Dr. Sandra Morgan and Dave Stachowiak talk to Dr. Michael Hanna about how addiction is actually a brain disease and that treating addiction is a very complicated task that involves the mind, body, and soul.
- The 5 Cs of Addiction: Control (loss of), Compulsive use, Continued Use, Consequences, and Cravings
- Addiction is a loss of control and continued use despite negative consequences.
- Addicts already know it’s bad for them — you don’t need to convince them.
- Most addicts don’t get the high that they used to — they’re just trying to maintain a sense of normalcy.
- Addiction is not a willpower issue — it is a physiological response.
- Addiction is a disease. We should treat it like one.
- Transcending addiction and redefining recovery | TEDxBoulder
- Brain Function can Recover after a Year of Abstinence from Methamphetamine
- All in Our Heads: How the Brain Creates Addiction
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Dave: [00:00:00] You’re listening to the Ending Human Trafficking podcast. This is episode number 166, The Science of Addiction with Dr. Michael Hanna.
Production Credits: [00:00:09] Produced by Innovate Learning, maximizing human potential.
Dave: [00:00:29] Welcome to the Ending Human Trafficking podcast. My name is Dave Stachowiak.
Sandie: [00:00:33] And my name is Sandie Morgan.
Dave: [00:00:36] And this is the show where we empower you to study the issues, be a voice, and make a difference in ending human trafficking. Sandie, just about every episode we do try to zero in on all those, and sometimes a specific one. And I have a feeling today studying the issues and learning more about especially addiction, is going to be key as far as a big takeaway from this conversation.
Sandie: [00:00:58] Well I’m excited to have as our guest, my colleague from Vanguard University, Dr. Michael Hanna. And he teaches at Vanguard neurobiology and he was a neurobiology lab teacher at UCI, he was adjunct faculty at Mount San Antonio Community College and Los Angeles Trade Technical College before he came to Vanguard. And he has a lot of experience in substance abuse, neurological disorders, developmental disorders. And he is also involved in tutoring and college prep programs for high school youth in Orange County. So, he’s absolutely our kind of guy. I sat down with him and had a conversation, and all the things that I want to read now, I am just so thrilled. Welcome to the Ending Human Trafficking podcast, Michael.
Michael: [00:01:57] Thank you very much for having me.
Sandie: [00:01:59] So let’s start off with our first question. What is an addiction?
Michael: [00:02:06] One of the ways I like addressing addiction is by C’s because unfortunately a lot of times we use that term addiction so lightly. You know I’m addicted to ice cream, I’m addicted to candy, but I think five C’s kind of comprise what real addiction is. And one of them is a loss of control, this inability to stop whenever you want to. And most people that are actually addicts, will tell you I really do want to stop but I just can’t. So that’s one of them. You know this compulsive drug use that’s kind of the second thing that I think of. And then a big one is continued use, despite negative consequences. People even though they know that it’s just harming their lives and it’s just causing all of these problems, and they logically notice stuff, they continue to use this. And then the last one that I think of is this strong craving for these drugs. And you know some that are just almost impossible or very difficult to overcome these cravings. So that’s kind of the way that I think of addiction, as this loss of control and the continued use despite negative consequences.
Sandie: [00:03:17] So let me make sure I’ve got all five Cs. The first one is a loss of control. What was the second one?
Michael: [00:03:26] Compulsive drug use.
Sandie: [00:03:29] So compulsive kind of means that I can’t stop myself.
Michael: [00:03:34] Right. It’s almost like I got to do it almost every day, or you know depending on obviously different types of drugs. You know I can’t go to sleep without thinking about when my next hit is. So, this constant need for it. So, the loss of control can be just even the amount of it, but the compulsive use is almost like an everyday thing that I’m thinking of.
Sandie: [00:03:55] And then the next one is continued use. And then the last one was craving so I think I didn’t get the fourth one written down.
Michael: [00:04:06] Oh the consequences was the fifth one, negative consequences.
Sandie: [00:04:07] Yeah. And that’s the part where when I’m logically trying to talk to a friend or someone that I’m concerned about, and I use my logic “well here the consequences” and I think that I’m being very convincing and then they don’t stop. So, logic isn’t very effective in addictions.
Michael: [00:04:33] No not at all. And they will tell you. If you talk to several addicts they will tell you, “I really want to stop and I know this is messing up my life.” And they logically know, you don’t have to convince them at all that it’s bad for them, they know that already. I would say a lot of times they’re the ones that actually want to stop. So, you don’t have to try to convince them that it’s bad for you, I think that’s beating a dead horse. They already know that.
Sandie: [00:05:02] So what do I need to know about what happens in your brain that is related to this addiction process?
Michael: [00:05:10] You know I think that’s one of the biggest misconceptions that it’s all about willpower, that people can just stop whenever they want. But addiction is a brain disease. Often times I make that analogy. Let’s say, someone who’s been eating really bad all their life, all their life they had junk food, and so now they have a heart condition, they have an enlarged heart. And now as a result of this damaged organ, this enlarged heart, they have high blood pressure. Right? Now imagine if you go to someone that has high blood pressure, and then you go to them and you tell them, “how dare you have high blood pressure, lower your blood pressure.” You know, go ahead, do it now. I mean we laugh at that because that’s just ridiculous. You would never go to someone that has high blood pressure and tell them you know just lower it. Because what it is, it’s a symptom of a dysfunctional organ, and that organ is the heart.
Michael: [00:06:02] Well it’s the same thing with drug addiction. The symptoms of drug addictions, instead of the high blood pressure, is this loss what ends up happening is, both behavioral addictions and drug addictions, they affect the part of your brain, especially your prefrontal cortex that’s the part of the brain that gives you the ability to make rational decisions. And what they often simplified term is a stop pathway. This pathway that tells you, “OK enough of a certain behavior” and drugs literally damage that pathway. So that pathway that helps you stop or decide not to do something, that pathway you literally just start degenerating. And at the same time, you’ve got this other pathway in the field it’s the mesolimbic pathway, it is a pathway that sends dopamine and it goes to your prefrontal cortex and tells you, “this behavior is important and it is important for survival”. And literally what drugs do is they hijack that natural system. And so, they increase the amount of dopamine a chemical in your brain beyond any natural physiological means. And so, they overpower the system, and so they tell the system to keep doing that behavior. And now your brain has just been hijacked by the system, and so it makes one pathway this pathway that makes you do something stronger and then the opposite pathway the stop pathway, it damages that pathway. So, it gets you in both ways.
Sandie: [00:07:36] So we actually have our own little drug factory, this dopamine. So, it’s not just oh they’re shooting up heroin, but there’s an intersection there.
Michael: [00:07:49] Yes. I mean all drugs are working on something that is a natural pathway in the brain. And just to give you an example, the two most physiological things that can increase dopamine levels in our brain will kind of raise it by maybe 50, 100, maybe 150 units at the max. Right? That’s the most physiological thing that you can do to increase it. Drugs on the other hand, for example like methamphetamine, raise it over a thousand-fold. You know, so way beyond this natural mechanism. Yeah, that’s why I like using that term “hijack” because there is this pathway. The funny thing is they did this study in rats. Where they went ahead and took a rat, they put him in a cage, gave him food, but got rid of the dopamine in this pathway the mesolimbic pathway, and the rat literally died because it never ate or never drank because there was nothing in the system to reward it to say hey this is important for you. So, we definitely do need that system. But drugs overpower that system, and that’s why they become so powerful.
Sandie: [00:08:59] I have so many questions but I’m going to save them for when I go to your workshop and Ensure Justice, about that dopamine pathway. But OK, so I’m not the only one with some misconceptions about addiction. Can you kind of outline some of those misconceptions?
Michael: [00:09:16] Sure. I think one of the biggest misconceptions I kind of already hit is that it is just purely a matter of willpower. But it is a disease. It’s very easy to go ahead and identify a brain that has been damaged by drugs. So that’s kind of the first one and I won’t elaborate on that because we kind of already talked about that. Another one that I would actually kind of bring up, is a lot of times people think that for drug addicts you know it’s that rush, and the feel of euphoria, that high, that actually kind of keeps them going into the drug lifestyle. And well it might be true as far as that’s what initially got them into drugs, is that high feeling. Once you really get into full-blown addicts, most addicts don’t get that high that they used to. Most drug addicts end up just taking the drug just to actually feel normal. Right? Because what ends up happening, is your body, your brain is so smart and your body’s so smart, it tries to compensate for things that are not natural. And so, as a result, at a certain point, you can’t get that high, but because your body has adapted it now needs the actual drug to go ahead and just function. So, I’ll read your quote from a 36-year-old recovering heroin addict. He said this, “when we are really strung out on heroin, we were spending 150 to 200 dollars a day just to feel normal. It’s one thing to spend that kind of money and get loaded. But when you’re spending that kind of money, just to function as a human being, it irritates.” And the problem with drug addiction is what’s that medicine that will go ahead and take away all of those horrible feelings and allow me to function, it’s the drug itself. And so, it’s a very vicious cycle. So, a lot of times when you get into full-blown addiction, you’re taking those drugs just so that you don’t have those horrible withdrawal effects, just so that you can function, just so that you can go to work. And I’ve known a lot of people there you wouldn’t recognize that they were actually drug addicts at all, but they are taking these drugs just so that they can barely function and get through work. So that’s another kind of misconception, is everyone just thinking that drug addicts just only want the high and that’s why they’re doing that, but not always.
Sandie: [00:11:46] So there’s a lot of different programs that some of them are very physiologically designed, others are behavior modification, there are some that are faith-based programs. Can you address some of those issues?
Michael: [00:12:04] To be honest, I think the best kind of ones are the ones that combine all of those because oftentimes I say addiction is a disease of body, soul, and mind. You got to sometimes address it in all of those. Another thing that they’re finding is, a lot of times you go to a rehab center. They’re really focused on your issue, you got a heroin problem, a meth problem, and they are focusing on that. But what we kind of now know is that there are so many things that kind of can induce cravings and can lower this natural dopamine that gets us to want to seek those behaviors. And so, what they’re finding out is actually one of the best ways in addition to dealing with your drug issues, are programs that address, “OK. What are the things that are stressing you out in your life?” Because obviously, most people that are really into the drug addiction have had family problems, they might be divorced, or kids might, solving those issues that they have, health issues, and all of those things that at first glance might be like that’s not important that’s just you know everyone has stress in their life. But those are actually really important to help drive a drug addict. And I’ll give you another one. It’s a really interesting program it’s called Phoenix Multisport. And what this does is it’s a program that’s been shown to be very effective. And they take recovering addicts and they take them on these amazing hikes, on these amazing bike rides, things that give them a natural high a natural substitute for the drug. And they found that to be very effective. I think when dealing with addiction, we got to hit it at all of the points, not just spiritual but also physical. And there are some people, their withdrawal symptoms are so bad that they definitely need medication to help them wean them off the drugs. So, you can’t just tell someone just go cold turkey or this one method will always work, I think usually a gamut of methods usually is kind of the best way. And obviously individualizing treatment for each kind of person.
Sandie: [00:14:08] So in my experience there is a lot of shame associated with just having to be in a program. I also work with young parents who’ve lost their children, so their motivation for rehab is to get their children back. And so, one of the places they often go is to the faith-based community, to the churches. And so, it feels a little bit like because of the shame, maybe they’re not going to be as transparent when they really do need support. I don’t know, is there any research on how that spiritual component works in addressing rehabilitation?
Michael: [00:14:55] They have definitely done studies, and they have seen that faith-based programs are definitely helpful. Both as a preventative means of getting into addictions. And there are some studies that have shown that research-based programs are successful. But I would also put that with a caveat, and that a problem oftentimes with faith-based programs. If it’s just purely “well we just got to pray about it” and those a lot of times to me actually don’t work. If they’re using that faith-based program along with other means, kind of like I was talking about before. But if it’s just purely “let’s sit down and you know to pray about it and then everything will go away.” Unfortunately, I don’t think that is actually very helpful. And I believe I was telling you yesterday, when we were talking about this wonderful article that said, “Christians make the worst addicts and how there is a lot of shame, and people oftentimes think you know if I’ve been praying to God every single day and I really have faith in him that he’s going to take away my addiction. Then why am I still struggling with it? Do I not have enough faith? Am I not a good enough believer?” And I think sometimes that shame is a huge hindrance.
Sandie: [00:16:16] Well and I liked how you frame this at the at the beginning of this section. That it is mind, body, and soul. And for a really successful outcome to use my grandma’s language you can’t put all your eggs in one basket.
Michael: [00:16:32] Exactly, yeah. It’s the same thing I always say someone has cancer, I’m not just going to go ahead and tell them to pray about it and it’ll just go away. Well, I am a strong believer in what prayer can do. I’m also going to go ahead and tell that person, in addition to prayer you got to also do your part and you got to go ahead and see what the doctor says. But unfortunately for some reason I think, I’m not quite sure why, but when it comes to addiction we don’t have that same kind of mentality. Well I definitely believe in prayer, but I’m also going to tell you since I know that it is a disease, you got to get the help that you need. And God can work through that doctor, through that program in a wonderful way. But I’ve known people who have come to me in tears who have said, “I must not be a strong enough believer or I must be doing something wrong because God hasn’t healed me and I’ve been told I just don’t have enough faith.” And I tell them, “you can have the strongest faith but that’s not going to remove your addiction.” And so, I think that’s a huge thing that we have to face and let people know that you’re going to pray and you’re going to do your part, but you also have to seek that medical attention.
Sandie: [00:17:41] And I think that’s back to where we started, it is a misconception that addiction is a willpower issue. It is a physiological response, and there are physical pathways in our brains that are impacted and to your point damaged, Michael. And that is really you know your image of the enlarged heart. I’m a nurse. I’m like OK. So, if you have an enlarged heart and you quit eating ice cream and sour cream on your potatoes, or better yet sour cream and bacon and cheddar cheese on your baked potato. Your heart isn’t going to suddenly shrink back down. You’re still going to have to deal with the consequences of that lifestyle. It’ll take a long time for it to be a healthier heart. So, I want to know how long does it take my brain to physiologically heal, to recover from that neurological damage?
Michael: [00:18:49] So one thing to keep in mind is that these answers are going to be generalized. Obviously, every single brain, in every single person is going to be different. The amount of drugs use, the type of drugs, all of those are going to change the numbers. But in general, what the neuroscience field has seen is that your brain does recover. That process is at least three months. And that is a long time, but there is hope that your brain does recover. And that’s kind of one thing that I always tell people because they’ll be like, “you know it’s been two months and I’m still having these strong cravings, I’m still liking them.” And I tell them, “that’s OK. You just got to give yourself a little bit more time to heal.” And you know with time your brain will recover, sometimes depending if it’s been longer use, heavier use it might be longer than three months. But typically, at least you need that three-month period for your brain to start the healing process.
Sandie: [00:19:46] So we have evidence, we have at least anecdotal at this point, of the intersection of substance abuse and human trafficking. And we have evidence that traffickers will actually hang out near recovery programs. And as someone is leaving will engage that person and recruit. Again, what makes them so vulnerable? If they’ve been in the program for three to six months, they should be able to just say “no”, right?
Michael: [00:20:18] Well, there are several things that come into play that trigger this relapse and triggers the craving. Because like you said, you can be in a rehab center for three months and even a year and you’re perfectly fine. But then it gives your brain is such a smart machine it recognizes certain cues in certain environments and certain things that are associated with drugs, and those small things because of your brain when it sees those two is expecting the drugs. So, what it will actually do is in thinking that it’s going to get the drug it actually does the opposite of what the drug would normally do. So, you get these strong real cravings and once this person is outside of their environment that rehab center. Anything that is associated with their former lifestyle can trigger a relapse, just like that. So that’s how scary it is. And that’s why drug addiction is such a tough thing to overcome. You’ve got to address so many aspects, not just your mindset and not just the physiology, but things that you’re not even conscious of, things that your brain will automatically do that you have no idea your brain is doing that will actually trigger and give you a greater chance of relapse.
Sandie: [00:21:33] And this is such a fascinating conversation and you start talking about triggers and it’s like OK we have to have another conversation about that. And that’s why it’s so important at Ensure Justice, that we’re going to look at this not just from physiological not just from psychological but also from spiritual. There will be the faith-based component there so that we can learn more about how to have those communities that stave off that triggering and support people without guilt and without falling victim on our behalf. Falling victim to judging people because they don’t have the willpower. And Michael, thank you so much for all of your expertise. I just admire you so much. And if you can send me links to any of the things you’ve mentioned, the five Cs, the articles the research, we’ll put that in the show notes so that people can study that a little bit more. But I really encourage people to plan to come and join us at Ensure Justice and meet you in person.
Michael: [00:22:40] Thank you very much and thank you for having me.
Sandie: [00:22:42] Alright. Thank you.
Dave: [00:22:44] Sandie, you captured it so perfectly. There’s so much complexity here. Thank you so much to Michael for beginning to put some framework around this complexity. So much for us to tackle as we get together for the Ensure Justice conference, March 2nd and 3rd coming up here 2018. If you’d like to learn more, go to ensurejustice.com. It is not too late to get a spot at the conference and you can join us in person, not only to learn, study the issues, and be a voice and make a difference but to build the relationships that are so key to this aren’t they, Sandie?
Sandie: [00:23:22] Absolutely.
Dave: [00:23:23] So we look forward to seeing you there. If you have a question in the meantime, that we could be helpful with visiting us via e-mail, go to feedback at endinghumantrafficking.org. Send us a message or just visit the endinghumantrafficking.org website. And we look forward to seeing you again for our next episode in two weeks. Thanks, Sandie, see you.
Sandie: [00:23:44] Thanks, Dave.
Dave: [00:23:45] Take care, everyone.