishly sliding down
a snow covered hill on a piece of wood for example, correct,
jump off a bridge connected to a bungee cable, biking downstairs. Yeah.
So um, these people may then transition to high UM
drug intake or high alcohol consumption UM. But then maybe

(57:35):
after a while, for example ADO lessons leading to adulthood,
they may stop drinking highly and they may just drink
socially for example. But a minor proportion of people will
transition to more compulsive drug intake, which may lead to
the dependence and relapse. So we're talking about a spiral

(57:56):
of addiction that is really hard to break if you
don't get good treatment, and so different genetic factors may
contribute at different stages of this addiction spirals. So for example, UM,
it may influence your decision to take the drug. It
may influence how sensitive you are to the effects of

(58:17):
the drug, the severity of the withdrawal symptoms, how quickly
you develop tolerance, or even your inability to quit. So
there are multiple elements genetic elements that may be influencing.
But what we know is that the proportion of how
much genetics explain is not a hundred percent. Biology is

(58:38):
not deterministic, so there is a high component of the environment.
So we may be born with a predisposition, but the
environment plays a big role, right, And that's the theme
that we keep finding in these discussions that, as you
so eloquently put in, biology is not destiny in some ways,
but it does contribute to where we end up. I

(59:01):
understand that you've partnered with twenty three and me taken
advantage of people's opt in ability to to join in research,
and you've discovered some things both about addictive behavior in
general and dependence in particular. Can you walk me through
what your study was and some of what it has shown. Sure, So,

(59:23):
as Sandra said, one of the things that we've emphasized
in our research is to try to decompose something complicated
like addiction into smaller factors where we could study the
genetics of those factors, and where we know or expect
that understanding the genetics of those factors would improve our
understanding of the genetics of drug abuse as a as
a disorder. So I want to start with the marshmallow tests. Yes,

(59:47):
I love marshmallows. Many of your listeners love marshmallows. Many
of your listeners smelled marshmallows. Who doesn't want to start
with marshmallows. I gotta camp fire in my mind right now. Yes,
that's right, And it was just Halloween, so that we're
writing the middle of the candy holidays right now. So, uh,
you could offer a child marshmallow, and you could tell

(01:00:07):
them that if they wait five minutes, they could have
two marshmallows instead of the one marshmallow. And if we
can put ourselves back into our childhood or imagine our
own kids, it's easy to envision that that would be
a real struggle. That the kid would understand that it
would be better to have too than one, but they'd
love to have that one marshmallow now. And in fact,
if you look at the kids offered this test, some

(01:00:28):
of them will take the marshmallow, some of them will
wait for the marshmallow. And that ability to delay gratification,
or that tendency to make impulsive decisions that have negative
long term consequences, that's a thing that we're very interested
in studying, and in particular in studying the genetics of
not because we don't believe that lots of life experiences
shape those kinds of decisions, but because we believe that

(01:00:50):
some of the variability and how people respond to situations
like that is genetic, and so we call that delay discounting.
And the large for that term delay discounting is that
the longer you have to wait for something, the less
it's worth. Okay, so you discount something based on the
delay or based on how long you have to wait
for it. So maybe five dollars now to some people

(01:01:13):
might be very similar to ten dollars a month from now. Okay,
they want the five dollars even though it's less. They
want it because it's sooner. And and so can I
just interject here because I get the idea I want
marshmallows now, not tomorrow, but perhaps because I don't have
as much confidence that tomorrow will even happen. But it
depends on my environment. And if I'm in a very

(01:01:35):
stressful environment and unreliable, volatile environment, that discount is high.
The future is worth a lot less. All I have
is the present. It sounds like what you're saying is
delay discounting is one of these factors that contributes to
addiction A and that genetics contribute to how much we
discount the future, like delay discounting is driven in part

(01:01:58):
by genetics. Is that right? That's exactly right, and that's true.
By the way, in humans you can also do delayed scounting,
and like pigeons and and non human primates, rats and
across the board, you see that there are genetic factors
that predict that. Okay, so you looked into these genetics
and and just trying to control or eliminate the idea
of the environmental effect I live in a volatile environment.

(01:02:20):
To morow is worthless. There's some genetic component. To what
degree does genetics contribute to this delay discounting? Well, so
it's a fraction, and you can estimate that fraction in
different ways, including using twins studies or using studies like
the ones we've done in twenty three and me that
emphasize a lot of people who are only distantly related
to one another. When you say twin studies, you mean

(01:02:41):
studying actual twins, identical and non identical twins. So this
is a classic study design. Identical twins are genetically identical.
Non identical twins share about fift because their siblings, and
so something is genetic. You expect the identical twins to
be more similar to each other than the non identical twins,

(01:03:02):
and you can actually do some relatively simple algebra to
come up with estimates where you get essentially the percentage
of the variability and a trait that's attributable to genetics
from that kind of a study design. All right, So
so keep taking me on this journey. You've explained kind
of delayed discounting. What else can you share about the
way the study was set up, in what you found out,
I would like um to add something to this, because

(01:03:24):
this is the uniqueness of our approach what we're trying
to do, and this is why we can study the
channel population, which is that we're studying a continuum. We're
not studying black or white. Were studying a scale of gray,
and we all carry certain risks, so we're all more
or less impulsive, and so that's why we can carry

(01:03:44):
out those studies in the general population, which can help
us get a large sample size, which is much needed
for genetic studies. We need not even hundreds, but thousands
or hundreds of thousand participants to really find robust genetic findings.
And I'd like to ask a follow up on that note,

(01:04:05):
because we've read most of us about scientific studies before
genetic studies, and you have to sign up, you have
to go through a clinical process, you opt in heavily.
Maybe you're a college student looking for some extra cash.
What is the difference between that classic model of a
study versus what you were able to do here. So, actually,

(01:04:27):
when I first started studying delay discounting, we were doing
it with that kind of college student model and paying
college students to come into a lab and fill out
questionnaires about a lot of things, including delay discounting, and
then we would genotype those college students with their consent
of course, and try to look at the relationship between
Jeanes and behavior. And the trouble was that even really

(01:04:50):
good people doing this kind of work, really very professional people,
a high quality operation, the best we could do was
a few hundred a year, okay, scheduling, it's cetera. And
as you get into genetics, and as we've progressed in
our understanding of genetics, it became clear that we didn't
need a thousand, We needed ten thousand or a hundred
thousand to really break this open. So this translates into

(01:05:11):
twenty five years of research that sounds that starts to
sound like a very bad idea, and so I became
interested in working with twenty three and me and other
groups that have large populations, populations that were already genotyped,
which can be an expensive step otherwise, and who we
could ask questions, including questions about delay discounting, questions about

(01:05:33):
alcohol use, etcetera. Because that meant that we could go
to a whole different scale, that we could get into
the hundreds of thousands, tens of thousands, hundreds of thousands,
the sample sizes that we really needed to address these traits.
And we could do that because the people are already genotyped,
because they're willing to participate in this kind of research,
and because we can ask them these questions over the internet,

(01:05:54):
so we don't have to do this scheduling bring them
into a laboratory environment. And that's a paradigm that many
gene deesists have started to use over the last few years,
and it's really uh accelerated enormously the progress in the area.
In fact, in less than four months, we collected information
from twenty five thousand participants, So twenty five years in

(01:06:15):
four months. Correct, that's uh my advantage. What are some
of the big conclusions, then, let's let me get back
on the road of the study in which you found
out you're looking at delay discounting, etcetera. But what do
we know now that we didn't know before? So, uh,
we can't give people marshmallows over the internet, of course,
And so we asked them questions about money, and I
gave an example of that earlier five dollars now versus

(01:06:38):
ten dollars in a month. And if you ask a
battery of questions, and there's some standardized batteries that have
been developed over decades, you could estimate which people are
more future oriented and which people are less future which
people have higher delay discounting, and which people have lower
delayed discounting. And in particular, by using these questions, we
were able to give everybody a score, kind of a
single value. And then we could ask of lots and

(01:07:01):
lots of sites where people are different, sites where they
have genetic differences. We could ask whether or not that
site accounted for any of the variability or the differences
in the way people answered those questions the score that
people got, and we were able to see that in fact,
there was a lot of signal there there were a
lot of sites that collectively could explain some of that variability,
And there were some particular sites that were so strong

(01:07:24):
in explaining that variability that we could be very confident
that there was a real association. When you're using the
words sites here repeatedly, you're referring to sites in the
human genome. Is that correct? That's right, particular basis, particular
letters in the DNA code, where some people have one
letter and some people have another letter. Some people have
one nucleotide to use a more technical term, and some

(01:07:46):
people have an alternative nucleotide. So, in other words, was
that the genetic risk was distributed across thousands of genetic
variants across the genome, and each with a little effect,
each contributed very little. It is the accumulation of all
those variants. And I like to use the metaphor of

(01:08:06):
going to Ikea and assembling a table, and it is
all those screws, little ones that make the table a table.
Each one has small contribution, but that all together create
the table. Maybe a silly metaphor, but I think it's useful.
I hope you're not buying tables with a million screws,

(01:08:27):
but okay, so you have it. Sounds like a clearer
picture of the genetic contribution too, you know, addictive behavior.
Is that a fair sort of summary, that's right. And
from that we can get a few things, And one
of them is we can identify particular sites, as I
said earlier, that we're very confident are really associated with

(01:08:51):
the trade, and those sites are going to be in
or near particular genes, and as biologists, we can then
start to try to understand how is it that that
gene is changing the way the brain works, is changing
the way a person or an animal would would respond
when posed with the choice between a smaller current reward
or a larger future reward. We really want to understand

(01:09:13):
as biologists exactly what's going on in the brain which
sells talking, how, talking to who? And maybe even how
can we intervene in that process in a way that
might be useful or therapeutic. So that's one of the
things that we're trying to get. The other thing we're
trying to get is a kind of a genetic signature,
or the ability to score people based on their genotype,

(01:09:35):
to score them on how impulsive do we expect them
to be, even for people who we haven't directly measured impulsivity,
and and that allows us to look at other samples,
say samples where somebody had done a genetic study of
attention deficit disorder a d h D, and to ask
whether or not this genetic signature of high impulsivity is

(01:09:57):
associated with or was related to the genet signature for
say risk of a d h D, or risk to
become a smoker, or risk to fail to quit smoking
once you've started. Those are some of the associations we
actually did see using this data so that we could
really demonstrate that the delay discounting high, high delay discounting,
or low delay discounting is a risk factor for various

(01:10:19):
things relevant to drug abuse and other psychiatric disorders. As
you alluded to earlier, addiction has a significant impact on
so many people. There's an economic impact, there's an emotional impact,
there's a relationship impact, and there's also shame and stigma
associated with living with these conditions and having these behaviors. Absolutely, so,

(01:10:41):
how do you bridge that experience, that pain, and that
cost with what you're starting to get clarity on with
these new studies about the genetic factors that contribute to
some of these behaviors. This is a great question because
we are currently facing an opiated crisis, for instance in
the US on many poul dyeing. As a result, UM,

(01:11:02):
substant use disorders are underdiagnosed. Um. We're also facing in
research that it is an area that is highly underfunded
as well. So stigma plays a big role. There seems
to be a negative label associated with substant use disorders.
And UM. It is interesting because no one would tell you, oh,

(01:11:23):
you can choose to have a heart attack, right, would
be very silly to say to someone. But yet it
seems that for substant use disorders, someone could say you
could choose to not take drugs. Right. And I'd like
to quote a sentence um that Nikki mentioned that he
was trying to feel a hole, which wasn't his fault.

(01:11:46):
So you could say that there is a predisposition, if
you will, a genetic predisposition, but that it was his responsibility.
And so what I'm trying to get to is that
there is a predisposition um, and this is what our
research knows. That there is a biological route to these conditions,
but that the effect of the environment is very powerful.

(01:12:06):
So to contradict another classic sentence of a junkie will
always be a junkie. That's certainly not true, and we
can do lots to change the environment and to develop
better treatments. And this is what we're trying to do
with research. We're trying to reduce the stigma, but showing
that there is a biological contribution and that perhaps one

(01:12:27):
day if we learn and know enough about the biology,
we can develop better treatments. So with more science we
have a better explanation, we will hopefully tend to blame
people less, but also develop new ways out of addiction
because of our new we site. Yeah, I mean, I
think two people that are working in the area of
the biology of addiction. The idea of blaming the patients

(01:12:52):
is it's not something we even talk about anymore because
nobody thinks that way in the medical community, in the
research community. But I think you're exactly right that by
doing this kind of research, we come up with really
concrete examples that maybe some of your listeners and other
people can relate to that demonstrate how not everybody's dealt
the same deck of cards, how not everybody goes into

(01:13:15):
these situations with the same strengths and weaknesses, and therefore
some people are very vulnerable to these substances which are
prevalent in our society. Uh, And that that shouldn't be
seen as a personal weakness, that shouldn't be seen as
something that they are blamed for. That should be seen
in stead as as a vulnerability that they have that

(01:13:35):
we all as a society need to help them to avoid. Ideally,
and if if avoidance fails, then to deal with and
recover from. As Sandra alluded to, one of the one
of our hopes personally is that this biological understanding might
lead to novel treatments, might need to new ways that
we could intervene so that somebody who's trying to remain

(01:13:55):
absent or is trying to decrease or completely stop drug
use would be able to do that more easily because
we would actually be able to say, look, we're going
to do something that's going to change the biology of
your brain in a positive way, in a way that
makes these drugs less tempting or that interrupts this kind
of compulsive tendency to seek and use the drugs. In fact,

(01:14:16):
we should be treating mental illnesses in the same way
that we're treating medical or physical conditions. Yeah. And and
as you said, you know, no one chooses to have
a heart attack, and I think that's just such a
powerful metaphor. We don't choose to break our bones. You know,
we have accidents, but to see these in a less
judgmental scale and more of this is part of what

(01:14:38):
it is to be a life form, and this is
part of what it needs to be human can strip
away some of the factors that inhibit us from from
approaching each other with compassion and with actual answers, such
as stigma. I agree. And also you could say that
it's a mistake for somebody who to have taken the
drugs in the first place, and it's a mistake for
somebody to have allowed themselves to progress down a road

(01:14:59):
towards a addiction. But we've all made mistakes, and indeed,
the people having the heart attacks may not have kept
up with the kind of diet and exercise advice that
they've been given. People who have made mistakes don't necessarily
need to be punished by our society for those mistakes.
We should instead be looking at that and saying, here's
a person seeking recovery, acknowledging that they've made mistakes and

(01:15:20):
now they need help and now they need our help,
and they need help of of you know, among others,
the research community, and that's the way we approach these problems.
Was reading your study and you use this phrase citizen
scientists to kind of refer to the people who opted
into this study, and you've just been talking about helping.
So can you explain the concept of the citizen scientists

(01:15:42):
and how folks listening now can be helpful to answering
these questions better in order to treat one another better. Yeah, well,
twenty three and me is one platform, not the only
platform in which citizens scientists, that is, people that want
to help with research can from their living room, from
their bedroom, can get involved by answering questions that various

(01:16:06):
researchers have decided are important to pose to them. And
they are not compensated for this. They're doing this because
they are interested in the research. They're interested in helping out,
They're interested in making the fact that they've already been
uh study genetically genotyped. They're interested in making that available
and uh that is the critical thing that this study

(01:16:29):
depends on. And indeed, other other studies that we've done
that have involved cohorts, including but not limited to twenty
three and me. All of them have to do with
the UH. These public efforts that have reached out to
people without compensation to participate in studies where they frankly
ask a lot of questions, where they take time that
they could have spent on anything, and they spend it

(01:16:50):
trying to advance research. And we are extremely grateful, in fact,
to all those people that donated their data for research
on We're hoping in a way that um, this conversation
today will inspire more people to participate in genetic studies
in the future. We've been called in the past to
donate blood, right to help with a blood drive, to

(01:17:11):
donate food, and now donate spit, you know, donate donate
some of your your genome to help scientists like you
two and those you work with help us. So I
I love that idea of the citizen scientists and that
there are ways that all of us can help you
help us. One of the hopes is that we can
get a handle on the genetic risk for these disorders.

(01:17:34):
Maybe because you'd want to make predictions for individual people
you're particularly susceptible to these disorders, you should be particularly cautious.
Although I want to say that right now, people already
can work with family history. They already know what their
family history is in most cases and exceptions being people
who are adopted, for example, and that family history is
presently more powerful than anything we can do with genetics.

(01:17:57):
Maybe that will change one day as we get larger
samples as is, but right now, people who know that
their families struggled with alcohol and drug abuse should assume
that they're higher than normal risk for alcohol and drug abuse,
and they may want to make decisions to avoid uh
using those drugs altogether, or be very careful about moderating.
And then the other critical thing that all of the

(01:18:19):
citizens science can bring to bear is, first of all,
it can make it much less expensive to do this research,
whereas it's very expensive to have clinicians diagnosed people with
alcohol use disorder and to gina take those people, or
to go out and to try to find people who
have particular sometimes rare disorders. Alcoholism is common, but some
genect disorders are rare. To find those people and then

(01:18:42):
gena type them is expensive and slow. So one of
the revolutions of this approach is that we can start
to do things faster, better, and cheaper, and again we're
thankful for all those participlintes, and we hope that more
and more people will allow us to do genetic studies
like the one that we did an all those are
doing m in the future. Completely. I agree about the

(01:19:04):
gratitude to the participants, us about our vision sort of
for the future. And I was talking about a little
bit about prevention because that's part of it, and then
I want to also emphasize that we're really very interested
in treatment and that if we can gain a better
understanding of what it is about a brain that's changed
in the addictive state, what is an addicted brain, then

(01:19:27):
we'll have a better understanding of how we can normalize that.
And in particular, the really problematic thing about addiction is
that people have this increased lifetime risk to return to
drug use to relapse. Those are the people that really
need help, and those are the people that we would
ideally like to be able to offer increasingly effective pharmacological

(01:19:48):
treatments so that they would go to their doctor they'd say,
this is the thing, this is the addiction. I'm trying
to recover from this now, and we could give them
something that would reduce the craving that would make it
easier for them to stay away from that uh that
very high risk of relapse. UH. And that's going to
require understanding what addiction is, what is unique about the
brain that makes it more or less susceptible for addiction,

(01:20:10):
what changes about the brain in that state of addiction.
And that's something that many, many people are working on. So,
you know, I was just at a scientific conference that
had literally thousands of people working on different aspects of
this problem, so very active area of research. Genetics is
just one component of that research, but it's one area
that allows us to generate new leads to kind of

(01:20:31):
identify do targets, new molecules, new genes, maybe new pathways
in the brain that hadn't previously been studied or understood,
and to bring in to focus their role in this problem. Okay,
so you're awesome, both of you. Dr Abraham Palm or
Dr Sandra Sanchez Roorgy, thank you so much for generating

(01:20:53):
new leads, for sharing your investigation with us. You science
detectives on what we can learn more or of through
genetics about how to treat each other better and how
to treat uh those suffering from and experiencing addictive use disorder, alcoholism,
and associated constellations of symptoms. Thank you so much, all right,

(01:21:13):
thank you for having us. I want to dig in
more on today's topics and guests. Check our show notes
and if you enjoyed the episode, share it with a friend,
all your friends, and be sure to leave a review.
If you want to hear more surprising stories about how

(01:21:34):
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