Elliot Stone: How M.A.T. Combined with Technology Can Halt Addiction

October 25th, 2018

Tracy: Why don't you start with Alavida’s medication-assisted-treatment program. Give me a breakdown of how it works and what it incorporates.

Elliot: It works by combining the best evidence-based practices in two worlds that are close but that don't often intersect. These are the world of psychotherapy and the world of medicine. We combine those two things and we use technology to empower the process, making it easier for everyone to collaborate. On the medical side, we're using medications in line with best practices and the leading research to help people. We use them as a tool for helping to basically retrain the brain and to just make the process of pairing down your drinking easier, from a biological sense. On the therapy side, we're using tried and true approaches like CBT and motivational interviewing; we put the patient first and guide them in a very practical way through successive achievements of small goals in order to get long-term success. The technology we use allows access to the program from wherever you are, and also makes communicating very easy; it also makes being in the program and being under our care simple. You're not taking half of your day off work to go to a meeting and you're also not leaving for 30 days to go to inpatient treatment.

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Dr. Luke Clark on the evolution of slot machines and what dopamine & the habit loop tell us about addiction

January 16th, 2018

Tracy: Addiction, in general, is a complex and deeply personal subject. Today there seems to be a divide within professional circles between those who believe that solely genetics cause the disease and those who believe that it's only caused by the social environment. What is your take? 

Dr. Clark: It's a curious movement. We talk about it a lot in the lab and try to get our heads around it. Anyone who works on brain systems of reward or [looks into] what dopamine does--well, to me, it seems really obvious that the brain system is going to be affected by social context. There are social and environmental risk factors for all sorts of problems and certainly for addictions. But you see this in other areas of mental health research as well, where a lot of people assume that you either have a neurobiological model of what's going on, or you have a psycho-social model of what's going on. You've either got brain factors, or you've got environmental factors. To most of the psychologists that I speak to, [they] view these things as being completely complementary and not at all at odds with each other.

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Dr. Alexander Goumeniouk: substance use disorder is anxiety-based which comes from trauma

July 4th, 2017

Tracy: You have your own ideas on the root causes of addiction. Can you talk a bit about this?

Dr. Goumeniouk: The interesting observation I've made about addiction is that while the popular data says that 80% of people who end up in rehab centres have trauma from childhood or otherwise, my experience is that 100% of our patients do. Sometimes it stares you in the face like PTSD, and sometimes it doesn't. But there is always an adverse childhood event. A brilliant neuroscientist, Helen Mayberg, can look at a PET scan of a 45-year-old woman and tell you whether she's had sexual abuse as a child or not, and I think that's just remarkable. Charlie Nemeroff, who's the head of the University of Miami's Behavioural Science and Psychiatry, has done a lot of work on looking at the input of adverse early childhood events on outcome, and it's clearly there. I have also lectured about it before. This is an under-appreciated component of addiction; that part of the [person's] history is very important.

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Dr. Deborah MacNamera: how addictions piggyback on our brain's love and attachment centres 

January 5th, 2017

Tracy: In a recent interview about your new book, Rest, Play, Grow, you stated that we need to “end our cold style of parenting”. This really stood out to me because we now know that parental affection significantly impacts brain development. In your own words could you expand on this comment further?

Dr. MacNamera: If you look at what the most essential human need is, you’ll always find you go back to relationship and attachment, which is especially true the younger you are. Everything we do in terms of raising a child, whether you're a teacher, a coach, a parent, or a grandparent, we always have to look through the lens of the relationship. Oftentimes we look at people through the lens of their actions and their behavior, also know as a “behavioral worldview”, but what we now know is that there are incredible innate drivers: instinct and emotion that drive those actions and behavior. The more immature [in the developmental sense of the word] you are, the less you understand and can control what those drivers are, and the more important it is for the adults in your life to help you understand and assist in the tempering of those emotions and instincts. Because our primary role as adults is to help children have a healthy relationship with things that drive behavior. Imposed ‘consequences’ or a strict focus on behavior misses the mark on the whole internal world of a child. We want to grow that child by understanding the emotions that lie behind that behaviour, because that's where true maturity comes from. When we talk about maturity, it’s [less about age and more] about a place of being able to relate to others as a social and emotional being. It's really that place, most of all, that is where you want to help a child grow.

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Megan Bruneau, M.A., RCC on addiction as an attempt to self-regulate stress and emotions

October 27th, 2016

Tracy: I'd like to open by touching on the research showing how early childhood experiences affect brain development. Based on your own work in the field, can you describe why this is important to look at?

Megan: Absolutely. We learn how to self-regulate and cope with difficult feelings in an environment that enables us to do so. When evolutionary responses like 'fight-or-flight'--which happen in the reptilian part of our brain called the amygdala--are piqued, it's through the safety of healthy, reliable, and stable relationships that we learn how to manage those uncomfortable feelings and react to them in healthy ways. But if a child grows up in a home where abuse is the norm, or where there is neglect of the child's attachment needs, then ultimately they develop while constantly feeling fearful, feeling anxious, or having that distrust response heightened. Their relation to others is ingrained at such a young age to be on high alert. Therefore they're that much more likely to look towards substances like alcohol, narcotics, food, pornography, etc., to relieve them of that heightened anxiety.

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Maia Szalavitz on how our social environments impact our biochemistry, and why addiction is partly maladaptive learning

October 12th, 2016

Tracy: You've mentioned that when people experience addiction, there's often a void of adequate relationships to other people: they've now found themselves in a relationship with a drug. Can you explain this a bit further?

Maia Szalavitz: Absolutely yes. You could define addiction as falling in love with a drug rather than a person, and that is really what goes on in the brain. The same kinds of brain systems and chemicals are involved in both love and addiction. If you listen to love songs, you could easily replace the 'you' lyrics in the song with the name of a drug, and everyone who has ever had an addiction would identify with it, because it's the same template. We can understand addiction once we understand love because it requires the same neuro-pathways. What happens is that the biological drive that mammals have for love, which is critical to reproductive success, gets transferred to this drug. When you don't have that drive for love towards other humans, you often have it for a drug or substance that gets abused.

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Chris Arnade on addiction as a result of the innate, biological drive for humans to connect within an alienating society

September 6th, 2016

Tracy: You’ve driven across the country multiple times photographing communities that are often marginalized and afflicted by addiction. Your portrait project Faces of Addiction gained a lot of attention. Want to tell me a bit about it?

Chris Arnade: Yes, I’ve put almost 200 thousand miles on my car over the last five years just driving and visiting places that--for lack of a better way to put it--very few people visit. Many people live in these places, but nobody visits. I did this because I had spent 6 years interviewing and becoming friends with a group of homeless addicts in Hunts Point, which is just up from us in the Bronx. It’s part of New York City just off the 6th train, so by subway it's 20 minutes from the Upper East Side, but it’s the poorest neighbourhood in New York, and by some measures one of the poorest in the United States. It's home to about 15,000 people and is one of the most statistically dangerous neighbourhoods in New York. It’s also one of the last places in New York that has a relatively open and active market for street walkers, so prostitutes who walk the streets, who are almost all homeless or heroin addicts. And frankly, I became very close friends with most of them.

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Don MacPherson on Drug Policy: separating drug compulsion from drug use, and how addiction is a result of bio-psycho-social factors

August 16th, 2016

Tracy: Let's open with the Canadian Drug Policy Coalition. From what I understand, your mandate is to raise awareness around harm reduction, and trying to get public policy away from the criminalization and incrimination of drug users. Want to open with a few words on the CDPC?

Don MacPherson: Yes, the genesis of the group grew out of the harm reduction action in the 90's, shortly after we got together at the end of a UN meeting in 2009. In 1998, there was a UN meeting in New York with the aim of the global eradication of narcotics. The slogan was something like, "A drug free world, we can do it!", because that was where the thinking was back then. It was this sort of fantasy thinking. When they were saying "A drug free world", they weren't talking about tobacco, alcohol, or prescription drugs, they were only talking about illegal drugs. It should've been called, "An illegal drug free world, we can do it." It was a fantasy meeting. So that was when a lot of drug policy reform people stood up and said, "Okay this is ridiculous, countries are actually aspiring for something that's impossible." They were aspiring to literally rid the planet of plants like the coca bush, the cannabis plant, the opium poppy. It was nonsense. So we had a meeting here in Vancouver afterwards with the North American UN regions. We met people from all over Canada and the US who were doing very interesting work discussing reducing the harm of using these drugs while they were still being consumed here on this planet until we could effectively curb their use. 

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Mike Pond & Maureen Palmer: fMRI brain scans prove we need to approach addiction and criminal justice system in new ways

August 4th, 2016

Tracy: You two are fresh off from filming your documentary Wasted, which is mirrored off your book Michael, that tells the story of your own journey through alcoholism. I want to start with discussing addiction in general and what the word means to you both.

Michael: Yes, addiction. I once read that the word is Latin for "to be enslaved by." We're enslaved by this substance or by this behavior. So whatever that is: eating [highly palatable] foods like chocolate, or drinking coffee. These things can affect our lives so powerfully that we can't function or focus properly on our lives without being in pursuit of them - of course there are varying degrees of this. Addiction is on a spectrum; it's all based on how severely the substance or behavior is negatively affecting your life.

Maureen: Right now there are a lot of competing theories as to what the cause of addiction is. Is it a learning disorder? Is it a habit? Is it brain disease? Is it genetic? Is it a lack of willpower?

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Dr. Carl Hart on why drugs & genetics themselves are not the cause of addiction, and how policy ignores the root causes

July 29th, 2016

Tracy: You have a fascinating backstory. Can you talk a bit about how you chose to go into neuroscience and why you specifically focus on narcotics in your research? 

Dr. Hart: One of the reasons that I got into this field is because I grew up in the hood. It was a place that was very poor and primarily black within the United States - in Florida. As a youth I carried a gun, I sold drugs, I used drugs and as I’m sure you know, that’s a dangerous endeavour particularly in the US. But eventually I decided to get serious about my formal education and earned a PhD in neuroscience, which changed my trajectory a bit. [Laughter] I went into neuroscience specifically because I wanted to fix the drug addiction problem that I saw in my community. I was told and I fully believed that the poverty and crime in my community was a direct result of drugs like crack-cocaine. But more than 25 years later I have still not found any evidence to support this. But pertaining to my path, the skills that sustain people throughout life are usually obtained through the critical period of young adulthood. I spent most of my young adult years in classrooms and labs, learning how to think and how to write, which were skills that enabled me to support myself and my family financially, and as a result, I have a stake in my sick society. I often say that because of this, society and I both benefit. Many of my friends that I grew up with didn’t ever get this same chance because they didn’t get the support they needed during that critical period. Instead they were under the supervision of a system that doesn’t seem to understand or care about the importance of the black male role in society.

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