June 12, 2014 • 30 mins
Highly addictive substances like meth and heroine are formidable enemies for the recovering addict, but what does the future hold for their treatment? In this episode of Stuff to Blow Your Mind, Robert and Julie explore the use of electromagnetic stimulation, vaccines and other treatments to help win the battle.
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Episode Transcript
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Speaker 1 (00:03):
Welcome to Stuff to Blow Your Mind from how Stuff
Works dot com. Hey you welcome to Stuff to Blow
your Mind. My name is Robert lamp and I'm Julie Tuckers.
We just published on episode the other day on the
science of addiction, and this is kind of the part two.
I mean, you can probably listen to this episode without
(00:24):
having listened to the previous one, but they go well together,
so we recommend that viewing order let listening order rather.
This episode is uh going to look at the future
of addiction. Uh, And we're not talking about just what
kind of crazy drugs would have in the future. Now,
we're talking about how can we treat addiction in the future.
What are some of the cutting edge and emerging techniques
(00:47):
and technologies that will be at our disposal to deal
with the disease of addiction. Yeah, and before we look
at the future stuff, let's just kind of look at
what's going on in the present. The number one driver
of aids in the world is used heroin needles, particularly
in countries where there's no needle exchange programs. So what
(01:08):
if you could get rid of the root problem, you
could eradicate heroin addiction or for that matter really any addiction. Yeah,
and we're not just talking instantly. Minds tend to turn
to Africa, and certainly that's one of the areas concerned here,
but other you know, countries that don't have needle exchange
programs include such large UH population nations as China and Russia. Yeah,
(01:29):
I think that people don't, you know, at least people
outside of the United States don't realize what in the
city is problem. This is half a trillion dollars are
spent worldwide to treat addiction. So here's just one little
prism of the addiction problem in the US. And estimated
one point four million Americans are addicted to cocaine, which
was the reason for more than four hundred and eighty
(01:51):
two thousand emergency department visits in two thousand and eight
and is a leading cause of heart attack and stroke
among people younger than age five. So the problem here,
of course is that we have access and if you
look at you know sort of where drugs are in
(02:11):
the time continuum with history here, Um, we have more
access to drugs than ever before, and more types of drugs,
and what emerges here are some highly highly addictive substances.
I'm talking about meth which creates one of the biggest
boost of dopamine in the brain, and prolonged use of
(02:32):
this can lead to psychotic like symptoms, walking about, strong hallucinations,
and really violent behavior. And studies of the brain patterns
of some long term matthews have shown that up to
their dopamine producing cells have been damaged. So if you
listened um to the other episode on this then you
(02:52):
kind of know already that, uh, this is a situation
where the person is just getting deeper and deeper into
the whole because it's not about free will anymore, because
the parts of your brain, the executive function have been
so eroded by drugs that even if you wanted to stop,
you might not be able to. Yeah, and and and
that's certainly the the anti drug messaging that I think
(03:14):
needs to be focused on more often with myth amphetamy,
because I was reading and according to neuro psychopharmacologist Carl Hart,
there's actually no empirical evidence to support the claim that
meth amphetamy causes one to become physically unattractive, which hopefully
they've they're calming down on that, but for the longest,
like like meth mouth you know, in the affirmation of
(03:36):
the meth addict and just some sort of subhuman hyena
person has been kind of the focus. When certainly that's
flashy that works on a billboard a little easier, but
the the reality of what's actually changing with the brain
that is far scarier than some sort of jackal and
hide show. I agree. I have seen the ads before
where there's like this beautiful woman and then she takes
out her false teeth and she takes off her makeup
(03:59):
and all of a sudden you ease her her methatic
riddled face, and they are appealing to vanity. But vanity
doesn't matter when addiction is highly routinized in your brain, Um,
nobody cares anymore what they look like. So if you
were to instead crack open the brain and show people
this is how your brain is actually like completely mutating here,
(04:20):
that might be a far more compelling story to people.
The next one is another biggie, and that is of
course heroin UH derived from opium, And of course this
one has been wreaking havoc for for years and years. Yeah,
thirty of first time users will become addicted. In two
thousand and five, two point four of the American population
said they had tried heroin at least once. The source
(04:42):
of that Department of Health, and withdrawal symptoms are really acute.
They arrived just a few hours after a dose swears off,
and because of this, users have a really high chance
for relapse. Because we talked about this in the last episode. UM,
at some point the addiction becomes less about chasing the
high and more about chasing some sort of equilibrium and
feeling normal again, which can only happen if you get
(05:05):
more of the substance in your body. All right, and
the next big one to hit might come as surprise
because it's not crack cocaine. It is nicotine. Nicotine is
a very addictive substance. But we often overlook this why UM,
I think it's because it's legalized, right, something like of
people who ever try cigarettes will become nicotine addicts. At
(05:28):
some point, you can buy it legally at the store,
at the gas station. Used to you could get out
of a machine. UM. Someone's liable to and it's given
its legality and an overall still social acceptance, UM, people
are liable to give it to you without it being
that big of a deal as well so, and it
still looks cool on TV, right, Yeah, and it's not
(05:49):
as big of a risk. And this is something that
David Lyndon, a professor of neuroscience at Johns Hopkins University,
pointed out. He said, you know, hey, if you have
a bag of heroin, you're not going to do a
whole bag of heroin. You know you're gonna overdose. But
if you have a pack of cigarettes and you have
ten or twenty of those cigarettes throughout the day, you
get that little ding of dopamine each time. And he
(06:12):
kind of yeah, he kind of like lined it to
pa off s dog, right, so he said that we're
really good at training or inner dog and sort of
being like, oh, I need a little pick up right now.
And you get that little dopamine um pleasure feeling from it,
But you're not going to necessarily um render yourself unconscious
or unable to work or any of those things. But
(06:33):
still it is an addiction, and it is an addictive behavior. Yeah,
you hear about people being one or two back a
day smoker. Whereas in the panel they pointed out that
that even a heavy heroin user is probably not going
to use more than three times a day. And so
to go back to what one of the topics we
discussed in the previous episode chunking that idea that the
(06:54):
brain is forming habits get x than Y and Z
and uh and then forming a shortcut kind of a
hot key for the brain for behavior encoding the memory
of usage. Uh, you're you're going to have what you know,
twenty times uh or more per day that you're enforcing
that shortcut as opposed to a maximum three times per
day with the hairin user. Yeah. And Charles Higg, the
(07:15):
author of UM, the Habit Loop, I think I totally
slaughtered that. But um, he's talked about this and written
about this at length, and he says his claim is
that percent of our decisions every day that's just habit.
We think we're making these decisions, but really we're just
responding to environmental cues in these well worn neural pathways
(07:37):
in our brains. Yeah, because we've discussed before, habits take
up energy, they take a cognitive power, and we don't
have a limitless amount of that. So we handed over
to to routine. We handed over to habit so that
we'll have some juice to handle the actual decisions that
are coming at us, and of course that the problem
with this is that again, your brain, your brain secretry,
(07:58):
isn't making any sort of like, hey, this could be
a terrible thing. Don't do this, um, and your prefrontal cortex,
your executive functions in your brain are already sort of
um lessened by the addictive behavior. All right. The next
thing we have here is prescription medication, one of the
rapidly growing substances of abuse in the US. Between nineteen
(08:19):
eighty and nine, abuse of prescription drugs increased four and
it has about the same amount of usage in America
as cocaine. According to the National Institute on Drug Abuse,
drug overdose was the leading cause of injury death in
two thousand and ten, and among people twenty five to
(08:40):
sixty four years old, drug overdose caused more death than
motor vehicle traffic crashes. So the National Institute on Drug
Abuse goes on to say, by the way, two intend
seventy eight percent of the drug overdose deaths in the
US were unintentional, seventy eight percent. And I think that
(09:02):
this is painting a story here about how prescription drugs
UH have become so accessible in people are mixing them
with other drugs or mixing them with alcohol to their detriment. Yeah,
I mean, it's it's important to to to to to
to point out that prescription drugs just because it's prescribed
does not mean it is necessarily a safe substance of
(09:25):
Any of these are very dangerou socis. I mean, any
of these are emphatamines. Uh, and they're not that different
from the illegal variant, and certainly methemphatamine itself is memory
serves as schedule to narcotic anyway, which means that it
becausivably has a medical purpose. Uh. And it makes sense
to like which which car is going to be faster?
The one made in a garage or the one made
(09:47):
uh at at a factory? Right? And what do we
have with with drugs? Your street drug is often made
in a garage, whereas your your pharmaceutical product is made
by a billion upon billion dollars in this tree. So
it's it's kind of like a supercharged vehicle. Yeah. And um,
I'm sure that people are aware that there are ways
(10:08):
that people get their hands on drugs that they shouldn't have.
There are legal drugs prescribed, and I won't go into that.
I will say that If you are interested in learning
more about this prescription drugs, check out the documentary American
Addict that goes into detail. It's pretty depressing, um, but
it's also very eye opening about this topic. All Right,
we're gonna take a quick break and we get back.
We're going to talk about the treatment of addiction. All Right,
(10:38):
we're back. So we've we've discussed addiction here. Let's talk
about the ways that we treat addiction. We have several
different approaches that are currently in play, and we're looking
at some some new methods of tackling in the future. Yeah,
and before we go into that, we should say, hey,
by the way, rate of relapse is really high for addicts.
(10:59):
I think this is something most people know. According to
the National Institute on Drug Abuse, relapse rates for drug
addicted patients about fort's similar to relapse and those suffering
from diabetes, hypertension, and asthma and drug addiction should be
treated like any other chronic illness, with relapse serving as
a trigger for renewed intervention. So keep this in mind. Um.
(11:22):
And we talked about this this idea of memory and
cooding behavior and there are being triggers for that. So
imagine that you have just completed a program, say from
heroin abuse, and you get out and um, I think
I called them before, these neural ghosts, these neural pathways
in your brain, the sort of cellular scarring that's still there.
(11:45):
It's very easy to tap into that and have that
behavior express itself again. A great example of this is
Philip Seymour Hoffman, which is brought up at the World
Science Festival for the panel of the Craving Brain. They said,
look at this guy. He was something like ten years
sober from heroin addiction, went to a rat party one night,
(12:06):
had a beer, and then something like I don't know
was it weeks or months later, had died from heroin overdose. Yeah.
I just started him down the path, opened up those
pathways again in the brain, those those pathways of habit
and behavior in addiction, and uh, and then they where
he ended up. Yeah, So you know you're not treating
something that's easily dealt with here, right, Just I keep
(12:28):
coming back to the idea of a cat's cradle, right,
you know, where you take the shoelace tied together and
you you string it between your fingers and it's all
the different fingers holding the string out to form this pattern,
and you can't you know, put a point at one
particular finger and say that is the cause of the pattern,
that is the cause of the the overall design here.
And just as there's no over that one finger you
(12:50):
can pin the whole design on, there's no one finger
you can remove, there's no one treatment plan. It's going
to be a magic bullet against the problem of addiction. Yeah,
because in one sense, um, it doesn't really matter anymore
if you have genetic dispositions to addiction, if you're in
the middle of an addiction, because at that point you've
got habit taken over, you've got the transfer station, there
(13:13):
are significant changes to your brain, and now you've got
you know, memory all wrapped up in it. So um,
so yeah, it is a bit of a cat's cradle,
But the treatments can't really treat a cat's cradle. You
can pretty much go after individual fingers. Yeah. Yeah, there's
no unified treatments. So the most widespread medication right now,
um is in a antidepressants, because this would address the
(13:37):
feelings of despair or you know, any sort of pre
existing condition like depression that may have led to the
addiction in the first place. So the problem with that
though is that you would have to really pair that
with behavioral therapy, because it's not just enough to say,
here's an antidepressant, and we have another a number of
other medications that sort of target individual parts of the
(13:59):
chemical cocktail involved in addiction. UM. We have, for instance,
one of them of famous being a methodone which suppresses
withdrawal symptoms and relieves cravings with the people are recovering
from from heroin, uh, you know, morphine addiction. UM. You
have other substances such as now trek zone, which works
by blocking the effects of heroin and other opiates at
(14:20):
the receptor sites. UM. You have, of course, so when
you're dealing with nicotine nicotine, you have nicotine replacement therapy,
where essentially you're still getting the nicotine, just not through
the cigarette, and that's used to help with the with
the with with the with cravings and whatnot. With alcohol,
you have now trek zone, which blocks opiate receptors that
(14:41):
are involved in the reroarting effects of drinking and in
the craving of alcohol. UM. So you see all these
types of medication there Again, they're going after sort of
a particular point in the chain chain of effect. And uh,
and but they can't they can't deal with environment. They
can only deal with with one point in in the
the chemical reaction, be it in how the brain is
(15:03):
receiving or how the brain is dealing with withdrawal from
the substance. And of course that has to have to
have a behavioral counterpoint counterpoint part in order to succeed. Yeah,
and in the case of methadone, that itself is highly addictive,
and it's been to argue that you're just delaying the
process of rehabilitation. Really you're just moving the goalpost out.
So what do we have on the horizon in the future,
(15:26):
And you've got some really interesting things going on. UM
one is called optogenetics, and are excuse me optogenics And
this is basically kind of like UM a light sensitive
molecule that's beamed into the brain so far of rats,
so rats that are learning certain habits. The researchers can
(15:50):
use this optogenetics treatment to basically turn on or off
neurons in the rats brains and block the behavior and
block the the ability of that rat to sort of
remember like Hey, I want to go and do this um.
And what's interesting about this is that the rats change
their behavior in response to different rewards even when the
(16:13):
light wasn't present. So after they got the initial zap
with the light, they still didn't return to the bad
behavior even when a significant amount of time had passed.
So obviously this is happening in rats right now, not
in humans. Um. But it plays into this other idea,
which is electromagnetic magnetic stimulation. Yeah, this is the form
(16:35):
that this would likely take in the treatment of of
of human addicts, and certainly this is where the research
is headed. Um. And and in this we would use
electromagnetic stimulation outside of the scalp, no surgery required, uh,
using transcranial magnetic stimulation on these particular parts of the
brain again to almost uh not to simplify it and
(16:56):
say it's just like turning a switch on and off
in terms of addiction, but uh, but but turning off
that that that that craving, right, Yeah, and increasing the
neural activity in the parts of the brain that deal
with executive functions like willpower. Right. So that's what we've
talked about that that's such a big part of this.
So then you have you know, willpower being ramped up,
(17:19):
and you have the addiction behavior being ramped down. What
you still have to deal with is memory in those triggers.
And David Lyndon, the neuroscientists and author of The Compass
of Pleasure, says addiction is a form of learning. When we,
for example, puff on a cigarette or inject heroin in
our arm, we are developing associations between the act of
puffing or the act of injecting all the other sensory
(17:42):
information that's around the sites and the smells, the people
were with, the music, we're hearing, the room. We're in
a situation that surrounds us and the pleasure that is
produced as the result of puffing on that cigarette or
injecting that heroin. Well, I hate to invoke the title
of the movie anymore since it's invoked again in every
every news article on science that deals with erasing a memory.
(18:03):
But you kind of have to go eternal sunshine of
his follows's mind on that particular drug memory because, as
we discussed in previous episode, uh, the drug memory is
has has is really firmly encoded. It's not just the
memory of taking the drug, is the memory of the environment,
the situation of the drug. All these things tied up
into it. So yeah, what if you could go after
(18:23):
that memory, If you could blast that memory sort of
photon torpedo it, then you could conceivably have a leg
up on beating the addiction, or you could you could
just like hose it down with a chemical, which is
essentially what researchers at the Script's Research Institute have done.
This is from a Fall two thousand and thirteen study
(18:44):
published online in Biological Psychiatry. For six days, they had
rats alternate between one of two rooms, and on the
odd days, they were put in a chamber let's call
it Chamber A and given meth. On even days they
were put in chamber B and given a sailine placebo.
So a couple of days later, half of these rodents
(19:07):
were given a choice between those two rooms, and the
room associated with that meth, of course, was preferred by
those rats who were injected with myth. But the other
half of the rodents were then injected with something called
La trunculin A or lat A, And this is a
chemical that interferes with actin, and that's a protein known
to be involved in memory formation. So when they were
(19:30):
injected with lacta excuse me, latte, the animals showed no
preference between rooms even up to a day later. Again,
this is all highly experimental, but it's it's giving us
an idea that there are certain interventions that can happen
to address all the different facets of addiction. And the
researchers do point out that you don't have to worry
(19:51):
about about this particular method being used to just erase memories.
Willy nilly. They say that you actually couldn't take their
discovery and array. It's your run of the mill memory
inside of the brain. Uh. They said, you can only
use this to get rid of the strong drug associated memories.
And of course there's gonna be many more studies and
they will have to be human trials in order for
(20:11):
this too for the FDA to approve of it um.
But that gets us into this other territory in which
the f d A has approved one type of vaccine
but not another. And when I'm talking about our vaccines
developed by Kim d Janda, he was on that World
Science Festival panel of the Craving Brain to block the
(20:33):
effects of heroin and users, but also block the effects
of nicotine and users. So guess which one is being funded. Oh, well,
obviously they're going to fund the nicotine one, because that's
your that's your kind of your your white collar drug. Right,
everyone is dealing with nicotine. But heroin, Oh, that's that's
a dirty that's a dirty drug. That's the that's the
at the bottom of the circus tent, right, that's the
(20:56):
that's down there with the safety nature. Yeah, even though
an estimated twelve million to four million people used heroin
as of two thousand and nine, accorded to according to
the United Nations Office on Tricks and Crime, and Americans
uh something like two in two thousand eleven. So obviously
it's a pervasive problem when we spend a lot of
money on that. But the vaccine itself stimulates the immune
(21:18):
system to recognize the substance, and it has to be
given over a period of weeks, which eventually renders the
person immune to the drug. Because how do our immune
systems try work? Right? Our immune systems evolved to deal
with foreign outside invaders, So our immune system doesn't doesn't
look at incoming cocaine or heroine or nicotine or alcohol
(21:38):
and say say, oh that's bad. Let's go after that,
they say, sorry, that's not on our list of suspects.
We're not gonna go. We're not gonna go arrest the
right you know. So the idea who are this vaccine is?
It is it puts those offenders on the on the
suspect list for our immune system and keeps them from
crossing a very important border, at least in the case
(22:00):
of the heroine. Yeah, the blood brain barrier, because that's
key here. That will actually block any psychoactive effects. So
in other words, you're not going to get high. Yeah.
And what they found in the rats, or what Genda
said he found is that they would give the rats
like uh doses, overdosed quantity, right, Yeah, and the rats
would survive when they were vaccinated. So of course it's
(22:24):
not something you would want to try and human trials,
but um, but it does lead us to this idea
that once you take the psychoactive part out, the actual
um blood brain barrier part where it doesn't get into
your brain and then affect the rest of the system,
is that you could render this the drug toothless. Yeah,
And it's it's important to know that this is not
(22:45):
like like a lot of other vaccines It's not a
situation where you'd say, all right, give everybody in the
population the heroin vaccine and then heroin doesn't work on anybody.
This would be more of a tool to prevent a relapse.
Really yeah, but again, the problem here is this digma
because of course the nicotine one has human trials. It's
brought to market. Let's look at those polite people and
(23:06):
the TV commercials dealing with their nicotine problems, right, and
certainly many of our listeners are dealing with nicotine problems.
I don't want to cheap in it or anything, but
it's it's far more socially acceptable. I think of your
TV version of the guy who's smoking too much, and
it's just a random guy. It might even be Goofy
from the Disney cartoons. I finally remember him trying to
quit smoking on the cartoon. I never saw a Disney
(23:27):
cartoon in which Goofy had to deal with a heroin problem,
even though that fits the time period right, the forties,
and you know perfect, I mean, you could see Mickey
tying his arm off. I mean, we're making light of this,
but really, I mean, this is this is something that
I think is very disheartening, especially for Kim d Janda,
who came up with a vaccine in the first place,
(23:48):
for heroin to stop this spread of AIDS, because of
course the vector here as uh use needles. So I
think it's got to be uh really just disheartening for
him to hear from um big farmat there's no market
for this. There's no market for a heroin vaccine, are
you kidding? Yeah, it's because again, when you look at
(24:10):
the huge public health benefit to something like this, it's
just it's insane. Yeah. And another thing that they said
on the panel is that this just has to become
more of the national discussion and that uh that doctors
need to have medical training on how to talk to
their patients about addiction, because they say right now that
(24:32):
they're not trained in that, and that the big joke
among doctors is that if a patient comes to you
and says, I drink four drinks a night, you should
probably double whatever it is that they say, um and
you and not even really address the problem or the
situation or dig any deeper. Yeah, it doesn't seem like
anytime you're you're you're dealing with the doctor, it's like
it's not maybe it's not firmly established in the public
(24:54):
mindset that this is a safe tone and then you
can actually talk about what you're putting into your body,
legally or illegally, because it is bottom line essential to
your health. But you know, I think that if the
I think that if the medical field approached it in
a different way, and like, for instance, I went to
(25:15):
um my doctor and she said, hey, Julia, find these
tests on you. It looks like you've got some genetic
predispositions for addiction. I wanted to, you know, just give
you a heads up or are you in any sort
of stress loops in your life that you need help
with or that you're aware of. Then it I know,
it takes up more time with your doctor, but again
(25:35):
it's opening up the line of communication and it's taking
out the stigma because you're talking about it. And if
this is something that is so pervasive in society, by
the way, something like all pharmacy suiticals are consumed by
the US by people in the United States, those are
a lot of drugs, legal drugs, but still drugs that
(25:59):
are being being distributed and um and consumed by people.
So this obviously is is not just a kind of
aside problem that some people have. You know, I want
to point out another possible application for the vaccine that
was brought up the heroin vaccine, is that, you know,
we were talking about rodents that were given this vaccine,
how they could take essentially almost like a lethal overdose
(26:22):
amount of the drug and still be fine. Uh, there's
a possibility that the vaccine could be used to treat
people who are who have overdose symptoms. So health care
professionals pick someone up or arrive at a scene someone's
clearly overdosing on on heroin, they can apply the vaccine
as a curative measure. Yeah, so emergency medicine could really
(26:43):
benefit from this. But again, I just keep pointing to
this idea that if you start to talk about it,
if you start to remove the stigma, then you can
really get to the behavior part of it, and to
the root causes of it, the depression, anxiety, whatever it
is that's going on in a person's life, and treat
the mental health part of this equation, which is so important.
(27:04):
And it's a shame that the whole topic becomes so
political as well, because like even a story like we
mentioned Phillips seem more Hoffman earlier. I looked him up
again and was looking at some of the various articles
about him, and you still see this sort of gut
reaction from from some commentators where some people you know,
were saying, oh, well, this is you know, horrible. This
is a very talented man who struggled with it with
(27:25):
his dan I don't even want to say his demons
because that personifies it as something supernatural and not something
that's based in in in physical illness. Um. But the
people were saying, oh, this is terrible. We had to
deal with this disease and it eventually caught up with him.
And then there's still people who are going to say, oh, well,
he was just essentially saying, oh he was just weak,
Oh he was just this is you know, moral failure
of his character. He was just another you know, Hollywood
(27:47):
phony or whatnot. You like, you still see that kind
of attitude, uh, you know, all over the place. Yeah.
I remember reading an op ed piece and I can't
remember if it was Slate or Salon, but there was
this forty five year old dad with a family who
wrote about, hey, look, this is a reminder of the
slippery slope when it comes to what you know, he
would say brain disease is when it comes to addiction,
(28:10):
because I was someone who was on the edge and
a very lucky to have not died with my addictions.
And I'm forty five years old, and I realized that
there are many triggers that could cause us just says
it did with Hoffman. So there you have it, a
little little luxie into the future. Uh, ways that we
(28:33):
can deal with addiction, the way the way that we
might deal with addiction. But again, there there has to
be enough of investment in the public mindset, um to
really see this. Uh, this heroin vaccine reached the point
where it's actually affecting world health. Yeah, and in the
healthcare system there has to be, um, you know, enough
(28:53):
support and money there. Um. Do you have any ideas
about this? Do you have any thoughts about the vaccines
or any of the other treatments in the stigma? If
you do, please let us know. Yeah. You can find
us at stuff to Blow your Mind dot com. That
is our website, that's the mother ship. That's where you'll
find every podcast episode we've ever done. You'll find all
the videos of the blog post. You'll find links out
(29:15):
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Because it how stuff works dot com. Could you plier
Welcome to Stuff to Blow Your Mind from how Stuff
Works dot com. Hey you welcome to Stuff to Blow
your Mind. My name is Robert lamp and I'm Julie Tuckers.
We just published on episode the other day on the
science of addiction, and this is kind of the part two.
I mean, you can probably listen to this episode without
(00:24):
having listened to the previous one, but they go well together,
so we recommend that viewing order let listening order rather.
This episode is uh going to look at the future
of addiction. Uh, And we're not talking about just what
kind of crazy drugs would have in the future. Now,
we're talking about how can we treat addiction in the future.
What are some of the cutting edge and emerging techniques
(00:47):
and technologies that will be at our disposal to deal
with the disease of addiction. Yeah, and before we look
at the future stuff, let's just kind of look at
what's going on in the present. The number one driver
of aids in the world is used heroin needles, particularly
in countries where there's no needle exchange programs. So what
(01:08):
if you could get rid of the root problem, you
could eradicate heroin addiction or for that matter really any addiction. Yeah,
and we're not just talking instantly. Minds tend to turn
to Africa, and certainly that's one of the areas concerned here,
but other you know, countries that don't have needle exchange
programs include such large UH population nations as China and Russia. Yeah,
(01:29):
I think that people don't, you know, at least people
outside of the United States don't realize what in the
city is problem. This is half a trillion dollars are
spent worldwide to treat addiction. So here's just one little
prism of the addiction problem in the US. And estimated
one point four million Americans are addicted to cocaine, which
was the reason for more than four hundred and eighty
(01:51):
two thousand emergency department visits in two thousand and eight
and is a leading cause of heart attack and stroke
among people younger than age five. So the problem here,
of course is that we have access and if you
look at you know sort of where drugs are in
(02:11):
the time continuum with history here, Um, we have more
access to drugs than ever before, and more types of drugs,
and what emerges here are some highly highly addictive substances.
I'm talking about meth which creates one of the biggest
boost of dopamine in the brain, and prolonged use of
(02:32):
this can lead to psychotic like symptoms, walking about, strong hallucinations,
and really violent behavior. And studies of the brain patterns
of some long term matthews have shown that up to
their dopamine producing cells have been damaged. So if you
listened um to the other episode on this then you
(02:52):
kind of know already that, uh, this is a situation
where the person is just getting deeper and deeper into
the whole because it's not about free will anymore, because
the parts of your brain, the executive function have been
so eroded by drugs that even if you wanted to stop,
you might not be able to. Yeah, and and and
that's certainly the the anti drug messaging that I think
(03:14):
needs to be focused on more often with myth amphetamy,
because I was reading and according to neuro psychopharmacologist Carl Hart,
there's actually no empirical evidence to support the claim that
meth amphetamy causes one to become physically unattractive, which hopefully
they've they're calming down on that, but for the longest,
like like meth mouth you know, in the affirmation of
(03:36):
the meth addict and just some sort of subhuman hyena
person has been kind of the focus. When certainly that's
flashy that works on a billboard a little easier, but
the the reality of what's actually changing with the brain
that is far scarier than some sort of jackal and
hide show. I agree. I have seen the ads before
where there's like this beautiful woman and then she takes
out her false teeth and she takes off her makeup
(03:59):
and all of a sudden you ease her her methatic
riddled face, and they are appealing to vanity. But vanity
doesn't matter when addiction is highly routinized in your brain, Um,
nobody cares anymore what they look like. So if you
were to instead crack open the brain and show people
this is how your brain is actually like completely mutating here,
(04:20):
that might be a far more compelling story to people.
The next one is another biggie, and that is of
course heroin UH derived from opium, And of course this
one has been wreaking havoc for for years and years. Yeah,
thirty of first time users will become addicted. In two
thousand and five, two point four of the American population
said they had tried heroin at least once. The source
(04:42):
of that Department of Health, and withdrawal symptoms are really acute.
They arrived just a few hours after a dose swears off,
and because of this, users have a really high chance
for relapse. Because we talked about this in the last episode. UM,
at some point the addiction becomes less about chasing the
high and more about chasing some sort of equilibrium and
feeling normal again, which can only happen if you get
(05:05):
more of the substance in your body. All right, and
the next big one to hit might come as surprise
because it's not crack cocaine. It is nicotine. Nicotine is
a very addictive substance. But we often overlook this why UM,
I think it's because it's legalized, right, something like of
people who ever try cigarettes will become nicotine addicts. At
(05:28):
some point, you can buy it legally at the store,
at the gas station. Used to you could get out
of a machine. UM. Someone's liable to and it's given
its legality and an overall still social acceptance, UM, people
are liable to give it to you without it being
that big of a deal as well so, and it
still looks cool on TV, right, Yeah, and it's not
(05:49):
as big of a risk. And this is something that
David Lyndon, a professor of neuroscience at Johns Hopkins University,
pointed out. He said, you know, hey, if you have
a bag of heroin, you're not going to do a
whole bag of heroin. You know you're gonna overdose. But
if you have a pack of cigarettes and you have
ten or twenty of those cigarettes throughout the day, you
get that little ding of dopamine each time. And he
(06:12):
kind of yeah, he kind of like lined it to
pa off s dog, right, so he said that we're
really good at training or inner dog and sort of
being like, oh, I need a little pick up right now.
And you get that little dopamine um pleasure feeling from it,
But you're not going to necessarily um render yourself unconscious
or unable to work or any of those things. But
(06:33):
still it is an addiction, and it is an addictive behavior. Yeah,
you hear about people being one or two back a
day smoker. Whereas in the panel they pointed out that
that even a heavy heroin user is probably not going
to use more than three times a day. And so
to go back to what one of the topics we
discussed in the previous episode chunking that idea that the
(06:54):
brain is forming habits get x than Y and Z
and uh and then forming a shortcut kind of a
hot key for the brain for behavior encoding the memory
of usage. Uh, you're you're going to have what you know,
twenty times uh or more per day that you're enforcing
that shortcut as opposed to a maximum three times per
day with the hairin user. Yeah. And Charles Higg, the
(07:15):
author of UM, the Habit Loop, I think I totally
slaughtered that. But um, he's talked about this and written
about this at length, and he says his claim is
that percent of our decisions every day that's just habit.
We think we're making these decisions, but really we're just
responding to environmental cues in these well worn neural pathways
(07:37):
in our brains. Yeah, because we've discussed before, habits take
up energy, they take a cognitive power, and we don't
have a limitless amount of that. So we handed over
to to routine. We handed over to habit so that
we'll have some juice to handle the actual decisions that
are coming at us, and of course that the problem
with this is that again, your brain, your brain secretry,
(07:58):
isn't making any sort of like, hey, this could be
a terrible thing. Don't do this, um, and your prefrontal cortex,
your executive functions in your brain are already sort of
um lessened by the addictive behavior. All right. The next
thing we have here is prescription medication, one of the
rapidly growing substances of abuse in the US. Between nineteen
(08:19):
eighty and nine, abuse of prescription drugs increased four and
it has about the same amount of usage in America
as cocaine. According to the National Institute on Drug Abuse,
drug overdose was the leading cause of injury death in
two thousand and ten, and among people twenty five to
(08:40):
sixty four years old, drug overdose caused more death than
motor vehicle traffic crashes. So the National Institute on Drug
Abuse goes on to say, by the way, two intend
seventy eight percent of the drug overdose deaths in the
US were unintentional, seventy eight percent. And I think that
(09:02):
this is painting a story here about how prescription drugs
UH have become so accessible in people are mixing them
with other drugs or mixing them with alcohol to their detriment. Yeah,
I mean, it's it's important to to to to to
to point out that prescription drugs just because it's prescribed
does not mean it is necessarily a safe substance of
(09:25):
Any of these are very dangerou socis. I mean, any
of these are emphatamines. Uh, and they're not that different
from the illegal variant, and certainly methemphatamine itself is memory
serves as schedule to narcotic anyway, which means that it
becausivably has a medical purpose. Uh. And it makes sense
to like which which car is going to be faster?
The one made in a garage or the one made
(09:47):
uh at at a factory? Right? And what do we
have with with drugs? Your street drug is often made
in a garage, whereas your your pharmaceutical product is made
by a billion upon billion dollars in this tree. So
it's it's kind of like a supercharged vehicle. Yeah. And um,
I'm sure that people are aware that there are ways
(10:08):
that people get their hands on drugs that they shouldn't have.
There are legal drugs prescribed, and I won't go into that.
I will say that If you are interested in learning
more about this prescription drugs, check out the documentary American
Addict that goes into detail. It's pretty depressing, um, but
it's also very eye opening about this topic. All Right,
we're gonna take a quick break and we get back.
We're going to talk about the treatment of addiction. All Right,
(10:38):
we're back. So we've we've discussed addiction here. Let's talk
about the ways that we treat addiction. We have several
different approaches that are currently in play, and we're looking
at some some new methods of tackling in the future. Yeah,
and before we go into that, we should say, hey,
by the way, rate of relapse is really high for addicts.
(10:59):
I think this is something most people know. According to
the National Institute on Drug Abuse, relapse rates for drug
addicted patients about fort's similar to relapse and those suffering
from diabetes, hypertension, and asthma and drug addiction should be
treated like any other chronic illness, with relapse serving as
a trigger for renewed intervention. So keep this in mind. Um.
(11:22):
And we talked about this this idea of memory and
cooding behavior and there are being triggers for that. So
imagine that you have just completed a program, say from
heroin abuse, and you get out and um, I think
I called them before, these neural ghosts, these neural pathways
in your brain, the sort of cellular scarring that's still there.
(11:45):
It's very easy to tap into that and have that
behavior express itself again. A great example of this is
Philip Seymour Hoffman, which is brought up at the World
Science Festival for the panel of the Craving Brain. They said,
look at this guy. He was something like ten years
sober from heroin addiction, went to a rat party one night,
(12:06):
had a beer, and then something like I don't know
was it weeks or months later, had died from heroin overdose. Yeah.
I just started him down the path, opened up those
pathways again in the brain, those those pathways of habit
and behavior in addiction, and uh, and then they where
he ended up. Yeah, So you know you're not treating
something that's easily dealt with here, right, Just I keep
(12:28):
coming back to the idea of a cat's cradle, right,
you know, where you take the shoelace tied together and
you you string it between your fingers and it's all
the different fingers holding the string out to form this pattern,
and you can't you know, put a point at one
particular finger and say that is the cause of the pattern,
that is the cause of the the overall design here.
And just as there's no over that one finger you
(12:50):
can pin the whole design on, there's no one finger
you can remove, there's no one treatment plan. It's going
to be a magic bullet against the problem of addiction. Yeah,
because in one sense, um, it doesn't really matter anymore
if you have genetic dispositions to addiction, if you're in
the middle of an addiction, because at that point you've
got habit taken over, you've got the transfer station, there
(13:13):
are significant changes to your brain, and now you've got
you know, memory all wrapped up in it. So um,
so yeah, it is a bit of a cat's cradle,
But the treatments can't really treat a cat's cradle. You
can pretty much go after individual fingers. Yeah. Yeah, there's
no unified treatments. So the most widespread medication right now,
um is in a antidepressants, because this would address the
(13:37):
feelings of despair or you know, any sort of pre
existing condition like depression that may have led to the
addiction in the first place. So the problem with that
though is that you would have to really pair that
with behavioral therapy, because it's not just enough to say,
here's an antidepressant, and we have another a number of
other medications that sort of target individual parts of the
(13:59):
chemical cocktail involved in addiction. UM. We have, for instance,
one of them of famous being a methodone which suppresses
withdrawal symptoms and relieves cravings with the people are recovering
from from heroin, uh, you know, morphine addiction. UM. You
have other substances such as now trek zone, which works
by blocking the effects of heroin and other opiates at
(14:20):
the receptor sites. UM. You have, of course, so when
you're dealing with nicotine nicotine, you have nicotine replacement therapy,
where essentially you're still getting the nicotine, just not through
the cigarette, and that's used to help with the with
the with with the with cravings and whatnot. With alcohol,
you have now trek zone, which blocks opiate receptors that
(14:41):
are involved in the reroarting effects of drinking and in
the craving of alcohol. UM. So you see all these
types of medication there Again, they're going after sort of
a particular point in the chain chain of effect. And uh,
and but they can't they can't deal with environment. They
can only deal with with one point in in the
the chemical reaction, be it in how the brain is
(15:03):
receiving or how the brain is dealing with withdrawal from
the substance. And of course that has to have to
have a behavioral counterpoint counterpoint part in order to succeed. Yeah,
and in the case of methadone, that itself is highly addictive,
and it's been to argue that you're just delaying the
process of rehabilitation. Really you're just moving the goalpost out.
So what do we have on the horizon in the future,
(15:26):
And you've got some really interesting things going on. UM
one is called optogenetics, and are excuse me optogenics And
this is basically kind of like UM a light sensitive
molecule that's beamed into the brain so far of rats,
so rats that are learning certain habits. The researchers can
(15:50):
use this optogenetics treatment to basically turn on or off
neurons in the rats brains and block the behavior and
block the the ability of that rat to sort of
remember like Hey, I want to go and do this um.
And what's interesting about this is that the rats change
their behavior in response to different rewards even when the
(16:13):
light wasn't present. So after they got the initial zap
with the light, they still didn't return to the bad
behavior even when a significant amount of time had passed.
So obviously this is happening in rats right now, not
in humans. Um. But it plays into this other idea,
which is electromagnetic magnetic stimulation. Yeah, this is the form
(16:35):
that this would likely take in the treatment of of
of human addicts, and certainly this is where the research
is headed. Um. And and in this we would use
electromagnetic stimulation outside of the scalp, no surgery required, uh,
using transcranial magnetic stimulation on these particular parts of the
brain again to almost uh not to simplify it and
(16:56):
say it's just like turning a switch on and off
in terms of addiction, but uh, but but turning off
that that that that craving, right, Yeah, and increasing the
neural activity in the parts of the brain that deal
with executive functions like willpower. Right. So that's what we've
talked about that that's such a big part of this.
So then you have you know, willpower being ramped up,
(17:19):
and you have the addiction behavior being ramped down. What
you still have to deal with is memory in those triggers.
And David Lyndon, the neuroscientists and author of The Compass
of Pleasure, says addiction is a form of learning. When we,
for example, puff on a cigarette or inject heroin in
our arm, we are developing associations between the act of
puffing or the act of injecting all the other sensory
(17:42):
information that's around the sites and the smells, the people
were with, the music, we're hearing, the room. We're in
a situation that surrounds us and the pleasure that is
produced as the result of puffing on that cigarette or
injecting that heroin. Well, I hate to invoke the title
of the movie anymore since it's invoked again in every
every news article on science that deals with erasing a memory.
(18:03):
But you kind of have to go eternal sunshine of
his follows's mind on that particular drug memory because, as
we discussed in previous episode, uh, the drug memory is
has has is really firmly encoded. It's not just the
memory of taking the drug, is the memory of the environment,
the situation of the drug. All these things tied up
into it. So yeah, what if you could go after
(18:23):
that memory, If you could blast that memory sort of
photon torpedo it, then you could conceivably have a leg
up on beating the addiction, or you could you could
just like hose it down with a chemical, which is
essentially what researchers at the Script's Research Institute have done.
This is from a Fall two thousand and thirteen study
(18:44):
published online in Biological Psychiatry. For six days, they had
rats alternate between one of two rooms, and on the
odd days, they were put in a chamber let's call
it Chamber A and given meth. On even days they
were put in chamber B and given a sailine placebo.
So a couple of days later, half of these rodents
(19:07):
were given a choice between those two rooms, and the
room associated with that meth, of course, was preferred by
those rats who were injected with myth. But the other
half of the rodents were then injected with something called
La trunculin A or lat A, And this is a
chemical that interferes with actin, and that's a protein known
to be involved in memory formation. So when they were
(19:30):
injected with lacta excuse me, latte, the animals showed no
preference between rooms even up to a day later. Again,
this is all highly experimental, but it's it's giving us
an idea that there are certain interventions that can happen
to address all the different facets of addiction. And the
researchers do point out that you don't have to worry
(19:51):
about about this particular method being used to just erase memories.
Willy nilly. They say that you actually couldn't take their
discovery and array. It's your run of the mill memory
inside of the brain. Uh. They said, you can only
use this to get rid of the strong drug associated memories.
And of course there's gonna be many more studies and
they will have to be human trials in order for
(20:11):
this too for the FDA to approve of it um.
But that gets us into this other territory in which
the f d A has approved one type of vaccine
but not another. And when I'm talking about our vaccines
developed by Kim d Janda, he was on that World
Science Festival panel of the Craving Brain to block the
(20:33):
effects of heroin and users, but also block the effects
of nicotine and users. So guess which one is being funded. Oh, well,
obviously they're going to fund the nicotine one, because that's
your that's your kind of your your white collar drug. Right,
everyone is dealing with nicotine. But heroin, Oh, that's that's
a dirty that's a dirty drug. That's the that's the
at the bottom of the circus tent, right, that's the
(20:56):
that's down there with the safety nature. Yeah, even though
an estimated twelve million to four million people used heroin
as of two thousand and nine, accorded to according to
the United Nations Office on Tricks and Crime, and Americans
uh something like two in two thousand eleven. So obviously
it's a pervasive problem when we spend a lot of
money on that. But the vaccine itself stimulates the immune
(21:18):
system to recognize the substance, and it has to be
given over a period of weeks, which eventually renders the
person immune to the drug. Because how do our immune
systems try work? Right? Our immune systems evolved to deal
with foreign outside invaders, So our immune system doesn't doesn't
look at incoming cocaine or heroine or nicotine or alcohol
(21:38):
and say say, oh that's bad. Let's go after that,
they say, sorry, that's not on our list of suspects.
We're not gonna go. We're not gonna go arrest the
right you know. So the idea who are this vaccine is?
It is it puts those offenders on the on the
suspect list for our immune system and keeps them from
crossing a very important border, at least in the case
(22:00):
of the heroine. Yeah, the blood brain barrier, because that's
key here. That will actually block any psychoactive effects. So
in other words, you're not going to get high. Yeah.
And what they found in the rats, or what Genda
said he found is that they would give the rats
like uh doses, overdosed quantity, right, Yeah, and the rats
would survive when they were vaccinated. So of course it's
(22:24):
not something you would want to try and human trials,
but um, but it does lead us to this idea
that once you take the psychoactive part out, the actual
um blood brain barrier part where it doesn't get into
your brain and then affect the rest of the system,
is that you could render this the drug toothless. Yeah,
And it's it's important to know that this is not
(22:45):
like like a lot of other vaccines It's not a
situation where you'd say, all right, give everybody in the
population the heroin vaccine and then heroin doesn't work on anybody.
This would be more of a tool to prevent a relapse.
Really yeah, but again, the problem here is this digma
because of course the nicotine one has human trials. It's
brought to market. Let's look at those polite people and
(23:06):
the TV commercials dealing with their nicotine problems, right, and
certainly many of our listeners are dealing with nicotine problems.
I don't want to cheap in it or anything, but
it's it's far more socially acceptable. I think of your
TV version of the guy who's smoking too much, and
it's just a random guy. It might even be Goofy
from the Disney cartoons. I finally remember him trying to
quit smoking on the cartoon. I never saw a Disney
(23:27):
cartoon in which Goofy had to deal with a heroin problem,
even though that fits the time period right, the forties,
and you know perfect, I mean, you could see Mickey
tying his arm off. I mean, we're making light of this,
but really, I mean, this is this is something that
I think is very disheartening, especially for Kim d Janda,
who came up with a vaccine in the first place,
(23:48):
for heroin to stop this spread of AIDS, because of
course the vector here as uh use needles. So I
think it's got to be uh really just disheartening for
him to hear from um big farmat there's no market
for this. There's no market for a heroin vaccine, are
you kidding? Yeah, it's because again, when you look at
(24:10):
the huge public health benefit to something like this, it's
just it's insane. Yeah. And another thing that they said
on the panel is that this just has to become
more of the national discussion and that uh that doctors
need to have medical training on how to talk to
their patients about addiction, because they say right now that
(24:32):
they're not trained in that, and that the big joke
among doctors is that if a patient comes to you
and says, I drink four drinks a night, you should
probably double whatever it is that they say, um and
you and not even really address the problem or the
situation or dig any deeper. Yeah, it doesn't seem like
anytime you're you're you're dealing with the doctor, it's like
it's not maybe it's not firmly established in the public
(24:54):
mindset that this is a safe tone and then you
can actually talk about what you're putting into your body,
legally or illegally, because it is bottom line essential to
your health. But you know, I think that if the
I think that if the medical field approached it in
a different way, and like, for instance, I went to
(25:15):
um my doctor and she said, hey, Julia, find these
tests on you. It looks like you've got some genetic
predispositions for addiction. I wanted to, you know, just give
you a heads up or are you in any sort
of stress loops in your life that you need help
with or that you're aware of. Then it I know,
it takes up more time with your doctor, but again
(25:35):
it's opening up the line of communication and it's taking
out the stigma because you're talking about it. And if
this is something that is so pervasive in society, by
the way, something like all pharmacy suiticals are consumed by
the US by people in the United States, those are
a lot of drugs, legal drugs, but still drugs that
(25:59):
are being being distributed and um and consumed by people.
So this obviously is is not just a kind of
aside problem that some people have. You know, I want
to point out another possible application for the vaccine that
was brought up the heroin vaccine, is that, you know,
we were talking about rodents that were given this vaccine,
how they could take essentially almost like a lethal overdose
(26:22):
amount of the drug and still be fine. Uh, there's
a possibility that the vaccine could be used to treat
people who are who have overdose symptoms. So health care
professionals pick someone up or arrive at a scene someone's
clearly overdosing on on heroin, they can apply the vaccine
as a curative measure. Yeah, so emergency medicine could really
(26:43):
benefit from this. But again, I just keep pointing to
this idea that if you start to talk about it,
if you start to remove the stigma, then you can
really get to the behavior part of it, and to
the root causes of it, the depression, anxiety, whatever it
is that's going on in a person's life, and treat
the mental health part of this equation, which is so important.
(27:04):
And it's a shame that the whole topic becomes so
political as well, because like even a story like we
mentioned Phillips seem more Hoffman earlier. I looked him up
again and was looking at some of the various articles
about him, and you still see this sort of gut
reaction from from some commentators where some people you know,
were saying, oh, well, this is you know, horrible. This
is a very talented man who struggled with it with
(27:25):
his dan I don't even want to say his demons
because that personifies it as something supernatural and not something
that's based in in in physical illness. Um. But the
people were saying, oh, this is terrible. We had to
deal with this disease and it eventually caught up with him.
And then there's still people who are going to say, oh, well,
he was just essentially saying, oh he was just weak,
Oh he was just this is you know, moral failure
of his character. He was just another you know, Hollywood
(27:47):
phony or whatnot. You like, you still see that kind
of attitude, uh, you know, all over the place. Yeah.
I remember reading an op ed piece and I can't
remember if it was Slate or Salon, but there was
this forty five year old dad with a family who
wrote about, hey, look, this is a reminder of the
slippery slope when it comes to what you know, he
would say brain disease is when it comes to addiction,
(28:10):
because I was someone who was on the edge and
a very lucky to have not died with my addictions.
And I'm forty five years old, and I realized that
there are many triggers that could cause us just says
it did with Hoffman. So there you have it, a
little little luxie into the future. Uh, ways that we
(28:33):
can deal with addiction, the way the way that we
might deal with addiction. But again, there there has to
be enough of investment in the public mindset, um to
really see this. Uh, this heroin vaccine reached the point
where it's actually affecting world health. Yeah, and in the
healthcare system there has to be, um, you know, enough
(28:53):
support and money there. Um. Do you have any ideas
about this? Do you have any thoughts about the vaccines
or any of the other treatments in the stigma? If
you do, please let us know. Yeah. You can find
us at stuff to Blow your Mind dot com. That
is our website, that's the mother ship. That's where you'll
find every podcast episode we've ever done. You'll find all
the videos of the blog post. You'll find links out
(29:15):
to our various social media accounts, including Facebook, Twitter, and Tumbler,
as well as our YouTube account, mind Stuff Show, where
we're always rolling out all sorts of really cool video products.
And let's say you want to get in touch with
us a more old fashioned way. Ah, well, here's here's something.
Um it's old fashioned, I suppose. And you also may
want to update your information here because our email address
(29:37):
has changed and I'm gonna tell you old one. Forget that.
It doesn't exist anymore. I don't even remember it. Yeah,
it is below the mind at how stuff works dot
com for more on this and thousands of other topics.
Because it how stuff works dot com. Could you plier
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