Addiction: Why Your Brain Resists Change (Part 2)

Can you really rewire your brain after years of addiction? Dr. Judson Brewer explains the science of neuroplasticity and the secret to unlearning any habit.

In this second installment, host Terry Maguire continues the conversation with world-renowned psychiatrist and neuroscientist Dr. Judson Brewer (Dr. Jud). We explore why habits are formed to help us survive and how those same mechanisms can be hijacked by addiction . Dr. Jud explains the Default Mode Network and why it's the "home base" for cravings, worry, and rumination .

Find mental health and addiction treatment near you: https://recovery.com/
Dr. Jud is the New York Times bestselling author of Unwinding Anxiety and The Craving Mind and currently serves as a researcher and clinician. In this episode, he breaks down why smartphones are essentially "pocket slot machines" that use intermittent reinforcement to keep us hooked . He also debunks the 21-day habit myth and shares laboratory data showing that reward values can actually shift in as few as 5 to 15 mindfully aware experiences.

Learn how to step out of the "shame loop" and into a "learning loop" by using curiosity as a clinical intervention . We discuss the HALT method (Hungry, Angry, Lonely, Tired) for identifying stress triggers and the neuroscience behind why meeting a need is always better than feeding a want . Whether it’s substance use, social media, or problematic eating, Dr. Jud proves that everything is recoverable if it is a habit.

Chapters:
00:00 – [Intro]
01:09 – Defining Addiction: Continued Use Despite Consequences
05:26 – Why Addiction is Not a Moral Failure
08:30 – The Default Mode Network & Brain Cravings
13:47 – How to Rewire Your Brain After Years of Use
20:13 – The 21-Day Habit Myth Debunked
27:14 – Are Cell Phones "Pocket Slot Machines"?
33:32 – Dealing with Slips and the "Shame Loop"
43:12 – How Mindfulness Rewires the Brain
51:18 – Dr. Jud's Advice for Loving Someone with Addiction

Questions the Video Answers:
What actually happens in the brain during a craving?


Is it really possible to unlearn any habit?


What is the Default Mode Network in the brain?


Why do slot machines and phones get us addicted?


How many times does it take to change a reward value?


Does a single slip mean I’m back at square one?


Can mindfulness help with addiction recovery?


What is the HALT method for stress management?


Why does curiosity help stop a craving?


Is addiction primarily about choice or survival?


How long does the brain take to form a new habit?


What is "Intermittent Reinforcement"?


How do parents protect their teenager's brain?


How do medications like methadone affect receptors?


Why is "meeting a need" better than "feeding a want"?


#Neuroscience #AddictionRecovery #HabitChange

Transcript

SPEAKER_04 0:00

Any habit that can be learned can be unlearned.

SPEAKER_00 0:03

World-renowned psychiatrist, neuroscientist, and best-selling author Dr. Judson Brewer shares his groundbreaking research on what works to break cycles of addiction and anxiety. We're talking about addictions and things that people can believe aren't recoverable.

SPEAKER_03 0:19

Everything's recoverable if it's a habit. Everything.

SPEAKER_00 0:26

Welcome to Recoverable. I'm your host, Terry McGuire. We continue our discussion today with Dr. Judson Brewer about the neuroscience of addiction. Welcome back. And you welcome back.

SPEAKER_04 0:36

Thank you.

SPEAKER_00 0:37

I'm really grateful for this conversation and the gift you have for explaining it with all of your experience, all of your research, all of your studies, all of your clinical work. And you can still break it down in a way that even I can understand. So thank you. Speaking of which, let's talk briefly. I mean, I always hesitate to get really into the science of it because I don't have that kind of brain and smoke will come out of my ears, which might be visible on setup. But if you can explain what actually happens in the brain when someone is in a situation that there's an addiction present.

SPEAKER_04 1:09

Sure. So let's start with a definition of addiction. Okay. So continued use despite adverse consequences. That's the definition I learned in residency, and I still use today. I think it's very useful. And one thing that that highlights is it's not about a substance or a chemical or some specific thing that we're putting into our body. It could also be a behavior. So this broadens the scope where people can find whatever the behavior is, if it's causing adverse consequences, then they can look at it in terms of it maybe being an addiction. And this is, you know, there are controversial elements around eating. Like, can eating be an addiction when it's something that we need for survival? Well, if we're binge eating or have some eating disorder, for example, you could say, well, there's a continued use despite adverse consequences. So regardless of how we define these things, I like to think of it that way because it reminds me that addiction is along the spectrum of a habit, right? So habits are formed to help us survive. So at the far end of that spectrum is an addiction, where that habit is something that we do automatically, but it's not help helping us survive. So what's going on in the brain? The shared element here is that when we do a behavior. So for example, you know, we talked in the last episode about survival, right? So our ancient ancestors go out on the savannah, they find a food, there's the trigger, they eat the food, there's the behavior, and then their stomach sends this dopamine signal to their brain that says, hey, lock that memory in. Remember what you found and where you found it. So that's how any habit forms, but that's also how an addiction forms. If we look at substances, for example, all substances that are abused act on the dopaminergic pathway. Now they might act in slightly different ways, but all of them tweak dopamine to some degree. So, for example, cocaine affects the dopamine transporter, whereas alcohol and benzodiazepines affect the benzodiazepine receptor, right? So there can be different receptors, and that the details aren't that important, but the key here is that they all share this common element of a habit loop, right? Trigger behavior result, and also share the same element of dopamine. They're affecting the dopamine system in some way. Now that dopamine fires, and we've talked last time about how, you know, dopamine fires often when we're surprised. So it kind of fires when something surprising happens, but then it fires in anticipation. It becomes this motivation molecule to go do the thing. That's why it feels itchy, urgy, and makes us restless to go get out of our seat to go do something, right? Not a pleasure molecule. It's a motivation molecule. One of the big internet myths that we see. Oh, dopamine pleasure. No, not pleasure, not supposed to be, not designed that way. That's not going to help us survive just by sitting around in the cave saying, oh, I'm fine. I don't need food. You know, from a brain standpoint, the details probably aren't as important as knowing the general pathway. So that we know that we start to set up a habit through this dopamine firing, that gets locked into automaticity, just meaning it becomes automatic over time, where we lay down the behavior and we forget about the details. There's the set and forget. You set the behavior, you forget about the details. Now, part of the setting is setting up how rewarding something is. And so when it's a substance and it hijacks that dopamine system, that can feel very itchy, urgy, restless, rewarding from a reward standpoint to our brain that really locks something in. Again, reward does not equal pleasure. It's a brain term for getting something to lock in as a habit. Okay. And so this is where addiction comes in when something gets locked in and we do it automatically enough where it becomes unhelpful, where there's this continued use despite adverse consequences. So when the adverse consequences start piling up, that's when we fall into addiction territory. Does that make sense? It does.

SPEAKER_00 5:14

But it also all seems to point toward it's not us. We're not choosing, we're not failing, we're not weak. It's something happened.

SPEAKER_04 5:26

Yeah, I'm glad you bring that up. That's really important. This is not about us. This is not about us being weak. This is not about us being broken. This is not us being less than. This is not us being a failure. I can think of all the ways that people come to me and say, you know, I get judged by people for having this addiction. And they say there's something wrong with me. It's a choice. I should just choose not to do it. Well, guess what? Every one of them would be like, you know what? I would choose not to do it because this is not good. And I certainly don't like being judged for it. And on top of that, they judge themselves. They feel like, oh, I can't do this. I'm a failure. You know, I should just give up. They feel like there's something wrong with them. So it's really helpful to know that this is a mechanism in our brain. It's set up as survival, and that survival mechanism got hijacked a little bit, and it's not our fault.

SPEAKER_00 6:19

Are there things in the beginning stages that we can do or not do that will make us less likely to get to the point where it's no longer optional or a choice for us? Does it happen independent of our best intentions?

SPEAKER_04 6:33

Yeah, I think there are probably some good protective factors. Uh so for example, just being with people, right? Being in community. You know, there are animal studies showing that uh rats in an enriched environment are less likely to turn to, you know, these are artificial uh markers of addiction, but it's the best that we have from these types of experiments. When they're in enriched environments, they're less likely to do the thing. Uh, there's good work with humans showing that when you treat people like humans and you help them meet their basic needs, including community, that that can be a protective factor and it can also help people maintain recovery. So here, I think there are a lot of good protective factors. And these go down to, you know, think of there's this guy, Abraham Maslow, who had this Maslow's hierarchy of needs. And I think that, you know, it's really basic when you think about it. Well, these base needs are, you know, food, shelter, you know, safety, these types of things. So having those basic needs met is very helpful because when we're stressed out, we might turn to something that's going to help us temporarily avoid that. And then we get locked into that cycle. Basic needs, also psychological needs are important. So when our psychological needs aren't met, which can include community, friendship, connection, kindness, these types of things. When they're not met, then we can be more vulnerable. And this is again where, you know, some of these things like adverse childhood events can be markers of where, you know, somebody has not had those needs met and then they're more susceptible to addiction. But again, if somebody has had adverse childhood events, it doesn't mean that they're destined for addiction. It just means that they might be more vulnerable.

SPEAKER_00 8:20

Thank you. I appreciate that. We're going to get back to the internet questions. On Google, one of the top searches on this topic is what happens in the brain during cravings?

SPEAKER_04 8:30

So there are a number of things that happen. One, we've taught, we've touched on a little bit of this, but there's more to that story. Okay. So with craving, we've talked about how dopamine fires as this motivation molecule. So if our stomach is empty, we're going to have a craving for food that says go get some food. You know, if we are addicted to nicotine and we smoke cigarettes, we're going to have this craving roughly every two hours to go smoke a cigarette to fill that deficit. There's another piece that's related to craving as well. And so there's a part of the brain, and there's a network of brain regions called the default mode network. And this is interesting. It somebody slapped a name on it. Well, they didn't do this haphazardly, but there was a research group at Washington University in St. Louis led by Mark Raikle. And what they did was they were doing these neuroimaging studies where they were trying to look at brain activity and they were trying to find a task that was just kind of an easy task that anybody could learn very quickly that they could use as a comparison task for other tasks. Cause you tend to need a comparison for doing brain imaging. So they taught people the simple uh simple instruction, which was lay still and don't do anything in particular. Okay. And they said, okay, whatever. Well, you know, it's easy. People can learn that in 10 seconds. And so what they found was that when people were lying still and not doing anything in particular, they were activating a network of brain regions over and over and over. And this is like one of the most reproduced findings in all of neuroscience at this point. And what they found, so they called it the default mode network because they didn't know what was happening, but it seems to be what people default to, hence the name. And what later was discovered was that this is a self-referential network. So what do we default to when we're not doing anything in particular? What do we think about? We think about ourselves, right? So we regret things that we've done in the past. We worry about things in the future. This is also where rumination with depression comes in, where we ruminate about the past. This is also where perseveration, which is just a fancy term for worrying, comes in with anxiety. We worry about the future. Both of these activate the default mode network. And when we crave things, this default mode network gets activated. Right. So this craving, and my lab's done a lot of work with looking at some of the hubs of this default mode network. There's one area called the posterior cingulate cortex. It's just, you know, about here in our brain. The details aren't important, but that seems to be a marker of getting caught up in our experience. So a number of studies have shown whether it's cigarettes, let's see, cigarettes, cocaine, gambling, even chocolate. All of these, when people are craving these substances, they activate this posterior cingulate cortex. What we found is that it seems to line up with the direct experience of getting caught up in our experience, right? So that craving feels more like this itchy urgy coiling up that gets us to spring into action, right? So that that contracted, coiled up feeling may correlate with activation in the posterior cingulate cortex, which also makes sense from a craving perspective because it says coil up to spring into action to go do something. Remember, this is about motivating us to go get things.

SPEAKER_00 11:45

Originally food.

SPEAKER_04 11:46

Yes, originally food and avoiding danger.

SPEAKER_00 11:48

Yeah. How do cues and triggers create intense cravings?

SPEAKER_04 11:53

Well, I would say cues and triggers don't create intense cravings necessarily. They might set the wheel in motion. Okay. So we might have a thought that could be a trigger. We might smell something, we might see something, we might, you know, run into somebody that we used to do things with, whether it was use substances or do certain behaviors. And those can trigger memories of past experiences, like, oh, and then that can trigger, like, oh, that was well, we that let's do that again, so to speak. That was fun or, you know, or whatever. Yeah. And then so that can kind of set the wheel of craving in motion, which then drives us into doing the behavior.

SPEAKER_00 12:34

Does it work the other way if it wasn't so fun? If you got in trouble with that person, is does it still start that ball rolling? Or is it like, oh no, I don't, I'm not going there again?

SPEAKER_04 12:45

If the net behavioral results was negative, you know, this is where this negative prediction error comes in, that fancy term for like if we can really recall what the results were, yes, and those results were negative, we're gonna learn, we're gonna have laid down that memory that, like, last time I did that, not so good. So, you know, that memory can be very different depending on what the results were.

unknown 13:08

Okay.

SPEAKER_00 13:09

Why does a trigger feel like a physical sensation in the body and not like a thought?

SPEAKER_04 13:14

Well, thoughts don't actually feel like anything, right? They're just thoughts that come up. So I think this is the embodied experience that drives us into action, right? So that's where they they feel like this itchy, urgy, coiling experience because that's what's going to drive us to do things. Thoughts themselves don't really have any power until they kind of lock into the body and get that body to do something.

SPEAKER_00 13:40

Google and YouTube top question. Can I really rewire my brain after years of use?

SPEAKER_04 13:47

Yes, we can really rewire our brains after years of use. So any habit that can be learned can be unlearned.

SPEAKER_00 13:55

Any habit. Any habit.

SPEAKER_04 13:56

Yes. It doesn't mean that the circuitry or that firing can't happen in the future, but I think of it as we can overwrite it. And when what I mean by overwriting and overwriting, where, you know, this is where this third step of the process comes in, where we find that bigger, better offer. When our brain learns, okay, here was a behavior, here's how rewarding it was. It's actually not that rewarding. We lay that down in memory. And then we learn, oh, here's something that's more rewarding, and we lay that down in memory and we overwrite it because that one's more rewarding, and we overwrite it because the more our brain's going to lean into the thing that's more rewarding.

SPEAKER_00 14:36

Do we remember that later when we're triggered?

SPEAKER_04 14:39

Sometimes we do, sometimes we don't. If we've had an old habit that's been there forever, it's just like a groove that we can just fall into and we're like, and we find ourselves doing the thing again. The more we learn to do the new habit, the more that becomes the groove that we're more likely to fall into.

SPEAKER_00 14:57

I'm thinking in specific about, say, drinking. You had substance use disorder with alcohol, you know, things happened that led you to quit years later. You know, I'd love some wine with dinner. Is that a normal thing? And is that jumping right back in and overriding what you've learned, or is that human or where does that fit on the spectrum?

SPEAKER_04 15:20

It's certainly human. Yeah. Yeah. So here's where we can bring in our recollection. And this is where memory is really important. So if we have the awareness to ask ourselves, okay, what did I get from this last time? Or even imagine, like, what would this be like? And where are we bringing that? You know, we're basically simulating what that future drinking is going to be like. That's all based on past experience. And so if we can really remember accurately what that past experience was, it's like, okay, what did I get from drinking? Was it worth it? You know, and so this is where if something really was unrewarding and we've locked that lack of reward in, that's where we were like, oh, is this really worth it or not? Just last night, I was out to dinner and was, you know, offered, you know, all the things. And I, you know, it was really helpful for me just to simulate like what would this be worth it? Right. So for example, for me, you know, I have a busy day today. I know what it's like even when I have a single drink. You know, I don't sleep as well, et cetera, et cetera. I was like, oh, is this worth it versus, you know, I just had some fizzy drink or whatever that was interesting to try that was non-alcoholic, slept much better. That was all predicated on me being able to recall what it was like, what I got from previous times when I had a drink versus when I didn't. So my brain could compare those accurately. And it was actually a no-brainer. It's pretty easy to do it. I didn't miss a thing and actually felt much better this morning and woke up, could come and do this podcast.

SPEAKER_00 16:55

Yeah, great. Thank you for doing that. What is the role of neuroplasticity in recovery from addictions?

SPEAKER_04 17:02

Well, neuroplasticity is a very broad term. It just means you can, well, it could mean a lot of things, but really it's you can grow new connections between brain cells, you know. So dendritic connections, you can, you can strengthen synapses, which is just a fancy term for these connections between neurons. It's a very dynamic process. So our brain's actually undergoing neuroplasticity all the time, unless we're dead. Okay. So that's a broad term where someone's like, oh, neuroplasticity. I'm like, you're alive, neuroplasticity. Congratulations, keep going, right? So, what might that mean in terms of a helpful, useful thing? Well, think of it as we're learning all the time. And if we're paying attention, we can actually learn more efficiently. And so we don't have to repeat things over and over and over to get it. Right. I think of this as the signal to noise ratio, right? When the signal is very clear, when we do something that's really helpful for us and we see how rewarding that is, that signal to noise ratio is high. So we're like, oh, I can remember that. That's easy to learn. There's neuroplasticity in play right in that moment. And so this is where a lot of things like recovery capital can be really helpful, where we not only learn to lean into these memories of how unhelpful the unhelpful habits were, but we can actually notice what it's like to do things that help us survive and even thrive. So that starts with simply not doing the thing that wasn't helping us, right? It already feels better, right? I didn't drink last night because it wouldn't help me and I feel better. I can recall what that's like. So that lays down that recovery capital, so to speak, where it's easier for me to recall that in the future. Well, this goes much farther than that. We can look at connection. What do I get when I connect with friends instead of isolating myself? There's some recovery capital. What do I get when I find purpose and actually act on that purpose in life? What do I get when I take care of myself, which can be both physically, like eating healthy food, exercising, sleeping, all the things that we all know that we should do, right? But this also includes taking care of ourselves mentally, right? Noticing these habit loops of judging ourselves, beating ourselves up, feeling like we're less than, letting go of those habits and building the habits of kindness and self-compassion.

SPEAKER_00 19:26

How long does it take? These are internet questions, by the way. How long does it take for a brain to recover to full function?

SPEAKER_04 19:33

Hard to say. It depends on the person, depends on the behavior, depends on the substance, depends on a lot of genetic factors. And in fact, because it's so individual, it's hard to say, oh, it takes this amount of time. Understand. What I would say is that one of the biggest internet myths I see about habit change is how long it takes.

SPEAKER_00 19:55

28 days. Yeah.

SPEAKER_04 19:56

So and I've actually seen the 21-day one. 21 day, okay. Yeah. So you know where the 21-day comes from is a book written in the 1960s by a plastic surgeon named Maxwell Mults. The book, I kid you not, you can look it up, called Psychocybernetics. Okay. And he suggested in that book, it was probably a throwaway line, that it takes about three weeks for his patients to get used to ready for this, their new nose jobs. Oh boy. So getting used to your new nose job does not equal changing a habit.

SPEAKER_00 20:29

They really extrapolated that one, didn't they?

SPEAKER_04 20:31

Well, it just sounds good. It's like, okay, if it was three years, nobody'd want to believe it. Right. If it was three days, no one would believe it. But three weeks sounds about right until you actually try to do it. At least for a nose. Yeah. Yeah. So when you look at the actual research, there aren't actually that many published studies on this. There's a huge range of how long it takes for somebody to form a new habit, how range it takes for somebody to break a bad habit. What I will say is we've done studies in my lab. This is specifically with eating. Some people who have overeaten for decades, we have them pay attention, really ask, what am I getting from this? And then really find what it's like not to overeat. Ready for this? It only takes five to 15 times of somebody overeating and paying attention for that reward value to drop below zero. Right. So their brain learns very, very quickly. That's very different than my patient who came to me smoking a pack a day for 40 years, who had reinforced that habit loop ready 293,000 times. Right. So it's not like we have to rewind that 293,000. Fortunately, our brains are very neuroplastic. So we can learn new things very quickly if we pay attention. And the more striking the results are, the more quickly we learn. So when somebody really pays attention and feels that gut bomb of overeating, it makes it much easier for them to stop doing that because they've developed that negative prediction error. That fancy term for saying, oh, gut bomb does not feel good. So it much makes it much easier for them to lay down that memory so they can recall it the next time they're about to overeat and ask, do I really want to do this? Again, not forcing themselves not to do it, but just asking that question. Well, this is what I got last time. Let's predict in the future what I'm gonna get. And you know what? If they're like, I'm not sure, and they do it, now they've just collected another data point. It's all good. All of it is there to help us learn. All of it's there for neuroplasticity.

SPEAKER_00 22:30

And it's fascinating that you're not, we're not talking about, you know, I'm learning not to leave at eight o'clock if I have to be somewhere at 8:30 and I know that there's gonna be a lot of traffic. We're talking about like the real stuff here. We're talking about addictions and things that people can believe aren't recoverable.

SPEAKER_03 22:48

Everything's recoverable if it's a habit. Everything.

SPEAKER_04 22:52

So this is really about leaning into the neuroscience and seeing what's real. You know, so I have a t-shirt that somebody gave me that says science, like magic, but real. You know? So when you do the science, you can really find the mechanisms of how we form habits. When you find those mechanisms, you can actually target those mechanisms. This is how cancer treatment works. People find the pathways, the protein synthesis pathways that become, you know, aberrant, that become broken. And they can target those specifically to get really good cancer treatments for certain cancers with very few side effects. Why can't we apply that to addiction? We can find the mechanism, we can target the mechanism. And when we do that, this is where we get five times the quit rates of gold standard treatment, like magic, but real.

SPEAKER_00 23:44

Shifting back to the internet questions. Are social media, gaming, and other behavioral addictions as bad as drugs for our brains?

SPEAKER_04 23:52

Well, I would say if you look at the adverse consequences, right? You anybody can calculate those for themselves. So it's like, what's my continued use and what are the adverse consequences? You could take somebody and look at all the results of what happened to them. So hitting rock bottom, somebody could hit rock bottom from gambling or drinking. Somebody could hit rock bottom from, you know, doing all internet porn, whatever, right? And so the the actual thing that they're doing, all of these can lead them to the same place. So that's where I look to answer that question is well, what are the adverse consequences?

SPEAKER_00 24:30

Do our cell phones activate the same reward pathway as drugs do?

SPEAKER_04 24:35

Our cell phones are interesting. I think of them as slot machines in our pockets. And what I mean by that is what's been shown in neuroscience is the most effective way to get addicted to something is through a process called intermittent reinforcement. And we've touched on that a little bit already. We haven't used that term specifically. What that means is getting random rewards, right? So you're surveying the savannah looking for food, you randomly find a food source, right? There's intermittent reinforcement, meaning you don't know when you're gonna find that thing. Otherwise, it wouldn't be a surprise. That's why we fish. Yes. Yes. That is why we fish. And that's also why slot machines are set up the way that they're set up. So if you could predict, okay, the 21st time that I pull the lever, I'm gonna win. One, it becomes much more boring from a brain perspective. And two, the casino wouldn't win. Yeah.

unknown 25:27

Yeah.

SPEAKER_04 25:27

So these are set up to get us to basically gamble our attention away in the sense that every time that we've set our phone to have notifications on, to you know, bing or beep or blip or whatever when we get a text message. If we've set up our social media accounts to alert us whenever we've got a message or a like on our post or something like that, every time we've set the or our emails, you know, all these things can, you know, really hijack our system where we set them up to get us to pay attention to our phone whenever they ring. You know, some people describe it as their phone burning a hole in their pocket because they're their brains don't like uncertainty and they're like, oh, what was that big and beep or blip? I don't know what it was. I have to check. Might be important. Yes. Yeah. On top of that, okay, that's not all, folks. On top of that, when we're bored, when we're lonely, when we're tired, we've got social media where we've got the endless scroll. So we can do something that is endlessly distracting that kind of numbs us to our situation as compared to leaning in to what we're actually feeling. So we can learn to lean on these weapons of mass distraction, as Cornell West puts them, right? We lean into these weapons of mass distraction because they distract us and they form these habit loops through negative reinforcement. We're bored, we're lonely, we're tired. There's the trigger, the behavior, go on social media and scroll. The result, numbed out for a while, or an hour, or eight hours.

SPEAKER_00 27:06

Should we be treating all addictive behaviors with the same seriousness and concern then?

SPEAKER_04 27:12

Yes, absolutely. I mean, any addiction continued used despite adverse consequences. Why wouldn't we want to trade it with that same type of seriousness and concern? To me, I'd love to see people get their lives back so that they can live, so they can thrive, so they can connect with family members and community, so they can live their best lives. Why not?

SPEAKER_00 27:37

One of the top Google searches is are teens more prone to addiction than adults?

SPEAKER_04 27:43

Looking at the literature on teen brain development, one could extrapolate the teen are more prone to teens are more prone to addiction than adults. Although I I'm not sure I know a specific study that shows that. So maybe there's a study out there. I don't know it, but I would suggest that teens are especially vulnerable, whether they get hooked right away versus adults. I don't know the answer to that. I would guess yes. And regardless, I would say teenagers are especially times where we need to be very careful about the habits that we set up because that can be harder to unwind in the future.

SPEAKER_00 28:22

A follow-up question is Does using substances as a teen permanently change the way their brain will work as an adult?

SPEAKER_04 28:30

I don't know the answer to that. I'm not sure that anybody has a good answer to that. I hesitate to say permanent because our brains are so neuroplastic. Thank you. So here I'd say probably not.

SPEAKER_00 28:43

Okay, good. What's the single most important thing a parent can do to help protect their teenager's brain?

SPEAKER_04 28:49

The single most important thing that a parent can do is model good behavior. So teens learn the most from their parents, whether they think they're rebelling or not, they're still watching their parents. And that doesn't start at the teenage years. You know, parents are modeling behavior all through development. So here I would say, you know, hey, parents, it's best that you kind of get a hold of your own habits and then model healthy behavior for your kids, which probably doesn't sound like rocket science to people, you know.

SPEAKER_00 29:19

It doesn't, but it does make me wonder are there particular habits that you're thinking of when you say that?

SPEAKER_04 29:24

I would say the biggest one I see is parents distracting themselves with phones. You know, there was a study when the iPhone was first starting to be rolled out across the country. And you it's going this could only be done when it was first rolled out. This couldn't be done subsequently, where people were looking at pediatric emergency room visits. And they found that as the iPhone was rolled out in these big cities, emergency room visits went up because parents are distracting themselves on their phones and not paying attention to their kids. So here I was, and that was early in the early days, you know, it's it's not gotten any better. Let's just put it that way. So I would say the biggest one that I see that's pretty plain, you know, in plain sight, so to speak, is you know, getting addicted to checking our phones all the time. You know, the other place that I see it is so sad is when people are watching, when people are walking their dogs, their dogs know that their owners aren't aren't paying attention to them when they're on their phone all the time. Those poor dogs not getting the attention that they used to get before there were these, you know, these smartphones, the ones that these weapons of mass distraction. Oh, we got the dog. So I would say, you know, hey, people, do it for your kids, do it for your pets. Do it for yourself. That too.

SPEAKER_00 30:45

Yeah, that too. Uh Google and YouTube top search. Does one slip in recovery mean my brain is back to square one? No.

SPEAKER_04 30:55

More? Yes, please. What else do I need to say? One slip means one slip. It means oops. And actually, depending on how we interact with that slip, it can make a night and day difference. So if we fall into the habit of beating ourselves up, oh no, I can't do this, I'm terrible. We're more likely to stay in that rut because we're feeding all this negative energy by judging ourselves, which makes us more likely to keep going down the road of whatever we're judging ourselves for. So that's road A. Road B could be, oh, well, that didn't go as well as expected. What can I learn from this? My wife calls this the FGO. I'll give you the PG version of that. The frickin' growth opportunity. Okay, you get the idea, right? So the FGO is where we can actually learn to lean in to things that we formerly call mistakes and say, wait a minute, you know what? This is a very valuable learning opportunity because I can lock in a memory of like what I got from that thing, which actually gets right at that reinforcement learning piece in second gear. Like, oh, what did I get from this? We've done it. We don't need to beat ourselves up for it because we can't change the past, but we can learn from it. What an opportunity to learn. And in that sense, you know, that's saying two steps forward, one step backwards. There's no such thing as going backwards because we're learning. Learning only moves us forward.

SPEAKER_00 32:23

You brought up that the cycle. If how do we help somebody move past the shame and that somebody might be ourselves when there's a slip or a return to you so that they don't give up or we don't give up?

SPEAKER_04 32:35

Well, here we can look at shame as a habit loop. Right. So we do something, there's a trigger, the behavior is to feel ashamed. Bad me, bad me, bad me. We beat ourselves up, we judge ourselves, we do all the shame type behaviors, and then we ask ourselves, what do I get from this? What do I get from beating myself up? Nothing. Right? It can feel empowering in the moment because we feel like we're doing something and being accountable even. Yeah. Yeah. But we're doing something now over something we can't change because we've done it in the past. That's lunacy. So in fact, we can see these shame spirals as habit loops, and we can work with them the same way. So, what's it feel like to beat ourselves up versus what's it feel like to give ourselves a break? Oh, that didn't go so well. What can I learn from this? Right. This is where we move into Carol Dwett calls this growth mindset, where we can open to our experience and learn from it instead of beating ourselves up and feeling ashamed, where we're actually closed down to learning. We're not actually open to learning in those moments. What a wasted opportunity. So here we can even use this same process to step out of shame spirals and into learning loops.

SPEAKER_00 33:51

So somebody could hear you say, look at myself and say, I'm going to give myself some grace as being part of a healthy learning cycle. And someone else could say, You're letting yourself off the hook.

SPEAKER_04 34:03

Well, I would say, what would the neuroscience say, right? That's why you're here. Okay. What do you mean by letting yourself off the hook? So let's walk through that. What's that look like? Let's go through that. Because you're going to see pretty quickly that there's nothing to that. That's just an old habit of shame and blame. Like, oh, you're letting yourself off the hook. Well, that means I'm responsible. Well, that means there's something wrong with me. Well, that means it's my fault. That's very different than, well, that means it's my brain. And when I get locked into this letting myself off the hook, there's something wrong with me. I get locked into the habit of thinking there's something wrong with me. Well, what if there is more right with me than wrong with me? You know, John Kabatzin talks about that all the time. There's more right with you than wrong with you. In fact, maybe there's nothing wrong with us. Maybe it's just our brain that got tweaked a little wrong and we're straightening it back out.

SPEAKER_00 34:54

I like that one better. Sounds much more productive. Yes. Does the brain remember and still benefit from the progress it has made, even if one returns to use?

SPEAKER_04 35:06

In fact, absolutely it does. And so here, this goes back to the FGO, right? Every opportunity becomes an opportunity to learn. So everything that we built up in the past, that's our, I think of this as our disenchantment database, right? We've built up this database of disenchantment. We can draw on that all the time. Or we can remember, okay, what did I get from this last time? Some of my patients describe this as playing the tape forward. Well, you know, like if I have a drink, then what? I'll have another drink, then what? I'll have another drink, then what? Well, then I'm in trouble, you know, that type of thing. Well, the playing a tape forward is only based, we the only way we can project into the future is based on our past experience. So, well, how do I know what will happen with that third drink? Is because this is what happened with the third drink the last 30 times I did it or 300 times I did it. So this is where we can really lean into that learning and develop that disenchantment database so that we can dip into that whenever, whenever we have an urge to do the thing again. And we can ask, well, what did I get from this last time?

SPEAKER_00 36:06

It's reminding me of that question. How's that working for you? Is it the same kind of thought process? I think so.

SPEAKER_04 36:13

Yeah. So the the way I interpret the how's that working for you is well, how did that work for you the last 10 times you did it? Yeah. And if it didn't work so well, it might be useful to ask, well, is this going to work for me again the next time? Right. I love that. Uh, there's a definition of insanity, which is doing the same thing again, expecting a different result. Yes. Right. I'm sure you've heard that. It's Einstein, everybody says. Oh, yeah.

SPEAKER_00 36:36

Yeah, Einstein knows attributed to just about everything. Yeah, exactly. Much of what you're saying, I'll be putting Einstein on the yes.

SPEAKER_04 36:43

Whoever it was, it's a great saying. It is. It is the definition of insanity. That probably was not Einstein.

SPEAKER_00 36:48

But anyway, great. You said so on the internet. Right, right.

SPEAKER_04 36:52

So here we can, how's that working for you? Is a great, you know, kind of catchphrase for what we've been talking about and looking at reinforcement learning. Well, what did I get from this last time? What am I going to get from this next time? How's that working for you?

SPEAKER_00 37:08

It does sound glib though. I like yours better. When I when I say it even to myself, I'm like, it sort of has a hand on a hip kind of a vibe.

SPEAKER_04 37:15

Yeah, it can have a judgmental quality to it, whereas there can be a kinder, gentler, like, oh, well, right, what'd you get from that last time? So there's a there's a kindness to that. There's a curious, a true curiosity. Like when we're true, like when I'm truly curious about what happened with a patient, like, oh, okay. Well, what did you get from that last time as compared to, oh, that worked for you?

SPEAKER_00 37:38

Yeah.

SPEAKER_04 37:39

Which is kind of like the good luck with that.

SPEAKER_00 37:41

Yes. Yes. Bless your heart. Okay. What have you found to be major triggers or reasons why people relapse or return to use? And are there things we can do to prepare for that?

SPEAKER_04 37:53

All of them. And the reason I give you that glib answer is because the reasons don't matter nearly as much as the what. So this goes back to the why. So why we get an urge to do something could be anything for anyone, right? These triggers are very individual. Certainly there can be commonalities and also we waste a lot of energy looking for the why. Instead of the why, it's the what. Right. So we really can turn that energy and repurpose it to focus on the what. What does this craving feel like? What did I get from this last time? And what's it like when I don't do the thing? Right. There's all three of those gears wrapped in one. What role does stress play in addictions? Stress can play a major role in addictions. So stress is a big uh vulnerability or relapse. People have probably heard the halt hungry, angry, lonely, tired, right? So you can think of all of those being stress-related pieces where when we're hungry, our body's in a little bit of uh it's it's out of balance a little bit. So that you can think of that as bodily stress. Uh, when we're angry, we're out of balance. When we're lonely, we're out of balance. When we're tired, we're out of balance. We need to get back into balance. Stress is a kind of a large category that fits these in even other things as well, where it's like when we're stressed out, it doesn't feel good. So our brain says, okay, it doesn't feel good, do something to make that stress go away. So if we're in the habit of doing some unhealthy behavior when we're stressed, we can see how that can trigger a habit loop. And also, if we're in the habit of taking care of ourselves when we're stressed, recognizing, oh, here's stress. What do I need to do to take care of myself? That's when we can slip into a healthy habit where we're actually meeting that need instead of feeding that want.

SPEAKER_00 39:40

Meeting that need instead of feeding that want.

SPEAKER_04 39:43

Yes. Yeah. So that want is that urge to make it go away. And that want can often be whatever the behavior was that we did to scratch that itch, which in fact, you know, think of this as poison ivy. You scratch the itch and it just spreads and it sticks around. Well, we're we're feeding that want by scratching that itch. When we meet the need, we step back with enough grace to ask ourselves, what do I actually need right now? So if I'm hungry, if I'm lonely, if I'm tired, you know, if I'm angry, if I'm whatever, can I actually meet that need so that it actually heals whatever was causing the itch in the first place, meeting that need instead of feeding the want. That's taking care of ourselves.

SPEAKER_00 40:25

I think I should have that tattooed. I just remember remind myself on a regular basis. Does stress make cravings stronger?

SPEAKER_04 40:33

It certainly can. Yeah, because they share a common element of that restless, itchy, urgy quality. And in fact, this is where anxiety I would add to that category as well. Stress and anxiety have a lot of overlap. And then those share a lot of commonality with a craving. So stress, anxiety can really tip people into a, you know, into a craving because there's so much overlap in terms of the embodied experience.

SPEAKER_00 40:59

Last internet question. How does treatment for addiction work in the brain?

SPEAKER_04 41:03

Treatment for addiction works in the brain through helping us rewrite our brain processes, right? So when we learn to be with our experience rather than running from it, we rewire our brains. And in that sense, we develop this distress tolerance that we've been talking about, learning to be with our experience rather than feeding some loop to make it go away. So from a brain perspective, we're overwriting these old habit patterns with newer habit patterns, same types of processes, but instead of worrying or feeding a craving, we're developing the new habit of curiosity and kindness.

SPEAKER_00 41:45

And what about when the which is probably often the feeling that we're trying to override is really unpleasant? You know, we're grief or or rage or something way up on the scale.

SPEAKER_04 41:59

So this is where we can learn to let these emotions come up and instead of resisting them or feeding them, we can let them flow through our experience. Sounds awful. Uh well, if we're not resisting our experience, it's not as awful as resisting it. So it's not that it suddenly makes an unpleasant experience become rainbows and unicorns. It's not going to do that. But it helps us be with even things that feel very bad. You know, a patient described feeling like his head was going to explode. He learned that that awful experience isn't as awful as he made it out to be and wasn't as awful as him feeding it every time he smoked a cigarette.

SPEAKER_00 42:43

And we might be back to the only way out is through. Absolutely. Right.

SPEAKER_04 42:48

So this is where we can learn that hey, it's human to have strong feelings. It's human to have strong emotions. And the place where we can actually intervene and change our relationship to our feelings is whether we resist them or not, right? What we resist persists. What we resist persists. There's this other part of the saying what we allow ourselves to feel, heal. Never hear that part. I know. Isn't that wild? I know. That's the best part. It doesn't have such a catchy phrase, but you know, that's the reality of it is learning, like, oh, I can be with myself, and that gives me strength. That gives me agency. That gives me, you know, that puts me back in the driver's seat.

SPEAKER_00 43:35

Which and control is what we feel like we've lost. Interesting. How do medications like methadone or naltrexone affect brain chemistry?

SPEAKER_04 43:44

Well, I won't go into all the details, but they certainly, you know, they will bind to the receptors that they're engineered to bind to, and they will help um activate those receptors so that our brains, you know, get the firing that they have become accustomed to, right? We habitually Certain things. So for example, methadone is used as a treatment for opioid addiction, right? So somebody can be tickling that receptor, so to speak, with methadone instead of heroin, for example. So it's used as a harm reduction strategy.

SPEAKER_00 44:17

What changes occur in the brain during therapy? Thinking of things like mindfulness, CBT, even 12-step programs.

SPEAKER_04 44:24

I'm not sure that there's a very good answer to that yet, you know, because there's a lot that goes into therapy, and not all therapy is the same. And unfortunately, not everybody gets great therapy. So you can imagine that it's hard to study and really isolate like what's going on in the brain during therapy. What I can say is so mindfulness training is something that my lab has studied. And what we found in both cross-sectional studies, where we look at, you know, one time point in people who haven't meditated and people who have meditated. And we've also looked at randomized controlled trials in people who've wanted to quit smoking, for example, is that we see a consistent deactivation of the default mode network when people are trained in mindfulness. And we've talked about the default mode network before because that's the network that gets activated when people are craving. It's also the network that gets activated when people are worrying. And so with mindfulness training, people are learning to be with their emotions. And what they're doing as they're learning to be with their emotions is kind of quieting down those self-referential brain networks. And from an experiential perspective, it may be that they're not getting as caught up in their experience. And not getting caught up helps us be with our experience more, where we can learn to be with whatever's happening. And so what we see pretty consistently now across a number of different studies is that the default mode network gets much more quiet. Whether somebody has learned, you know, we've done studies with people using app-based mindfulness training programs, where they, you know, the more they deactivate their default mode network, the more they cut down on cigarettes, for example, as compared to people using cognitive therapy. We've seen this in people who even who have learned to use mindfulness training if 15 minutes before we scan their brains, where they can deactivate that default mode network within 15 minutes and they see a pretty significant reduction. So it's not like somebody needs to become some monastic or join some monastic order and meditate for 30 years in a cave. You know, you can we people can learn these techniques pretty quickly. And this is what also what I found when I was working at the VA, you know, in my outpatient clinic, people could learn these practices pretty quickly.

SPEAKER_00 46:38

Do you think the average person listening or watching thinks, you know, if you were to say, here's here's two options. You have a, you have an addiction, you we'll go with an addiction, and you can take this pill and it might help you have fewer cravings, or you can learn to sit with it and use mindfulness. Do you think most people would understand, would believe that the mindfulness is real and effective?

SPEAKER_04 47:00

It's a good question. I would say on average, people, one, they're looking for the magic pill and the magic bullet. So the tendency would probably be to go the easy route, say, oh, if I could take this pill, I'm gonna take this pill. There is no magic bullet, unfortunately. Um, so I think there's a growing evidence base around mindfulness training. And so more and more people are trying it, but it does take a commitment to actually learn to be with their experience. And so the good news there is that's a long-acting pill, so to speak, or path forward. Yet it takes some commitment to actually be, you know, be courageous and learn to say, okay, I'm gonna actually tiptoe into these waters of feeling my embodied experience. And a lot of people with addiction have spent years, even decades, avoiding their experience. So it might feel very dangerous because it's different. And so for that reason, that could it could be a challenge for somebody to say, oh, yes, I'd love to lean into discomfort. This feels great. No, it doesn't feel great. No. But you get to learn all of these skills that are not only gonna help you with cravings, but they're gonna help you throughout life. Because guess what? Life is not always easy. And if we can learn to develop these distress tolerance skills, they're gonna help us with everything.

SPEAKER_00 48:26

So if somebody really dear to you, somebody who loved a dear friend or somebody in your family had an addiction and said, Jud, what what what what the hell do I do? Well, what would you say?

SPEAKER_04 48:38

It depends on the person, right? So there's a lot of individual paths that I could, you know, I would navigate with that person depending on where they are in their, you know, in their stage, stages of of recovery, so to speak, what it is, how much it's affecting them, and you know, how how interested they are in actually changing. So there could be a lot of different routes that combine, you know, medications and mindfulness or or this and that. But here I would say, you know, for some people, you know, medications, for example, can be very helpful. For everybody, learning how their brain works can be extremely helpful.

SPEAKER_00 49:19

And it doesn't have to be in that complicated way we've been kind of avoiding in this conversation. It doesn't have to be the you know, the amygdala does this and the prefrontal cortex does that. It's how we deal with the reward circuitry and what we've been talking about for two episodes.

SPEAKER_04 49:34

Yes, absolutely. It's it's not about memorizing brain structures, it's about feeling embodied experience.

SPEAKER_00 49:42

And I love that you have made it clear that that puts us more in control, even though it might feel a little like we're ceding control by leaning into something we didn't want.

SPEAKER_04 49:52

I know it's a little paradoxical, you know, letting go is actually giving us more control.

SPEAKER_00 49:58

Thank you so much for your time and for sharing your expertise with us.

SPEAKER_04 50:01

My pleasure.

SPEAKER_00 50:02

Greatly appreciate it. And we will be back next week with a deep dive into another topic.