Addiction is compulsive behavior despite negative consequences.
And it's really important to start by defining addiction because for a long time we really
defined it very poorly.
We used to think that addiction was needing a substance to function.
And what that resulted in was that cocaine was not addictive because cocaine does not
produce physical withdraw that is noticeable.
You may be cranky and irritable and crave cocaine, but you won't be puking and shaking
and have the classic symptoms that you would see with alcohol or heroin withdrawal.
So cocaine wasn't addictive.
Then crack came and we realized that defining addiction in that way not only harms people
by telling them that cocaine is not addictive, it also harmed pain patients because people
who take opioids daily for pain will develop physical dependence but they are not addicted
unless they have compulsive behavior despite negative consequences.
I see addiction as a learning disorder and the reason that I see it that way is because
the biology of addiction unfolds in a developmental context over time and that means that a huge
amount of variables come into it, not only genes and early environment, but also culture,
your family, the way you interpret your own experience.
So it becomes very complicated pretty quickly.
Addiction is a learning disorder because it can't occur without learning.
You have to learn to associate the drug with some kind of relief or pleasure.
And you need to do that repeatedly over time before you can become addicted.
This is why a baby can't be addicted because a baby who is born with physical dependence
on something like heroine doesn't know whether it needs a diaper change or just wants mommy
or wants heroin.
And it certainly can't you go out and score despite negative consequences.
So that's another reason what that it's really important to distinguish between physical
dependence and addiction.
So the learning is involved where you learn that this works to fix a problem and you basically
then fall in love with the substance.
And once you've fallen in love with somebody or something you will persist despite negative
consequences in order to sustain that relationship because the biology is going to tell you that
your life depends on this.
It basically acts in the brain region that is involved in survival and reproduction and
those are the two fundamental purposes of biology.
So that creates really, really strong cravings and it changes your priorities tremendously.
And we don't really think about that when somebody falls in love and gets married and
has a kid, we think that's very normal.
And it is very normal.
But if you notice how people behave around love affairs, where licit or illicit, they
will tend to put that first and they will do things that they might not otherwise do
in pursuit of that.
And you can certainly see that when people have affairs where they will lie, et cetera.
It's both.
In order to overcome addiction you need to figure out what purpose the addiction was
serving.
In my case I had a lot of depression and I had a lot of difficulties connecting with
people.
I was also sort of overwhelmed by my senses and emotions a lot of the time and opioids
turned that down very nicely.
So I needed to sort of figure out what was up and deal with those issues in order to
be healthy and comfortable in recovery.
And that's going to be different for different people because they are going to have different
issues that they are medicating with the drugs.
I think psychedelics may be very useful in the treatment of addiction, but they are certainly
not a cure.
I think it's very important to keep in mind that insight alone does not change behavior.
And with the drugs like ibogaine, which seems to help relieve opioid withdrawal, it's all
well and good if you have a trip and then you are no longer physically dependent on
the drug.
But if you then go back to the same environment and you haven't made changes that are going
to allow you to cope in a different way you will probably relapse and end up back in the
same situation.
So while it could be very useful to gain insight on what's going on with you via psychedelics,
this idea that there will be a sort of one shot cure for addiction has been a tremendous
problem in the field for a really long time and I think it's really important for the
people who are promoting the use of psychedelics in addiction treatment not to over promise.
Addiction is a very human problem and this is often why people propose and some people
benefit from a spiritual solution to it.
That's not to say we should treat medicine and medical conditions as spirituality, but
the reality is that addiction and depression and a lot of other mental illnesses do often
involve struggling with that potential question.
And so it is not going to be the case that you can just put a brain implant in and addiction
it will go away without a big chunk of yourself going away.
So the Chinese are horribly experimenting with this horrific brain surgery where they
ablate, i.e. burn out the nucleus accumbens, which is basically the brain region that provides
pleasure and motivation and they think that this is actually going to cure addiction.
Of course, what happens is you get to people who are just anhedonic who relapsed because
now they have even less.
So this idea that like we could use a drug that would block the effects of the drug of
choice is generally misguided because the problem isn't the drug of choice, the problem
is why you need that drug and why those drugs appeal to you and why you are trying to get
out why you are trying to escape and what you need in your life in order to feel comfortable
and safe and productive.
So I don't think that there will be future weird cures like that.
But what I do think is interesting about the future of drugs is that we can make better
drugs.
Part of the reason that prohibition is collapsing at the moment is because of what are called
new psychoactive substances or legal highs.
And basically you can make a new recreational drug by sort of tweaking molecules of the
other ones and it will be technically legal because it hasn't been made illegal.
And what this reveals is that our system for making drugs illegal is completely irrational
and based on 19th century prejudices.
It has nothing to do with science.
And if we apply science to this problem and look at well people are always going to want
to alter their consciousness in some ways, how do we reduce the harm associated with
this?
How do we create drugs or medications that will allow people to feel safe and comfortable
in the world but not be so distracting or it's problematic that they will not be able
to connect with other people, they won't be so out of it.
So I think the future of drugs is better drugs.
I don't think the future of drugs will be, or virtual reality these kinds of things could
all be very interesting.
But I think that so long as people ask the question why am I here and so long as people
need each other to love and connect we are going to have people who want to find ways
to make that work better.