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What is Addiction?

The recent interview with Columbia psychology professor Dr Carl Hart launched us off into a lively and wide-ranging discussion of - what is an addictive drug, and how do we define addiction. In comments made on MSNBC, Hart said that "there's no biological distinction" between addictive and non-addictive drugs, arguing the environment plays a dominant role in addiction. LSD is being studied again as a treatment tool for a number of psychological condition including anxiety. We reinforce the idea that the news stores do not tell enough about the experiments being conducted, and more research needs to be done. Marijuana stories continue, with more on super-potent forms, like "wax" and also more about the key medicinal component of pot, the CBD molecule, which we taked about recently as "Charlotte's Web." And more about heroin, and the super-powerful designer version, based on the pharmaceutical Fentanyl.

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Transcript (edited):

HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions. Hi and welcome once again to the CNS Addiction Podcast. I am Howard La Mere here with Dr. Darryl Inaba. Several things to talk about today  we have a revisit with Dr. Carl Hart of Columbia who was on a MSNBC show recently, LSD as therapy, more about marijuana, of course, and more about heroin, of course, and some about CBDs also. So, Darryl, should we just launch off through the list there?

DARRYL: Yeah, I think we both had sort of raised eyebrows and got into a little controversy over Dr. Hart. I think maybe about 6 months ago we talked about him as well and we revisited him again today. He is strongly into the environmental aspects of addiction and disregards other aspects. Its a danger, I think, of anybody who gets into sciences. We oftentimes see our viewpoints (I do myself) and we get blinded by other things when true science is actually where youre going to continue to find discrepancies with what you actually believe in, and leave yourself open to seeing as many different viewpoints as possible to get really close to the reality. And he came up with a shocking statement, I think, at his interview recently at MSNBC and its all over the wires from the Huffington Post and other things that he says that in reality theres no difference in drugs that cause addiction and drugs that dont cause addiction. What the situation is, is it is the environment and the environmental influences that play the major role in whether a drug is going to be addicting or non-addicting and not anything to do with the drug themselves. I have personally a big issue with that. I dont think thats true and based upon my years of work and research that Ive read and things like that, I think its a misleading statement and its a dangerous misleading statement. I think drugs do have different vulnerabilities to cause addictions and certain drugs wont cause addiction at all, so Im not sure why this is getting played up so much except that he is a very good speaker, I guess, and very popular and in the news right now.

HOWARD: Well and Darryl and I were talking about, you know, what were going to talk about and we got into a discussion about this about what he says and you know, one of the things that came up was well, what defines an addictive drug and then we were talking about aspirin and ibuprofen and those kinds of things that people take routinely and how that is not the same as an addictive drug or is it? And that was part of the question you know, what are the defining characters or characteristics of a drug of addiction. That question remains unanswered for me I mean you know, I mean there's a lot of different...and at some levels as were seeing all the time, pretty much everything in our society is an addiction in one way or another if you look at it in those terms. But, I don't know that that's too useful to call everything an addiction.

DARRYL: Yeah, and I would argue with that because the argument was if you have arthritis and its a chronic pain and you get relief from ibuprofen or Tylenol or aspirin and you're taking that chronically and you're taking it for the pain, that why isn't that called addiction. And its not addiction to me because with addiction, I'm talking about basically the obsession/compulsion and the extremes of which somebody will need to take that substance in regards to every other aspect of their life. And with somebody with arthritis and who is in pain and they run out of aspirin or nobody is going to prescribe it to them or give it to them, you're not going to find somebody, you know, doing whatever they can and you know, bottoming out or producing a lot of problems for themselves legal or otherwise in order to get aspirin. They're just not going to do that. Whereas, if somebody is taking heroin for addiction or an opiate for addiction and they lose their connection or they lose their access to it, the obsession and the compulsivity is such that they will do anything to continue to use it including creating more harm. I guess that's a key with somebody who's taking aspirin for arthritis  do more harm to themselves in order to keep access to their aspirin for arthritis and I don't think they would. Whereas, if somebody was a heroin addict or an opiate addict and they ran out, would they do harm to themselves to gain access to it and absolutely they would and that's part of the definition of addiction.

HOWARD: So, but to what extent does the illegality of these drugs come into play there because obviously aspirin is legal and if you had to you know, do criminal things to get your aspirin to get your pain relief, well? So I mean that's you know, I think that's part of the case being made for legalizing all drugs and then taxing them, which of course the government likes because they need a new source of revenue. And then advocating for not using it and treatment.

DARRYL: Well, that's exactly the point I'm trying to make. If a drug is addictive, then you're going to make money off of it. People are going to do whatever they can to get it. Whereas, if a drug is like aspirin that's not addictive, they're not going to do anything you say its illegal now, they cant use it, there's no compulsion or obsession to go out and seek that out. Now, maybe this is easier explained back to my old research and looking at many things when I got started in this field like the positive reinforcement activity of drugs that we can measure in drugs. Certain drugs that they're willing to electrocute themselves for or swim through acid for or stand on a hot plate for in order to have access to and other drugs that they don't. And were looking at psychoactive drugs I mean, there's a whole plethora of drugs like penicillin say or gout medicine or high blood pressure that don't affect the brain at all. Were just looking at all the drugs that affect the brain to put them as Dr. Hart says in the same profile and we find that definitely there are drugs that alter states of consciousness that animals will not do anything to keep access to. As a matter of fact, once they try them, they don't even want to try them again. Things like thorazine and stellazine and prolixine and even many of the antidepressants and many of the drugs were turning to and looking at for treatment of addictions and helping them deal with ancillary problems and emotional states which we know are non-addictive and so they're not going to potentiate or keep them in the problem that they're being treated for and that's the addiction. Whereas other drugs, and we can rate them and we rate them way back in the 1960s and 70s  things like cocaine and heroin are the top of the line where animals and human beings seem to be willing to undergo any adverse experience you can put in front of them in order to stop them from accessing and yet they will continue to harm themselves to access it. That to me is the point of addiction.

HOWARD: So that has to be a physical.

DARRYL: Instead of a legal or moral issue absolutely. It has to be a biological issue and that's our whole presentation on addiction  that there is an addictive pathway in the brain and there is the go switches and the stop switches and certain drugs activate them and certain drugs don't. For Dr. Hart to ignore that is irresponsible, I think, and doesn't give justice to the drugs or give justice to addicts. It sort of puts it in their own bag again and its their environment and if we gave everybody idyllic environments that they would not have to become addicted and that's another point. In the 1960s, we shocked the world when we were profiling heroin addicts who had every economic, every emotional, every physical attribute, every wonderful characteristic in the world that nobody would ever think would make them want to alter their states of consciousness for and yet here they were, shooting and addicted to heroin. And for Dr. Hart to say its merely in the environment and how they're using and the environment and the people around them are and having to deal with those traits has caused them to be an addict, I don't think is correct.

HOWARD: Well, perhaps its not correct but its generated a good discussion here and I would imagine some other good discussions and doing some serious thinking about our conceptions and preconceptions. This kind of leads us into LSD as treatment, but is there more that you want to add about Hart.

DARRYL: Yeah I do because Dr. Hart is correct in that we certainly have ..

HOWARD: I mean environment certainly plays a key part.

DARRYL: And we certainly have messed up our world. I mean, we've messed up our families. We've messed up our neighborhoods. We've messed up our communities. We've messed up everything in which we as a species have to sit back and look at about trying to be much more positive and provide environments for everyone that can promote the positive outcomes in those people and yet case after case and especially in the criminal justice system and stuff where you see people just exposed to horrendous conditions and you can start to understand why they need to alter states of consciousness. But the point is, that's part of it. I agree that's part of it, but that's not the whole picture and the whole picture needs to look at the biology, the neurochemistry, the genetics. It has to look at foods. It has to look at all the things we talk about that bring the brain to that vulnerable state that we call the addiction threshold or shifting the hedonic threshold that makes a person an addict and its just not one of those things.

HOWARD: Well, like I say good opportunities for discussion and evaluating our preconceptions. So, the next thing on our list was LSD, which we've talked about through the months and the last couple of years being revisited as a therapeutic device a therapeutic agent and in this case it is being looked at for anxiety, I guess.

DARRYL: Yeah, you know, this also raises my heckles a little bit because you know, this hearkens back to the 1960s and a work by Stensal Graf and others in Spring Grove, Massachusetts when they were finding tremendous benefits in treating a variety of mental conditions and alcoholism with LSD. Recently a piece of research published in the Journal of Nervous and Mental Diseases by Dr. Gasser has resulted in a lot of people looking or re-looking at LSD, saying it may be very beneficial in anxiety and a lot of other mental disorders. The problem I get with this and that's why I'm so upset in the way these things are reported, is that Im sure Dr. Gasser did a tremendous amount of work with these people to prepare them for their experience with LSD. Im sure he got their trust first of all. You've got to have trust if you're going to take something like this from somebody. He got them comfortable. He had them looking at their experience and that's what Stensal Graf and others did with the early research on LSD. They didn't just give it to people. They actually had them in long term psychotherapy, prepared them, gained their confidence and they in an essence as Dr. Gasser, I'm sure and his staff, they became Captain Tripper. They became the guide that when this was taken, people were led into experiencing what they were experiencing. They were led out of getting into crisis situations. They were given the instructions that they were going to be alright. They were reassured that they were fine and they're alright and that goes a long way and why in the 1960s it wasn't pursued was that when after Stensal Graf and others research was published and many people tried it, they couldn't replicate the results. They had panic attacks. They had, you know, bad trips. They had continual bad situations from LSD and so they said, no we cant replicate that so we cant use it.  And the same thing is happening now. Dr. Gasser's research is published but none of the work that goes into it. People are going to read it and maybe some clinician is going to read it and just give LSD to people without even knowing, you know, what it is or how its going to affect the people without preparing them and its a recipe for danger as it was in the 1960s. Whereas if they would take the time and even take LSD recreationally and especially that first experience, if there is a Captain Tripper there if there's somebody knowledgeable about it, somebody who they can feel safe with, somebody who can guide them, somebody who can reassure them, and somebody who can deal with them when they're going through the phases of not sure  they're peaking and un-peaking and on that rollercoaster ride. If they can get that interaction, they can have a pretty interesting and wonderful time. They might get some great therapeutic value with it. In psychotherapy, the value with it from Stensal Grafs point of view was that he had been working with these people all along to get unblocked in their paranoia, unblocked in their stress, unblocked in their alcoholism and its only through this LSD experience that he led them through were they able to finally see and appreciate what he was trying to bring to them and were able to have long term benefits and I believe that is still possible, but to just put it out as all the news stories are coming out now. You know, lets look at this thing. Its a great new thing for psychiatric treatment. Its just a prejudice against it. Its a disservice to drugs and its a disservice to the researchers who are trying to look at drugs for a positive thing.

HOWARD: Well, yeah. I have to come to the defense of journalism a little bit though, having done that a few times in my life  worn that news persons hat and say that, you know, its hard to encapsulate all that information in a short story that is what the public demands. And on a short deadline, which is what the editors demand. So, you do end up with incomplete stories that dont tell the whole story, but again, that's part of our culture and its part of what we've evolved into.

DARRYL: Howard, it seems like you're defending follow the money today because that's what makes the money. Its the sensationalism, its the headlines they've even got you know, when I was lots of times misquoted and had things published about me in San Francisco, you know, lots of times the story had nothing to do with the headline. They had people who were headline artists or who wrote the title for these things and they wrote them to just be sensational and grab peoples attention and thing, but had nothing to do with them. But a lot of people are lazy. The majority of people are lazy. They're going to just read the titles and then if you say these things are made on deadlines and put out for the least amount as possible, then even if they do read the whole thing, they're going to only read the brief part of it and get a total misunderstanding of whats being presented and maybe we do need to look at journalism and what it is. I don't want to step on free press that's a founding thing, but we really need to have some ethics involved with how things are presented, I think.

HOWARD: Well, yeah and increasingly the line between the editorial and the advertising is blurred in the last 20 years especially. You know, again, that's just part of our society. I don't know how we go back, but it would be nice to go back. Anyway, interesting this discussion of hallucinogenics and therapeutic agents and you know, we've talked about it not just with LSD but with several other psychoactive hallucinogenics in the past and I'm sure well hear more about it and its nice that studies are ongoing. Now, all over the news of course still is both marijuana and heroin being, I guess we could say, the most popular drugs in the country or in the world these days. Marijuana, of course, becoming more accepted as treatment for various maladies and heroin, of course, being the epidemic along with the various opioids that is plaguing the entire country. So, I don't know which one of those you want to talk about first, Darryl, but they're obviously so much both in the news.

DARRYL: Yeah, marijuana is a big thing. I don't think you can pick up any paper across the nation or any magazine without some story on marijuana because of, of course, the recent legalization for recreational use in Colorado and in Washington and then many initiatives being put on the ballot here in Oregon, California and elsewhere to expand medical marijuana as well as looking at recreational marijuana. And it comes, you know, it brings to the focus a lot of important things. It comes to the time of recognizing that this is one of the more popular drugs that has been around for a long time, but not a lot of good research and not a lot of very rigorous research has been done on it that should be done, I don't think by the pharmaceutical companies that might benefit the most from research and having their products available to sell in terms of medical purposes or even recreational purposes. But maybe should have been stimulated by more objective resources maybe by foundations or by universities. I'm sure the government would be looked upon as having a bias on their own, but we need a lot more research because as were coming out with much more liberalized attitudes for marijuana, the research seems to be from as many different sources as possible that there are some deep concerns. There is of course the growing potency we've talked about several times. The concentration of fido marijuana which with its THC growing stronger, then we have the synthetic THCs and then the understanding of the endocannabinoids  your own brains marijuana substance that your brain produces and finding more and more of those substances and more and more of those receptor sites. There is some good concern that marijuana may very much impair a developing brain  a teen brain that hasn't fully become hardwired and making it more having a greater potential in the teen brain for future problems with mental illness and things like that. The other thing is that there's now several people who have hybrid marijuana to make it more medically oriented, to increase the CBD contact I've actually seen some reports saying that they've gotten the THC concentration  the most active brain affecting chemical in marijuana down to 0 and actually boosted up the CBD, the non-psychoactive substance in marijuana  cannabidialol  to maybe 13%, maybe higher than that which bodes well for its medical use because CBD is a positive medical thing for most of the things that marijuana does. But despite doing that, I cant find anybody in the net or anything who's really interested in that.

HOWARD: Well, apparently there are some people and I was surprised because I thought it was kind of somewhat new when we talked about Charlotte's Web a few weeks ago, but which is being developed in Colorado, but then I was talking to a friend here locally about his medical conditions and he was going he was working on getting some CBDs and apparently they are available everywhere, but they're not too easy to find.

DARRYL: Yeah, the growers or even the people who made Charlotte's Web are saying that, you know, when you go to their website and stuff, Im shocked. They refer you to just regular marijuana growers because they cant make money off of it. Like Im saying, there are people who genuinely need marijuana for their health and are seeking it for their health, but because of the lack of interest in buying that type of marijuana, its hard to find and its hard to produce. On the opposite end of that, the THC and the brain altering effects  the recreational substance in marijuana seems to be increasing more and more and now here even in Southern Oregon, everybody is talking about the extraction products and the butane hydros and the wax and making wax that some people.there was an alternate article saying that they look at it as a government drug panic propaganda, but its not. Its wax or butane extraction products have resulted in extremely powerful concentrated THC and that product that's called wax, ear wax, dabbing, a variety you know, honey oil, honey, wax, things like that that actually is so powerful that I don't think you can hold it in the same vein in terms of effects as you would just smoking regular marijuana. Its just 90% THC or more and therefore its liable for lots of panic attacks, paranoia, maybe all this new thing about schizophrenia that's coming on and a lot of other things. So that is of deep concern. But medical marijuana is a reality. We have good products, I think, that have been produced and should be used. We just have to find people who are willing to take marijuana for its medical purposes like some of the people you talk to and are not interested in its recreational use properties and then we have to have providers who can, I guess, make as much money selling that as they would or maybe more money selling thatmaybe the government should buy it and dispense it rather.so these guys have a business and shut out the recreational marijuana users who give a bad name to marijuana.

HOWARD: Well, that's an interesting notion that government should subsidize it, do research on it. That would be a positive thing that the government can do which sometimes is in short supply it seems like. Not to pick on the government, of course. What can we say more about heroin and opioids that we haven't covered in the last several weeks? I will say that it continues to be all over the news as the huge and horrific problem it is everywhere. We've heard a lot from the New England area, but it is certainly in the south, its certainly in the west, its certainly in the mid-west, its certainly in the west coastits everywhere. So, you wanted to talk a little bit more about Philip Seymour Hoffman and Fentanyl? Well, just once you know, first of all, we are in the midst of a beginning downer epidemic.or upper/downer syndrome we talk about sometimes. We've been on this methamphetamine, cocaine, and stimulant era for about 30 years and we're headed now ... were probably already in the midst of a heavy depressant drug epidemic and that drug that's leading the way is heroin. This looks like it is following the old upper/downer cycles that has happened throughout the history of the United States. And in that, were seeing more and more of these stories. Of course, the prescription opiates and the deaths now that outnumber highway deaths every year is shocking and certainly an indication of that, but what this new heroin epidemic that's sweeping lots of people you wouldn't think would be interested in heroin, that's grabbing a lot of news and that's something we saw in the 60s. I just want to mention and I forgot to mention about when Philip Seymour Hoffman was thought to have overdosed on.it turns out he overdoses on a combination of a speed ball  cocaine, heroin in his system, benzodiazepine in the system, a bunch of other drugs in his system. But originally they were concerned because of where he did it. He had OD'd and died back in Florida and the east coast that there was this boom of Fentanyl, the synthetic, very, very potent heroin that was out there and being put into weaker actual heroin in order to mask it so the authorities wouldn't know there these synthetic new designer heroins around. There was that scare going around and I forgot to mention that in classic to what happens on the street with the addicts. Instead of many addicts reading that and fearing my gosh, that's a dangerous thing. I better watch out for my heroin Im buying now. It has the opposite effects. Once a story goes out that there is a new heroin in town that's more potent or a new synthetic heroin that's going around that's more potent, everybody seems to be looking for it and we certainly have that in Southern Oregon. I'm shocked that, you know, from our treatments and stuff, how many people are talking now about Fentanyl and where its at and how its here in the valley and how people are into it and that's what happened in the Hate. Anytime we had a rash of ODs, everybody is looking for the connection to buy that substance rather than being scared away.

HOWARD: So they can have an OD too, right? It seems not logical.

DARRYL: Well, its the, its the....

HOWARD: Its the old make it stronger is better.

DARRYL: Right. Well, its a false impression that all addicts have. Its a misunderstanding or its the illusion that all addicts have that they're not going to be the one who suffers any consequences. That they're not going to be the one who has an overdose because they can control it more. They can, you know, cut it more. They can be more careful with how they use it and its that old dilemma that gamblers have, that, you know, if they flip the coin 50 times and it has come up 70% heads, they're going to say its gotta come up tails when every toss is 50/50 regardless of how many times you throw it and so when there's something strong around, they're thinking I'm going to get me some good stuff now. Im really you know too tired of this old tolerance stuff I'm used to so I'm going to get some good stuff and because I know people have died on it, Im going to be more careful and not succumb to that.

HOWARD: Well, all I can say is good luck, good luck! And you know that's, you know, some of the stories I read are about Americas love affair with addiction in general which I mentioned earlier and all the talk about addiction to food, to internet, to gamblingwe could make the case that were addicted to everything which makes, you know, takes the distinction out of it and makes it harder to find any useful way to address it, I guess. So, I don't know what more to say than that, so Ill just leave it at that.

DARRYL: Addiction to me is not about, you know, you could say.like you're saying, were addicted to life and living and stuff, but its not. Its when its an overpowering obsession. When everything that you're doing revolves around something in the visual thing thats outside of the norm, outside of the system. That to me is addiction where its so overpowering, its so necessary, that even though its something like your old strange addictions. I don't know if you found a new one this week, but eating cat fur or chewing on dirty diapers or whatever it is, if that becomes such an obsession that your survival depends up on you needing it, that definitely is addiction and everything may have maybe a potential for it, but certain things you know, how many people are going to try chewing on a dirty diaper or eating cat fur?

HOWARD: Ill pass. Ill pass on both!

DARRYL: Yeah, but other things.and for those you try how many are going to get addicted? But whereas opiates or say methamphetamine is different. Certain people are going to try it, but of those people who try it, a lot higher percentage is going to develop that tremendous obsession and compulsivity where it becomes the most important thing in their life, you know, above their need to eat, their need for sex, or need to have relationships or need for friends their need for everybody and that to me is addiction and that's why I look at it as not just being an environmental thing, but a biological thing as well as environmental and as well as just how something disrupts the brain.

HOWARD: That was really good, Darryl. You brought us right back around to Dr. Carl Hart, where we started. That was good! Okay, so I guess well call that good for this time. As ever, thanks for listening and we enjoy your comments, questions, and suggestions whenever you care to leave them and we welcome it. You can do so at cnsproductions.com and we'll be back again soon. Thanks Darryl.

DARRYL: Hey, real provocative show, Howard. Thank you very much.

HOWARD: It was it was, you know, kind of the same topics but a little different spin. Thanks. That wraps our pod for today. Thanks for visiting the CNS Podcast. Please check back soon for the next in the series and visit our website, www.cnsproductions.com

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